An Eminent Psychiatrist Demurs on Trump’s Mental State

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https://www.nytimes.com/2017/02/14/opini...state.html

An Eminent Psychiatrist Demurs on Trump’s Mental State

FEB. 14, 2017

To the Editor:

Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.

Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.

Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).

Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.

His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.

ALLEN FRANCES

Coronado, Calif.

The writer, professor emeritus of psychiatry and behavioral sciences at Duke University Medical College, was chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV).

[$tevie]

He may have a good point, but the ethical constraints part is too much like not yelling that the ship is sinking because yelling is considered rude.

[DeusxMac]

For the sake of discussion...

" I wrote the criteria that define this disorder..."

For the DSM-IV, written over 22 years ago.

“Published on May 18, 2013, the DSM-5 contains extensively revised diagnoses and, in some cases, broadens diagnostic definitions while narrowing definitions in other cases. The DSM-5 is the first major edition of the manual in twenty years.”

And his "The antidote to a dystopic Trumpean dark age is political, not psychological." sounds like a "not my job" cop out.

[mrbigstuff]

He's arguing for the sanctity of his profession. And,fof course, so that people don't get the idea that they can label people at will with psychiatric disorders. And, lastly, that people will continue to fork over many thousands of dollars for that diagnosis.

[DeusxMac]

I looked it up, and Frances is misrepresenting the section of the DSM-IV he implies authorship of.

"Distress" is NOT a requirement for the diagnosis. The section reads "Only when personality traits are inflexible and maladaptive and cause significant impairment OR subjective distress do they constitute Personality Disorders."

[SteveG]

Or he could be using those tactics the sicko Roy Cohn taught him. That raving Miller guy reminds me a lot of that parking lot stain Roy Cohn. They know what they are doing. It's a technique.

[Wags]

Here's one signed by 33 head shrinkers

http://www.lancedodes.com/new-york-times-letter

[Shera]

DeusxMac wrote:
For the sake of discussion...

" I wrote the criteria that define this disorder..."

For the DSM-IV, written over 22 years ago.

“Published on May 18, 2013, the DSM-5 contains extensively revised diagnoses and, in some cases, broadens diagnostic definitions while narrowing definitions in other cases. The DSM-5 is the first major edition of the manual in twenty years.”

And his "The antidote to a dystopic Trumpean dark age is political, not psychological." sounds like a "not my job" cop out.

Here is a DSM IV vs. DSM 5 Personality Disorders comparison chart. The current diagnosis still requires, "Significant impairments in self (identity or self-direction) and
interpersonal (empathy or intimacy) functioning." (top of page). The specific diagnostic criteria for Narcissistic Personality Disorder are about half way down.

By the way, you can have fun diagnosing friends, family, and yourself with this chart!
http://www.psi.uba.ar/academica/carreras...al/dsm.pdf

[Bill in NC]

It's not simply ethical - a psychiatrist could find themselves sanctioned by the state medical board for offering a "diagnosis" without having personally examined the patient.

$tevie wrote:
He may have a good point, but the ethical constraints part is too much like not yelling that the ship is sinking because yelling is considered rude.

[gabester]

NPD or not, what is one who inflicts distress and harm upon others called?

A bully.
An abuser.
A terrorist.

I'll take all of the above for a restoration of our constitutional democratic representative republic, Alex.