Medical Examiner

Stop Saying Donald Trump Is Mentally Ill

He is a “reality” artist, building an evil new society. We must realize this to stop him.


By the force of his personality, power, and bullying tendencies, Trump can bend reality.

Photo illustration by Derreck Johnson. Photo by David Becker/Getty Images.

Donald Trump’s mental health has been a favorite topic since well before he officially took office. In the weeks since the inauguration, though, the debate over whether we should invoke the 25th Amendment to declare him mentally ill and incapable of performing the job has reached an almost fevered pitch. Trump himself seems to reinvigorate this debate on a regular basis, for example in his recent tweet that the “sick” Obama White House had his phones tapped.

Many of the nation’s psychiatrists and psychologists, along with thousands of other health professionals have weighed in on the side of mental illness, in the Huffington Post, in the New York Times, in Slate. More than 30,000 mental health professionals have signed on to an online petition, directed to Sen. Charles Schumer, arguing that Trump “manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States” and “he must be removed from office.” Case closed?

Not so fast. None of these health professionals have indicated how they define mental illness. Instead, they follow the unfortunate tendency of modern psychiatry, exacerbated by the profit motive of the medical industry, to confuse symptoms with illnesses and to offer criteria for diagnosis so broad that they would apply to most people. And, in fact, they do. According to statistics from the U.S. Centers for Disease Control and Prevention, using current DSM-V criteria, an astonishing 25 percent of Americans can be considered to have a mental illness in any given year, and 50 percent can be diagnosed with a mental illness sometime in their lives.

This goes for presidents as well. A recent study in the Journal of Nervous and Mental Diseases found that nearly 50 percent of presidents in American history met the criteria for a psychiatric disorder, and 27 percent exhibited the disorder while in office.

Does that mean we haven’t invoked the 25th Amendment often enough? No, in fact, I would argue that without a working definition of mental illness, these statistics are meaningless. Before tackling the question of whether Donald Trump is of sound mind, we must first ask: What is a mental Illness?

In general, mental health professionals tend to draw from two radically different perspectives to determine what is and what is not mental illness, with each view invoking a rather different set of criteria and values. Some use normativity as their standard of measure, viewing deviations from the norm as a sign of mental illness. According to the World Health Organization, someone suffering from narcissistic personality disorder (which is most frequently given as Trump’s mental illness) must demonstrate “extreme or significant deviations from the way in which the average individual in a given culture perceives, thinks, feels and, particularly, relates to others.” Thus, these clinicians assert, Trump is mentally ill because he is delusional about reality, grandiose, impulsive, and believes himself to be the most powerful man in the world.

Alternatively, diagnoses can be based on experiences of distress, combined with social and occupational impairment. This diagnosis requires the individual to be suffering from the subjective experience of distress alongside objective criteria of compromised functioning in relationships or employment.

It is easy to dispense with the second option, since Trump is evidently not suffering and he cannot be said to be impaired. We may not like his leadership style, but his personality seems mainly to have been an asset for him in the worlds of real estate and politics. And he seems constitutionally incapable of self-doubt or other kinds of personal distress, and perhaps even derives pleasure from his aggression and impulsivity. As Allen Francis, the psychiatrist who wrote the criteria for narcissistic personality disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the DSM, put it, “He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose a mental disorder.”

If there’s no distress, what about the other criteria? Is his insanity simply self-evident because he deviates from what any child would recognize as normal? Paul Krugman seems to think so, tweeting shortly after the inauguration: “An American First: a president who was obviously mentally ill the moment he took office.” But this may not be so clear-cut, either. Do we really want to use deviation from the norm as criteria for diagnosing mental illness? After all, one person’s impulsivity is another person’s courage. Would we consider Albert Einstein or Steve Jobs mentally ill, simply because they deviate from the norm? In America, at least, we admire people who “think different” and “just do it.”

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But the real problem with diagnosing Trump as mentally ill based on deviation from the norm is that Trump himself is a master at determining what counts as normal. Especially in our brave new world of reality television, Trump has an outsize influence—he is such a virtuoso of media-made reality that media coverage itself often helps turn his wildest statements into fact sooner than fact checkers can convince Americans otherwise. Let’s not forget that immigrants may not have been rioting in Sweden when Trump made his mysterious claim, but they actually did begin rioting soon afterward. And Trumps’ far-fetched statements about a deep state and rampant immigrant terrorism may actually help bring these about, strengthening Trump’s hand. And now, even his outlandish claim of being wiretapped is being given some credence.

Sigmund Freud had a word for those whose unique gifts permit them to bend reality to their will: artists. According to Freud, the artist “allows his erotic and ambitious wishes full play in the life of fantasy. He finds the way back to reality, however, from this world of fantasy by making use of special gifts to mold his fantasies into truths of a new kind.” Trump has to be understood, then, as a reality artist, one who is adept at the strategies that turn his biggest whoppers into reality. It is reminiscent of Charles Foster Kane, in Orson Welles’ classic film, who, when informed by the war reporter he dispatched to Cuba that there was no war to be found but only delightful girls and beautiful scenery worthy of prose poems, famously replied, “Dear Wheeler, you provide the prose poems, I’ll provide the war.”

By the sheer force of his personality, power, bullying tendencies, and money, Trump can bend reality to his perspective, which he does using a simple technique: He simply shifts the evidence for what is real from facts to feelings.

Thus he employs to great effect his strategy of appearing insane, impulsive, vengeful, and unpredictable—frightening his opponents with “American carnage” at one moment and taking advantage of their relief, the next, when he suddenly appears compassionate, reasonable, and “presidential.” He intensifies his supporters’ feelings, too, when it serves his reality—elevating their pain and suffering into evidence of his own sanity in a world gone mad and mobilizing their aggression at those who can be blamed for their misery. Bobbing and weaving between cruelty and compassion, impulsivity and sobriety, he makes his own definitions of what is real, changing them when they cease to be useful and turning the tables on his critics when challenged significantly.

We must understand that Trump thrives in the aftermath of his provocations. Like a looter who instigates a riot, Trump is a master at navigating the chaos he himself provokes. To call Trump’s exaggeration of immigrant criminality delusional is to miss Trump’s real aim of bolstering the emotional evidence for his narrative: that outsiders have stolen Americans’ birthright and only a strong leader can make this right. To make his claim an emotional reality, he plans to create a new police force to crack down on immigrant crime and widely publicize the evidence.

We have seen how successful the shift from facts to feelings is as political strategy. Let’s not forget that we live in a country where a majority believe the government is hiding the truth about the 9/11 attacks, and more than a quarter believe the same about Obama’s birth certificate.

But it is time we understood that when therapists call Trump crazy, hoping for some higher authority to invoke the 25th Amendment and save the country, what they are really saying is that Trump lives in a reality that they don’t like and don’t understand. And in doing so, they are playing right into Trump’s preferred reality—no longer holding him to account on the basis of law, politics, and personal responsibility, but rather transferring him, like Brer Rabbit, into the briar patch of feelings, charisma, and threat. And in that particular briar patch, Trump is the professional and the psychiatrists are amateurs. So, like the gangster or outlaw who runs out of bullets when faced with a stronger foe, they stoop to the last resort and throw their gun: He’s crazy! When in reality what they are saying is: He is off-the-charts scary, and I don’t know how to stop him.

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In Totalitarianism, Hannah Arendt writes:

It is inherent in our entire philosophical tradition that we cannot conceive of a “radical evil.” … Therefore we actually have nothing to fall back on in order to understand a phenomenon that nevertheless confronts us with its overpowering reality and breaks down all standards we know.

It is time for us to give up the fantasy that, when applied to political figures, the term mental illness means anything more than that the people in power hold values and beliefs so radically different from what we thought was reasonable that we are justifiably afraid of what they will do with that power. We may want to believe that we live in a society where self-aggrandizement, aggression, valuing wealth above all else, doing whatever is necessary to guarantee the power and influence of oneself and one’s family, and forcing into submission all those who stand in the way were not traits that lead to success and admiration, but we don’t. We may wish that America were a country where people used the “greatest good for the greatest number” as their ethical model and politicians used science and data to determine the fate of the world, but we don’t.

If we are to combat Trump, we must understand how he has elevated and manipulated certain American values, like greed and exceptionalism, to undermine so many others, like truth, justice, and the American Constitution.

This is not madness. And the impulsivity, threats, aggression, ridicule, denial of reality, and mobilization of the mob that he used to get there are not symptoms. It is time to call it out for what it is: evil.

Arendt goes on to explain that we in the West are susceptible to such evil precisely because we cannot conceive of it. We prefer to believe that people are innately good, and evil is some kind of “fall from grace,” an anomaly, a madness perhaps, but one always “explained by comprehensible motives.” We are at a loss to confront Trumpism, because his strategy is evil for its own ends, and thus reflects, as Arendt described, “a system of values so radically different from all others, that none of our traditional legal, moral, or common sense utilitarian categories could any longer help us to come to terms with, or judge, or predict their course of action.”

If Arendt is right and we are susceptible to radical evil because we cannot conceive of it, then the work of opposition must begin with learning to call it what it is. So here is a definition for our time: Radical evil is the manipulation of others’ perception of reality in order to increasingly concentrate power and wealth in the hands of the few. It is a strategy to sow chaos in order to take advantage of the fear that chaos brings. It is the twisting of facts to frighten citizens into believing that their safety requires them to turn against others. And it is the collapsing of what is good and moral into what is rich and powerful, and ruthlessly using that wealth and that power to accrue more wealth and power.

That is why our efforts have to be aimed not at diagnosing Trump, but at stopping Trumpism. To call it madness is to try and bring it into the realm of the familiar and to miss the real threat that Trump embodies: He thrives in turmoil, he has an uncanny ability to bend the world to his reality, he is charismatic and ruthless, hypnotic and terrifying, and we, in this country, have rarely seen his like before. To fight Trumpism, we must actively expose and combat the overpowering reality he is trying to create—and we must abandon the comforting delusion that Trump is delusional.