Medical Mysteries: Diagnose Trump and Santos

 Medical Mysteries: Diagnose Trump and Santos

By Hal Brown, MSW, Retired psychotherapist and mental health center director

I subscribe to a medical newsletter which regularly has a "medical mystery" article which has a quiz of sorts where a patient is described with a list of presenting problems and symptoms. Then the reader goes through a number of pages which asks questions as to what the reader thinks the diagnosis is. The New Yorker may not be publishing these anymore, but they used to have articles about medical mysteries where a  patient presented with unusual symptoms and the quest to determine the rare disorder was described.

Now we have two politicians who present a psychiatric diagnostic conundrum. 

Trump was the easiest until recently. Numerous mental health professionals went public explaining how he fit the (unofficial) diagnostic criteria for being a malignant narcissist. By now I should have the link to this Wikipedia entry memorized having posted it so often in my articles.

Today we have two Raw Story articles related to Trump's mental health:

Click above to read

George Conway isn't a mental health professional and may or may not be using the reference to losing touch with reality colloquially or clinically. Perhaps he means them both way since he has demonstrated that he's psychologically very well informed. Not being in touch with reality, that is being able to differentiate what is real from what isn't real (called "reality testing") is a hallmark of someone who is on the verge of having a psychotic episode or already being psychotic. 

This summarized an article in the conservative National Review:

Click above to read

Consider this excerpt:

National Review columnist Charles C.W. Cooke believes that former President Donald Trump has been more unhinged than usual, and his latest essay examines what he describes as Trump's "deterioration" as observed through his Truth Social posts.

Cooke describes Trump as "ranting like a deranged hobo in a dilapidated public park" and he notes that his Truth Social posts are loaded with esoteric references that only his diehard fans can even begin to understand.

Note the words unhinged and deranged both of which are slang for someone who is be psychotic. The message being conveyed here is that his behavior has worsened to the point he may be veering into psychosis.

HUFFPOST had this article about the Cooke piece in The Wall Street Journal and offered this excerpt:

“There was a point in time at which Trump’s unusual verbal affect and singular nose for underutilized wedge issues gave him a competitive edge. Now? Now, he’s morphing into one of the three witches from Macbeth. To peruse Trump’s account on Truth Social is to meet a cast of characters about whom nobody who lives beyond the Trump Extended Universe could possibly care one whit.”

I used up my last free Wall Street Journal click to read the article and noted the first sentence: "The former president’s deterioration is on full display in the Truth Social asylum he built for himself." The word deterioration is often used in psychiatry and in the same sentence with asylum it seems the writer is making the case that Trump is ready for the rubber room.

Here's how the WSJ article ends:

Throughout his public career, Trump has resembled nothing so much as a drunken talk-radio caller from Queens, and, on Truth Social, readers get the treat of watching him at the zenith of his rhetorical powers. Nobody — and I mean nobody — can shift gears as fast as Donald J. Trump. One moment he’s proposing that the solution to the Supreme Court leak is to “arrest the reporter, publisher, editor—you’ll get your answer fast,” or, if that fails, “put whoever in jail.” The next, he’s describing the prosecution of his business associate, Allen Weisselberg, as “the greatest Witch Hunt of all time.” His repertoire is unmatched — and unmatchable. He can do edgy insult comedy for the people listening in at the bar: “The reporter was a shaky & unattractive wack job, known as ‘tough’ but dumb as a rock.” He can make numbers up off the top of his head: “The change in the Election was Complete & Total, with Millions of votes switched, at least 17%.” He can use hyperbolic analogies: “Our Country is SICK inside, very much like a person dying of Cancer.” He can even do angry: “May he Rot In Hell!” He can do anything.

Anything, that is, except focus on the world outside — where the problems that Donald Trump once used to propel himself into the White House remain real and pressing, whether or not he chooses to engage with them.

Several times a week it seems there are news reports of Trump lying with no regard for, or not caring about, the bad publicity it will generate. For example: 

Click above for MSNBC story.

We know Trump is impulsive. We don't know if he has an impulse control disorder, or whether his impulsivity is part of another disorder.

In this age of QAnon and election denial there are so many people who believe things that are both irrational and false that researchers have looked into and discovered that the rates of people suffering from mental illness are much higher. than previously thought. Consider this article in The Conversation: 

Many QAnon followers report having mental health diagnoses

Back in 2020 I wrote 

What psychotherapists can't tell us about Donald Trump. Why does he lie? Will be become psychotic?

Hardly a day goes by that one or more Trump Truth Social posts make the news. Many of them are rants that come close to or cross the border between rationality and irrationality. 

As far as George Santos goes, just this morning there are the following articles on Raw Story:

Clockwise from left by first words in title: Bizarre, Complete Chaos, Man Listed, Critics rip.

Since putting together this story collage another Santos story went up on Raw Story:

Click above to read

Updates: 

George Santos made 'offensive' past joke about Hitler and 'The Jews': report

View - Screenshots from over a decade reviewed by Patch show Rep. George Santos has what the ADL called a "deeply offensive" social media history.

George Santos was 'sweet and caring' — until he started stealing from everyone: ex-boyfriend

Posted Fri. Jan. 27:

George Santos appears to admit drag queen past in Wiki post

A user with the name Anthony Devolder wrote in 2011 that they won several drag pageants. Anthony Devolder is a Santos alias.

All of these articles paint a somewhat different picture of Santos but what they have in common is that they describe someone who, to be trite, just isn't normal.

Over my 40 years as a psychotherapist diagnosing uncountable patients I find Santos to be presenting a medical, or psychiatric if you prefer, mystery. Diagnostically the question about Trump and his diagnosis is easier because he has, probably since early adulthood, been a malignant narcissist. 

Currently the question, the mystery, is whether or not he is either becoming irrational because he is having narcissistic rage episodes (read article) or is becoming psychotic.

Santos may just be a stupid sociopath (now called anti-social personality):

Antisocial personality disorder, sometimes called sociopathy, is a mental disorder in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to antagonize, manipulate or treat others harshly or with callous indifference. They show no guilt or remorse for their behavior. Reference

Most addressing this in the general media seem to believe this is the case and don't go deeper by delving into other possible explanations for his behavior.

There are other possibilities. 

The first that comes to mind may be the least plausible but I think of it because of Hershel Walker. Walker wrote a book (probably ghost written) about how he overcame having a dissociative identity disorder, commonly called multiple personality disorder. I am skeptical about the truth of this but it does explain some of Walker's behavior. It also could explain some of Santos's behavior. While most common in women who were sexually abused as children, it conceivable that Santos actually has different personalities (called alters) some of who have amnesia for that the others do.

We do know that Santos, on the surface at least, is a serial liar since it isn't telling a lie if you don't remember doing something you really did. There's no official psychiatric diagnosis for being a serial liar. Like Trump, Santos has lied many times and paid no heed to the fact that his lies could easily be exposed as such. Of course if it was a horse race Trump would cross the finish line while Santos was just leaving the starting gate.

Santos could have a borderline personality disorder, also known as emotionally unstable personality disorder. This is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions.Wikipedia

My sense is that there is evidence he has histrionic personality disorder. It is defined as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval.Wikipedia

No matter what one might deign to diagnose either of these individuals as having Trump is exponentially more dangerous since his cult doesn't care whether he's batshit crazy or not.  Santos is a gift to Democrats. Read  Santos leads the GOP in eliciting Schadenfreude, no doubt more to come.

 Watch satire of supporters of George Santos from his home district explain why they support him: