The Dangerous Case of Donald Trump

by Bandy X. Lee

  At least three complexities stand in the way of offering up a simple solution: Are mental health professionals duty-bound to speak their truth about a presidential candidate’s fitness for duty, or should they, rather, be constrained by professional ethics from doing so? What are the measurements by which we evaluate the first? What are the injuries of its absence? Is it a matter of a personal decision, or a decision by the community in which one lives?

  The second difficulty has to do with the following: When we investigate the wellness of an individual, are we focused on his freedom from disabling characteristics that compromise his own life or, rather, do we concern ourselves with whether he is a danger to himself or others? Finally, we will briefly turn to how we evaluate risk, whether publicly shared or not.

  Two Types of Mental Illness

  More than eighty years ago, in a polemic against religion and politically based theories, Freud asked, “Does psychoanalysis lead toward a particular Weltanschauung?” (Freud, Sprott, and Strachey, 1933, p. 158). Answering this question in the negative, Freud chose empirical science over what he considered to be illusion and emotion. His new psychotherapies would, if Freud had his way, rely on no assumptions whatever about the good life, but solely on scientific methodology and clear-minded examination of the observable. While this may seem perfectly reasonable, let me point out that the sciences—as is the case with the purest of them all, mathematics—depend not only on the correctness of the investigators’ logical moves but also on the postulates or axioms we begin with.

  Let me, then, state my own position: While in the natural sciences, it is assumed that researches and classification systems are generally independent of values, in the psychological and social sciences, such theoretical neatness is a luxury. Psychological theories of health are inextricably intertwined with the views of a healthy polity, with the need to protect the community, and with a vision of the good life. When we apply knowledge from one group to another, we speak of an error of cultural bias. Even science cannot be thoroughly free of assumptions and values.

  Whatever paradigms one selects for describing mental health and mental illness, there will be questions of how the individual processes feelings, thoughts, and actions. Consider, for instance, anxiety. Humankind has developed anxiety as an adaptive signal to the body to prepare for danger—danger from another person or from a feral predator. However, if the anxiety expresses itself in eating disorders or digestive failure or in facial tics, we see it as maladaptive. Similar constructions can be offered for other responses, such as depression, anger, guilt, and shame.

  On the other side is the arguable value in examining mental structures that foster civilized behavior and a capacity for nondestructive membership in polities of mutual concern. These, too, are adaptive and promote wellness both in the individual and in groups. These two perspectives are joined in a three-part definition of emotional health. The healthy person has:

  • the capacity to recognize his own wishes and impulses and those of others with clarity;

  • the ability to determine whether the actions that express these impulses are likely to cause avoidable damage to himself or others, and when such actions or speech are deemed safe; and

  • the agency necessary to act upon those impulses without intrusive anger, anxiety, depression, guilt, prohibition, or shame.

  Those who either are incapable of or disinterested in measuring the impact they may have on another or on others may well appear symptom-free, functional, and at times even quite successful in their work lives, but they are typically not so in their relationships. In very general terms, those who suffered internally were thought to be living with symptomatic disturbances, while the latter group was described as having character pathology, or personality disorders.

  Here, too, our discussion gets more than a little messy. As noted earlier, what constitutes healthy interpersonal relationships varies from culture to culture; perhaps a recognition of this messiness contributed to the unwillingness of some mental health professionals to define what is meant by a healthy individual or a well community. And here, too, we cannot escape making certain postulates about the good life.

  Freud focused on the puzzling development of conscience. He reasoned that the child begins life with a sense that all are present to serve him. A youngster eventually recognizes that others exist but not initially that they are complex beings with their own thoughts and relationships. Freud discovered that the child’s life changes dramatically when he realizes that others are subjects, just as he is: subjects in their own right (Covitz 2016). Until that time, the child understands others more or less only in their capacities to satisfy his needs: as either good or bad, as satisfying his demands or not. When the child accepts the complexity of family relationships and is able to understand that Mom and Dad have an independent relationship, he has begun to embrace them as subjects (i.e., as doers) with their own thoughts, feelings, and relationships. He has, Freud would say, developed a conscience (an uber-Ich, or a “Guiding I”). Those who fail to accept others as subjects in their own right comprise the personality-disordered subgroup of humanity.

  Let me be a little more specific as to the typical characteristics seen in personality-disordered individuals.

  1.   Such people are generally incapable of understanding and responding in an emotionally empathic way to how another feels. They may well, in an intellectual way, be able to know how others react or even what they might be thinking, but this has little bearing on how they treat others, who remain objects to them, like pieces on a chessboard to be moved about in order to win the game.

  2.   This black-and-white thinking effectively splits the world into friend or foe, into those who support him and all those others who are against him. Such a person may, indeed, grow to be incapable of bigotry—for, to be bigoted or racist or sexist, one must feel allegiance to a group. Still and all, they may have no qualms about using bigotries for their own purposes.

  3.   Lacking the need to evaluate how their actions may impact others, these people react more quickly, and with less skepticism about the correctness of their actions.

  4.   Such individuals have not yet developed respect for others’ thinking, relationships, or efforts, which leads them to put little value in the accomplishments of others. As such, they tend not to recognize the necessity for maintaining extant organizations, government structures, conventional practices, and laws. They may appear civilized but are not safely socialized.

  5.   Due to the aforementioned (points 1–4), their thinking is focused but lacks nuance. They demonstrate no apparent ability to see more than one not-unreasonable view: a monomania of sorts. These views, additionally, can flip to their opposite, since what makes any new attitude acceptable to them is under the control of a “my will be done” syndrome, no matter what that will is.

  6.   Finally (following on 1–5), they display a limited capacity to distinguish the real from the wished for or imagined, and demonstrate a ready willingness to distort the truth.

  Two Fables

  There are two distinct general types of emotional illness: those that precipitate symptoms in the individual and those that represent a risk to relationships and the communities in which the person lives. This leads directly into our second concern: Is the mental health of a powerful leader to be measured by the person’s relationship to oneself or by one’s ability to be safe and constructive in a polity of mutual concern?

  I’ll ask the reader to imagine two fables and some thought experiments.

  Fable 1. The Policeman

  I was driving down Old York Road in my police cruiser when I saw this driver, a funny-looking kind of old guy. He was driving his brand-new Bentley, so I assumed he was pretty safe, even though he was weaving just a little haphazardly. Y’know, a little erratic. He had his window open and was calling some immigrant-looking pedestrians pretty angry names. I pulled him over. He had a small arsenal of automatic weapons up front and
what looked like an RPG launcher on the backseat. I asked him: “What’s with all the weapons, sir?”

  He says, “Officer, I’ve got a license and Montgomery County is Open Carry. I have every right to go where I want. Anyhow, it’s a pretty dangerous world out there. You know, there are a lot of immigrants, and I think I saw Muslims dancing in Wall Park.”

  I go back to my cruiser and call the station house. “Sarge. Any report of dancing foreigners in the park?” Sarge asks me what I’ve been smoking; I understand his intent. So, I go back to the guy’s car. “Sir, I cannot confirm any disturbance going on in Wall Park.” “Officer, I saw it myself, and I should know because I have a lot of money.” The man then goes on and on talking trash about people who are different, saying that everybody who disagrees with him is a liar and one of them might have killed a Kennedy and another one should be sent to the Women’s Detention Center because she’s the world’s biggest crook. Then he tells me it’s not raining and that it never rains when he’s riding in his Bentley. Meanwhile, the water’s pouring off my Stetson. He starts swearing about the township commissioners and accusing them of being stupid. In any case, I have choices, don’t I? I think to myself, I could say any of the following:

  1.   “Sir. You be careful now, and have a blessed day.”

  2.   “Sir. I just wanna say that your car is the tiger’s roar. Be careful, now!”

  3.   “Sir. I think you might be batshit crazy, but I can’t be sure, so, have a good day.”

  4.   “Sir. Take me for a ride in your car, please, and gimme a good job, and we’ll forget about all this silliness.”

  or

  5.   “Sir, would you step out of the car and we’ll take a ride and see if we can’t settle down those images in your head of Muslims dancing in the park? By the way: Were they barefoot?”

  Fable 2. The Casual Customer and the Man in the Psychotherapist’s Office

  A person comes into my psychoanalytic office or, for that matter, sits down next to me at Starbucks carrying a small-caliber handgun. I ask the reader to imagine that, in listening to him, I recognize the six characteristics I’ve just described. In any case, imagine further that time is up on our meeting or that our coffee is finished. I’ve not administered any objective tests. The man shows no signs of anxiety; he has only expressed disdain for others, and assuredly no shame or guilt. He seems to be oriented in time and space. Still, I have a strong if tentative diagnostic impression that this man suffers from serious character disorders. What shall I do, and what is my ethical duty to do as a citizen, and/or as a citizen possessing special training?

  But back to President Trump. I’ve gone back, in my mind, to Leviticus time after time since the election. It occurred to me more than once that the behaviors of candidate, President-elect, and now President Trump may have been—as is the case with the television persona Stephen Colbert presented for many years—an act.

  As a psychologist and psychoanalyst with more than forty years of experience, I cannot say with certainty, for instance, whether Trump’s sexist comments and claims of sexual acting out, his unempathic responses to the Khans (who’d lost their soldier son overseas) or to a handicapped man at his rally, or his calls for violence at those rallies were no more than performance art. Perhaps, in his heart of hearts, I thought, Mr. Trump has an empathic soul, does not split the world into with-him and against-him groups, and is a careful and nuanced thinker. Perhaps, even, Mr. Trump knows the difference between alternate reality and reality, and perhaps he simply uses alternate reality as a strategic ploy. I did consider this and concluded, nonetheless, that his actions still showed severe gaps. After all, and briefly, the damage to the Khans was done, the lies were believed by tens of millions of Trump’s followers, violent rhetoric at his meetings produced real harm, and Mr. Trump has irresponsibly alienated (so far) five of our closest trading partners.

  The Simple Arithmetic of Risk Management

  Since the attack on the Twin Towers and the Pentagon of September 11, 2001, the leaders in the United States and other nation states have communicated to their citizens the need to be vigilant. George W. Bush advocated repeatedly our need to go on living our lives, walking about freely, and carrying out the tasks of living, working, and shopping that preceded the many terrorist attacks the world has come to know as, more or less, weekly events. In addition, however, President Bush and others have advocated that we all remain vigilant. We are told that if we see a suspect package on a bus or airplane or at the Boston Marathon, or if we notice a suitcase left alone at an airport, we should immediately leave the area, warn others, and contact the police. Schools have since developed zero-tolerance rules requiring that if a student is heard speaking of violence toward himself or others, he must immediately be removed from the school and not reinstated until an expert deems him safe to return.

  Mathematicians use an intuitive construction that combines the probability of a negative outcome multiplied by the result of that negative outcome. For example, if the probability of losing a certain wager is 1 percent and would result in their losing $10, most people would feel comfortable taking that risk. The risk in mathematical terms? One percent x $10 or 10 cents. However, if the probability is the same and the loss would result in losing a $200,000 home, it’s time to buy insurance! There, the risk is 1 percent x $200,000 or $2,000, which is more than the cost of an insurance policy to recoup such losses, making it, so to speak, a reasonable expenditure to buy the insurance. Having said that, I feel that our risk calculation involves considerably more than whether it is a reasonable expenditure to buy the insurance; the loss of a home for most people would be devastating.

  Conclusion

  Donald Trump has displayed, frequently, all six of the characteristics that I and many other mental health professionals associate with severe character pathology. I cannot say with certainty what diagnostic box, if any, he fits—not, indeed, before and without careful examination and testing, as those who support the Goldwater rule avow. Some of my colleagues, citing the duty to warn others of possibly imminent danger, are comfortable assigning Mr. Trump in this category or some other condition from the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V); I am not comfortable doing so. Still, I strongly agree with the likelihood that these fit the preponderance of people who behave as President Trump does. This doubt is equally present when I’m reporting to the appropriate social service agency my sense that there is a likelihood that a certain child is being molested or that one of my patients may be planning to shoot his wife’s lover. I needn’t be certain if the outcome is potentially dire. When the outcome is possibly devastating, even if the probability that it will occur is relatively small, the clinician and perhaps every citizen is duty-bound to warn.

  In becoming president and commander in chief of the most powerful armed forces on earth, Trump is armed to the teeth and has openly spoken about the wonder he experiences, though we simultaneously maintain this nuclear firepower, that we have a reluctance to use it. He displays all the signs of a seriously personality-disordered person and has repeatedly spoken of using violence. And the outcome? The outcome, if he is indeed as ill as some sizable portion of the mental health professional community suspects, could well be potentially devastating to a significant percentage of humanity.

  Back to me: I believe that my ethical duty to warn is unquestionable, as is my ethical responsibility to work within the confines of the law to have Mr. Trump psychologically and psychiatrically examined—or, in the absence of his willingness to do so, to have him removed from office.

  Indeed, I am in good company. The policeman who meets a driver armed and talking crazy is ethically bound to disarm that driver. The shopper or passenger on a city bus or marathon route who sees an unattended package lying about is responsible for taking action. The coffee-drinking Starbucks customer, as well as the psychotherapist in her office, who is confronted by a gun-toting, crazy-talking person has the citiz
en’s responsibility either to disarm that person or to arrange to have it done. How much less can I or any other mental health professional be ethically bound by a duty to warn and by the biblical proscription not to stand idly by as others are placed in potential danger (Leviticus 19:16)? This assuredly applies to a possibly unfit-to-serve president who is in possession of the U.S. nuclear codes.

  Howard H. Covitz, Ph.D., A.B.P.P., has combined the practice of psychoanalysis in the suburbs of Philadelphia with a variety of other interests. He has taught university-level mathematics, psychology, and biblical characterology (1968–2011), was a training analyst at the Institute for Psychoanalytic Studies and the Institute for Psychoanalytic Psychotherapies, and its director (1986–98). He also ran a school for disturbed inner-city adolescents in the 1970s. His Oedipal Paradigms in Collision (1998, reissued in 2016) was nominated for the Gradiva Book of the Year Award. His connectedness to his wife, grown children, and grandchildren motivates his writing and thinking.

  References

  American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association.