Trump’s Mental Health: Is Pathological Narcissism the Key to Trump’s Behavior?
Diagnosing the president was off-limits to experts – until a textbook case entered the White House

BY ALEX MORRIS
AT 6:35 A.M. on the morning of March 4th, President Donald Trump did what no U.S. president has ever done: He accused his predecessor of spying on him. He did so over Twitter, providing no evidence and – lest anyone miss the point – doubling down on his accusation in tweets at 6:49, 6:52 and 7:02, the last of which referred to Obama as a “Bad (or sick) guy!” Six weeks into his presidency, these unsubstantiated tweets were just one of many times the sitting president had rashly made claims that were (as we soon learned) categorically untrue, but it was the first time since his inauguration that he had so starkly drawn America’s integrity into the fray. And he had done it not behind closed doors with a swift call to the Department of Justice, but instead over social media in a frenzy of ire and grammatical errors. If one hadn’t been asking the question before, it was hard not to wonder: Is the president mentally ill?

It’s now abundantly clear that Trump’s behavior on the campaign trail was not just a “persona” he used to get elected – that he would not, in fact, turn out to be, as he put it, “the most presidential person ever, other than possibly the great Abe Lincoln, all right?” It took all of 24 hours to show us that the Trump we elected was the Trump we would get when, despite the fact that he was president, that he had won, he spent that first full day in office focused not on the problems facing our country but on the problems facing him: his lackluster inauguration attendance and his inability to win the popular vote.


Since Trump first announced his candidacy, his extreme disagreeableness, his loose relationship with the truth and his trigger-happy attacks on those who threatened his dominance were the worrisome qualities that launched a thousand op-eds calling him “unfit for office,” and led to ubiquitous armchair diagnoses of “crazy.” We had never seen a presidential candidate behave in such a way, and his behavior was so abnormal that one couldn’t help but try to fit it into some sort of rubric that would help us understand. “Crazy” kind of did the trick.

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And yet, the one group that could weigh in on Trump’s sanity, or possible lack thereof, was sitting the debate out – for an ostensibly good reason. In 1964, Lyndon B. Johnson had foreshadowed the 2016 presidential election by suggesting his opponent, Barry Goldwater, was 
too unstable to be in control of 
the nuclear codes, even running 
an ad to that effect that remains 
one of the most controversial in 
the history of American politics. In a survey for Fact magazine, more than 2,000 psychiatrists weighed in, many of them 
seeing pathology in Goldwater’s supposed potty-training woes, 
in his supposed latent homosexuality, and in his Cold War paranoia. This was back in the Freudian days of psychiatry,
 when any odd-duck characteristic was fair game for psychiatric dissection, before the Diagnostic and Statistical Manual of Mental Disorders cleaned 
house and gave a clear set of 
criteria (none of which includes 
potty training, by the way) for a 
limited number of possible disorders. Goldwater lost the election, sued Fact and won his suit.
 The American Psychiatric Association was so embarrassed that 
it instituted the so-called Goldwater Rule, stating that it is “unethical for a psychiatrist to offer 
a professional opinion unless he 
or she has conducted an examination” of the person under question.


All the same, as Trump’s candidacy snowballed, many in the mental-health community, observing what they believed to be clear signs of pathology, bristled at the limitations of the Goldwater guidelines. “It seems to function as a gag rule,” says Claire Pouncey, a psychiatrist who co-authored a paper in The Journal of the American Academy of Psychiatry and Law, which argued that upholding Goldwater “inhibits potentially valuable educational efforts and psychiatric opinions about potentially dangerous public figures.” Many called on the organizations that traffic in the psychological well-being of Americans – like the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers and the American Psychoanalytic Association – to sound an alarm. “A lot of us were working as hard as we could to try to get organizations to speak out during the campaign,” says Lance Dodes, a psychoanalyst and former professor of psychiatry at Harvard Medical School. “I mean, there was certainly a sense that somebody had to speak up.” But none of the organizations wanted to violate the Goldwater Rule. And anyway, Dodes continues, “Most of the pollsters said he would not be elected. So even though there was a lot of worry, people reassured themselves that nothing would come of this.”

But of course, something did come of it, and so on February 13th, Dodes and 34 other psychiatrists, psychologists and social workers published a letter in The New York Times stating that “Mr. Trump’s speech and actions make him incapable of safely serving as president.” As Dodes tells me, “This is not a policy matter at all. It is continuous behavior that the whole country can see that indicates specific kinds of limitations, or problems in his mind. So to say that those people who are most expert in human psychology can’t comment on it is nonsensical.” In their letter, the mental health experts did not go so far as to proffer a diagnosis, but the affliction that has gotten the most play in the days since is a form of narcissism so extreme that it affects a person’s ability to function: narcissistic personality disorder.

The most current iteration of the DSM classifies narcissistic personality disorder as: “A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts.” A diagnosis would also require five or more of the following traits:


1. Has a grandiose sense of self-importance (e.g., “Nobody builds walls better than me”; “There’s nobody that respects women more than I do”; “There’s nobody who’s done so much for equality as I have”).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love (“I alone can fix it”; “It’s very hard for them to attack me on looks, because I’m so good-looking”).
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people or institutions (“Part of the beauty of me is that I’m very rich”).
4. Requires excessive admiration (“They said it was the biggest standing ovation since Peyton Manning had won the Super Bowl”).
5. Has a sense of entitlement (“When you’re a star, they let you do it. You can do anything. Grab them by the pussy”).
6. Is interpersonally exploitative (see above).
7. Lacks empathy, is unwilling to recognize or identify with the feelings
and needs of others (“He’s not a war hero . . . he was captured. I like people that weren’t captured”).
8. Is often envious of others or believes that others are envious of him or her (“I’m the president, and you’re not”).
9. Shows arrogant, haughty behaviors or attitudes (“I could stand in the middle of 5th Avenue and shoot somebody, and I wouldn’t lose any voters”).

NPD was first introduced as a personality disorder by the DSM in 1980 and affects up to six percent of the U.S. population. It is not a mood state but rather an ingrained set of traits, a programming of the brain that is thought to arise in childhood as a result of parenting that either puts a child on a pedestal and superficially inflates the ego or, conversely, withholds approval and requires the child to single-handedly build up his or her own ego to survive. Either way, this impedes the development of a realistic sense of self and instead fosters a “false self,” a grandiose narrative of one’s own importance that needs constant support and affirmation – or “narcissistic supply” – to ward off an otherwise prevailing sense of emptiness. Of all personality disorders, NPD is among the least responsive to treatment for the obvious reason that narcissists typically do not, or cannot, admit that they are flawed.

Trump’s childhood seems to suggest a history of “pedestal” parenting. “You are a king,” Fred
 Trump told his middle child, while 
also teaching him that the world
 was an unforgiving place and that 
it was important to “be a killer.” Trump apparently got the message: He reportedly threw rocks 
at a neighbor’s baby and bragged
 about punching a music teacher in
 the face. Other kids from his well-
heeled Queens neighborhood of Jamaica Estates were forbidden from playing with him, and in school
 he got detention so often that it
 was nicknamed “DT,” for “Donny Trump.” When his father found 
his collection of switchblades, he
 sent Donald upstate to New York Military Academy, where he could be controlled while also remaining aggressively alpha male.