Escalating domestic and international tensions compel me to speak out against claims I’ve seen and heard in the media ad nauseum regarding President Trump (Trump). Dr. Allen Frances (Frances) has touted his message repeatedly that Trump is “not mentally-ill.” He has authored such articles in various publications including The New York Times, USA Today, and The Boston Globe. I believe that Frances’ self-assigned position as the ultimate expert, coupled with his assertion that those who disagree with him do so in ignorance, is profoundly dangerous. I fear Frances’ discrediting of mental health professionals will impede their efforts to convey the seriousness of Trump’s conduct and that the death toll will rise out of complacency fueled by this discrediting.
Frances contends that Trump does not have Narcissistic Personality Disorder (NPD) and has justified, “I wrote the criteria that defines [Narcissistic Personality] Disorder”, referring to the Diagnostic and Statistical Manual (DSM). With this statement, Frances effectively made himself the ultimate expert, while dismissing the numerous scholars and professionals who were part of the task forces involved in writing the 3rd,4th and 5th Editions of the DSM as well as those who have been writing about narcissism for literally hundreds of years. Frances was part of a ten-member subcommittee that formalized NPD in the DSM 3RD Edition in 1980; the current version has since been revised twice. My point in these details is to demonstrate that the formal diagnosis of NPD is hardly a single-handed effort by Frances; he does not have the clout he conveys. Frances directly discredits a group of then 61,000 people who have publicly identified Trump as having severe personality disorder traits, by calling them “amateurs” (even though the majority of these are mental health professionals who have up to 40+ years of experience) and characterizes their efforts as “misguided” (even though Frances himself also recommends taming Trump before he essentially blows us all up!). Frances offers distorted information to combat a very serious warning regarding Trump’s obvious impairments.
Frances insists Trump does not meet the diagnostic criterion of distress necessary to assign personality disorders, but in so doing, he distorts the nature of that criterion. Distress does not refer to the persons feelings about having the disorder as Frances asserts. In short, people with NPD are driven to NOT feel worthlessness, so to protect themselves, they subconsciously create a personality façade that represents the opposite: ”I am the best.” Contrary to Frances’ argument, a narcissist will not feel distressed about feeling like “the best.” Instead, the distress in NPD refers to the anxiety experienced when the façade is threatened and may not be able to succeed in avoiding the feelings of worthlessness. Trump frequently demonstrates distress through his retaliatory and blaming behaviors.
Frances argues that diagnosing Trump is stigmatizing to others who have the same diagnosis. That idea is nonsensical. All psychological disorders exist in varying degrees, manifest with varying characteristics, and their effect is situationally dependent. To imply that what is being said is that all people with narcissistic behaviors would and could do what Trump has and can potentially do is absurd. Trump exhibits severe behavioral concerns and has the power to act on those reactionary behaviors in a way that can kill millions, reverse decades of social achievements and destroy democracy. The combination of power and dysfunction is the problem. There is literally one individual to whom those elements apply. More relevant, however, is that the President of the United States should expect to be under scrutiny. The presidency is not a position that should be filled by an individual who is profoundly self-serving and consistently demonstrates disregard for others; just two of the aspects of the disorders of concern. Frustratingly, Frances states that Trump does not meet the criteria for NPD, but in fact states that he is a “world class narcissist.” To clarify, if one is a narcissist, they have NPD; those are not two separate things. I am left wondering what point Frances is actually trying to make and why he has endeavored to have his voice of objection so heard because he essentially has the same message as those he is criticizing; Trump is a narcissist and he is dangerous (implied in his needing to be tamed).
We are on the brink of both civil and nuclear wars! Trump has been instrumental in aggravating both. He demonstrates dangerous outwardly observable behaviors that, when coupled with immense power and opportunity, could not be more potentially deadly. There is not empathy, loyalty or morality that guides people with his behavior combinations. He is NOT going to turn into a caring, conscientious leader. Therefore, it is the humble opinion of myself, a psychotherapist with 15 years’ experience in private practice and a 3-year post-graduate study of personality disorders, that it is irresponsible for Dr. Frances to continue in his discrediting of the warnings of tens of thousands of mental health professionals. I can only hope his message does not contribute to the rise of hate and death in this country and, likely, the world.