If Trump believes some of his pronouncements he may be clinically delusionalBy Hal Brown, MSW
I am tired of writing about Trump's psychopathology. Today's HUFFPOST story "Trump Says Biden 'Convinced' Putin To Bomb Ukraine In Mar-a-Lago Campaign Speech" prompts me to write yet another blog story about the question as to just how mentally ill the beleaguered former president might have become.
We know he's a malignant narcissist, but how can we tell whether he is veering into becoming a delusional psychotic?
In half of my 40 year career as a psychotherapist I worked in a community mental health center. Most of the severely mentally ill patients I worked with had been stabilized on medication so I only had a few chances to see someone exhibiting the delusions that were manifest prior to being stabilized on medications. Those times I did see patients who weren't medicated their delusions were the more typical. Several patients off medication had religious delusions and another believed a movie star was in love with him to the extent he ended up at the airport trying to board a plane without a ticket to be with his lover in Hollywood.
When a clinician does a diagnostic assessment they evaluate the patient's rational thinking and reality testing. A simple mental status exam includes the following (reference):
- Thought process
The flow and coherence of thoughts, inferred from a client’s observable behaviors, especially speech. For example, if the client’s speech is rambling and disorganized, the examiner may infer that their thinking is also disorganized. - Thought content
Thought content can be inferred from spontaneous speech and direct questioning by the examiner. For example, the examiner might ask, “Have you ever heard things other people don’t hear or seen things other people don’t see?” An answer of “yes” to such questions raises the possibility of hallucinatory thought content. - Insight
How aware is the client of their own strengths and limitations? - Strengths and limitations
Traditional forms of the MSE have been designed to record any cognitive, emotional, or behavioral deficits. Consider how a clinician would fill out portions of a standard mental status form like this, in particular the parts below, for Trump:
Here's more
Delusional disorder, previously called paranoid disorder, is a type of serious mental illness called a psychotic disorder. People who have it can’t tell what’s real from what is imagined.
Delusions are the main symptom of delusional disorder. They’re unshakable beliefs in something that isn’t true or based on reality. But that doesn’t mean they’re completely unrealistic. Delusional disorder involves delusions that aren’t bizarre, having to do with situations that could happen in real life, like being followed, poisoned, deceived, conspired against, or loved from a distance. These delusions usually involve mistaken perceptions or experiences. But in reality, the situations are either not true at all or highly exaggerated. From WebMd
Perhaps Trump is already so detached from reality that any mental health professional would diagnosis him as having a psychosis. There's no way to tell how much of his pronouncements are performances and what he really believes.
Anybody who truly cares about his well-being ought to be very concerned about his lapsing into a psychotic state. Consider what you would do if you had a loved one who was expressing some of the beliefs Trump has been expressing.
Those who consider him the leader of the GOP, those cult members who blindly follow him, should also ask themselves whether they are being led by someone who is so unmoored from reality that they may be clinically delusional.
Another question which researchers could well look into is whether someone who deliberately uses gaslighting (defined as manipulating someone so as to make them question their own reality) for their own purposes can eventually gaslight themselves.
Marjorie Taylor Greene as an example of a low information and gullible person as opposed to being delusional
Just yesterday Rep. Greene addressed her pervious belief in QAnon conspiracy theories:
This doesn't mean they are clinically delusional. It may suggest that they have a low IQ but above average intelligence isn't a requirement for holding public office.
If anyone running for a major political office had to have above a 120 IQ and pass a battery of psychological tests I venture to suggest that the GOP side of the House would look very different. To the delight of Democrats, the GOP itself wouldn't be having to deal with this guy:
Update:
Thanks for blending in criteria. This helps secure our assertions that he is not mentally fit to hold any public office.
Mentally fit - I do not believe it matters whether genetics, experiences, trauma, parenting or personal choices have led us to this place of a fellow who simply blathers about in social media. He has no ability to filter. Delusional disorders is the correct section of DSM 5-TR to be reading and giving consideration. That section, in addition to considering his personality disorder cluster, should be the hub of any diagnostic conversation wheel we use to chat about how best to manage our feelings about him, vis-a-vis his repeated insistence on being vocal on social media.
There is a misperception of who might be considered "mentally ill." What I am referring to is the first defense he threw out to his crowd, "I'm rich!" Is there something about being wealthy that magically inoculates a person against mental disorder? I would offer the converse argument. Mo' money, mo' crazy. You need sage and sound counsel to help you manage your false-bottomed sense of total safety and security while living on this planet.
Donald simply does not know when to shut the f#$k up.
I am reminded of a training video in which Dr. Sal Minuchin was interviewing a patient with disorganized thinking. To characterize just how disturbing it is to the treatment professional to work with these folks day after day, Sal could not restrain himself and uttered, "What are you talking about??" in a most directive manner, hoping to encourage the client to get back on track.
In delusional disorder, there's no thesis, no theme, no specific argument, no path that gets to anywhere. It is walking with a person who is lost in the forest and then finds yet another distraction. Being lost is the entire point of their delusion. It is how they guard against the reality of life. Life breaks through their ordinary protections with ordinariness.
THat's much, much more than they can handle.
The warning we who study the disordered persons and the qualitative/quantitative means by which they've gotten into the swamp they are in, need to heed is in the sheer number of people who are also in that swamp with him, and who came to that swamp, expecting to find a country club swimming pool. His ability to hold them in a promise of prosperity has increased whatever disordered thinking and feeling these folks experienced prior to believing his siren song.
Crazy draws more crazy to itself. There's kinship in delusional status.
Is Donald delusional? I think I agree with that assertion, and I encourage other helpers and human services workers and professionals to see the dead poseys in the hands of their clients, and although you want to be kind and offer unconditional positive regard, keep the truth in your head that no matter what else you hear, those flowers are dead.
Donald is holding out dead flowers to his followers. That's what he's selling them. Dead flowers, purporting to re-animate them and make them alive again...
If you are a realist like I am, then you see how difficult it will be to convince folks who drank his dead flower tea to walk away from believing the delusional reality they've walked through the looking glass and entered.
Below from Tibel:
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