I posted the first comment to Jennifer Rubin's newsletter.
Trump’s decline: His interviews and lies get worse (I added the spiral background)
Here's what I wrote:
There's a line between being unable to "handle reality" and being able to discern what is real from what isn't real. Trump may be engaging in wishful thinking and avoidance if this is the former, but if it is the latter he is clincally delusional. Mental health experts refer to "reality testing", ie, it is a concept in psychoanalytic theory in which the ego, or conscious self, recognizes the difference between the external, what is real, and internal world, what they wish was real. In other words, it is the ability to see a situation for what it really is, rather than what one hopes or fears it might be. If someone is unable to engage in reality testing they may be entering into a psychotic state.
RawStory has a good summary of Rubin's article here.
In the Rubin piece the words delusion or delusional are used three times. Consider each of them in context:
- As lawyer and anti-Trump commentator George Conway said on MSNBC, “He has completely lost it. This post is, beyond question, delusional. But is was also inevitable because he realizes … he’s not just running for the presidency, he’s running for his freedom.”
- (Axios commented on his AI delusion: “Trump’s advisers and allies worry he’s spending so much time in an alternative reality that it’s undermining his real-world campaign.” How about asking hard questions about how a party can stand behind someone in an alternative reality?)
- With time, Trump’s delusions have gotten wilder, his thinking more scattered. The worse Trump gets, the more untenable the media’s unwillingness to level with voters becomes. Will Bunch of the Philadelphia Inquirer wrote, “[The] false claim by Trump that Harris is generating fake big crowds with AI was a true Captain Queeg moment, maybe the most bat-guano crazy thing I’ve seen in 40 years of covering presidential elections.”
George Conway says Trump has "completely lost it." I ask what is it that Trump has lost? Of course, Conway is saying that Trump has lost his connection with reality. If one is disconnected from reality they have to be looked at as having some kind of psychosis.
The Axios article references a party standing by someone who is living in an alternate reality. There is only one reality. Those who living in their own reality are suffering from a severe mental illness whether they see or hear things that aren't there or believe things that aren't real.
The word crazy - the Captain Queeg moment described above - can be used colloquially but in the case of the Queeg character played by Humphrey Bogart in "The Caine Mutiny" when he went off on "the strawberries" he was in the throes of a paranoid delusional psychosis.
For those who want look beyond the forest and analyze the tree this is from "Psychotic disorders in late life: a narrative review" published by the National Library of Medicine:
Abstract: Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.
There is no way, aside from a complete psychiatric assessment, to diagnosis anybody with late-in-life onset psychosis. Since Trump lies all the time there's no way to discern how many of the lies he tells he believes. Lies are his stock in trade. He tells them and since millions of his supporters believe them there's no reason for his to stop. If he believes the lies he is delusional.
It seems to me as a clincian that it isn't likely he is really psychotic. While Trump does meet the diagnostic criteria, or have many traits of, two personality disorders (narcissistic personaity disorder and anti-social, aka sociopathic disorder) these are not psychoses.
If Trump did have a psychosis he could be successfully treated. There are highly effective medications for psychotic disorders often used with supportive psychotherapy. There are no treatments for the disorders Trump has.
