November 16, 2017

Trumpology, Trumpism, and What We Need to Know and Malignant Narcissism

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Sat. Nov. 18, 2017
Afternoon update:

Here’s another reason why we find that so often facts don’t appear to matter:

Slowly, hopefully surely, diagnostic terms are being used to describe Trump.

In Mocking Franken Over Claims of Sexual Misconduct, Trump Joins a Debate He Started

Excerpt (emphasis added)

But the notion that Mr. Trump himself would weigh in given his own history of crude talk about women and the multiple allegations against him surprised many in Washington who thought he could not surprise them anymore. A typical politician with Mr. Trump’s history would stay far away from discussing someone else’s behavior lest it dredge his own back into the spotlight. But as Mr. Trump has shown repeatedly during his 10-month presidency, he is rarely deterred by conventional political wisdom even as he leaves it to his staff to fend off the cries of hypocrisy.

“Like everything else Trump touches, he hijacks it with his chronic dishonesty and childishness,” said Mark Salter, a longtime adviser to Senator John McCain, Republican of Arizona. “The intense, angry and largely ignorant tribalism afflicting our politics predates Trump’s arrival on the scene. But he has infused it with a psychopath’s inability to accept that social norms apply to him.”

White House aides labored on Friday to distinguish Mr. Trump’s case from those of others, arguing that the president’s conduct was not at issue because he won the election last year after voters had a chance to evaluate both the claims against him and his denials.
ඛඣFriday, Nov. 17, 2017


In the future, how do you think Trump's voters will rationalize supporting his disastrous and embarrassing presidency?

The Bulletin of Atomic Scientists has moved the "Doomsday Clock" closer to midnight. To be honest, I think it’s actually chiming at midnight right now. I don’t think people have any idea how close we are the point of no return. I think there is an 80 percent chance he’s going to push that nuclear button. Why? Number one, Trump is a malignant narcissist. As far as I know, I cannot recall a single malignant narcissist in history who did not start a major war.
Now add one more factor: Under the surface, this [Robert] Mueller investigation is turning him and his family into cornered animals. They are guilty of treason, guilty of money-laundering, guilty of collusion, guilty of obstruction of justice. They are guilty as sin and they know it. The noose is tightening around their necks and, unlike Richard Nixon, Trump and his cabal are not going to leave gracefully.

Donald Trump is going to be like Bonnie and Clyde; he’s going to shoot his way out. The best way for him to shoot his way out is to start a war and distract from his misdeeds, rally the country behind him and -- most importantly from a psychological perspective -- to transform the feeling of being a weak victim of a massive criminal investigation into that of an omnipotent destructive and powerful leader by destroying and killing millions of people.
When you ask me, “What are people going to say about it?” What are Germans saying now about the Holocaust? None of them were Nazis. No one is going to be proud of what they did if they don't stand up to Donald Trump now.

There is an abundant evidence to show that Donald Trump is a malignant narcissist with sociopathic tendencies. Yet some psychologists and psychiatrists continue to hide behind the so-called "Goldwater rule.”

They are ridiculous cowards. We are afraid to speak up because of the Goldwater rule? Are you kidding me?

If you were to explain in simple terms why the Goldwater rule doesn’t apply here, how would you explain it to a layperson?

The American Psychiatric Association is a guild. Its main interests are the those of the American Psychiatric Association and American psychiatrists. This is very, very important. They are just trying to stay out of the way of anyone powerful who might get angry at them and interfere with them making money. It is that simple. The Goldwater rule is not an example of psychiatric ethics. It is an example of psychiatric corruption where they put the needs and the money of their profession above the welfare and the survival of the American public.

Nov. 16, 2017
Evening edition:
Shared if only for the illustration:

The salacious excerpt with a bit of treason thrown in:

Steele’s collaborators offered salacious details. The memo said that Russian intelligence had sought to exploit “TRUMP’s personal obsessions and sexual perversion” during his 2013 stay at Moscow’s Ritz-Carlton hotel for the Miss Universe beauty pageant. The operation had allegedly worked. The tycoon had booked the presidential suite of the Ritz-Carlton hotel “where he knew President and Mrs OBAMA (whom he hated) had stayed on one of their official trips to Russia”.
There, the memo said, Trump had deliberately “defiled” the Obamas’ bed. A number of prostitutes “had performed a ‘golden showers’ (urination) show in front of him”. The memo also alleged: “The hotel was known to be under FSB control with microphones and concealed cameras in all the main rooms to record anything they wanted to.”
As well as sex, there was another fascinating dimension to this alleged plot, categorically denied by Trump. According to Steele’s sources, associates of Trump had held a series of clandestine meetings in central Europe, Moscow and elsewhere with Russian spies. The Russians were very good at tradecraft. Nonetheless, could this be a trail that others might later detect?

Steele’s sources offered one final devastating piece of information. They alleged that Trump’s team had co-ordinated with Russia on the hacking operation against Clinton. And that the Americans had secretly co-paid for it.

My take: How does this personally effect Trump? There are a number of people who know exactly what Trump did: those in on the honey pot sting,  Putin and Trump himself. As a therapist trying to figure out what, if anything, could lead Trump to have a complete breakdown of his psychological defenses, I put this in a high risk (for him) group. Trump already survived the Access Hollywood scandal that never was, and the credible accusations from women he groped. But could his defenses stand up to revelations that he engaged in the notorious golden showers? Perhaps not. It isn’t just that he engaged in a sexual activity most people find, at the least, a little bit “off” - that he might shrug off. It’s that he was lured into a classic honey trap.

What is Trump’s Achille’s heel. Is it something sexual? Is it being outed as having committed  treason. My bet is on the former.  HB

On Trump the malignant narcissist:

“The fish rots from the head”: a historian on the unique corruption of Trump’s White House

"Politicians lie, but this is different."

Regular readers may have noticed that I changed the heading of the website again. I previously called myself a Duty to Warn therapist. The title has gone through several iterations. Here’s why I changed it.

As those the mental health professionals who have been endeavoring to explain why Trump is mentally unfit to be president to the public, pundits, and politicians know, our movement suffered an unfortunate setback due to an arcane thing called the Goldwater rule. Few outside the mental health community ever heard of it, even when it made the news when Senator Goldwater was running for president.
Just about every article published about the concerns of therapists about Trump’s personality referenced the Goldwater rule.  

The lay reader could easily gather that because it was considered by the American Psychiatric Association to be unethical to diagnose a public figure, when some mental health professionals did so, this discredited their argument.

In fact, psychiatrists adhering to the Goldwater rule have the same data at their disposal as any other mental health professional and I would venture to say if pressed confidentially to do so, would probably come up with the same or similar diagnoses as those who have diagnosed him in public.  I find it difficult to believe that Goldwater rule bound psychiatrists haven’t had private conversations with their colleagues about the probable diagnosis of Donald Trump.

The therapists writing about Trump fell and still fall into opposing groups even though their goals were and are the same. 

One group believed that they had to adhere to the Goldwater rule and did not use diagnostic jargon to describe why Trump was mentally unfit. Instead they substituted synonyms that described the same behaviors in the DSM only in lay terms. However there are only so many words to describe Trump’s diagnostically significant behavior without getting close to suggesting he has a diagnosable mental illness. 

Bandy Lee, a psychiatrist who has not only become prominent as the organizer of a major conference about Trump  and the editor of a best selling book, is also among those wanting to adhere to the Goldwater rule. She comes very close to at least suggesting Trump has a diagnosis, for example note the terminology in this article: mental impairment, mental health issues, the symptoms he displays, bad as well as mad, toxic and unpredictable, mental instability, Trump (and his follower’s) pathology:
  • "I’ve been thinking from the very beginning that he exhibits many signs of mental impairment."
  • "We have an obligation to speak about Donald Trump's mental health issues..." 
  • "There are certainly the symptoms that he displays." 
  • "In other words, bad as well as mad. It’s really the combination that makes it so toxic and unpredictable that we felt that there was a need to speak out."
  • "I think by sounding the alarm about his mental instability and position of power that some kind of consensus as to a process would be developed.."
  • "We could speak to the president’s mental impairment, the effects of that impairment and the dangerous situation we’re in."
  • "We can either amplify and encourage Trump and his followers' pathology…"

Clearly, Bandy Lee and all the mental health professionals who are deeply concerned about Trump agree with her saying that:

"This situation has come to such a critical level. In fact, a state of emergency exists and we could no longer hold back. We have an obligation to speak about Donald Trump's mental health issues because many lives and our survival as a species may be at stake.

This is from the prologue to “The Dangerous Case of Donald Trump:"

 “Collectively with our coauthors, we warn that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency,” Judith Lewis Herman of Harvard Medical School and Bandy X. Lee of the Yale School of Medicine.
I think we can agree with this, even if some therapists choose to delve rather explicitly into Trump’s diagnosis and some, for whatever reason, don’t. 

For good or bad as far as our movement succeeding, there is another group of mental health professionals, notable among them John Gartner and Howard Covitz, who reacted to the prohibition in the Goldwater rule by citing Tarasoff :

Tarasoff v. Regents of the University of California17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976), was a case in which the Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient. The original 1974 decision mandated warning the threatened individual, but a 1976 rehearing of the case by the California Supreme Court called for a "duty to protect" the intended victim. The professional may discharge the duty in several ways, including notifying police, warning the intended victim, and/or taking other reasonable steps to protect the threatened individual.

These therapists said that – with an odd semantic irony (changing the word protect to warn) that the duty to warn trumped Goldwater.  

Without getting into the mud, there are several splits in the duty to warn group between those who are diagnosing Trump and those who choose another way to describe the behavior that leads them to believe in their duty to warn. 

John Gartner was, as far as I know, the first to explain why he thought Trump met the diagnostic criteria for malignant narcissism. 

John D. Gartner, a practicing psychotherapist who taught psychiatric residents at Johns Hopkins University Medical School, minces as few words as the president in his professional assessment of Trump. 
"Donald Trump is dangerously mentally ill and temperamentally incapable of being president," says Gartner, author of "In Search of Bill Clinton: A Psychological Biography." Trump, Gartner says, has "malignant narcissism," which is different from narcissistic personality disorder and which is incurable. 
Gartner acknowledges that he has not personally examined Trump, but says it's obvious from Trump's behavior that he meets the diagnostic criteria for the disorder, which include anti-social behavior, sadism, aggressiveness, paranoia and grandiosity. Trump's personality disorder (which includes hypomania) is also displayed through a lack of impulse control and empathy, and "a feeling that people ... don't recognize their greatness. 
"We've seen enough public behavior by Donald Trump now that we can make this diagnosis indisputably," says Gartner. His comments run afoul of the so-called Goldwater Rule, the informal term for part of the ethics code of the American Psychiatric Association saying it is wrong to provide a professional opinion of a public figure without examining that person and gaining consent to discuss the evaluation. But Gartner says the Trump case warrants breaking that ethical code. U.S. News and World Report January , 2017
To give credit where it is due, while he didn’t use the term malignant narcissism, psychologist Dan McAdam beat Gartner into the mainstream media in The Atlantic in an article where he described Trump’s extreme narcissism.

All one has to do is read “The Dangerous Case of Donald Trump” critically to see the diversity of explanations as to why the authors think Trump is dangerous. 

If I were to do a review of the book I’d take a different approach than most of those who have already reviewed it, although psychiatrist Andrew Spitnaz comes close to saying what I’d want to. His is the best review I’ve read and I suggest you read it in its entirety.

Excerpt: Part One (The Trump Phenomenon) focuses upon the symptoms and behaviors that render the president imminently dangerous.  The various authors in this section argue that Trump exhibits impairments consistent with multiple diagnoses, including Narcissistic Personality Disorder, Antisocial Personality Disorder (or sociopathy), paranoia, hypomania, and possibly dementia. 
The clinicians do an excellent job, assembling a greatest hits collection and several B-sides of Trump’s deranged statements and abhorrent behaviors to make their cases.  Their assessments span the president’s entire lifetime, though with emphasis primarily upon his words and deeds while campaigning and now as president.  Their summation is a horrifying trek down Memory Lane and utterly damning in its totality. 

 I’d try to analyze what there is about Trump that leads so many experienced mental health professionals to come up with so many different explanations for his behavior. Can they all be right? 

As far as I can tell, having been following our movement since its inception, it was the "Tarasoff trumps Goldwater" justification which led to the name Duty to Warn being used to describe that part of the movement. 
One thing all of us can agree with is that, and Bandy Lee puts it, we have a MORAL OBLIGATION TO WARN.
Duty or obligation? Does it even make any difference? 
Duty: a moral or legal obligation; a responsibility: it's my duty to uphold the law | she was determined to do her duty as a citizen | a strong sense of duty. • [as modifier] (of a visit or other undertaking) done from a sense of moral obligation rather than for pleasure: a fifteen-minute duty visit.
Superficially it shouldn’t matter. However, unbeknownst to the general public, there are two groups with the same goals. One has a name, Duty to Warn, the other while making a major impact, doesn’t have a name. 

I propose a name that all mental health professionals can agree with: perhaps we can call ourselves Moral Obligation to Warn or, for short, M.O.W. therapists.  It doesn’t have the same ring to it at Duty to Warn and D.T.W., perhaps because it’s new. But perhaps with a new name all the professionals can come together under one umbrella the way 27 of them (counting Noam Chomsky and Gail Sheehy as honorary shrinks) did in the book “The Dangerous Case of Donald Trump."

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