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August 16, 2016

Vetting Trump

When can we write about something else than Trump being unhinged?

Ethicist and lawyer Jack Marshall’s blog.
Last month: Terry Tao’s blog
My photo blog is here. +++ Links to all the several dozen articles I cross-posted to Daily Kos with comments are here.

 Ethics AlarmsEthics Alarm blog of the month
Last month’s blog of the month: Terry Tao

Weds, August 17, 2016
Comment here
Read comments here
2,200 shrinks diagnosing Trump: The Goldwater rule goes mainstream (in the New York Times): 

"The Psychiatric Question: Is It Fair to Analyze Donald Trump From Afar?"

Count me among the mental health professionals (as a retired clinical social worker and mental health center director who was licensed to diagnose and treat patients) who disagrees with the Goldwater Rule under special circumstances. These exceptions occur when a candidate offers ample evidence that he has one or more psychiatric diagnoses that make him or her unfit or even dangerous to be president.

Now, while Republican physicians are speculating about Hillary Clinton’s physical fitness to be president while Trump himself has started  not only saying she is (mentally) unhinged, but that  she looks like she had a stroke, and has trouble walking up a flight of stairs unaided, and needs to sleep between brief speeches. 

Obviously the physicians that speculated on this have scant evidence to go on. Physical diagnosis requires an examination and often tests. Psychiatric diagnosis is usual accomplished with a face-to-face interview or two, and infrequently psychological tests like the Rorschach and MMPI.

However, because Trump has been unscripted in so many of his rallies and demonstrated a wide variety of symptoms of disorders that make him temperamentally unfit to be president. Even if we don’t count his lack of empathy (a characteristic of narcissistic personality disorder), there’s his pathological lying (pseudologia fantastic) and fantastic confabulation and his impulsiveness. Add to this that his narcissism makes him highly unlikely to heed advice that challenges his beliefs.

While not showing enough symptoms to make a likely diagnosis of paranoid personality disorder he does seem to believe a lot of conspiracy theories. Also not a true anti-social personality (aka sociopath) he seems to relish being a bully and his NPD lack of empathy is also a characteristic of this with anti-social personality.

If Trump was somehow persuaded to undergo a psychiatric examination knowing the results would be public he’d be guarded and I’d wager figure out that he’d better not let his unhinged stream of conscious and word salad speech take over. I wouldn’t be surprised if he took some Xanax prior to his interview. In fact, if I was his campaign advisor I’d suggest he do so.

Here’s an excerpt from the New York Times article:
The 2016 Republican nominee’s incendiary, stream-of-consciousness pronouncements have strained that agreement to the breaking point, exposing divisions in the field over whether such restraint is appropriate today. 
Psychiatrists and psychologists have publicly flouted the Goldwater Rule, tagging Mr. Trump with an assortment of personality problems, including grandiosity, a lack of empathy, and “malignant narcissism.” The clinical insults are flying so thick that earlier this month, the psychiatric association posted a reminder that breaking the Goldwater Rule “is irresponsible, potentially stigmatizing, and definitely unethical.” 
Putting a psychiatric label on a candidate they oppose can be a “seemingly irresistible tool for some in the field,” said Dr. Paul Appelbaum, a professor of psychiatry, medicine and law at Columbia University who disapproves of the practice. “This year, perhaps more than most, they’re persuaded they’re saving the nation from a terrible fate.”
 A group of professional mental health therapists have a website, ,  with a manifesto which over 2,000 therapists have signed:

A Public Manifesto

Citizen Therapists Against Trumpism

As psychotherapists practicing in the United States, we are alarmed by the rise of the ideology of Trumpism, which we see as a threat to the well-being of the people we care for and to American democracy itself. We cannot remain silent as we witness the rise of an American form of fascism. We can leverage this time of crisis to deepen our commitment to American democracy.
What is Trumpism?
Trumpism is an ideology, not an individual, and it may well endure and grow after the Presidential election even if Donald Trump is defeated. (Variants can be seen all over Europe.) Trumpism is a set of ideas about public life and a set of public practices characterized by:
  • Scapegoating and banishing groups of people who are seen as threats, including immigrants and religious minorities.
  • Degrading, ridiculing, and demeaning rivals and critics.
  • Fostering a cult of the Strong Man who:
    • Appeals to fear and anger
    • Promises to solve our problems if we just trust in him
    • Reinvents history and has little concern for truth
    • Never apologizes or admits mistakes of consequence
    • Sees no need for rational persuasion
    • Subordinates women while claiming to idealize them
    • Disdains public institutions like the courts when they are not subservient
    • Champions national power over international law and respect for other nations
    • Incites and excuses public violence by supporters
At the political level, Trumpism is an emerging form of American fascism, a point being made by social critics across the political spectrum, including Robert ReichRobert Kagan, and Andrew Sullivan. As journalist Adam Gopnik points out, whether or not the term “fascism” fully fits, it’s clear that the American republic faces a clear and present danger when the candidate of a major political party embraces an anti-democratic ideology. At the cultural level, the Urban Dictionary has defined Trumpism as “the belief system that encourages pretentious, narcissistic behavior as a way to achieve money, fame, and power.”
What are the Effects of Trumpism?
  1. Fear and alienation among scapegoated groups, beginning with Latino immigrants and Muslims, and then other groups who become identified as threats
  2. Exaggerated masculinity as a cultural ideal, with particular influence on young people and economically insecure men
  3. Coarsening of public life by personal attacks on those who disagree
  4. Erosion of the American democratic tradition which has emphasized the agency of we-the-people instead of the Strong Man tradition of power
Where Did Trumpism Come From?
This question is bigger than Donald Trump. The next public figure to capture the wave of Trumpism may be less clownish and have a better set of movement-building skills, and thus be even more dangerous. Following is a partial list of forces that underlie Trumpism:
  • Economic insecurity, particularly among working-class Americans
  • The threat of terrorism since 9/11
  • Fear of immigrants (related to economic insecurity and threats of terrorism)
  • Distrust for government and politicians at a time of polarized gridlock
  • Growing distrust for other institutions such as religion, the press, and the courts
  • Rapid cultural change that has left many people confused and alienated
Why Therapists Must Speak Out
We must speak out for the well-being of people we treat and care for in our work. Trumpism will undermine the emotional health of those seen as the “other” in America—both historically denigrated groups and those whose turn will come. And it will compromise the integrity of those who are seduced by the illusion that real Americans can only become winners if others become losers. The public rhetoric of Trumpism normalizes what therapists work against in our work: the tendency to blame others in our lives for our personal fears and insecurities and then battle these others instead of taking the healthier but more difficult path of self-awareness and self-responsibility. It also normalizes a kind of hyper-masculinity that is antithetical to the examined life and healthy relationships that psychotherapy helps people achieve. Simply stated, Trumpism is inconsistent with emotionally healthy living—and we have to say so publicly.
We must speak out for the well-being of our democracy, which is both a way of living and acting together and a set of political institutions. Therapists have taken for granted how our work relies on a democratic tradition that gives people a sense of personal agency to create new narratives and take personal and collective responsibility for themselves, their families, and their communities. Reliance on a Strong Man who will solve our problems and deal with internal and external enemies is a direct threat to the democratic basis of psychotherapy. Therapy only flourishes on democratic soil.
Why speak collectively? Our responses thus far have been primarily personal—and too often confined to arm-chair diagnoses of Donald Trump. But a collective crisis faces our nation, a harkening back to the economic depression and demoralization of the 1930s (which fed European fascism) and the upheaval over Jim Crow and Black civil rights in the 1950s. Fortunately, the resolution of these crises led to a deepening of American democracy, not the abandonment of it. Martin Luther King, influenced by his mentor Bayard Rustin and by theologian Reinhold Niebuhr, didn’t just critique unjust systems from the outside. He called for strategic, collective work to take back an American democracy that belongs to all the people. As therapists, we have been entrusted by society with collective responsibility in the arena of mental, behavioral, and relational health. When there is a public threat to our domain of responsibility we must speak out together, not just to protest but to deepen our commitment to a just society and a democratic way of life. This means being citizen therapists who are concerned with community well-being as much as personal well-being, since the two are inextricably joined.
Where We Stand as Citizen Therapists
We understand the draw of Trumpism and we acknowledge that some of our fellow citizens, and some of our clients, may vote for Donald Trump not because they embrace all aspects of Trumpism but because they are frustrated with their circumstances and fed up with the current political system. We are against Trumpism and its architects, not against those who are inclined to give it a chance to change the direction of the country.
But we reject the false equivalence of saying that because there is dishonesty and demagoguery on all political sides, why not support someone from the outside? Trumpism is qualitatively different. To repeat: Trumpism undermines the core of American democracy by promoting the idea of a single leader who will bring greatness to the nation by battling Those People. Democracy requires personal and collective agency so that we can work together across differences to solve problems and develop a shared way of life. Psychotherapists must be firmly on the side of democracy and work in solidarity with groups directly threatened by current and future versions of Trumpism. This work will not end with the election in November 2016. The wake-up call has been received. Our first response is this manifesto. More to follow.
Therefore, as citizen therapists we stand united against the dangerous ideology of Trumpism, and we encourage others to join us in a deepened commitment to a democratic way of life that engages the talents, yearnings, and capacities of all the people.

Here’s another excerpt from the New York Times article:

Dr. Steven Buser, a psychiatrist who with his colleague, Dr. Leonard Cruz, coedited a new book, “A Clear and Present Danger: Narcissism in the Era of Donald Trump,” stressed, “We are careful not to make a clinical diagnosis here, to say that Donald Trump has narcissistic personality disorder.” The contributing writers include psychiatrists and psychologists, but Dr. Buser said, “We are focused on the image he projects, on TV, in tweets, in quotes.” 
Dr. Appelbaum  ( a professor of psychiatry, medicine and law at Columbia University who disapproves of diagnosing politicians) calls this distinction a convenient splitting of hairs. “It takes a skilled therapist months, sometimes longer, seeing a person regularly and asking probing questions to make a determination of whether a disorder is present,” Dr. Appelbaum said.
Actually Appelbaum’s notion that it takes months to make a diagnosis is a bit of professional snobbery. Most clinicians make a tentative, usually correct, diagnosis in one or two sessions unless the patients exhibits complex symptoms — suggestive of a constellation of disorders, or a hard to diagnose disorder like dissociative (multiple personality) disorder or a neurological disorder like temporal lobe epilepsy which can cause hallucinations (suspicion of this requires a referral to a neurologist).

My previous and controversial articles about Trump’s likely diagnoses, all published on Daily Kos, which combined I call Trump derangement syndrome:

Tuesday, April 16, 2016
Just a thought: Trump wants extreme vetting for VISA applicants. How about requiring extreme vetting for presidential candidates? Start with requiring they release their income tax returns. A Rorschach Test and MMPI should also be required. 
Not fit enough to fight World War II?
Trump is saying that Hillary isn’t physically fit enough to fight ISIS. 
In what was billed as a major foreign-policy address in Ohio, Donald Trump suggested—as he has in the past—that Hillary Clinton is somehow secretly ill. This time though, he said Clinton lacks the “mental and physical stamina” to take on ISIS, a declaration that comes just a week after conspiracy theories bubbled to the surface once again saying that the Democratic presidential nominee has some terminal ailment. Daily Beast 

Monday, August 15, 2016
A rare gift to the electorate from Donald Trump

Simply put, Donald Trump has demonstrated his dark side more that any other candidate in this election and possibly in history. The only candidates in my memory that come close are George Wallace and Pat Buchanan. Add to this that we have seen so many examples of his bullying and mean  and/or threatening reactions to slights that even without making a psychiatric diagnosis we can make judgments about his temperament. 

Trump believes in himself with such conviction that he sees no need to heed advice from those who want him to win that he has to “act” presidential. Give Trump credit for refusing to act a role that would be dishonest. 

As an evil Popeye, he proudly lives by the credo “I yam what I yam.” And that is good for us!

New to this blog… read previous “editions” here.

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