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The Consequences of Diagnosing Donald Trump With Mental Illnesses

Dr. Elizabeth Yuko is the Health Editor at SheKnows. She is a bioethicist and writer specializing in sexual and reproductive health and the intersection of bioethics and popular culture. She is an adjunct professor of ethics at Fordham ...

Is diagnosing Trump with narcissistic personality disorder letting him off the hook?

Since before he even settled into the Oval Office, there has been wide speculation over the mental health of Donald Trump. For many professionals in the field, it can be hard to resist diagnosing a person constantly appearing on our televisions and in our social media feeds, exhibiting a range of sometimes extreme behaviors. For some, he has the qualities of a strong leader, while others fear that the presidency is held by someone with a serious and potentially dangerous mental illness. If the latter is the case, what can be done about it, and how would such a diagnosis even be made?

In January, an article in U.S. News & World Report raised the question: “[I]s this just a case of a president with predictable quirks, or is it something that raises concerns about Trump’s judgment and adherence to factual reality?”

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In the same article, Johns Hopkins psychologist Dr. John D. Gartner said, “Donald Trump is dangerously mentally ill and temperamentally incapable of being president,” diagnosing him with malignant narcissism — which differs from narcissistic personality disorder and is incurable.

By saying this, Gartner knowingly violated the American Psychiatric Association’s ethics code, which prohibits practitioners from offering their professional opinion or diagnosing a public figure without first evaluating that person with their consent, arguing that Trump’s case warrants breaking the professional ethics regulation.

On July 25, Stat reported that the American Psychoanalytic Association emailed its 3,500 members, saying that they should not feel restricted by the rule not to publicly comment on a public figure's mental health — and that includes the president. To be clear, this is not the same organization as the American Psychiatric Association, and is much smaller in size than the latter organization's 37,000 members. Still, the announcement reignited the debate surrounding whether mental health professionals have the right — or even duty — to discuss the president's mental state.

Dr. Celia B. Fisher, director of the Center for Ethics Education at Fordham University and chair the committee that wrote the current American Psychological Association’s Ethical Principles and Code of Conduct cautions against using unofficial diagnoses as an excuse for Trump’s behavior.

“Dr. Gartner's unfounded ‘diagnoses’ of Donald Trump not only undermines public confidence in the professionally responsible assessment of mental health disorders, but such misuse of psychiatric terminology undermines our democracy by providing a 'mental health' excuse for Trump's false and authoritarian statements rather than a political analysis of the real-world threats his words and actions present to our country,” Fisher told SheKnows in January.

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But what about the armchair psychologists throwing around the narcissism diagnosis with no formal training?

First, it’s important to recognize that there’s a difference between the dictionary definition of a narcissist (regarding a person’s egocentric character) and the mental health diagnosis of narcissistic personality disorder (which “crosses the border of healthy confidence into thinking so highly of yourself that you put yourself on a pedestal and value yourself more than you value others”). At this stage, the terms are used virtually interchangeably by many, but represent two very different scenarios.

Second, as Fisher pointed out, any diagnosis of Trump should not be used as a way of excusing or legitimizing his statements and actions. In order for a positive result to come from the diagnosis of narcissism, he would need to seek professional help and consent to a treatment program. Given his own description of his demeanor — “I think I have the best temperament or certainly one of the best temperaments of anybody that’s ever run for the office of president. Ever” — this seems unlikely.

What these diagnoses do accomplish, however, is to further stigmatize those who do struggle with personality disorders. When mental health terms become shorthand for character traits — like referring to someone who is extremely organized as “obsessive-compulsive” — it reduces a legitimate psychiatric condition to a punchline.

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So whether it’s the meticulously tidy colleague in the cubicle next to yours or the president of the United States, leave the diagnosing up to the professionals.

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