Mental health professionals have a "duty to warn" people about the danger posed by Trump’s mental illness.
In psycholanalyzing Donald Trump, we may seem to be violating the “Goldwater Rule” that enjoins psychotherapists from diagnosing public figures based on second hand information. However,we happen to agree with the consensus of a recent conference of mental health professionals at Yale University that argued that mental health professionals have a “duty to warn” people about the danger posed by Trump’s mental illness).
We are going to analyze Trump because we think that media analyses have been too superficial and that understanding Trump more deeply can help us decipher actions and attitudes that might otherwise be bewildering. In my view, there isn’t anything quirky or confusing about Trump’s psychopathology. It makes perfect sense if seen through the right lens.
Most approaches to psychotherapy assume that people naturally avoid painful emotions. One person can’t tolerate feeling dependent; for another, it’s anger; and for still another it might be guilt. People do all sorts of things to avoid the danger of feeling painful emotional states. They might simply deny them (e.g. “I never feel sad”). They might exaggerate the opposite. (E.g. I’m powerful, not weak, happy not sad,” etc.) Or they might project these feelings outward, thereby making an internal problem into an external one. (E.g. “I don’t hate the world; the world hates me.” ) These are examples of psychological defenses. More often than not, the difficulties that people experience in their lives—or create for others—come from their attempts to defend themselves against emotional pain. Their solutions, in other words, become a problem. So, for example, if someone fears feeling angry, he or she might assume an exaggerated position of meek compliance which might then lead to situations in which he or she is inauthentic or self-sabotaging. Or such a person might externalize feelings of anger and become paranoid about imagined aggression in others, believing that he or she is the target of others’ anger. Such a person is chronically defensive and mistrustful of others. A paranoid person is very hard to get along with.
Our psyches are wired to seek to eliminate or escape painful feelings. Sometimes, however, emotional states feel so dangerous that a person’s efforts to safely avoid them have to be similarly extreme and involve distorting reality. And if that person has a lot of power—the President, for example—such extreme defenses pose a serious threat to others.
Donald Trump’s psychopathology is expressed primarily by his defenses against certain painful feelings. I would argue that among the emotions he most likely dreads the most are inferiority, helplessness, and shame. This triad lies at the heart of what makes Trump crazy. Trump can easily be diagnosed, as many have done, as a “malignant narcissist”—someone who has, according to the DSM-V, a narcissistic personality disorder but who, in addition, shows prominent symptoms of paranoia and an inability to feel guilt or remorse. Such a diagnosis, while accurate, is simply descriptive and doesn’t go deep enough into the real sources of his pathology. It’s not enough to diagnose him. Instead, we have to understand how a man with such a diagnosis is likely to feel inside, the fears and desires that motivate him and the strategies he uses to escape painful emotions. Understanding how Trump is constantly defending himself against feelings of inferiority, helplessness, and shame brings us closer to the truth. Viewed this way, malignant narcissism is merely the shape that Trump’s defenses –the defenses of any malignant narcissist for that matter--take as he struggles against the threats of this triad of feelings.
For example, take Trump’s extreme grandiosity. He is always the biggest, the best, and the greatest. This self-aggrandizement makes sense if it is seen as a defense against feeling small and insignificant—in other words, inferior. The exaggerated degree of his grandiosity is a measure of the depth of his dread of being inadequate. Similarly, Trump surrounds himself with a type of garish superficial beauty (gold fixtures in the bathroom, and golden trophy wives) to counteract feelings of lack of worth. In other words, this surface is absurdly glorified in order to counteract feelings of internal damage. Further, his incipient dread of feeling small (for example, his obsession with proving his hands are not small) is also defended against by projecting “smallness” onto others. We all remember that Marco Rubio was “little Marco,” and he calls people he doesn’t like “losers,” thereby reducing the pressure of feeling that way about himself. Over and over again, he paints his critics as losers, petty powerless people, momentarily escaping a dreaded belief that he is the real loser.
Trump is constantly battling feelings of shame and humiliation. We know that because he is frequently expressing “disgust.” Disgust is a way to keep shame at a distance. It’s a way of saying that something bad isn’t inside, it’s outside, and disgust warns us to keep away from it. Trump can barely contain expressions of disgust and contempt. During the campaign we saw this defense emerge in regard to women; he was disgusted, for example, by Hillary’s use of the bathroom during their debate at Saint Anselm College, and fulminated about Megyn Kelly’s bloody secretions after she was tough on him in their first debate. Even Trump’s alleged sexual preference for “golden showers” during a sexual tryst in a Moscow hotel speaks, if true, to his struggle with shame. A sexual fetish like this is his attempt to overcome feelings of disgust by enacting a disgusting scenario (being urinated on) but scripting it so that everyone is sexually excited rather than repelled.
Trump is obviously extremely vulnerable to feeling shamed and humiliated. Moreover, I would argue that, in general, he finds women to be essentially and especially disgusting and avoids getting too close to these dangerous feeling by using women as things. Relationships with things are safer than actual intimacy and exposure.
Shame, helplessness, and inferiority are mutually reinforcing. Helplessness and inferiority are shameful and being exposed as pathetic or inferior increases feelings of vulnerability and helplessness. The threat of experiencing all three of these emotions can be seen in Trump’s by now famous inability to pay attention in meetings or to read. When he has to pay attention for too long, I think he begins to feel anxious, as if he is being helplessly cornered and made to feel one down, and he can’t stand it. Further, if he has to consider a difficult problem or focus on material about which he is ignorant, Trump has to face feelings of being flawed, helpless, and embarrassed. In other words, he begins to feel like a stupid loser and he can’t tolerate it. So he has to interrupt and quickly change the subject to one with which he’s comfortable or one that features his greatness. In this way, he relieves himself of dreadful feelings of being defective. Such feelings trigger his private fear that he is, indeed, insignificant and weak.
For someone plagued with feelings of helplessness, shame, and inferiority, the danger of exposure is ever-present. Such a danger is captured by the colloquial expression “being caught with one’s pants down.” It shows up in our dread of incontinence, of an involuntary disclosure of one’s private secrets or “tell,” of being found out. But found out as what? In Trump’s case, it’s found out to be dirty and bad, unworthy and defective, instead of deserving and greatly valued. This is also why he is a conspicuous spender—also a defense. Trump is consumed by this conflict. His paranoia reflects his constant worry about the critical judgment of others, a worry that, in his heart, Trump secretly fears is justified. As a result, he is angrily fixated on being “found out” by investigative reporters or exposed from within by “leakers.”
In the context of such a formulation, it makes sense that, more than anything, Trump dreads revelations that make his electoral victory last November seem illegitimate. He simply cannot tolerate the fact that he lost the popular vote nor even a hint that the Comey letter and/or the Russians helped him defeat Hillary Clinton. In Trump’s disturbed mind, this makes sense because he is horrified by feelings of being a loser, horrified by evidence of the dirty fraudulent underbelly that might lie at the foundation of his personality and life. He has to stamp out this accusation—which is really a self-accusation—at all costs.
In his years as a real estate tycoon, Trump could exercise enormous control over his environment, sanitizing it of any evidence that contradicted his idealized version of himself. He could surround himself with flatterers and the trappings of wealth and power—the external cues that he is special. As President, however, he finds himself under constant hostile scrutiny, and this scrutiny threatens his defenses. He is constantly compelled to preemptively reassert his invulnerability, his power and greatness, which come across as what they are: boorishness--a braggart desperately trying to save face.
If reports are true, Trump frequently loses his temper, striking out and blaming others for chinks in his narcissistic armor. Of course he does. His outbursts are a belated attempt to master and control an environment that is relentlessly whispering—actually, at times shouting--that he’s a bad, inferior, defective man. He can’t stand being the helpless victim of these whispers and shouts. He’ll do anything to shut them up—fire press secretaries, obstruct justice, bribe allies, anything to restore the moat defending him against criticism.
Real losses—say, votes in Congress—are psychically equated with being a loser. Revelations that his campaign colluded with Russia are psychically equivalent to admitting that his victories weren’t real. Impeachment, of course, would be the ultimate realization of Trump’s nightmare—proof that he is helpless, damaged goods, a public failure, and that everyone is contemptuous of him. Such a trauma could produce extreme and radical reactions, from a frank psychotic break, to a reckless military attack, to resignation and a panicked flight back to his private castle in Trump Tower.
Knowing what makes Trump tick doesn’t allow us to make specific predictions about his likely political positions, but it should make his frantically chaotic and sociopathic maneuvering around the Russia investigation seem quite understandable. I’m sure that intelligence agencies around the world already have a book on how to deal with Trump that is based on analyses of his personality similar to this one. As part of his domestic opposition, we ought to understand at least this much, namely that Trump will always be propelled by his defensive need to prove that he’s good, not bad, powerful and not weak, a winner and not a loser. This need will lay behind everything he does.
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