THE DANGEROUS CASE OF DONALD TRUMP: 27 Psychiatrists and Mental Health Experts Assess a President
By Bandy X. Lee (ed.). Thomas Dunne Books. 360 pp. $27.99
TWILIGHT OF AMERICAN SANITY: A Psychiatrist Analyzes the Age of Trump
By Allen Frances. William Morrow. 326 pp. $27.99
FANTASYLAND: How America Went Haywire, a 500-Year History
By Kurt Andersen. Random House. 462 pp. $30
Gone are the days when euphemisms about President Trump’s mental health insulated the man like so many padded walls. Erratic. Unpredictable. Unstable. Unmoored. Temperamentally unfit. This was what politicians and commentators said when they wished to question Trump’s state of mind but feared the consequences of a more colloquial assessment. Yet the deeper we plunge into this presidency, the more willing people become to call it like they see and hear it.
“I think he’s crazy,” Sen. Jack Reed (D-R.I.) confided to his colleague Sen. Susan Collins (R-Maine) in a July exchange inadvertently caught on a microphone. (“I’m worried,” she replied.) CNN’s Don Lemon, flabbergasted after a Trump speech last month, concluded that “he’s unhinged. . . . There was no sanity there.” Even some Republicans have grown more blunt, with Sen. Bob Corker (Tenn.) recently suggesting that Trump “has not yet been able to demonstrate the stability nor some of the competence” to succeed as president.
Now, some psychiatrists and other mental-health professionals are shedding long-held norms to argue that Trump’s condition presents risks to the nation and the world. “The Dangerous Case of Donald Trump” features more than two dozen essays breaking down the president’s perceived traits, which the contributors find consistent with symptoms of narcissistic personality disorder, sociopathy and other maladies. “Collectively with our coauthors, we warn that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency,” Judith Lewis Herman of Harvard Medical School and Bandy X. Lee of the Yale School of Medicine write in the book’s prologue.
If so, what should we make of the nation that entrusted him with precisely such powers? In his new book, “Twilight of American Sanity,” psychiatrist Allen Frances asserts that Trump is not mentally ill — we are. “Calling Trump crazy allows us to avoid confronting the craziness in our society,” he writes. “We can’t expect to change Trump, but we must work to undo the societal delusions that created him.” And those delusions, Kurt Andersen contends in “Fantasyland,” have been around for a long time. “People tend to regard the Trump moment — this post-truth, alternative facts moment — as some inexplicable and crazy new American phenomenon,” he writes. “In fact, what’s happening is just the ultimate extrapolation and expression of attitudes and instincts that have made America exceptional for its entire history.”
So, depending on which of these books you trust — and their persuasive powers vary considerably — you might conclude that Trump is of unsound mind, or that we’re the deranged ones for electing him, or that America has always been disturbed, with Trump’s presidency just the latest manifestation.
And here’s the really crazy thing: These options are not mutually exclusive.
Mental illness hardly disqualifies one from the presidency. Abraham Lincoln is thought to have suffered from severe depression, but he held himself together and the union, too. “Equating mental illness with incapacity merely stigmatizes the mentally ill,” clinical psychologist Craig Malkin writes in “The Dangerous Case of Donald Trump.” But Malkin and other contributors argue that Trump’s behavior — his political statements and actions as well as his interviews, books and social-media activity — suggest more ominous possibilities.
Trump displays signs of “extreme present hedonism,” the tendency to live in the moment without considering consequences, seeking to bolster one’s self-esteem no matter the risk. Or he exhibits “narcissistic personality disorder,” which includes believing you’re better than others, exaggerating your achievements and expecting constant praise. Combine hedonism, narcissism and bullying, and you get “an impulsive, immature, incompetent person who, when in the position of ultimate power, easily slides into the role of the tyrant,” Philip Zimbardo (of the famous Stanford prison experiment) and Rosemary Sword write. Others suggest that Trump shows indications of sociopathy, including lack of empathy, absence of guilt and intentional manipulation. Put it all together and you have “malignant narcissism,” which includes antisocial behavior, paranoid traits, even sadism.
“Mr. Trump’s sociopathic characteristics are undeniable,” retired Harvard psychiatry professor Lance Dodes concludes. “They create a profound danger for America’s democracy and safety. Over time these characteristics will only become worse, either because Mr. Trump will succeed in gaining more power and more grandiosity with less grasp on reality, or because he will engender more criticism producing more paranoia, more lies, and more enraged destruction.” And when the president stands before the U.N. General Assembly and threatens to “totally destroy” an enemy country of 25 million people, enraged destruction seems on point.
The writers emphasize that they are not, technically, diagnosing the president. “Assessing dangerousness is different from making a diagnosis,” Herman and Lee argue. “Signs of likely dangerousness due to mental disorder can become apparent without a full diagnostic interview.” Even so, these mental-health professionals run afoul of the American Psychiatric Association’s Goldwater Rule, which deems it unethical to offer a professional opinion on a public figure without conducting a personal examination and without authorization to release the conclusions. (The debate dates to the 1964 presidential campaign, when a magazine published a survey of psychiatrists’ views on Republican nominee Barry Goldwater.)
The volume’s contributors take solace in Tarasoff v. Regents of the University of California, a 1976 case in which the California Supreme Court held that mental-health experts have a responsibility to speak out when they determine that someone poses a physical danger to others. Nevertheless, all these distinctions can be a bit fine. “Am I making a diagnosis of President Trump?” psychiatrist Henry J. Friedman asks. “Well, yes and no — and even maybe.”
The stand these psychiatrists are taking takes courage, and their conclusions are compelling. But it’s hard to read “The Dangerous Case of Donald Trump” as simply the dispassionate insights of well-trained experts. “The majority of mental health professionals tend to be liberal in their leanings,” admits clinical psychologist Jennifer Contarino Panning, while psychiatrist David M. Reiss cautions that “those who speak out must do so carefully, not without risk, and to a populace that should be reasonably skeptical.” Comparisons between Donald Trump and Adolf Hitler abound in this volume. “History will not be kind to a profession that aided the rise of an American Hitler through its silence,” clinical psychologist John D. Gartner writes in a typical passage. MIT linguist Noam Chomsky makes an odd cameo in the book’s epilogue, warning that the Trump administration may stage a fake terrorist attack. And clinical psychologist Michael Tansey suggests, with disdain and needless vulgarity, that “there is considerable evidence to suggest that absolute tyranny is DT’s wet dream.”
In the final chapter, psychiatrists Nanette Gartrell and Dee Mosbacher call for an independent panel to evaluate Trump’s fitness for office, and they urge Congress to pass legislation ensuring that future presidential and vice-presidential candidates undergo evaluations. I would not want Tansey, for one, serving on that body. Wouldn’t dream of it.
Allen Frances wrote the criteria for narcissistic personality disorder used in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and he doesn’t think Trump qualifies. In “Twilight of American Sanity,” Frances says the diagnosis requires the patient to experience significant distress because of his condition. But throughout his life, Trump “has been generously rewarded for his Trumpism, not impaired by it,” Frances writes. “Trump is a threat to the United States, and to the world, not because he is clinically mad, but because he is very bad.”
I appreciate this focus on Trump as a political rather than psychoanalytic problem. There is something too simple about dismissing his misdeeds as signs of mental illness; it almost exonerates him, and us. But Frances’s judgment proves even more damning. He trashes Trump as a “secular antichrist,” a “two-bit, would-be Mussolini,” even an instrument of divine vengeance. “If you were assigned the task of punishing humanity for its original sins,” he thunders, “you could do no better than invent a Donald Trump and give him extraordinary power.”
After a while, you almost forget Frances is a psychiatrist at all. America is delusional not just because it elected Trump, but because it doesn’t conform to Frances’s views on climate change, population growth, technology, privacy, war, economics and guns. “We’ve lost touch with the reality of starkly obvious existential threats,” he asserts. And when Frances strays into political strategizing, he is not only predictable but generic. “We must find a crossover AntiTrump president,” the author writes, “someone who can bring out our better angels on both sides of the polar gaps and who can replace buzzwords with common-sense solutions.” (Yes, please, especially buzzwords such as “common-sense solutions.”)
Frances worries that Trump has “a particular gift for bringing out all the worst irrational thinking and impulsive actions in his followers.” But “Studio 360” host Kurt Andersen is here to tell us that America has featured magical thinking and nutty impulses for centuries. Thanks to our mix of religiosity and Enlightenment values — plus the do-your-own-thing vibe of the 1960s and the super-powered distribution channel known as the Internet — Americans have developed a “promiscuous devotion to the untrue,” Andersen writes. In “Fantasyland,” he chronicles those he considers purveyors of secular and religious pipe dreams, from Cotton Mather to P.T. Barnum, from Walt Disney to Oprah Winfrey. And, of course, from Donald Trump the real estate huckster to Donald Trump the commander in chief.
“Fantasyland” reads like the work of an author who comes up with a catchy idea and then Dumpster-dives his way through history for anything supporting it. The Salem witch trials, the Gold Rush, Scientology, Civil War reenactors, the tech bubble — all are evidence of Fantasyland, a place where reality and make-believe are blurred and exploitable. It’s all quite clever, but if ever a 462-page book felt fleeting, this is it. Andersen rushes through so much, and it’s not always clear why. Hip-hop rates a random paragraph; so does the pill. Some variant on the word “fantasy” appears on virtually every page, just in case we didn’t get it. And the author’s contempt for people of faith grates. From the Puritans on out, almost any religiously inclined community resides in “Fantasyland,” save American Jews, whom he considers “religiously reasonable,” and American Catholics, whom he finds at least “more reality-based than Protestants.”
The story concludes, inexorably, with the American president. “Donald Trump is a pure Fantasyland being, its apotheosis,” Andersen writes, describing Trump’s personal reality as “a patchwork of knowing falsehoods and sincerely believed fantasies.” Still, Trump gets some credit for keeping a firm grasp on the nation’s unhinging. “Trump waited to run for president until he sensed that a critical mass of Americans had decided politics were all a show and a sham,” Andersen explains.
At that point, Trump fit right in.
There is an addendum to the speculation over Trump’s mental health and our own. Whether or not the American mind was already long gone, the Trump presidency may be adding to its frenzy, even prompting mental-health professionals to reconsider their approaches. One of the psychiatrists in “The Dangerous Case of Donald Trump” warns of the rise of “Trump Anxiety Disorder.” (Feeling helpless? Stressed about politics? Binging on social media? Ask your doctor about T.A.D.) Another contributor proposes the notion of a “citizen therapist” who “works with people in the office and the community on coping productively with public stress and becoming active agents of their personal and civic lives.” And even Frances writes sympathetically, if still condescendingly, about how opposing politicians can reach Trump voters. Rather than confront them with fact-based arguments aimed at proving them wrong, “you must first gain [their] trust as a precondition for exploring the fears, feelings, fancies, stressors, legitimate beefs, and experiences that have made the false beliefs so believable.”
Of course, writing books lamenting America’s generalized insanity — and the delusions of Trump supporters in particular — may not be the ideal first step to win that trust. For all their expertise in human behavior, these psychiatrists don’t seem well-equipped to coax us out of our current political madness. Perhaps the Trump era also requires new therapy for America’s shrinks. To use another euphemism: They seem a little on edge.