Diagnosing Dangerous Donald

It's Official: the President of The United States is

a ...Well, just what is wrong with him?
And If your hair Isn't on fire yet ...take a
look at
THE DANGEROUS CASE OF DONALD TRUMP.
Ed. by Bandy Lee, M.D

Executive Summary

The recent publication of a book of articles by Mental Health experts on the

unsuitability of Donald Trump to be U.S. President is noteworthy. No, not
noteworthy...how about ASTONISHING. To start with, American Psychiatrists,
who are expressly forbidden by The American Psychiatric Association to publicize
their professional opinions of public figures, have added their voices to other
highly qualified contributors in order to reveal the destructive monster beneath the
clown makeup. No such work has been created for any other President. ...Because
there has never been an American President like the current one. Fortunately.

The book is a brave and worthy effort. However, the psychiatric argument against
Trump-as-President involves some technical matters that are likely to be confusing
or unclear to even well-educated readers. Furthermore, the book is a compilation
of pieces and not a coherent, unitary statement, and suffers from both redundancy
and self-contradiction.

Several authors try to get across the notion that the President's personality is
poorly suited to the job even though his peculiarities may not add up to one of the
mental disorders on the Official List. That point is well-taken. Other authors
struggle mightily to convince the reader that Mr. Trump does indeed suffer from a
diagnosable pathology and for that reason ought to be removed.
The difference between these two positions has as
much to do with Political Science as with the
subtleties of Psychopathology. You may have
noticed that professional pundits are focusing on
this issue now, venturing to question the President's
ability to perceive reality. In the past a particular
Tweet might have drawn a comment about dignity
or wisdom;this week's analysis employs words like
fantasy and forgetfulness. More than one
commentator has mentioned the need for a
Doctor and the phrase 25th Amendment enters
the conversation more frequently.

As you will glean from the commentary that follows,

much of the description of an individual's mental
machinery uses comparative terms such as very,
mainly, slightly and so forth. An attempt to
push The President out of office on the basis of
descriptions that rest on matters of degree will seem
unfair to those who support him. From a practical
standpoint the best psychological argument for
engineering this President's removal comes in the
form of a clearly medical illness that can be
assessed with equipment that shows abnormalities
of brain function. I believe that there is enough
behavioral evidence to warrant an examination of
this man's Neuro-psychological condition.

The analysis of Mr. Trump's mental functioning can

be divided into four areas of concern, or four
systems of mental functioning:

1. INTELLECT--Does this President possess the

requisite mental horsepower to do the job. Is his
intelligence, his problem-solving ability, his
capacity to take in and integrate a great deal of
new, complex information, sufficient ? And even if
the man sometimes displays the necessary abilities,
does his functioning decline noticeably at times? Is
there evidence that he used to be substantially better
at mental tasks than he is now, raising the concern
that some disease process is at work.

2. NARCISSISM--A seriously self-centered,

egotistical President will respond to the affairs of
state only in terms of how a situation and his
response to it makes him look. Can he,for instance,
let someone else win if it is to the advantage of
this country? Is the management of self-esteem so
all-consuming that time and energy are taken away
from the real business of the nation?

3. CONSCIENCE--Is the President basically an

honorable person. Is he guided by a strong sense of
values that includes being truthful. When things go
wrong is this someone who blames others
automatically-or can he reflect HONESTLY on his
own part in the problem. Can he admit error. Can
he refrain from taking advantage of others even if
he can get away with it? Is this person's primary
drive CONSTRUCTIVE, or is he mainly driven
by a need to defeat a perceived rival and to tear
down anything he has not created. Does he appear
to relish DESTRUCTION?

4. REALITY-ORIENTATION-The three mental

functions outlined above operate simultaneously to
affect a person's grasp of reality. One might
consider the perception of reality to be a function
in its own right; there are some very serious mental
disorders that distort reality all by themselves. But
it's also possible to have a warped perception of
events if one or more of the other three functions is
inadequate.

___ ___ ___

My remarks are meant to help the concerned reader
to understand the Psychological and Psychiatric
issues presented by this President. Many of you who
are reading this are far more knowledgeable about
politics and history than I am. You don't need me to
tell you how damaging this administration is to our
nation's government. You already know that
something must be done to restore Liberal
Democracy. I offer my limited expertise in the hope
that a little more knowledge, a little more light on
the subject, will enable us to figure a way out of this
frightening and increasingly catastrophic situation.
1. The Setting: A Reign Of Terror Created By A Fool Is No Laughing Matter

Not very long ago I saw another one of those Trump-related jaw-droppers, and this time my
brain froze. There has been a particular topic that I've wanted to write about but I couldn't
squeeze out anything until my cerebral cortex defrosted...

You probably can recall the episode; it involved Mr. Trump making a belated phone call to
the grieving widow of a young sergeant (La David Johnson) who was killed in action in a
special mission in Niger. The call was a disaster in which the great genius tried to console the
woman by reminding her that her husband knew what he was signing up for. Given the
general tone of the call, it felt as if he was saying that one shouldn't grieve too much since the
possibility of serious injury or death was predictable.

The fallout from the call went on for days. A Congresswoman who is a friend of the family
had been present when the widow received the call, and she described the horrific impact the
call had. That led to an attack on the Congresswoman by both the President and his Chief of
Staff. The Chief, none other than adult-in-the-house General Kelly, revealed himself to be a
foul racist who pines for the days when people knew their place. I kid you not!

In the midst of this brouhaha I saw Colonel Jack Jacobs (on MSNBC) trying valiantly not to
weep as he recalled the times when he had to tell the relatives of a young soldier that the body
will be arriving at Dover AFB, where there will be a brief ceremony, etc, etc. The difference
between the Colonel's demonstrated feelings and Donald Trump's total absence of
compassion is yet another example of Trump's psychological deficiencies.

He doesn't know how to speak to people who have suffered a loss. He doesn't know what to
say because he'd never consider getting some instruction from those with relevant experience
and then actually working on his presentation. Nor can he rely on his own basic humanity to
guide him, because HE DOESN'T HAVE ANY.

I am grateful to humorist Patton Oswalt for his insight into the peculiar effect Mr. Trump has
on those who want to comment on some instance of the man' foolishness. In an effort to
regain my equanimity I watched Mr. Oswalt's latest stand-up performance on Netflix. In this
monologue Oswalt explains that Trump's buffoonery is not the comedic bonanza we might
think it is, because, in essence, each dim-witted stunt is so quickly replaced by yet another
that the topical-comedian feels that his witty comments are about yesterday's news.

Mr. Oswalt tells us that it's as if he has spotted a lunatic on a busy sidewalk in New York
and the man has removed his pants and taken a great steaming dump right on the spot. Mr.
Oswalt pictures himself turning away from the scene for a moment to call out to the crowd.
Look at that guy behind me. He's taken a crap here on the sidewalk, in front of all of us!!
And someone in the audience yells back at him

TURN AROUND! That crazy guy has picked up the pile and put it on his head and IS
NOW WEARING IT LIKE A SOMBRERO!
Over the past few weeks I have been moved a number of times to begin an essay on some
aspect of the current political situation that contains Psychological elements, and then my
wife puts down her breakfast coffee and passes her iPAD to me. Bang! there it is: Trump is
now wearing something gross on his head in addition to that yellow assemblage that's
supposed to fool us into thinking he isn't bald.

2. Bold Opposition: You wanna know how to get Capone? They pull a knife,
you pull a gun. He sends one of yours to the hospital, you send one of his to the
morgue. ... If you open the can on these worms you must be prepared to go all the way,
because they're not gonna give up the fight until one of you is dead.
From THE UNTOUCHABLES, 1987, DePalma: Sean Connery's
grizzled old Chicago cop to Kevin Costner's Special Agent Eliot Ness

The arrival of the book THE DANGEROUS CASE OF DONALD TRUMP is the subject
that called out to me for comment, before I was stunned into silence by that especially nasty
bit of poo-flinging from the Orange Man. The book is a compendium of articles about
Trump's personality, written by more than two dozen professionals in the general field of
Mental Health. The authors come from the various applied disciplines involved in the
treatment of mental disorders, such as Psychiatry, Psychology, and Social Work. Their
clinical training and their approach to treatment is quite diverse. Where we see unity is in
their view of Mr. Trump. The book's title serves as a succinct summary of its contents.

The point of the book is the unsuitability of the man for the particular job he holds. The
power of the American presidency is probably evident to most of you who are reading this.
We have had inadequate presidents before now but according to the book's authors Mr.
Trump's deficiencies and peculiarities pose an especially grave danger to the health and
safety of the nation and indeed the entire world.

The contributions to the book of the Psychiatrists are particularly noteworthy because their
professional association, The American Psychiatric Association (The APA), expressly forbids
its members to make public statements about people (even famous people) unless they have
personally examined each person and obtained each person's permission to publicize findings.
The (Psychiatric) APA has been asked by quite a few of its members to relax the Goldwater
Rule as it is called informally, but the association has doubled down on it. The doctors who
have contributed to the book have done so in violation of a long-standing rule of their
profession's flagship organization. This can have real-life consequences.

One can understand the APA's reluctance to modify their position. The Goldwater Rule was
instituted after the presidential candidate Senator Barry Goldwater (Republican Party
Presidential Nominee of 1964) successfully sued FACT magazine for publishing an article
that featured the comments of Psychiatrists in open opposition to him. Goldwater lost the
election that year. He was trounced! One tv commercial that was run against him implied that
the man was a blood-thirsty maniac who would get us all killed in a nuclear war. The ad,
known (unofficially) as Daisy Girl was aired only once and at a point in the campaign when
Goldwater already stood little chance of winning. Nevertheless, it galled the man, doubtless
contributing to his resentment of the attacks on his character and his depiction as mentally
deranged.

Compared to Donald Trump, Goldwater should be seen as calm, diplomatic, and

knowledgeable. If the Psychiatric community was worried about our safety under Goldwater's
leadership, it ought to be absolutely hysterical with Trump at the helm. And it is! But if the
relatively sane Barry Goldwater was angry enough to sue those who questioned his mental
fitness for The Presidency, one can only imagine what the wildly uncontrolled, easily
offended, Mr. Trump will do to psychiatrists (and allied professionals) who he feels have
contributed to the effort to get him removed from office.

I imagine that if Trump's position in the White House comes under serious threat he will lash
out at organizations and individuals whom he sees as responsible. His history is one of
extreme litigiousness and a taste for violence. Given his considerable money, his backing by
literally tens of millions of individual followers, and the aggrieved justification for all kinds
of nastiness that those followers feel, this is not a man who one opposes lightly.

Who can blame people for shying away from opposing this man. I say that somewhat
sarcastically; I certainly can't admire cowardice. On the other hand, given my profession I
guess it's my job to understand even what I'd rather not see. And while I'm talking about
people who have reason to fear this bully let me at least mention the politicians from his own
party who are trying to confuse the public and derail the investigations into Trump's actions
both before and after his alleged election. Yes, there are ideologues among the Republicans,
who feel that they can use the wild man to achieve political ends, but there are probably a
great many who find this president to be a mockery of the institution. Their very soft
criticism, which they mix with flattery whenever possible, is a sign of their fear.

3. The Doctors Who Can See Inside This President Tell Us What's In There.

So much for the issues surrounding the book. What can we glean from it that might prove
useful? I'm ploughing through it myself and I can honestly recommend it, but I can see places
where the intelligent lay reader who is not a student of (or practitioner in) one of the Mental
Health disciplines is likely to become confused, or perhaps just not get what an author is
driving at. What I think I can do is point out such stumbling blocks and offer some
explanatory remarks.

Now that I think about it, there has been a need for explanatory remarks about psychiatric
terminology appearing in the popular media ever since Trump became a presidential
contender. Even if you'd just as soon not read a whole book about about the man's mind, you
might find it useful to clarify the often muddy concepts you've already encountered.

One point that needs to be reinforced is that the danger posed by Mr. Trump as President does
not necessarily owe to his suffering from a mental illness Several of The Book's authors
make this point. That is to say, whether or not Mr. Trump has a mental illness is of no
consequence in terms of his suitability for his office. Here are the two reasons why this is the
case;
a)The are many conditions that are listed in the Psychiatric Diagnostic and Statistical
Manual of Mental Disorders (The quasi-official nosology (catalog of diseases used in
many clinical, insurance, and research settings in this country) that have no impact
whatsoever on the functioning of a white collar official such as The President.

In 1972 the Democrats' Vice-presidential Candidate, U.S. Senator Tom Eagleton, was found
to have undergone treatment for depression. The condition was serious enough to warrant
E.C.T. (So-calledshock therapy). Although Mr. McGovern claimed that he supported his
running mate, Eagleton withdrew after two weeks on the ticket. His candidacy was destroyed
by the simple fact of his having been diagnosed as suffering from a mental illness at one time.
His record in government up to that point was very good and he went on to serve additional
successful terms in the senate.

The Eagleton example may lead the reader to believe that the irrelevance of the Senator's
illness lay in its timing. Tom Eagleton's depression hit when he was a young man; at the time
of the campaign he was a very different person. But it's also possible to have an active mental
illness that causes no disruption in either of the two main spheres of life,work & personal
relationships.

As is the case with ailments of the body, many conditions can be treated with medicines,
devices, and changes in behavior; with illnesses of the mind we can add to the list of effective
treatments several kinds of 'talking therapies. Although John Kennedy was relatively young
when he served as a senator and subsequently as The President, he suffered from several
significant medical conditions. Addison's Disease, some painful back problems, colitis, and a
urinary tract infection, make up an incomplete list. He also suffered from anxiety at times.
These complaints were bothersome and necessitated the use of quite a string of medications
but they did not prevent him from discharging his responsibilities.

It is also possible to suffer from diagnosable mental disorders but find that they are of no
consequence given the living circumstances of the patient. To pick a simple example, many
common phobias (irrational fears) cause very little difficulty for people who are well-off or
well-positioned in their work and general life-situation. Even a serious fear of heights, for
example, matters not at all to someone whose work and living arrangements present no
altitudes that surpass a person's tolerance.

The more sophisticated version of the previous sentence uses the concept of 'Social
Compliance to explain that a great deal of the psychopathology that exists in a given
society goes away if the society offers more possibilities in terms of work, relationships, and
recreation.

Modern democratic societies offer many possibilities in all domains of life. This means that
there is no single correct personality type. Someone who craves attention and approval
might have a hard time living in a tightly controlled environment that frowns on exhibition of
any kind. But if society is open to the idea of entertainment the person who wants to wear a
funny suit and tell jokes could find his niche as a comedian.
b) The idea of the right job for the right person applies even to very lofty positions such as
President of The United States. While there might be certain personal characteristics that fit
that position well, the ideal presidential personality might not be the best all-around person.
I remember an interview with Jimmy Carter long after he had left the Oval Office.

If ever there was a Boy Scout in the Presidency it was Jimmy Carter. He seemed to exemplify
all the virtues of mainstream America. He was even thrifty, keeping the winter temperature in
the White House so low that people had to wear a sweater, even though there was a very
adequate heater and a good supply of fuel. But then came the interviewer's big question:
what was it like to wake up in the White House for the first morning of your presidency,
she asked. Did you think about who else had sat in the chairs, or signed papers at a desk that
one of the great, historic presidents had used? Mr. Carter said that he had indeed considered
those things. His head was filled with the names of the great men who had preceded him in
those rooms and corridors.

The Interviewer continued, pressing a little harder. She asked if he had said to himself
something like...Lincoln, Washington, Jefferson, The Roosevelts...Carter...hmmm...what am
I doing here?!

Oh , NO!!, Terri ![I think the interviewer was Terri Gross]. I never thought That! ...and
he continued... You see, Terri, I appreciated the company I was in, but I never doubted that I
belonged here too. I think when you're the kind of person with the kind of ego that lets you
run for President, you don't doubt that you belong there!

So the Boy Scout appeared to have the quality of modesty, but not really. President Carter
taught us something about the kind of person who runs for President. That's not the
personality of someone who would feel fulfilled as an actual peanut farmer. If Mr. Carter had
not been allowed to become a person of great power working in the public sector, he might
have felt confined, unfulfilled.

All of this rather meandering disquisition is my attempt to make the following point very
clear: The Correct Question is NOT Whether Mr. Trump suffers from a mental Disorder.
What the Experts Are Really Asking is Whether Mr. Trump's Personality and mental state are
Suited To The American Presidency.The Answer Is A Resounding NO!

All of the experts who contributed to this book about Trump's personality are saying that he
cannot do the job. Some may have confused the issue by claiming that he suffers from a
mental illness. That may be true, depending upon the definition, but given the requirements of
the position it is possible to make the judgment that a person is not up to the task even if he or
she doesn't quite qualify for one of the defined illnesses.

Intellect A mental Property That Even Comes With Scores

Here's a quick and easy example of someone who can't do the job but doesnt have a mental
disorder:
Consider the suitability of a person with an 85 IQ who is applying for the job of President of
this country. According to the Psychiatric DSM (any one of them, from 1 to 5), an 85 IQ, as
assessed with a test such as the Wechsler Adult Intelligence Scale, administered by a
qualified Psychologist, under proper conditions, with no sub scales falling far below or far
above the full scale score does NOT constitute a symptom of pathology. Such a score is
however indicative of intellectual functioning that is well below what is called for. It lies in
the bottom 17% of the population, and while a person who is so endowed is not considered to
suffer from even borderline mental retardation, he would be unable to keep up in a college
preparatory high school program.

It is hard to say just how much intellectual horsepower is required for the position we are
discussing, but I would hazard a guess that an IQ of at least 120 might suffice. That figure
was the average IQ of an American College graduate back around 1970, which is close to
when the current President finished up at the Wharton School. That score lies roughly on the
91st percentile. If a representative sample of 1000 members of the American population were
drawn, the person with an IQ of 120 would rank higher than 900 of the others.

Looking at a much higher level of academics, we found a volume that listed the IQ of every
student attending Johns Hopkins Medical School during a given year. The average score was
about 130, which lies around the 98th percentile.

While the difference between the two groups seems small what it means is that in an
elementary school in which each classroom contained 33 students one would encounter about
3 children in each classroom with a 120 IQ but just 1 kid or less with a 130.

And now what about Donald Trump? How many DJT's would we find in each classroom?
This is one of the toughest appraisals that Psychologists are called upon to make, even those
of us who have done a great deal of clinical and educational testing. The problem is not
gauging Trump's intellectual ability when he was a young fellow in college. Based on
samples of Trump's use of language years ago, his accomplishment in just graduating from
the Wharton School (where he earned no distinction), and the unfortunately scanty
commentary about him by fellow students and faculty who knew him, his IQ probably did not
rise above that of the average college graduate of the time, which was 120. Unlike some
obviously brilliant fellows who never excelled in college (or perhaps never finished their
degree) but went on to do work that required great intellectual strength,Trump has not done
anything that requires more of the kind of computing ability represented by his score.

As a matter of fact, it isn't raising our estimate that we now propose. Something has
happened, something unfortunate. Mr. Trump's impoverished use of language compared to
his earlier facility suggests that hisprocessor isn't functioning very well. We also see
evidence of memory lapses, poor grasp of new information, and other cognitive glitches, all
of which look a lot like one of the numerous forms of senility. (That is a general term for
intellectual decline often seen in older people. It is due to several quite different causes and is
not synonymous with Alzheimer's Disease). This is not my specialty, but if this man were my
patient I'd certainly send him to a neurologist, particularly one specializing in Geriatrics.
Therefore, we must consider that unless the President were to receive a clean bill of health
from a physician, or medical team able to evaluate him properly, he is not intellectually fit to
do his job. (This team should include a Psychologist with advanced training and experience in
Neuro-Psychological Assessment.) Even if this President were in possession of a much
greater intellectual engine than he appears to possess one would be reluctant to entrust the
huge demands of the Presidency to someone with a misfiring brain.

Of course if one is out to destroy the federal government or try to reduce its importance and
its capacities in accordance with a particularly American brand of fascism one might think
that a broken Chief Executive is the perfect leader of a rump central government. But even if
such a foolish goal is what the ascendant Right has in mind, it might not enjoy the impact of
putting the nuclear codes in the hands of a sputtering brain.

Narcissism--Inflation of Self

The other qualities in which the current president is inadequate are not evaluated on scales
that produce a score like an IQ. It can be hard for the reader to understand the real meaning of
terms like very or barely. When one of the Mental Health experts says that Mr. Trump is
highly narcissistic the reader might think My Aunt Fanny thinks about herself quite a lot
and her self appraisal is very flattering, but she does well at her job and on the personal front
she can be a lot of fun even though she spends too much time admiring herself in the shop
windows whenever we walk in the mall.

Well compared to your Aunt Fanny Mr. Trump appears to be in a different league. (I'm
judging by his public appearances and statements as well as what I've read about him in the
book cited and in numerous pieces that have appeared since he first rode the escalator into
political life.) He doesn't think about himself quite a lot; he thinks of nothing else. Really.
Every reference to anything is reframed so that it pertains to him. And anything that can't be
translated into something that has to do with him is simply not dealt with. That's why trying
to brief him on technical matters is useless. If one were to tell him about astronomical
phenomena such as the discovery of a new galaxy it would not intrigue or amaze him. The
incredible size of the universe is meaningless to him. I imagine him thinking of things in
terms of properties that he owns. If told that the sun is actually enormous despite its
basketball-sized appearance he might wonder if it is larger than Mar-A-Lago.

Lest you think I exaggerate, you might recall that he recently told the Prime Minister of Japan
that until he was elected President he never knew there were so many countries. !! This
comes from a man who attended The University Of Pennsylvania's Wharton School of
Business. He never knew there were so many countries?! This from a man who flies around
in his own jumbo jet. He has had business dealings in a number of countries, including
Russia. Did he never look at a world map? Who among us has not wondered at the crazy quilt
of color patches, some huge, some barely visible that tell us that our world consists of many,
many nations.

At this point we have a President who appears never to have been among the many who are
considered gifted in terms of general intellectual capacity. He had at one time the ability to
get through a reasonably difficult college program. Today even that level of intellectual
competence seems questionable, and a full physical and mental examination is strongly
advised.

Secondly, the man's thinking is damaged by his extreme preoccupation with himself. Every
interaction that he has is damaged by his need to come away feeling puffed up. He is
sensitive to the slightest hint that he is not the grandest, greatest, most impressive Pooh-bah
who has ever lived. This is a man who cannot function if he is suffering from the smallest
insult to his grandness.

Jiminy Cricket Has Laryngitis--The Problem of the Micro-Conscience

And now we come to the third aspect of personality that gives those who understand Trump's
mind a great deal to worry about. There has been a lot of humorous talk about this man's
hands. We all understand that there is a joking correlation between the size of a man's hands
and the size of his junk as the kids call it nowadays. Not being a urologist I am unprepared
to assess Trump's junk, but I can tell you that one part of him is indeed minute and that is his
conscience . It's very small. His Conscience. Very small indeed.

By putting this function in size terms we can intuitively understand what kind of impact a
deficiency in this area will have. The conscience (which is the part of the super-ego that we'll
discuss here) is the set of mental structures that govern moral behavior. If someone has a
small or weak conscience they are not troubled by their own wrong-doing. Where the person
with a normal conscience refrains from certain behavior simply because it is wrong, and
NOT just because he might get caught and then be punished, the person with deficiencies in
this area thinks only of the probability of negative consequences.

The conscience even has a special tool at its disposal to keep us on the straight and narrow.
That tool is GUILT. (Which should not be confused with shame, a completely different
experience.) Even the threat of GUILT is sufficient to guide us. How often have you thought
something like I'd like to skip Uncle Joe's funeral, but I can't; I'd feel too GUILTY.

Guilt can even be clever, making itself experienced in the form of other feelings that we don't
know are just guilt with a wig and mustache. Take the classic novel CRIME AND
PUNISHMENT. The protagonist kills a dreadful old lady (it's okay for me to call her that;I'm
an old man!), and is investigated by a police detective who hasn't a clue as to who committed
the crime. The detective is interviewing everyone in the neighborhood.

The murderer thought he was justified. He had read a book on philosophy that proposed that
one would actually do the world a favor by getting rid of certain bad people. So informed,
the killer did not expect to feel guilt. And he didn't. Instead he felt persecuted. Persecuted by
the detective who really knew nothing and who wasn't being clever in the questions he asked.
He was being lost and honest about it.

Now what about Trump. What kind of conscience does he have? I've characterized it as small
and weak. It's also grossly immature.

Several systems exist for evaluating the maturity of conscience. All of them start with an
infantile level of development in which the person has essentially no moral guidance system
at all. The person is a law unto himself. Above that is a level of morality that recognizes a
few very simple rules that exist in all-or-none form allowing no exceptions or gradations.
Very young pre-schoolers live at that level. The rules have to do mainly with toilet training
and not biting someone who makes you mad.

Children just above that level know not to take other people's things and not to hit other
children (there are variations in this rule depending upon the culture in which the child lives).
When we reach the elementary grades children learn more rules and they learn to be honest
about their actions. The first-grade child who answers honestly, but unhappily, that he stole
another child's crayons is exhibiting good development of conscience.

As we grow and develop, morality becomes increasingly complex. We learn to factor in

multiple elements in evaluating the rightness of an action. The story of Les Miserables
demands that we understand the difference between the hero Valjean's morality and the more
primitive all-or-none view of Javert. The hero broke the rule against theft in order to prevent
a child from literally starving. He escapes from prison and goes on to lead an exemplary life.
Javert cannot understand that laws themselves can be immoral and that the system that
employs such laws is morally corrupt.

Mr. Trump's job requires that he understand morality at the highest levels. He is dealing
with an entire world of cultures, each of which has its own definitions of crime, punishment,
morality, and justice. Those who live in cultures with the most mature levels of morality seem
incomprehensible to Trump. He may see sophisticated societies as weak and vague, or he
may be embarrassed by his inability to understand their complexity, causing him to deal with
them aggressively for making him feel stupid.

In discussing Mr. Trump people who are familiar with clinical language may use a shorthand
in referring to Trump's inadequate moral development. They may call him a Psychopath.
Others call him a Sociopath. Which is it? The discussion that follows gives some background
into the business of naming mental dysfunctions.

Understanding Moral Under-development, And a bit of background on Psychiatric

Terminology

A psychopath or sociopath or anti-social personality, or delinquent personality, or

dissocial personality is a person with severe deficiencies in the mental systems we call
Conscience or Superego(to use the Psychoanalytic term). The definitions of these terms are
not identical. In fact one of the Psychiatric DSM's used both the ANTI-social and Dis-social
labels in an attempt to differentiate the lone-wolf miscreant from the chronic law-breaker who
was part of a gang. The idea behind this was that group-affiliation implies the capacity to
invest in other people while the solitary law-breaker may lack an important humanizing
capacity. This distinction did not pass the test of time. It is best to think of the similarities
among these disorders.

What one who is new to learning and thinking about a personality type that is marked by a
lack of a moral guidance system might not suppose is that such people can be superficially
charming. Many of them learn how to simulate caring and one can be fooled into seeing them
as normal, sympathetic people who are kind and good-natured. It can be a very serious
mistake to be taken in by such a person. Not only will they do harm to you if there's some
advantage in it for them, but they are capable of destructive behavior for its own sake. This
latter point cannot be emphasized strongly enough. This personality is built on a bedrock of
hatred, not love, and while normal people have a general desire to be constructive,
Psychopaths destroy things because that's what they do.

Perhaps the best name given to this condition comes from a psychiatrist named Hervey [sic]
Cleckley. He called these disorders THE MASK OF SANITY. First published in 1941, the
book underwent republication for forty years. I am not recommending this book, but its title
has stayed with me since I first heard of it almost exactly half a century ago.

While we're on the topic of Psychiatric names for mental disorders this seems like a good
place to insert a brief history of the subject. There may be no other branch of Medicine or
Social Science in which there is so much professional controversy.

After the Second World War several organizations created quasi-official nosologies of mental
disorders in order to bring some uniformity to the field of Psychopathology. Two that are
heavily used come from The World Health Organization and the American Psychiatric
Association (The APA). They created separate but rather similar classifications which have
undergone numerous revisions. While these systems have brought some order to a chaotic
field, enabling people in widely separated parts of the country (or world) to understand one
another, they have brought with them their own problems.

In the U.S. the domestic Psychiatric association's manuals have dominated the field of mental
health, but there is much dissatisfaction with the listings of disorders and the way they are
defined. Since 1952 when the first DSM (Diagnostic and Statistical Manual) was published
we have seen a substantial revision of the manual roughly every ten years.

The numerous names that we see for the same condition are attributable in part to the changes
in these official manuals. Many clinicians have only very slight contact with the DSM. Their
names for various conditions may come from the DSM that was current during their training
years. Or maybe the DSM never was the source of their personal nosology*. (*Nosology is
the classification of diseases).

Early in this century several Psychoanalytic organizations worked together to create an

authoritative alternative to the American Psychiatric Association's DSM. Psychiatry and
Psychoanalysis are not synonyms. The former is the branch of Medicine that deals with
disorders of the mind. It is closely associated with Neurology, but the two are not identical.
Psychoanalysis is a particular system of thinking about the mind. It was invented about 120
years ago by Sigmund Freud and has undergone many changes since its earliest form.
Sometimes Psychoanalysis is the name of a particular form of talking therapy. The roadmap
of the mind and the talking therapy are both called Psychoanalysis but are separate, and one
may use the model of the mind while practicing other forms of therapy.

Reality Testing --What Planet Does One Live On

The final mental function that is mentioned by those who are alarmed by Mr. Trump's
behavior is Reality Testing. Without getting too bogged down in philosophical discussions
of reality, we need to discuss how well Mr. Trump perceives what is going on in the world
around him. As already pointed out there are mental disorders that specifically affect the
perception of reality. One may even hear voices that sound as real and as external to one's
own head as any genuine encounter with another person. And one may correctly see an
airplane overhead but incorrectly know that it is there to spy on one's house, perhaps by
employing special equipment that can see through walls and roofs.

From his public presentation of self, Trump does not appear to be suffering from a Psychotic
disorder which carries with it such (accessory) symptoms as hallucinations and delusions, the
names given to the phenomena just described. But distortions and inadequacies in one's
mental makeup such as those already discussed (under the headings Intellect, Narcissism,
and Conscience ) cause distortions in one's apprehension (or perception) of reality.

Consider the impact on seeing things realistically if one cannot bear the idea that one has
laid an egg (Use any term for a presentation or performance that falls flat.) Is there not
room to misperceive the enthusiasm of the audience, to hear polite laughter or applause as a
much heartier response. It happens to many of us. Hence our own feeling of uncertainty. We
finish a performance, the listeners respond right in front of us, and yet when we leave the
podium or the conference room we turn to a trusted ally and ask how was it? We do that
because we are self-aware enough to know that our interpretation of audience response can be
skewed. We'd know the difference between stony silence and wild, standing-ovation
applause. It's the stuff in the middle that's hard to feel certain about.

Trump does NOT ask for a real appraisal of how it went. Instead, he tells people. And if he
does happen to ask, one knows! what he wants to hear. If his action has been a public one he
may hear it critiqued by people who are not his friends or relatives or fans. And if that
appraisal is negative he is clearly enraged. He begs to differ. Surely his critics heard the (non-
existent) cheering of an adoring audience. What are we to make of Trump's distortions. Are
they just a bit wide of the mark, or does his view seem really peculiar. How about when he
looked at actual photographs of his inauguration and compared them with Mr. Obama's.
Everyone I talked to saw clearly that Obama's crowd was much larger than Trump's, yet
Trump still insists that he had the bigger crowd.

When someone distorts reality to the extent that Trump does there is no question that
something is wrong with the man. His reality-testing is damaged. Frankly I have only
rarely encountered distortion this great in a patient not suffering from a serious mental
disorder. As I've said before, he does not seem psychotic, but is he so narcissistic that he
actually believes that less is more when it comes to looking at the crowd in a clear
photograph. Or is he so Psychopathic, so dishonest, that he will insist that night is day right to
your face and dare you to challenge him. Does he exercise his power over people by twisting
reality into a pretzel? Is he having a good laugh at our expense. (Psychopaths love to do that.)

And then we must ask whether his unexplained seeming intellectual decline isn't a symptom
of brain dysfunction (perhaps of one of the types often seen in older patients. Lying, covering
up mistakes, exaggerating often accompany organic mental decline. While some patients are
acutely aware of their decline, others develop a pattern of rather obvious compensation. If the
deterioration in the brain affects particular areas the patient becomes dis-inhibited, so that an
impulse that would ordinarily be suppressed by the patient is allowed to be expressed.

What we may be looking at in this case is a coming-together, a confluence, of three streams

to create a raging torrent. Each of the three dysfunctional systems, intellect, narcissism, and
conscience, affects our ability to see what is real. The combined effects of all three could well
be responsible for the very substantial deficiency in perception.

Wrapping it all up

Donald Trump's words and deeds are disturbing to many people, including those who claim
some allegiance to the Republican Party. A large number of mental health professionals have
stated both privately and publicly that Mr. Trump is unqualified and unsuited to the job of
United States President. Recently more than two dozen of these professional analysts of the
human mind have committed their observations and their fears to writing in the form of a
book of signed articles. Psychiatrists are expressly forbidden by their flagship professional
association to do just what they did, but they have bravely gone ahead anyway.

This commentary is meant to provide interested readers with some background in the various
issues raised by people in my profession. As the late pioneer in the field of psychotherapy for
severely disturbed children, Dr. Bruno Bettelheim, wrote about his adaptation to his being
placed in a concentration camp during WWII, when one is faced with a situation that is
dreadful but for the time being inescapable, the thing to do is STUDY the phenomenon. We
are fortunate to have his writings and the writings of others who have survived the horrors of
government gone mad.

Much is known today about apparent proto-fascists like Donald Trump whose malevolence
proves attractive to millions of followers. The situation is perilous, but we, WE THE GOOD
AND DECENT PEOPLE OF THIS COUNTRY, are not helpless. If you are among the many
who are concerned, or rather, sickened, by the rampant destruction being committed by
Trump and his allies in Congress, please read as much as you need to in order to understand
what is happening and then join others to work at tasks that speak to you. Together we can
put an early end to this coup, this right-wing takeover of our country.
Thank you all for reading this.

Armond Aserinsky, Ph.D.

(Retired) Clinical Psychologist
Palm Harbor, Florida

Addendum.. For the sake of professional propriety and scientific accuracy I must make it
clear to the reader that I have never had the opportunity to interact with the subject of this
article. As I have stated earlier, my knowledge of the man comes from seeing and hearing
him via television, seeing and hearing television commentary about him, and from reading
many articles about him. Given his importance to the country and the world I would love to
talk with him, at some length, and without the influence of other people in the room. This is
not likely to happen. My desire to be in his company, alone, also tells us that I do not fear that
he would eat me alive or lop off my head. I have had that thought about other world leaders.
Perhaps this tells us something about my perception of the man's nature.