A new article and an old one about Trump's dangerous malignant narcissitic psychopathology prompted this Substack. By Hal M. Brown, MSW (Retired psychotherapist)

 

D. Earl Stephens1 wrote a piece in Raw Story+ (the subscription opinion section of the website) today and my comment, below, became my Substack for today. The title is Holy hell! I literally wrote the book on Trump but this has me stunned.Fortunately for those without a subscrption to RawStory+ the same article is on the author’s Substack, Enough Already, here with the title THE MORON - Our pathetic media has learned NOTHING the past decade while covering the stupidest, most dangerous man on the planet .

Stephens is the author of the Toxic Tales book shown below.

The only quibble I have with it is that the title in RawStory+ should read “a book” not “the book.” Except for the group of mental heath experts who contributed to “The Dangerous Case of Donald Trump” nobody can claim they wrote “the” book on Trump. “Dangerous Case” could be considered “the” book since it and a second edition with addtional articles were best sellers.

Below is my comment to the RawStory+ article, including the illustrations I used:

Even before you published your book (shown above), in 2017 John D. Gartner, the clincial psychologist who started the Duty to Warn group, published a book based on Trump's Tweets. Salon has an article about it here: What Donald Trump’s tweets reveal about his mental health.  

Trump told us who, and what he was before he was elected the first time. Psychologically he can be viewed as a malignant narcissist who has a sadistic streak as wide as the stripe down a skunk's back. People with this diagnosis depending on the position they hold can just be unpleasant to deal with or the more power they have the more dangerous they become. Since Trump has become the most powerful person in the world the book that laid this out from the point of view of therapists was "The Dangerous Case of Donald Trump" edited by psychiatrist Bandy Lee. Gartner authored one of the chaprters. See Wikipedia page.  

This is from Wikipedia: 

The authors argue that Trump's mental health affects the mental health of the people of the United States and that he places the country at grave risk of involving it in a war and of undermining democracy itself due to his dangerous pathology.  Consequently, the authors claim that Trump's presidency represents an emergency which not only allows but requires psychiatrists in the United States to raise alarms.

Since 2016 as much as eminent mental health professionals like Bandy Lee, James Gilligan, Lance Dodes, John Gartner, Justin Frank, Robert Jay Lifton, Phillip Zimbardo, David Reiss, Steven Buser and others, including not so eminent ones like myself, tried to warn about Trump’s dangerous psychopathology our warnings and reasoning was relegated to progressive venues and media outlets like Salon, The Atlantic, MSNBC , and Daily Kos where I used to post my stories. (I now post in Substack here) In fact, only John Gartner as far as I can tell made it into the mainstream media with an article published in USA Today in May 2017 Donald Trump's Malignant Narcissism is Toxic. (He used the word toxic in the title the way Stephens did in his later book.)  It is no solace that the predictions of so many have come true. We (I include myself because I have been one of the therapists writing about this since 2017) tried to warn people. It's possible this had an effect after his first term when he lost to Joe Biden. Obviously we failed in 2024. I venture to say that none of us are surprised at what Trump has done. The only surprise I think most of us would agree on is that he was able to do it this quickly.

Now I am fleshing out this Substack by referencing this article and the comments myself and others made to it.

For those who want to go into more depth about Trump and the role of mental health professionals read this article which was published in the website Mad in America in 2020: Muzzled by Psychiatry in a Time of Crisis The Man in the White Coat, The New York Times and The Stifling of the Public Debate about Donald Trump’s Fitness to Serve as President

I forgot about this article until today. Looking at it I was reminded that a comment I posted to it led to a long string of comments and replies. Many are from Steve McCrea, a mental health professional who has made nearly 10,000 comments to article on this website.

I first wrote the following:

Thank you for this behind the scenes account which explains a great deal. As one of the early members of John D. Gartner’s Duty to Warn group I am surprised it is the first that I learned of it. (A video of a Gartner speech was also presented as part of the Yale conference – you can read it here: https://www.dailykos.com/stories/2017/4/23/1655450/-Exclusive-Dr-John-Gartner-s-speech-to-Yale-Duty-to-Warn-Conference-on-Trump-s-mental-unfitness

Both the APA and Dr. Allen Frances did a lot of harm. The latter is the psychiatrist who says that because he wrote the DSM criteria for narcissistic personality disorder he is the only one qualified to say Trump doesn’t fit the definition because he doesn’t suffer or perceive any ill effects. (see https://www.theverge.com/2017/9/2/16239892/allen-frances-twilight-american-sanity-goldwater-rule-trump-personality-disorder).

Since 2016 as much as eminent mental health professionals like Bandy Lee, James Gilligan, Lance Dodes, John Gartner, Justin Frank, Robert Jay Lifton, Phillip Zimbardo, David Reiss, Steven Buser and others including not so eminent ones like myself, tried to warn about Trump’s dangerous psychopathology. Our reasoning was relegated to progressive venues and media outlets like Salon, The Atlantic, MSNBC , and Daily Kos where I post my stories. In fact, only John Gartner as far as I can tell made it into the mainstream media with articles published in USA Today.

We should take issue with the argument put forth by Allen Francis because it is a ludicrous one (people with NPD like those with anti-social personality, don’t usually suffer, they make other people suffer). The leaders of the American Psychiatric Associate and their adherence to the Goldwater rule as if it was superglued to the Hippocratic Oath really kept the responsible mental health community from getting the message out that Trump was dangerous, not only because he was an autocrat but also because he was a malignant narcissist with no conscience or empathy and is an exemplar for The Dark Triad, the deadly combination of extreme narcissism, sociopathy, and megalomania.

To find the comment thread my post led to scroll down the comment section until you see what I copied above. I won’t report all of them. They are long and detailed. I will just post my response to this one from Steve McCrea, another mental health professional:

Steve McCrea April 26, 2020 at 10:04 pm

I appreciate both your viewpoint and the civil tone of the discussion. I think the challenge that professionals (and I qualify as one) face here is that concern for safety of the nation can be very legitimate without invoking any kind of “mental illness” as a causal factor. There are plenty of people who are willing to kill other people who have no “mental illness” at all, even by DSM standards. They just think killing people is a good way to solve certain problems. They may even have their own internal “ethics” of when it is and isn’t OK to kill. In some cultures, it may even be required to kill someone if one’s honor is sufficiently undermined.

It is in my view utterly impossible to disentangle “personality disorders” from problems of ethics, morality, and social values. Until and unless there is an objective way to “diagnose” someone with a verifiable “mental illness,” we’re building castles in the air. I’d rather go back to philosophy and ethics to handle this kind of situation. Bringing in “mental illnesses” just adds confusion and controversy.

Here’s my reply:

Steve, I see you live in Portland too, but this is besides the point since what with Covid-19 it may be 1-2 years before we can even consider discussing our different opinions in person.

That being said I think whether done from a distance or not diagnosis has never been precise. When I started working the DSM was nothing more than a little booklet with pages held together by plastic clasps. The the pressure of insurance companies led to the requirement we diagnose. My psychoanalyst friends find making a diagnosis irrelevant for most of their patients. Who when push comes to shove would probably just say they were neurotic or in the most difficult clients perhaps borderline and if they needed a diagnosis would use the code we used in community mental health for years, 309.28.

I think the conceptualization of Trump as a malignant narcissist which was first offered by John Gartner is very useful. As I’m sure everyone reading this knows the personality type never made it into a DSM after it was described by Erich Fromm as a combination of NPD, sociopathic disorder, aggression, and sadism. He described it as a “severe mental sickness” representing “the quintessence of evil”. He characterized the condition as “the most severe pathology and the root of the most vicious destructiveness and inhumanity” (Wikipedia)

No less than the distinguished psychoanalyst Otto Kernberg built on Fromm’s conceptualization. Again from Wikipedia, he noted that “malignant narcissism includes a sadistic element creating, in essence, a sadistic psychopath. In his article, “malignant narcissism” and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984.”

Of course it never became a diagnostic category, but this doesn’t mean the combination of other disorders can’t exist in one person. Add to that the third element of what is called the Dark Triad along with sociopathy and extreme narcissism, megalomania, and the power of the president, and you have an incredibly dangerous psychopathology.

Who better to explain this to the public, and to members of Congress as Bandy Lee has to Democratic members, than mental health experts? Those who understand this have a moral and ethical responsibility to sound the alarm as Bandy Lee who doesn’t outright diagnose but still makes the case for Trump having a psychiatric assessment, and others like those in my first comment have been doing. Should we leave it up to lawyers like George Conway who wrote GEORGE CONWAY SAYS TRUMP IS A ‘MALIGNANT NARCISSIST’: HE’S ‘BOTH MENTALLY DISORDERED AND EVIL’ in Newsweek?

I don’t think so. If you had a client who told you their spouse or partner was abusing a child or threatening to harm someone it would be very clear that even without the legal backing of Tarasoff you would also have a duty to warn – a moral and ethical obligation to use what you know as a psychotherapist to protect someone in danger.

As the book title says, in the dangerous case of Donald Trump because of our being experts in assessing psychopathology in person and , when we have an incredible amount of data from observations, from afar we are the only people with the training and expertise to warn about the most dangerous person in America.

Steve took over replying to numerous comments before I posted my last one in response to Gracie:

Hal Brown,

From the daughter of a narcissist, and a close family member of a 2nd, but infinitely more abnormal and dangerous malignant narcissist, thank you for speaking out and thank you for this very sensible comment.

Those of us from around the world, as well as in the US, who have survived a malignant narcissist up close for years recognised Trump very quickly. Malignant narcissists can “ never be wrong” are hyper vigilant in their application of their psychopathy/sociopathy, devoid of empathy or conscience, delighting in sadistic pleasure, and absolutely are not just abusive, but dangerous, homicidally dangerous, deliberately dangerous.

To leave someone we recognise as an extreme example of this condition in a position of national, international, and most importantly, nuclear power is unconscionable.

To leave them in that position of power when they could be curbed or replaced with a person of the same political party is a dereliction.

To deliberately, consistently, attempt to stop people most qualified to speak on this type of person is unconscionable.

To go further to stop the media from talking about it is staggering and blatantly self-serving in some respect, whether in terms of power, political, or financially.

In years to come, IMHO, there will be a reckoning in the US, and many millions saying “why weren’t we told”.

This is what I wrote:

Gracie,

I am sorry you had these experiences and learned the hard way how toxic these people are.

In my 40 years of practice I saw many people, mostly women, who felt trapped in close relationships with extreme or malignant narcissists. If you do a web search for surviving living with a narcissist you will find numerous articles… 

https://duckduckgo.com/?q=how+to+survive+living+with+a+narcissist&t=h_&ia=web

If you search Amazon there are dozens of books with title like “Emotional and Narcissistic Abuse: The Complete Survival Guide to Understanding Narcissism, Escaping the Narcissist in a Toxic Relationship Forever, and Your Road to Recovery”

https://www.amazon.com/s?k=surviving+living+with+a+narcissist&ref=nb_sb_noss

Here’s a very brief therapy primer for treating victims of abusive relationship:

Once a trusting relationship is built, successful therapy with such people has several primary aspects. As therapists we help our clients build their self-esteem and gain insight as to what in their own personality keeps them in such a toxic relationship. But we also educate them as to why their abuser will never change no matter how many times they promise to do so. We essentially diagnose them from A DISTANCE as an extreme narcissist, sometimes combined with sociopaths, who are often master emotional manipulators. We sometimes recommend they read books on the subject.

Americans are married to Trump. Some married him the way women marry abusive men, falling in love with someone who manipulated them. Impeachment should have been a divorce. It didn’t work.

Congratulations to anyone who actually made it to the end of this lengthy Substack and who actually read every word. For thos who skimmed it I hope you got the idea. Put simply, mental health professionals were warning about Trump since 2017 and now everything they anticipated would happen, and worse, has be born out.

1

(D. Earl Stephens is the author of “Toxic Tales: A Caustic Collection of Donald J. Trump’s Very Important Letters”and finished up a 30-year career in journalism as the Managing Editor of Stars and Stripes. You can find all his work here.)

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MAGA World loves that Trump's a malginant narcissist, will they care that he's become cognitively impaired?

 

By Hal Brown, MSW, Retired psychotherapist

Few residents of MAGA World read HUFFPOST. I can tell this from from the few trolls who comment of their articles. I doubt many will read this article: 

Befuddled Trump Can't Figure Out Which Bush Did What In Bizarre Rant

I won't even excerpt the article since this wouldn't do it justise. Vox associate editor sums it up in his post on X: 

if Joe Biden confused Jeb and George W. Bush, Hannity would anchor special coverage that would last until the 2024 election

Here's another article:

'Terribly confused' Trump's rant about whales could be sign of cognitive decline: Morning Joe

If you do a search on Google with the words Trump malignant narcissism (here) you find numerious articles. Scroll down to the 32rd and you'll find one of mine.

Here's what I posted on Daily Kos.

Click above to read

For this blog I've changed the illustration.

The HUFFPOST article decribes the most recent example of cognitive confusion that any objective clinician would see as alarming indications that their patient might be suffering from early dementia. The only other explanation that I can see is that Trump's confusion about which Bush was which is due to his being under extreme stress. Of couse one explanation doesn't preclude the other.

I am not a medical clinician but I have been trained to know when a patient has symptoms that require a referral to a neurologist for an assessment. If Trump was my patient this is what I would have done when I was in practice. A neurologist would do more than administer the MOCA.

I am not even sure that if Trump took the MOCA test (above) now he would be given a clean bill of health as far as signs of early dementia.

The question as to whether his hard-core MAGA cult would care about this is something to consider. The typical member of the Trump cult is White and poorly educated. Part of the - love is not too strong a word - for him comes from his being a grandiose narcissist who rants about vegeance against his enemies. They vicarously enjoy how he relishes expressing how he'd destroy his enemies if he become president again. They not only care about him wanting to also destroy democracy but practically drool over the idea he'd become a dictator who whould empower them and push policies that express their bigotted beliefs.

Trump has built a cult of personality. It is difficult to imagine MAGA World with anyone else as its ruler. Unlike Trump's good pal Kim Jung Un he wasn't groomed to be successor to a dynasty.

There's no way Donald Jr. and certainly not Eric, could out-Trump or eve come close to equal-Trumping the original.

The salient question for Trump's reelection is whether his cult wants someone who is the embodiment of the mad king from The Game of Thrones as their leader but who is also becoming senile.

Click to read article

I can't see any of the other GOP presidential candiates coming close to having the kind of charisma Trump exudes for his cult. Trump's madness is his brand.

If you add senility, or fast developing dementia, to his madness it will be fascinating to see if he can keep a grip on the hold he exerts over his cult.

Addendum:

The only GOP candidate who actually has their own kind of charisma is Chris Christi. I think this is why Trump fears him the most. While he can never be a cult leader, and I doubt he aspires to be one, there's no doubt that the man is a commanding pressense.

Christi can equal or better the bloviating of Trump, and he does so with a razor sharp wit using fresh rather than stale retorts and talking points the way Trump does.

If it comes down to Republicans wanting a Trump-lite candidate who promises a renewal of Trump's policies only from someone who has full command of their mental faculties they will go with DeSantis or Ramaswamy. They could want someone more in the middle like Nikki Haley. They won't want Christi who is more of a Republican like John McCain was or Mitt Romney is today. Christi doesn't represent today's  MAGA Republican Party.

If I was a small government Republican rather than a big and effective government liberal Democrat I'd favor Chris Christi. He doesn't believe in America First nationalism and he doesn't want to dismantle democracy and replace it with autocracy. He is also very, very smart.

Since the GOP has done an effective job of demonizing President Biden I actually think Christi would stand a good chance of becoming the next president if he pulled a rabbit out of the hat and won the GOP nomination.

It is possible if Trump's cognitive decline contiunes to the point that it is impossible to deny unless one is a totally brainwashed member of his cult. This will leave the GOP candidates to battle it out among thmselves and Christi will then have an opportunity, to use the Mafia term popularized in The Godfather, to make his bones, and take out the other candidates.

.

Christi should educate Republicans about Trump's psychopathology

By Hal Brown, MSW

The following is from the Raw Story, above

"As far as what's going on with Donald Trump in terms of these charges, the fact is that he doesn't believe he won," he explained. "He was concerned before the election that he was losing, and I know that because he said it to me directly. So he knows he didn't win, but his ego, George, won't permit him to believe that he's the only person in America, outside the state of Delaware, to ever have lost to Joe Biden."

Christi makes a reference to Trump's ego here...

So he knows he didn't win, but his ego, George, won't permit him to believe that he's the only person in America, outside the state of Delaware, to ever have lost to Joe Biden."

What needs to be understood in this is what the ego is (in Freudian psychology and common parlance)

The ego is the personality component responsible for dealing with reality.

Everyone has an ego. The term ego is sometimes used to describe your cohesive awareness of your personality, but personality and ego are not the same. The ego represents just one component of one's full personality.

The ego operates based on the reality principle, which strives to satisfy the id's desires in realistic and socially appropriate ways. The reality principle weighs the costs and benefits of an action before deciding to act upon or abandon impulses. Reference https://www.verywellmind.co...

What Christi should have said was that "this pathological grandiose and delusional narcissist is unable to accept that he lost...." even though most people know what he means when he simply says ego.

Christi is in a position to remind people ignorant of psychology who never heard the message form so many mental health professionals that Trump is mentally unfit to be president. He can explain how his psychopathogy renders him dangerous to our democracy not only here but in the world.

Here on Morning Joe he says Trump is detached from reality. This is a diagnostic term in psychiatry.

Mental health professionals from those like the contributors to "The Dangerous Case of Donald Trump" to comparatively obscure psychotherapists like me have been educating those willing to learn about Trump's psychopathology, his malignant narcissism, mostly to Democrats, Independents, and anti-Trump Republicans, since 2016. We need someone like Christi who will educate Republicans ingorant about his psychopathology and who will hear him as he campaigns for the GOP nomination. 

Addendum:

Back in April I published the following on my blog:

Nobody knows for certain how Trump feels except Trump

Caricatures by DonkeyHotey

By Hal Brown, MSW, Retired clinical social worker and psychotherapist

This is the title of a Washington Post (subscription) article today:

Shocked and defiant: How Trump is responding to unprecedented indictment

Since a grand jury issued charges related to hush money to an adult film star, the former president has cycled through a range of emotions and postures.

This is an article by Ashley Parker and Josh Dawsey

I added this comment to the article:

Nobody knows how Trump is feeling except Trump himself. All that can be reported on with certainty is what is observable. The words "as if he is" should preface any sentence purporting to describe how he feels. Thus even the title of this article makes assumptions. This to be accurate it should read Acting shocked and expressing defiance.

Psychotherapists like me look at this through a different lens than many others. The public would gain a better understand of him if they looked up the term narcissistic injury. They will find this article by Mary Trump: Donald Trump's niece says her uncle felt "narcissistic injury" from being GOP's "biggest loser".

Even Mary Trump, a clinical psychologist, is speculating each time she describes her uncle's inner life. Her describing Uncle Donald feeling narcissistic injury makes sense. Look at the definition here and see what you think.

I am as guilty of speculating as all the other mental health professionals who have gone public with their psychological analyses of Donald Trump. Look my name up with Trump and this is what you'll find:

Click above to enlarge image

Google search of Hal Brown Trump here.

My articles and those by mental health professionals who are prominent in the field all helped inform the public as to the likely psychodynamics of Donald Trump, emphasize likely.

If a research psychologist was to construct an experiment in an attempt to determine whether a subject met various diagnostic assessments such as their being a malignant narcissist they could begin with a list of observable behaviors they would predict would manifest themselves in the future if they had the theorized diagnosis. 

Donald Trump has been diagnosed as both an extreme narcissist, a sociopath, and a malignant narcissist which combines the two disorders. We don't actually know, absolutely know, that any of these diagnostic assessments are 100% accurate.

100% certainty is a standard rarely met with a psychiatric diagnosis. There's no MRI machine to scan Trump's brain. There's no pathologist's microscope to put a slide of his mind under to see just how malignant it is.

As Trump will find out within a year or so, 100% certainty isn't even a standard relied on for conviction in a criminal court where the standard is guilty beyond a reasonable doubt.

Ashley Parker and Josh Hawley, not to pick on them, are not mental health experts. Here's an excerpt of what is in today's article:

Yet in the immediate aftermath of the grand jury’s decision related to hush money paid to an adult-film star, Trump was not happy, said one person with direct knowledge of his reaction. Others described Trump as “upset,” “irritated,” “deflated” and “shocked,” though some noted that he also remained “very calm” and “rather stoic, actually.”

Even they are relying on second hand reporting, and they only say that "others" who aren't identified described Trump's behavior. We don't know if these are people who actually were with him.

More people described in the article say they know how Trump feels:

• “He’ll do Trump,” said David Urban, a longtime Trump adviser who is not working on his 2024 campaign. “He’ll show up. He’ll be indignant.”
• “He initially was shocked,” said Joe Tacopina, a Trump lawyer, on NBC’s “Today” show Friday. “After he got over that, he put a notch on his belt and he decided we have to fight now, and he got into a typical Donald Trump posture where he’s ready to be combative on something he believes is an injustice.”
• “He has never been concerned about any story that paints him as a moral reprobate,” one Trump ally said. “His whole life and career have been full of those stories and they’ve never harmed him, in his mind.”

There's one quote at the end of the article which makes sense:

But the defiant posture seems likely to remain. In a statement, Taylor Budowich, the head of MAGA Inc., railed against the indictment and promised it would deliver Trump another stint in the White House.

The use of the word "posture" is accurate. The head of MAGA Inc. isn't saying he knows for sure what Trump is feeling. He is predicting how he will act. He's probably correct. 

Only Trump is capable of knowing whether he's playing a role or whether he's struggling to avoid experiencing fear. I say "capable" because Trump, like anyone, has psychological defense mechanisms to prevent anxiety from percolating into conscious awareness.

Bottom line:

Only this guy knows what is happening in his mind, and then only in the part of his mind he is aware of.

By definition, nobody knows what is occurring in their unconscious mind. Self-aware people can make informed guesses about this but the unconscious is not conscious. It manifests itself though feelings, behaviors, and hints as to what is going on in the recesses of our minds often comes out in our dreams.

An iceberg is often used to provide a visual representation of Freud's theory that most of the human mind operates unconsciously. Public domain

Updates:

1) In RawStory, writing about the jury pool Trump will face in NYC, Tom Boggioni writes:

Donald Trump faces the embarrassment of arraignment, fingerprinting and a police mugshot in Manhattan on Tuesday, but one legal expert suggested his worst nightmare will come from a jury made up of New Yorkers who know him all too well.

 

Here again we see Trump being described as if he is psychologically normal. He faces what we would be embarrassed by, hell, we'd be mortified. There are two meanings of the word "nightmare" of which one is being applicable here, ie. a terrifying experience. Trump may find it exhilarating. What he can't control is an actual nightmare occurring while he is sleeping. I'd say there is more chance he'll have one or more of these than his actually experiencing conscious manifestations of anxiety.

2) Michael Cohen told Joy Reid that Trump can put on fake bravado but is petrified. He has no way of knowing this is true. He ought to have said that Trump, if he was normal, would be petrified.

3) There is one thing we know for sure abut Trump. It is that yesterday he took a motorcade to play golf (article). However this was arranged, it was done is such a way that he would pass by his supporters. I think it is significant that there were no photographs of him actually playing (at least none that I could find). These might have captured expressions that suggested he was feeling the stress of being indicted.