Is Trump is spiraling into a delusional personal reality that could become outright psychosis? By Hal Brown, MSW, Retired psychotherapist

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.

Read previous blogs.

Putting aside Trump's dangerous psychopatholgy we're left with his personality, by Hal Brown, MSW, retired psychotherapist

 

Yesterday I wrote about Trump's psychopathology:

Does Trump have a mental illness and if he does does this make him dangerous and unfit for office? 

Today I will focus on what most readers of this blog consider to be his vile odious personality.

Having what at least half of the country considers to be a vile odious personality doesn't make someone unfit to be president. It merely could mean that they will have trouble getting elected, and if elected will have difficulty working with staff and world leaders. 

Without analyzing the why of Trump's behavior which leads to his having the personality which he does, I will consider how the most unpleasant aspects of it are manifest in his behavior. 

* He is just plain nasty. Without skipping a beat reverts from talking about issues to hurling insults at his rivals. It matters little that these insults are often juvenile. What matters is that he revels in making them whether in a Truth Social post, interview, or to cheers at a rally. 

* He takes a normal and healthy aspect of someone else's personality and turns it against them. For example saying about Kamala Harris "do you see how she laughs, that's the laugh of a crazy person."

* He brags about himself all of the time whether he's alone posting online or in front of others. The focus of attention has to be on him. He has no interest in how anyone else feels or whay their ideas on a subject are.

* If it was possible to lie one's ass off Trump wouldn't have the ample posteria he does. How would you feel if you had to be in the company of someone who not only never stopped talking about how great they were but lied non-stop to prove it?

* He thinks he's a comedian, but he tells a jokes, often using insult himor, as well as he dances. I am sure he believes he's a great dancer. In truth  he makes Elaine Benese's Little Kicks dance on the classic Seinfeld episode (view it here) look like a Broadway musical casting director's dream. George described it as looking like a full-body dry heaves set to music. (By the way, Kamala can dance - video.)

Have you ever been with someone who tells decidedly unfunny jokes and expects you to laugh at them? Have you ever been at a dance where someone (hopefully not someone you went there with) tries to hog the attention by getting in the middle of the room and, even if they can dance, tries to show what a super dancer they are.

The question sometimes asked in polls is which candidate the respondents would rather have a beer with. This is described as "the beer question" on Wikipedia as follows:

The beer question is a thought experiment in politics that attempts to measure authenticity and likability in politicians by asking or polling voters about which politicians they would prefer to drink beer with, as in, spending casual time "hanging out" with. The question has been discussed as far back as the 2000 United States presidential election, as well as in the context of fictional political works such as The West Wing. The question has been criticized for the gender bias implicit in referencing a predominantly male drinking culture, and some have questioned the relevance of likability in choosing candidates for public office.

At present Harris leads Trump in a beer poll that predicted past winners (read Newsweek article). Excerpt:

A Bullfinch survey of 1,500 registered voters, spread equally across the three key swing states of Michigan, Pennsylvania and Wisconsin, showed that 40 percent overall would prefer to drink with Harris, compared to 36 percent who said the same for Trump. More than one in five voters (21 percent) said they would rather drink alone than with either the Democratic or Republican presidential hopefuls.

In 2016, a Rasmussen Reports survey found that 45 percent of likely voters said they would prefer to have a beer with Trump over his Democratic election rival Hillary Clinton (37 percent).

In 2008, polls suggested Barack Obama was the candidate whom voters would rather have a beer with over his Republican challenger, John McCain.

George W. Bush won reelection in 2004 as he was widely considered the guy "you'd rather have a beer with" over John Kerry. A 2004 Zogby/Williams Identity poll that year found that 57 percent of undecided voters would rather have a beer with Bush than Kerry.

These poll numbers suggest that personality is a factor in who wins presdiential elections. 

For fun I'd much rather have a beer with Kamala. However, as a blogger and retired psychotherapist who has been writing about Trump's psychopatholgy since 2016, if given the choice I'd opt for having a beer, or a cup of coffee or Diet Coke, with Trump. 

As far as I know Trump has never sat down for an informal conversation with an experienced psychotherapist whose, please forgive the lack of modesty, colleagues used to liken to Columbo in figuring out a client's personality they way he figured out who the killer was.  40 years of experience taught me to see through, to put it bluntly, the bullshit to see the real person. 

I am open to being proved wrong about my opinions about him. As a lefty I still need my right arm, but metophically I would give it up to have a chance to do this.

Comment from Pytho Black 

17 minutes ago·mmpmagicmodernizationproject.com

I just read this in another blog, an hour or so ago.

“…the stupider one is, the closer one is to reality.  The stupider one is, the clearer one is.  Stupidity is brief and artless, while intelligence wriggles and hides itself. 

Intelligence is a knave, but stupidity is honest and straightforward.  I’ve led the conversation to my despair, and the more stupidly I have presented it, the better for me.” –Ivan Karamazov, The Brothers Karamazov

Of course, it is easy to see how Ivan and somebody we know have a common nature. And all those somebodies who love and support that aforementioned somebody we know, they too have something in common with good old Ivan, at least in the sense of his statement regarding stupidity.

But leaving psychopathology aside for a moment, I want to say something about fools. In my old age I have developed an approach different from suffering those I considered to be fools out of benevolent exasperation, to seeing myself through their eyes, and who is the fools then?

Now, poor Donald John Trump cannot help it that he is a pathological narcissist. You of all people should know that, or else your life’s work was based on mere vanity and greed. Maybe some nerve got twisted in the womb, or from some trauma at an early age, or exposure to gamma radiation in his baby food, or god-only-knows what kind of series of circumstances that caused him to transform into the charismatic obscenity that he has become.

I feel sorry for him, and for the people who are sucked into his tornado of pathology. It has to feel good, has to stimulate endorphins, has to cause one to feel less like a fool and more like a victim of those other fools tobe on the side that adores and supports such a person. He truly is a kind of Jesus, just as delusional, just as deranged, just as mythological.

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