Is President Trump mentally fit to hold office?
This question has floated around for months, but the issue reignited recently with the publication of Michael Wolff’s bestselling book, Fire and Fury, which gives an account of life in the White House.
Michael Wolff has said that Trump’s own staff “came to believe he was incapable of functioning in his job”.
It’s not just journalists who have cast doubt on Trump’s state of mind. A host of psychologists and mental health experts have made similar claims.
One psychologist even started a petition for Trump to be removed from office, claiming he “manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States”.
But there are deep divisions among mental health professionals about these attempts to diagnose the president with a mental health disorder. Let’s look at the claims and counter-claims.
The claims vary
Wolff has questioned Trump’s “intellectual capacity”, explaining that he “doesn’t read” and “doesn’t listen”.
One psychiatrist says it is Trump’s “difficult relationship to reality and his inability to respond in an even-handed way to a crisis [that] renders him unfit to be president”. Another believes he is a psychopath.
So, there is a range of different questions here, not a single, uniform argument.
Of course, some people may believe this is because the president has multiple mental health issues.
But we should nevertheless try to be clear in distinguishing between them in order to assess each case on its own merits.
The experts disagree
One of the leading voices making claims about Trump’s mental health is Bandy Lee, an assistant clinical professor at the Yale School of Medicine, but she’s not alone.
Indeed, Lee has said that “at no other time in US history has a group of mental health professionals been so collectively concerned about a sitting president’s dangerousness”.
This is one point of view. After all, Lee published a book on the subject along with more than two dozen mental health experts.
But there are also those who take a different position, such as Allen Frances, Professor Emeritus of psychiatry and behavioral sciences at Duke University Medical College, who believes some of the claims made by various people do not stack up.
In a letter to the New York Times, he warned against those who “have mislabeled President Trump with the diagnosis of narcissistic personality disorder”.
“I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill.”
Here in the UK, some experts have also distanced themselves from claims that Donald Trump is ill. Psychologist Dr John McGowan, for instance, has written that “saying Donald Trump is mentally ill is unethical, inaccurate and unhelpful”.
McGowan points out numerous flaws, including that “a significant problem with mental health judgements is that they are somewhat subjective”.
Likewise, Dr Meron Wondemaghen, a lecturer in criminology at the University of Southampton, has argued that the traits Donald Trump displays “are not necessarily symptoms of mental illness”.
“Many unappealing human behaviours are still dismissed as behaviours of the mentally ill,” she writes.
“Too often, we seem incapable of distinguishing between a disorder of mind and a disorder of character. Clinical definitions and diagnoses rely on subjective psychiatric observation and judgement rather than identification of specific disease pathways.”
Trump might behave differently in private
The biggest problem mental health experts face when trying to make claims about President Trump is a lack of insight into how he acts in private.
Some leading figures say there is “tons of information about his behaviour”. But others disagree.
As Dr Wondemaghen points out, most psychiatrists agree that close observation and access to the person’s family and medical history is essential for diagnosis.
This is why most mental health experts, like Bandy Lee, stop short of issuing a specific diagnosis and merely say the signals are enough to cause concern.
But many of the claims are based largely on Trump’s public life – speeches, interviews and tweets. The problem for psychologists is determining where his public life ends and private life begins. To what extent is his public persona just an “act”?
One would expect any politician to speak differently during a speech than how they would with their family.
So even if we believe his public “act” is poorly-judged or concerning, it is still difficult to distinguish the mental health from the politics.
Steven Berglas, a psychologist who works as an executive coach and consultant, has said: “You cannot discern from public behavior whether a person’s behavior represents an authentic personality style or is choreographed.”
Even for those who believe Trump’s public appearances can be used to judge his mental health, it is still important not to be too selective with the evidence.
It’s not enough, for example, to rely on a single anecdote from Michael Wolff Trump allegedly failing to recognise friends at his Mar-a-Lago estate.
Likewise, linguistics professor Mark Liberman deconstructed claims published by health a website, STAT News, which he said only presented “a scant handful of anecdotes” to argue that his speech patterns had deteriorated. Some of the Trump interviews cited in the article, Liberman says, are only a few seconds long.
Could the claims be politically motivated?
Mental incapacity could allow for the removal of a president under the 25th Amendment, so it’s important to recognise that some people may have a political interest in him being diagnosed.
Clearly Trump’s mental health is a different question to whether or not you personally like him or his politics.
But some of the claims and media coverage seem to blur the lines of this distinction. Political points come hand-in-hand with claims about his mental health.
For instance, in an interview with Vox, Lee says that “declaring Jerusalem as Israel’s capital” was “consistent with the pathological pattern [Trump] has already shown of resorting to violence the more he feels threatened.”
However – no matter how bad a decision you might think it is – there is a debate to be had about whether this really reflects on his mental health.
After all, before he became president, George W. Bush made the exact same pledge about Jerusalem. And Bill Clinton and Barack Obama both made similar suggestions as well. So, did they all suffer from the same condition as Trump?
Lee also said: “The sheer frequency of his tweets seemed to reflect the frantic state of mind he was entering, and his retweeting some violent anti-Muslim videos showed a concerning attraction to violence. And then there were the belligerent nuclear threats.”
Again, there seems to be an assumption here that no one would possibly do these things for political reasons – so the only explanation must be pathological. But it’s possible that Trump (rightly or wrongly) did these things because he genuinely just thought it would be politically worthwhile.
Similarly, the suggestion that Trump’s speech patterns could be a sign of “significant cognitive decline” could have an alternative political explanation instead.
For instance, adjusting one’s speech in the belief that shorter, more fragmented language is more soundbite-friendly.
This is not to say that Lee, or any of the other experts, are necessarily politically motivated. But removing a psychologist’s political opinions from their professional judgement is always going to be difficult in certain cases, given that judgements are partly subjective.
“Most definitions [of mental health disorders] focus on deviations from ‘normal’ behaviour, but that raises the question of what standard of normality should apply,” writes Dr Wondemaghen.
“The messiness of these definitions leaves them open to social and political abuse.”
Mental health does not necessarily determine ability
Suffering from a mental health issue does not necessarily mean someone is incapable of being president. And, conversely, someone with good mental health might be utterly unsuitable for office.
Actually, it is not unusual for world leaders to display signs of mental health problems. An academic study of the 37 US presidents between 1776 to 1974 found that half of them “met criteria suggesting psychiatric disorder”.
Professor Allen Frances has outlined his personal take on this point, saying: “Donald Trump is evil—bad not mad—and incompetent.”
“It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither). Bad behaviour is rarely a sign of mental illness, and the mentally ill behave badly only rarely.”
For those who believe Trump is a dangerous and bad president, it may be tempting to conflate his perceived shortcomings with mental illness – and then use this as a reason to remove him from office.
It’s possible some of the claims may ultimately turn out to be correct, but the issue is more complex than is often presented.
Indeed, this is a point recognised by many of the experts who have raised concerns about Trump, such as the psychohistorian, Robert Lifton.
“It isn’t always the question of a psychiatric diagnosis,” he explained. “It’s really a question of what psychological and other traits render one unfit or dangerous.”
Meanwhile, Trump denies all the claims. “Throughout my life, my two greatest assets have been mental stability and being, like, really smart,” he tweeted. He said he was a “VERY successful businessman” and television star who won the presidency on his first try. “I think that would qualify as not smart, but genius….and a very stable genius at that!”
Elaborating during a meeting with reporters at Camp David later in the day, Mr. Trump again ticked off what he called a high-achieving academic and career record. He raised the matter “only because I went to the best colleges, or college,” he said. Referring to Wolff’s book about his presidency, he said: “I consider it a work of fiction and I consider it a disgrace.”