The Dangerous Case of Donald Trump

by Bandy X. Lee

  Hypomanics are whirlwinds of activity who are filled with energy and need little sleep, less than 6 hours. They are restless, impatient and easily bored, needing constant stimulation and tend to dominate conversations. They are driven, ambitious and veritable forces of nature in pursuit of their goals. While these goals may appear grandiose to others, they are supremely confident of success—and no one can tell them otherwise. They can be exuberant, charming, witty, gregarious but also arrogant. They are impulsive in ways that show poor judgment, saying things off the top of their head, and acting on ideas and desires quickly, seemingly oblivious to potentially damaging consequences. They are risk takers who seem oblivious to how risky their behavior truly is. They have large libidos and often act out sexually. Indeed all of their appetites are heightened.

  This description sounds an awful lot like Trump who reports, “I usually sleep only four hours a night” (1987), which by itself is usually a pretty reliable indicator of hypomania Indeed, he boasts about it: “How can you compete against people like me if I sleep only four hours?” He claims to work seven days a week and, in a typical eighteen-hour day, to make “over a hundred phone calls” and have “at least a dozen meetings.” He also tweeted, “Without energy you have nothing!”—hence his taunt of Jeb Bush as “a low energy person,” by contrast, a charge that proved quite effective. Like most hypomanics, Trump is easily distracted. We could add attention deficit disorder to the Trump differential, except attention deficit disorder almost always goes with the territory for hypomanics. “Most successful people have very short attention spans. It has a lot to do with imagination,” Trump wrote with Meredith McIver in Think Like a Billionaire in 2004. He is correct. The same rapidity of thought that helps engender creativity makes it difficult for one to stay on one linear track of ideas without skipping to the next. Like most hypomanics, Trump trusts his own ideas and judgment over those of anyone and everyone else, and follows his “vision, no matter how crazy or idiotic other people think it is.”

  One of my dictums when working with hypomanic patients is that “nothing fails like success.” If they succeed in achieving one of their wildly ambitious goals, there is often a noticeable uptick in their hypomania, sometimes even precipitating a full-blown hypomanic episode, which, unlike hypomanic temperament, is a diagnosable disorder. They become more aggressive, irritable, reckless, and impulsive. Now seemingly confirmed in their grandiosity, they drink their own Kool-Aid and feel even more invincible and brilliant. They pursue even bolder, riskier, and more ambitious goals, without listening to dissent, doing their due diligence, or considering contradictory facts. Their gut is always right. Once, Trump was asked whom he went to for advice. With a straight face, he said, “Myself.” Trump is Trump’s most trusted adviser. In the same vein, with the increase in grandiosity comes a corresponding increase in paranoia over the fools and rivals who might nay-say the hypomanic’s insights, impede his progress, or destroy him out of jealousy or ignorance.

  In fact, this is a pattern for Trump. In 1988, after the publication of his best-selling book The Art of the Deal, Trump’s celebrity really took off. His response was an increase in his hypomania, according to Politico writer Michael Kruse (2016) in his article “1988: The Year Trump Lost His Mind”:

  [H]is response to his surging celebrity was a series of manic, ill-advised ventures. He cheated on his wife, the mother of his first three children. In business, he was acquisitive to the point of recklessness. He bought and sold chunks of stocks of companies he talked about taking over. He glitzed up his gaudy yacht, the yacht the banks would seize less than three years later. He used hundreds of millions of dollars of borrowed money to pay high prices for a hotel and an airline—and his lenders would take them, too. And he tussled for months with game-show magnate Merv Griffin for ownership of his third casino in Atlantic City, the most expensive, gargantuan one yet, the Trump Taj Mahal, which led quickly to the first of his four corporate bankruptcy filings.

  During that period, Trump the storied dealmaker went on a buying binge, and made impulsive, ill-advised investments, often paying the asking price without negotiating at all. As Kruse wrote in his Politico piece:

  That spring, though, he purchased the Plaza Hotel because he openly coveted the Manhattan landmark, so much so that he paid more for it than anybody anywhere ever had spent on a hotel—$407.5 million—[for] a hotel that wasn’t turning enough profit to service the debt to which Trump [was] committed.

  And in the fall, he agreed to buy the Eastern Airlines [sic] Shuttle, which he wanted to rename the Trump Shuttle, for a sum that analysts and even his own partners considered excessive—more than the airline itself thought the shuttle was worth.…

  “It was not a lengthy financial analysis,” [said] Nobles [president of Trump Shuttle], describing it as “back-of-the-envelope” and “very quick.… Donald said, ‘I really want to buy it.’”

  Trump could be the poster child for the dictum that when it comes to hypomanics, nothing fails like success. Kruse continued:

  If Trump’s current campaign is the culmination of a lifelong effort to turn his name into a brand, his brand into money and all of it into power, 1988 was the first sustained look at what the man who is the shocking favorite to be the Republican Party’s nominee does when he gets ahold of it. It was the year when Trump’s insatiable appetites and boundless ego—this early, spectacular show of success—nearly did him in.

  Fast-forward twenty-eight years, to 2016, when Trump once again achieved success beyond anyone’s wildest imaginings. He became addicted to rallies, where he excited crowds with his hypomanic charisma, and where they in turn threw gasoline on the fire of his hypomanic grandiosity. This culminated in the Republican National Convention, at which Trump made a grandiose statement that encapsulates it all: “Only I can fix it.”

  David Brooks (2016) is not a mental health professional, but he astutely commented on what appeared to him to be Trump’s increasing hypomania:

  He cannot be contained because he is psychologically off the chain. With each passing week, he displays the classic symptoms of medium-grade mania in more disturbing forms: inflated self-esteem, sleeplessness, impulsivity, aggression and a compulsion to offer advice on subjects he knows nothing about.

  His speech patterns are like something straight out of a psychiatric textbook. Manics display something called “flight of ideas.” It’s a formal thought disorder in which ideas tumble forth through a disordered chain of associations. One word sparks another, which sparks another, and they’re off to the races. As one trained psychiatrist said to me, compare Donald Trump’s speaking patterns to a Robin Williams monologue, but with insults instead of jokes.

  Trump’s first hypomanic crash resulted only in a few bankruptcies, but while he is president, the consequences could be on a scale so vast it’s difficult even to contemplate.

  Let’s put these two moving parts together, bad and mad. Trump is a profoundly evil man exhibiting malignant narcissism. His worsening hypomania is making him increasingly more irrational, grandiose, paranoid, aggressive, irritable, and impulsive. Trump is bad, mad, and getting worse. He evinces the most destructive and dangerous collection of psychiatric symptoms possible for a leader. The worst-case scenario is now our reality.

  Often as therapists we are called on to help our patients see that their life circumstances are not as catastrophic as they might feel. In the case of Trump, however, our job is the opposite: to warn the public that the election of Donald Trump is a true emergency, and that the consequences most likely will be catastrophic.

  It’s a catastrophe that might have been avoided if we in the mental health community had told the public the truth, instead of allowing ourselves to be gagged by the Goldwater rule. “See something, say nothing” appears to be the APA’s motto when it comes to national security. History will not be kind to a profession that aided the rise of an American Hitler through its silence.

  John D. Gartner, Ph.D., is a clinical psycholo
gist. He taught in the Department of Psychiatry at Johns Hopkins University Medical School for twenty-eight years. He is the author of In Search of Bill Clinton: A Psychological Biography and The Hypomanic Edge: The Link Between (a Little) Craziness and (a Lot of) Success in America. He practices in Baltimore and New York.

  References

  Bleuler, Eugen. 1924. Textbook of Psychiatry. New York: Macmillan, p. 485.

  Brooks, David. 2016. “Trump’s Enablers Will Finally Have to Take a Stand.” New York Times, August 5.

  Cheney, Kyle, et al. 2016. “Donald Trump’s Week of Misrepresentations, Exaggerations, and Half-Truths.” Politico, September 25.

  Fromm, Erich. 1964. The Heart of Man. New York: American Mental Health Foundation, p. 63.

  Gartner, John. 2005. The Hypomanic Edge: The Link Between (a Little) Craziness and (a Lot of) Success in America. New York: Simon and Schuster.

  ______. 2008. In Search of Bill Clinton: A Psychological Biography. New York: St. Martin’s Press.

  ______. 2015. “Donald Trump and Bill Clinton Have the Same Secret Weapon.” The New Republic, August 25.

  ______. 2016. “What Is Trump’s Psychological Problem?” Huffington Post, June 9.

  Gass, Nick. 2016. “New York AG: Trump U ‘Really a Fraud from Beginning to End.’” Politico, September 25.

  Goode, Erica. 2003. “The World; Stalin to Saddam: So Much for the Madman Theory.” New York Times, May 4.

  Haberman, Maggie. 2016. “Even as He Rises, Donald Trump Entertains Conspiracy Theories.” New York Times, February 29.

  Holan, Angie, and Linda Qui. 2015. “2015 Lie of the Year: The Campaign Misstatements of Donald Trump.” PolitiFact, December 21.

  Kernberg, O. 1970. “Factors in the Psychoanalytic Treatment of Narcissistic Personalities.” Journal of the American Psychoanalytic Association 18: 51–85.

  Kraepelin, Emil. 1908. Lectures on Clinical Psychiatry. Bristol, UK: Thoemmes, pp. 129–30.

  ______. 1921. Manic Depressive Insanity and Paranoia. Edinburgh: Livingstone, pp. 125–31.

  Kretschmer, Ernst. 1925. Physique and Character. New York: Harcourt and Brace, pp. 127–32.

  Kruse, Michael. 2016. “1988: The Year Donald Lost His Mind.” Politico, March 11.

  Lange, Jeva. 2016. “Donald Trump Turned His Back on His Closest Friend When He Heard He Had AIDS.” The Week, April 8.

  Pollock, G. H. 1978. “Process and Affect.” International Journal of Psychoanalysis 59: 255–76.

  Reisner, Steven. 2017. “Stop Saying Donald Trump Is Mentally Ill.” Slate, March 15.

  Scott, Eugene. 2015. “Trump Believes in God, but Hasn’t Sought Forgiveness.” CNN.com, July 8.

  Tansey, Michael. 2017a. “Part VIII. Delusional Disorder.” Huffington Post, February 24.

  ______. 2017b. “Part X. Trump and the Codes: Why ‘Crazy Like a Fox’ vs. ‘Crazy Like a Crazy’ Really Matters.” Huffington Post, March 19.

  Tashman, Brian. 2016. “58 Conspiracy Theories (and Counting): The Definitive Trump Conspiracy Guide.” Right Wing Watch, May 27.

  Trump, Donald. 1987. The Art of the Deal. New York: Random House.

  Washington Post Editorial Board. 2016. “Donald Trump’s Campaign of Conspiracy Theories.” Washington Post, February 19.

  WHY “CRAZY LIKE A FOX” VERSUS “CRAZY LIKE A CRAZY” REALLY MATTERS

  Delusional Disorder, Admiration of Brutal Dictators, the Nuclear Codes, and Trump

  MICHAEL J. TANSEY, PH.D.

  Since becoming president, Donald Trump has made increasingly staggering statements contradicted by irrefutable evidence to the contrary (videos, photos, tweets), such that we have no choice but to consider whether his psychological disturbance is far more severe than what has widely been proposed as merely narcissistic personality disorder, merely antisocial personality disorder, or merely pathological lying.

  Delusional Disorder

  I begin with a presentation of the exceedingly rare diagnosis of delusional disorder, which may help us understand why DT makes such jaw-dropping statements. I am intending not to diagnose but to educate the general public so that each person can make his or her own informed assessment. (The criteria from the Diagnostic and Statistical Manual, 5th ed., are easily observable, simple behavioral characteristics that even a fifth-grader could understand.) I will then examine the final five minutes of a meandering, free-flowing, fifteen-minute videotaped speech DT delivered to the CIA the morning after Trump’s inauguration, to see if the diagnosis can provide a lens through which to make sense of three egregious, separate, and startling statements contained in a mere five minutes.

  Delusional disorder is coded as 297.1 (F22) for the purpose of insurance coverage for treatment. Those with delusional disorder scoff at the notion that there is a problem in the first place, such that insurance coverage for treatment is irrelevant. This “stealth” disorder is exceptionally beguiling because such individuals can seem perfectly normal, logical, high functioning, and even charming so long as the delusion itself is not challenged. Delusional disorder is described as “one of the less common psychotic disorders in which patients have delusions that differ from classical symptoms of schizophrenia.” Psychosis is defined as “a condition in which there is profound loss of contact with external reality.” The schizophrenic person tends to display bizarre behavior, hallucinations, and overtly disordered thinking. Whereas in schizophrenia the disconnection tends to be highly visible and all-encompassing, the less serious delusional disorder is neither bizarre nor readily apparent to the outside observer:

  • Delusions are beliefs that exist despite indisputable, factual evidence to the contrary.

  • Delusions are held with absolute certainty, despite their falsity and impossibility.

  • Delusions can have a variety of themes, including grandeur and persecution.

  • Delusions are not of the bizarre variety (“I am being poisoned by the CIA”) but, rather, seem like ordinary figures of speech except that each word is meant literally: e.g., “I alone am the chosen one, invincible, extraordinary beyond words, the very best of the best in every way.”

  • Delusional people tend to be extremely thin-skinned and humorless, especially regarding their delusions.

  • Delusions are central to the person’s existence, and questioning them elicits a jolting and visceral reaction.

  • Delusional disorder is chronic, even lifelong, and tends to worsen in adulthood, middle age, and beyond.

  • Words and actions are consistent and logical if the basic premise of the delusion is accepted as reality: “Because I am superior to all, it follows that I would never apologize because I am never wrong.”

  • General logical reasoning and behavior are unaffected unless they are very specifically related to the delusion.

  • The person has a heightened sense of self-reference (“It’s always all about me”), and trivial events assume outsize importance when they contradict (“You are a con man, not a great businessman”) or, conversely, support the delusional belief (“These adoring crowds recognize that I am extraordinary beyond measure”), making trivial events, whether positive or negative, hard to let go of and move past (“Have I mentioned my greatest ever electoral landslide?”).

  Delusional disorder may help us make sense of the last five minutes of DT’s CIA address (CNN videos 2017), which contain three staggering statements that lead us to think, “He can’t possibly mean that.” In the tenth minute, DT declared he was “a thousand percent behind” the CIA, and accused the Fake Media, “some of the most dishonest people on the planet … of making it sound like I had a feud” with the intelligence community, when the truth is the “exact opposite.” Anyone in the audience with a cell phone who doubted his own memory could instantly have googled DT’s innumerable tweets about the incompetence and dishonesty of the “so-called intelligence community,” a position he has since reverted to. Did DT actually believe that the truth was defined by his words and not hard facts to the contrary? Why would he
merely lie despite knowing that each and every person in attendance knew there was not an iota of truth to the claim? His stunning falsehood lacks the shrewdness of the typical pathological liar. If he had been hooked up to a reliable lie detector test and were in fact delusional, he would have passed with flying colors because he literally believes every word he says, despite irrefutable facts to the contrary. He takes it as a given that the world around him will conform to his own warped view of events, and that those who do not believe so are irrational enemies backed by the Fake Media.

  A minute later in the speech, he described his disappointment that, as he began his inaugural address, it was raining, but then he claimed, with a finger to the sky, “God looked down and said, ‘We’re not going to let it rain on your speech.’” He then insisted that the rain stopped immediately and it became “really sunny” before it “poured right after I left.” Again, anyone at the CIA that day with a cell phone could immediately have watched the video demonstrating clearly that the drizzle on Inauguration Day started as DT began to speak, and that it never got sunny. It never subsequently poured. Again, did he believe every word he was saying? If the answer is yes, this would be compelling evidence of underlying delusional disorder leaking through the veneer of normality.

  The third statement, of course, was his insistence that the inaugural grounds were packed “all the way to Washington Monument.” Despite his badgering the National Park Service to come up with photo angles that might suggest a larger crowd, the aerial shots clearly showed that DT’s audience was many hundreds of thousands fewer than Obama’s in 2009. Again, DT claimed this was another example of Fake News, because the photos did not accord with his certainty of his personal reality. Again, his otherwise inexplicable insistence can be explained only by an understanding of grandiose, delusional detachment from reality.