by Bandy X. Lee
Actions such as those of President Kennedy are often attributed to the “great man,” to the remarkable or praiseworthy characteristics of the individual. President Kennedy’s actions in the Cuban Missile Crisis reflect his wisdom and skills but also the social relationships that surrounded him. That he took a hand in constructing and managing these relationships points to an important dialectic between the individual and the social, but diminishes neither.
Social Networks and Support
Many studies document the impacts of social relationships. One of the most provocative found that social connections with spouse, parents, family members, coworkers, groups or organizations protect against the “common cold” (Cohen et al. 1997). What was most important about this finding, however, was that it was not just the number of social connections that protected against symptoms such as a runny nose, but also their variety. Having many versus fewer friends was not protective, but having a variety of types of relationships with family, friends, etc. resulted in fewer symptoms following exposure to a cold virus. Similarly, the variety of social connections predicted death among older adults in a more recent study (Steptoe et al. 2013).
Why should the variety of social connections matter? One answer comes from work many years ago by the anthropologist Erving Goffman, in his study of “asylums” such as prisons and mental hospitals. Goffman observed that inmates or patients in such institutions have but one social role. The patient hospitalized in a psychiatric facility is seen by all (professionals and staff, family members, former acquaintances, and even other patients) as a patient with a mental illness, not as a spouse, child, friend, or coworker (Goffman 1961). Being stuck in one role limits our ability to buffer the stressors of daily life. This is because we often cope with stressors in one setting by complaining, getting advice, or simply seeking solace in another. We complain about our coworkers to our spouses and complain about our spouses, children, and/or in-laws with our coworkers or close friends. For the hospitalized schizophrenic patient, however, this is not possible. As all come to see her/him as schizophrenic, all complaints to or about family, friends, hospital staff, doctors, etc. are taken as expressions of schizophrenia, and thereby invalidated. The individual is isolated in only one role from which she or he cannot escape.
The importance of not being locked in one role, even as the all-powerful president, is reflected in a current book on the office of White House chief of staff (Whipple 2017). A recurrent theme is the importance of the chief of staff being the one person who can tell the president he cannot do something. President Carter’s initial decision not to have a chief of staff and then appointing one who was not an effective manager is suggested as a major cause for problems in his administration. Turning to President Trump, doubts about his trust in his chief of staff are frequently cited as key to problems in the execution of his plans during the early days of his administration.
Applying Goffman’s observations to the president of the United States is ironic. Goffman developed these ideas in observing and trying to understand the challenges of those stripped not only of their multiple roles but also of their independence and freedom. But the observation may also apply to those who become isolated in a single social role amid privilege. A concern one might raise about President Trump is his apparent choice always to be “the Donald.” Consider, for example, his making Mar-a-Lago an extension of the White House. Rather than preserving it as a place to which he can get away and separate himself at least somewhat from his role as president, he chose to go there weekly during the first months of his administration and to “bring his work home with him,” including his official visitors, such as President Xi Jinping of China.
A final important feature of social connections points also to the importance of varied perspectives. In examining how groups adopt innovations, sociologist and communication theorist Everett Rogers noted the importance of tight-knit, cohesive networks in quickly and effectively acting to implement a good idea (Rogers and Kincaid 1981). But where do the good ideas come from? One source of good ideas was observed to be “weak ties.” One member of a tightly knit group might have a connection to someone in another village, a sister-in-law who is a lawyer, or a job that takes him periodically to the “big city.” Such weak ties, not intimate or especially important in day-to-day activities, nevertheless provide exposure to innovations. The combination of new ideas plus a cohesive network to implement them provides the idea for and the execution of innovation.
The variety, provision of multiple roles, and availability of weak ties in social networks seem to fit well the social setting in which President Kennedy worked through the Cuban Missile Crisis. The variety of connections was clear. An important feature of his network was Kennedy’s preserving of his relationship with his brother, through which he could complain about his group of advisers, perhaps, but also seek an outside perspective in making sense of the advice he was getting. He also read widely and drew on that reading in his thinking. Barbara Tuchman’s The Guns of August, detailing how European leaders miscalculated and slid into World War I, was much in Kennedy’s mind. As noted, President Kennedy maintained “weak ties” with those with varied viewpoints through his wide reading, intellectual curiosity, and openness to a wide range of views.
Turning to President Trump’s social connections, an April 2017 article in the New York Times noted a “group of advisers—from family, real estate, media, finance and politics, and all outside the White House gates—many of whom he consults at least once a week” (Haberman and Thrush 2017). They include nine millionaires or billionaires (Thomas Barrack, Carl Icahn, Robert Kraft, Richard LeFrak, Rupert Murdoch, David Perlmutter, Steven Roth, Phil Ruffin, and Steve Schwarzman); the conservative television cable news host Sean Hannity; the conservative political strategists Corey Lewandowski and Roger Stone; Republican politicians Chris Christie, Newt Gingrich, and Paul Ryan; a financial lawyer, Sheri Dillon; President Trump’s sons; and his wife. Although the article says that President Trump “needs to test ideas with a wide range of people,” those in whom he confides are described as “mostly white, male and older” and were chosen based “on two crucial measures: personal success and loyalty to him.”
A somewhat more critical characterization of President Trump’s circle of relationships emerges through a recent article in The New Yorker, by Evan Osnos: “He inhabits a closed world that one adviser recently described to me as ‘Fortress Trump.’ Rarely venturing beyond the White House and Mar-a-Lago, he measures his fortunes through reports from friends, staff, and a feast of television coverage of himself.”
Quoting Jerry Taylor, “the president of the Niskanen Center, a libertarian think tank,” Osnos describes how “he is governing as if he is the President of a Third World country: power is held by family and incompetent loyalists whose main calling card is the fact that Donald Trump can trust them, not whether they have any expertise.”
As the noted constitutional lawyer Lawrence Tribe (2017) has put it, “He only wants loyalists.” Later, Osnos notes that:
it’s not clear how fully Trump apprehends the threats to his presidency. Unlike previous Republican Administrations, Fortress Trump contains no party elder with the stature to check the President’s decisions. “There is no one around him who has the ability to restrain any of his impulses, on any issue ever, for any reason,” Steve Schmidt, a veteran Republican consultant said.
Of greatest concern, Osnos (2017) reports that
Trump’s insulation from unwelcome information appears to be growing as his challenges mount. His longtime friend Christopher Ruddy, the C.E.O. of Newsmax Media … noticed that some of Trump’s associates are unwilling to give him news that will upset him … Ruddy went on. “I already sense that a lot of people don’t want to give him bad news about things. I’ve already been approached by several people that say, “He’s got to hear this. Could you tell him?”
Psychopathology
Although no firm conclusions should be ventured or consider
ed possible without detailed, firsthand knowledge or examination of President Trump, categorizations of him that have been suggested have included narcissism, psychopathic deviance, and attention deficit/hyperactivity disorder (ADHD). Despite the impossibility of a conclusion, discussion of which one of these may best fit the president has been lively. The assumption that there should be one best diagnosis, however, is at odds with important trends in how we view psychopathology in general. In fact, 50 percent of those qualifying for one diagnosis meet criteria for an additional diagnosis (Kessler et al. 2011). Thus, the inability to reach agreement among speculative diagnoses of the president’s mental status may well reflect that several diagnoses may be pertinent. What is important is not a specific diagnosis but, rather, understanding the behavior patterns that raise concerns about mental status and that affect policy decisions and public welfare.
In addition to overlap among the categories, there is increasing recognition that the diagnostic categories of the DSM-V, the Diagnostic and Statistical Manual of the American Psychiatric Association (American Psychiatric Association 2013), are themselves flawed. For example, a diagnosis of major depressive disorder requires (a) either dysphoria or anhedonia (diminished ability to feel pleasure); (b) four of seven symptoms, such as insomnia, fatigue, decreased concentration/indecisiveness; and (c) the presence of these most of the day and nearly every day for at least two weeks (Ritschel et al. 2013). That means that one person with dysphoria and symptoms one through four and another with anhedonia and symptoms four through seven both meet criteria for the same disorder, even though they have only one feature in common. Similar problems exist with other diagnostic categories, each judged by the presence or absence of sufficient numbers of symptoms or characteristics from a longer list of possible symptoms or features.
A recent approach to categorizing psychopathology that has been promoted by the National Institute of Mental Health focuses on individuals’ strengths or deficits in more discrete categories of psychological function rather than the broad categories of DSM-V. Among these, for example, are acute threat or fear, potential threat or anxiety, sustained threat (such as in PTSD), loss, working memory, cognitive control, affiliation/attachment, social communication, perception/understanding of self and understanding of others, arousal, and biological rhythms (Kozak and Cuthbert 2016). The theme of this approach is that individual functions or groups of functions might account for patterns of aberrant behavior. In the case of President Trump, acute threat, cognitive control, affiliation/attachment, social communication, perception/understanding of both self and others, arousal, and biological rhythms are all functions that may be pertinent to a number of the concerns that have been raised about his behavior. From such a perspective, the issue is not which of such a group of psychological functions might be primary, but how they interact to lead to troublesome patterns of behavior that, in the case of the president, have substantial societal implications. So, an inability to identify “whether it’s basically perceptions of self or perceptions of others” is of little concern. Rather, recognizing the confluence of deficits in these functions as they build an alarming pattern of behavior becomes the basis for sounding an alarm.
If we are to focus on more specific behavior patterns that raise concerns about the mental fitness of President Trump, we still have an outstanding question. How do we judge that a particular characteristic is abnormal, pathological, or indicative of compromised mental fitness? The field of psychopathology and abnormal psychology has long wrestled with this question. When does a quirk or a distinctive personal style become the object of clinical concern and the basis for encouraging the individual to recognize her/himself as having a problem or, even, qualifying for loss of rights or enforced hospital commitment? Among the criteria that have often been proposed for identifying pathology are: resistance to change or to normal social pressure; an almost automatic repetitiveness; disregard for consequences or an inability to adjust behavior according to consequences; harmfulness to self or others; negative impacts on relationships, work, or key interests; and distortions of reality that are frequent, disruptive, and go beyond normal variation in judgments and perceptions. The criteria for identifying psychopathology might be applied to judging the fitness of the president to exercise his power.
For example, what is striking is the persistence of some of his behavior in spite of strong disconfirmation, such as in his arguments about why Hillary Clinton won the popular vote, the size of his inaugural crowd, or the assertion that President Obama had wiretapped him and his colleagues during the election campaign. So, too, he seems not to notice the harmfulness of his behavior, such as in his contradictory and self-indicting comments about the firing of former FBI director James Comey. He also appears to deny or ignore the aggressiveness of his behavior, as in his admonition to “beat the crap out of him” (referring to a protester being removed from a campaign rally) or in the Twitter threat to Comey about the possible existence of recordings of their conversations. Remarkably, these patterns persist despite their negative characteristics receiving broad attention and even though they may place President Trump in jeopardy of criminal charges or impeachment.
Another approach to making the judgment that behavior is a problem lies in the criminal law for judging innocence by virtue of insanity. In most jurisdictions, the criteria for innocence are an inability to appreciate the criminality of one’s actions and to conform one’s behavior to the requirements of the law. Whether this is by virtue of schizophrenia or depression or personality disorder or some other posited diagnosis is not critical. What is determinative is the inability to follow the law and understand how it applies to one’s own behavior. Clearly, many of the instances observed and widely remarked upon with regard to President Trump would suggest an inability on his part to recognize how his behavior is at odds with applicable laws, including the U.S. Constitution. In his disparaging comments about judicial decisions, and in his ad hominem attacks on a judge who presides over one of the cases in which he is a defendant, and in the comments indicating that he asked Comey about investigations of him during a conversation about Comey’s tenure as FBI director, President Trump manifests an apparent lack of recognition of how his behavior is at odds with law, the Constitution, and important precedents for the conduct of his office.
The judgment of “innocent by virtue of insanity” is a legal decision, a finding of innocence, not a finding of psychopathology. Expert opinion about possible pathology may be pertinent to the finding but is not determinative. This suggests considering the judgment of fitness for office as not a medical or psychiatric or psychological question but as a legal and political judgment. As James Gilligan noted at the Yale conference, “It’s not whether [President Trump] is mentally ill or not. It’s whether he’s dangerous or not” (Milligan 2017; Osnos 2017; and Gilligan’s essay in this book, “The Issue Is Dangerousness, Not Mental Illness”). Research and clinical knowledge about mental health may be helpful in making the judgment of dangerousness, but they do not themselves determine the decision. Abraham Lincoln apparently suffered serious depression, but few would say it compromised his ability to serve. Yet, the observations of experts in mental health and psychopathology suggest real liabilities in President Trump’s behavior. The question remains, however: does it matter?
One answer to that final question has recently been posed by strong voices on the conservative side of the political spectrum. Under the title “Trump Has a Dangerous Disability,” George Will wrote in the Washington Post, on May 3, 2017:
It is urgent for Americans to think and speak clearly about President Trump’s inability to do either [i.e., think and speak clearly]. This seems to be not a mere disinclination but a disability. It is not merely the result of intellectual sloth but of an untrained mind bereft of information and married to stratospheric self-confidence …
His fathomless lack of interest in America’s path to the present and his limitless gullibility leave him susceptible to being blown ab
out by gusts of factoids that cling like lint to a disorderly mind.
Americans have placed vast military power at the discretion of this mind, a presidential discretion that is largely immune to restraint by the Madisonian system of institutional checks and balances.
Writing two days later, on May 5, 2017, also in the Washington Post, Charles Krauthammer articulated further the psychological dimensions of President Trump’s fitness to serve:
And this is not to deny the insanity, incoherence and sheer weirdness emanating daily from the White House …
Loud and bombastic. A charlatan. Nothing behind the screen—other than the institutional chaos that defines his White House and the psychic chaos that governs his ever-changing mind …
Krauthammer goes on to describe what he considers to be a blunder of threatening to make South Korea pay for a defensive missile system and to renegotiate trade agreements. He asserts that this blunder forces
lingering fears about Trump. Especially because it was an unforced error. What happens in an externally caused crisis? Then, there is no hiding, no cushioning, no guardrail. It’s the wisdom and understanding of one man versus whatever the world has thrown up against us. However normalized this presidency may be day to day, in such a moment all bets are off.
What happens when the red phone rings at 3 in the morning?