Written by Maureen Herman & Katie Schwartz

image by sambeet

The presidency and public are in transition, awkwardly adjusting from Obama’s audacity of hope to Trump’s audacity of grope. As we watch Trump’s latest Twitter attack, America is living out a version of “The Emperor’s New Clothes,” with Donald Trump parading around, sporting classic symptoms of a severe personality disorder, while we bow and pretend it’s normal. If he has it, we need to question the impact it might have on the country. What if Trump had a massive tumor bulging out of his neck and the public were told it was normal, but the medical community knew otherwise, and stayed quiet? What if some of them came forward, and were ignored, attacked, or ridiculed for questioning the impact of the tumor on the president’s fitness and potentially his ability to govern? It’s not an “armchair diagnosis” or accusation — mental illness is not a crime — it’s a valid question about the presidency.

We are two people healing from long relationships with personality disordered people — one with a parent, the other with a partner. From our personal experience, knowledge, and observations of Donald Trump’s extensive public record of behavior, the new leader of the free world seems to exhibit all the known symptoms and diagnostic criteria of Narcissist Personality Disorder, aka NPD. Without questioning this possibility, there’s an elephant the size of Cleveland missing in the press and public’s understanding of Donald Trump that has been perilously sidelined. It has been challenging for us to watch as pundits attempt in futility to frame Trump’s actions in normal terms to an increasingly alarmed America, including those who supported him.

But don’t just take our word for it. Even though the writers of this piece, combined, have over five decades of experience in relationships with people who have NPD, many psychiatric professionals and journalists have come to the same conclusion about Trump and have written extensively about it.

The definition of NPD from the U.S. National Library of Medicine:

Narcissistic Personality Disorder (NPD): an enduring pattern of grandiose beliefs and arrogant behavior together with an overwhelming need for admiration and a lack of empathy for (and even exploitation of) others.

No big deal. Just sounds like another asshole, right? You might even argue that you need those characteristics to lead. This is where the “disorder” part is critical to understand as a risk. One of the writers of this piece has Major Depressive Disorder. Having mental illness is not something to be ashamed of. It doesn’t mean someone is a bad person. The point is, that with so much power, the negative traits of Narcissistic Personality Disorder can become weaponized. We’ve personally witnessed the recognizable manifestations of this disorder in Trump’s behavior and actions. This is very relevant to the presidency — if he has it, it affects all of us.

Here is the list of NPD symptoms from The Mayo Clinic:

Having an exaggerated sense of self-importance Expecting to be recognized as superior even without achievements that warrant it Exaggerating your achievements and talents Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate Believing that you are superior and can only be understood by or associate with equally special people Requiring constant admiration Having a sense of entitlement Expecting special favors and unquestioning compliance with your expectations Taking advantage of others to get what you want Having an inability or unwillingness to recognize the needs and feelings of others Being envious of others and believing others envy you Behaving in an arrogant or haughty manner

“Although some features of narcissistic personality disorder may seem like having confidence, it’s not the same. Narcissistic personality disorder crosses the border of healthy confidence into thinking so highly of yourself that you put yourself on a pedestal and value yourself more than you value others.”

image by geralt: Personality disorders are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual’s culture.

We have watched as journalists increasingly notice the behavior, but haven’t connected the dots with a potential disorder— at least publicly. After meeting with Trump in New York, in a piece titled, “Donald Trump’s Demand for Love,” New York Times columnist Frank Bruni observed:

“Winning the most powerful office in the world did nothing to diminish his epic ache for adoration or outsize need to tell everyone how much he deserves it. That was perhaps the most interesting part of the meeting, the one that makes his presidency such a question mark. Will he tilt in whatever direction, and toward whichever constituency, is the surest source of applause? Is our best hope for the best Trump to be so fantastically adulatory when he’s reasonable that he’s motivated to stay on that course, lest the adulation wane?”

As Trump begins to flip-flop on some campaign promises and continues using Twitter as a means of attack, both sides are finding themselves questioning what this presidency is really going to be like. Post-election, Trump’s thumbs are manning his Twitter account seemingly unrestrained, keeping the focus on him with tone deaf, inappropriate tweets. The press, the left, and a growing resistance movement consume his fast food diet of tweets, while trying to feed the country with the heartier fare of conflicting business interests, unsettling cabinet choices, blatant nepotism, and their grim national consequences and dangerous precedent.

For us, it has been like watching a journalist covering a blind president, and wondering why he never looks you in the eye. No matter how much you treat him like a sighted person, he will not change. You can take to social media and complain about how you were right in front of him and he didn’t see you. You can drone on about how unfair it is, how the previous president always looked you right in the eye. In fact, all the previous presidents did. The dude is blind, you guys. No amount of research is going to change that. No matter how often the press and public exhausts itself unpacking tweets about Hamilton, spending hours of research, with documentation, interviews, and cross-referencing, we believe, from our experience, that it will continue. Trump’s seeming “strategies” are very characteristic of a hard-wired psychiatric disorder that, for its sufferers, is essentially untreatable— there is no medication for it, and therapy is rarely sought or effective.

photo by Marion S. Trikosko: 1964 presidential candidate Barry Goldwater

The Goldwater Rule

Some may wonder how such important information about an elected official could be overlooked, but it hasn’t been. It’s just not talked about. The reason? The Goldwater Rule. The psychiatric community is gagged by an ethics rule enacted in short-sighted reaction to a lawsuit brought on by presidential candidate Barry Goldwater after the 1964 election. He sued FACT magazine for running the results of a very unscientific and misleading poll of 1,189 psychiatrists, about Goldwater’s mental health before the election. The poll was unfair, but there’s a very big difference between questioning a candidate’s mental health and that of a president. It is not only fair, but an imperative responsibility.

If Michael J. Fox exhibits all the publicly noticeable symptoms of Parkinson’s, it’s not unfair to come to the conclusion he may have it. However, in 1964, mental health disorders were considered something to be ashamed of, instead of the physical conditions we now know they are. And so, the American Psychiatric Association added the Goldwater Rule:

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

However, psychologists and psychiatrists commenting on a health problem that so seriously impacts the public good is consistent with the Hippocratic Oath, which says in part:

“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

The Goldwater Rule, which we feel is outdated and needs reassessing, revising, and possible removal, hasn’t precluded many psychologists from speaking out anyway, but they have been overlooked. One of the most powerful pieces on the subject was a cover story in The Atlantic by Dan P. McAdams, a professor and chair of the Northwestern University Department of Psychology. In a comprehensive piece titled “The Mind of Donald Trump: Narcissism, disagreeableness, grandiosity — a psychologist investigates how Trump’s extraordinary personality might shape his possible presidency,” he addresses the very relevant nature of narcissistic psychological pathology and its impact on a presidency:

“A cardinal feature of high extroversion is relentless reward-seeking. Prompted by the activity of dopamine circuits in the brain, highly extroverted actors are driven to pursue positive emotional experiences, whether they come in the form of social approval, fame, or wealth. Indeed, it is the pursuit itself, more so even than the actual attainment of the goal, that extroverts find so gratifying. When Barbara Walters asked Trump in 1987 whether he would like to be appointed president of the United States, rather than having to run for the job, Trump said no: “It’s the hunt that I believe I love.” Indeed, anger may be the operative emotion behind Trump’s high extroversion as well as his low agreeableness. Anger can fuel malice, but it can also motivate social dominance, stoking a desire to win the adoration of others. Combined with a considerable gift for humor (which may also be aggressive), anger lies at the heart of Trump’s charisma. And anger permeates his political rhetoric. The real psychological wild card, however, is Trump’s agreeableness — or lack thereof. There has probably never been a U.S. president as consistently and overtly disagreeable on the public stage as Donald Trump is. If Nixon comes closest, we might predict that Trump’s style of decision making would look like the hard-nosed realpolitik that Nixon and his secretary of state, Henry Kissinger, displayed in international affairs during the early 1970s, along with its bare-knuckled domestic analog. That may not be all bad, depending on one’s perspective.”

Can a diagnosis be made by observing someone’s behavior? One of us is a recovering alcoholic with thirteen years of sobriety. When I was an active alcoholic, my symptoms were classic. I personally believe anyone familiar with alcoholism, observing my behavior and especially its impact on others, would be able to responsibly diagnose me. In fact, given the danger to myself and others, I think they would be remiss not to. Alcoholism affects the brain — arguably one of the most important organs right up there with our lungs and heart. That’s why the Surgeon General now classifies addiction as a brain disorder. Mental health is physical health. In our experience, NPD can be red-flagged by the negative impact on those the afflicted person interacts with — in the case of the presidency, its impact on American lives.

Michaelangelo: Michelangelo’s “Narcissus”

The Impact of Narcissism

We believe, if we’re all exposed to someone who has the flagrant symptoms of NPD at such a frequent and daily level, we need to get very familiar with what that means very fast, because it can seriously impact our national security, freedom of the press, and individual freedom of speech. It’s hard for us to watch people allude to NPD behavior as a political strategy, without saying something.

NPD is not a minor condition. Personality disorders (PD) are organized into three “clusters” based on their similar symptoms and characteristics. Narcissism is in Cluster B, together with Antisocial personality disorder, Borderline personality disorder, and Histrionic personality disorder. The disorder has recognizable and diagnosable features. So, if someone defines narcissism as confidence or an inflated ego, they don’t know what NPD is. Most people don’t. We certainly didn’t, until we sought treatment and understood what we were dealing with and how it was affecting our very identities.

That’s why we feel strongly that Americans need to know how they may be affected. Our society often normalizes this pathology — specifically in men, who are the majority of the afflicted. One major characteristic of NPD is a lack of empathy. That is not a healthy characteristic for anyone who is supposed to look out for the interests of all Americans. There are tests for NPD, and we believe presidential candidates should undergo a rigorous mental health exam for fitness to serve, especially for any conditions that would affect national security, domestic stability, the economy, or cause civil unrest, to name a few. If a candidate needs to be in functional physical health, mental health must by definition be included.

While Trump’s meteoric rise was seen by many as a partisan issue, to us, it feels like a grave national security issue and a public health crisis. Imagine the advantage a foreign power would have in understanding and exploiting any predictable behaviors and reactions of a president with a personality disorder?

Jesusemen Oni / VOA: America is awkwardly adjusting from Obama’s audacity of hope to Trump’s audacity of grope.

Regarding public mental health, NPD by its very nature is manifested in the relationships between the narcissist and those he is in contact with. That is why the most common route to diagnosis is via the NPD’s victims, who often suffer from narcissistic abuse. Psychiatrists with expertise in Cluster B disorders and NPD pathology should have been part of the election and post-election narrative, as a public service.

At a 2015 rally in Iowa, Trump himself said of Ben Carson, now tapped for HUD Secretary, “I don’t want a person that’s got pathological disease. I don’t want him. He’s saying he’s a pathological liar. He actually said he’s got pathological temper and then he defined it as a disease. Pathological, there’s no cure.”

Not only is there no cure, but for narcissism in particular, it is rare to seek counseling, because of their egotistical persona. It is their victims who most commonly seek help. Narcissistic abuse is a subject we’re both painfully and thoroughly familiar with. We have seen our own symptoms crop up in the public psyche. We are seeing abuse victims targeted in the same way we were targeted.

Narcissists crave attention, and it doesn’t matter if it’s positive or negative attention. That’s how they get their fix of what is known as narcissistic supply. From our perspective, having been sources of this supply, we see how the media has played a similar role. To us, watching Trump’s rallies and hearing his plans for a “victory tour“ are red flags.

Whether he has NPD or not, Trump has spent 17 months systematically chipping away at the public’s confidence in our branches of government and the media, particularly The New York Times. He prioritizes discrediting journalists who criticize him to an alarming degree. But it is not alarming if you understand narcissism. We watch as the media are being attacked and summoned for doing their jobs: informing Americans about important issues that affect them. We both know that people with this disorder take any and all criticism personally and find it near impossible not to react. This is known in psychology as narcissistic injury and narcissistic rage.

It has been frustrating to watch people try to analyze the puzzling behavior we are so familiar with. The New York Times even published an exhaustive list of people, places, and things Trump has insulted from his Twitter account. If Trump does have this mental health condition, we are concerned it could result in crisis.

Photo by Maureen Herman: Read all about it

The Press

Scrolling through Twitter, we watch as journalists we respect start to show signs of fatigue at having major stories ignored. We know the feeling. We recognize it. In fact, for one of us, the debates were like a typical argument with the narcissist in our life:

“During one of the many arguments, he kept interrupting me so much, I set a timer and asked him not to interrupt me for three minutes. He agreed, and then continuously interrupted me, turning the discussion into a three-hour tangle of tangents and distractions that kept the focus off of his behavior and his accountability for it. Defeat. Surrender. It seems easier to lose the little battles, but they start becoming big ones. I started to accept the bad behavior instead of fight it. That is what I came to understand as “managing down expectations.” I just wanted to get through the day. I put up with things I never thought I’d put up with. I began to normalize them, because fighting was futile and exhausting. Facts didn’t sway.”

What concerns us is that, from our observations, we are about to be governed by a person with the same malevolent behavior we spent years trying to disengage from, at no small price. if NPD is a factor, we feel strongly that the public needs exemplary reporting and that the press be armed with the knowledge to respond accordingly. Trump is riddled with unprecedented conflicts of interest before even taking office, and we feel his mental health issues are not only relevant, but imperative.

We urge the press and public to understand what Narcissist Personality Disorder is. It manifests as impairments in the way someone functions and interacts with others, combined with the specific pathological personality trait of antagonism, characterised by grandiosity and attention seeking. We feel the finer points are something the public should promptly familiarize itself with.

The negative effect of NPD happens in stages, and we have watched Trump’s relationship with both his supporters and his detractors, and it is very familiar to us. In a classic NPD relationship, first comes the love-bombing: the narcissist tells you what you want to hear. Then they manage down expectations: doing whatever they want, and expecting or demanding that you accept it without incident. Now, the pathological lying comes full force: you call them out on what they said or did and they vehemently deny it, making you question your sanity. Then comes the devalue stage: because you questioned or criticized them, they discredit you. Now, the discard: the punishment and alienation begins, and any attempts to please them are used to gain more control over you. It doesn’t end there. The cycle continues and the disorder becomes your new normal. It’s not.

There are known narcissistic terms, strategies, and agendas. We urge the media to learn the terminology, and use it: love-bombing, gaslighting, devalue & discard phase, narcissistic abuse, managing down expectations, and flying monkeys (e.g. Kellyanne Conway).

We have often had to translate language from the narcissists in our life from NPD-speak into English. Some examples of things the president-elect has said that are very similar to the NPD-type statements we are so familiar with:

Statement: Just had a very open and successful presidential election. Now professional protesters, incited by the media, are protesting. Very unfair! @realdonaldtrump Our Translation: Celebrate me! Shower me with love and adoration! Worship me! I am your king! Fall in line! Statement: Love the fact that the small groups of protesters last night have passion for our great country. We will all come together and be proud! @realdonaldtrump Our Translation: Dishonest media saying thousands of protesters! Statement: I settled the Trump University lawsuit for a small fraction of the potential award because as President I have to focus on our country. @realdonaldtrump Our Translation: I am not a fraud! You don’t know me! I made people millionaires! I’m a national hero!

Statement: The ONLY bad thing about winning the Presidency is that I did not have the time to go through a long but winning trial on Trump U. Too bad @realdonaldtrump Our Translation: I’m a winner, not a loser! Statement: I worked hard with Bill Ford to keep the Lincoln plant in Kentucky. I owed it to the great State of Kentucky for their confidence in me! @realdonaldtrump Our Translation: I saved thousands of jobs! I’m a hero to my subjects in Kentucky! Statement: If the election were based on total popular vote I would have campaigned in N.Y. Florida and California and won even bigger and more easily @realdonaldtrump Our Translation: I’m a winner! No matter where I go, I win! Nobody beats me at anything EVER!

People with NPD target victims

For us, watching the election has been an exercise in re-traumatization. One of us has survived a parent who was a narcissist, and know how it feels to be mistreated and feel pathologically beholden, incapable of realizing that what was happening was abnormal. Healing has been arduous:

“The enormity of my pain this past year has been unfathomable, wrestling with feelings of rage, frustration, shock, emptiness, mourning and prolonged sadness. Feelings of shame are dissipating, though my inability to discuss it or write about it in complex detail feels seemingly impossible. The narcissist informed every aspect of my life. In the context of this article, I felt compelled to share this.”

There are typical consequences and known reactions of approaching someone with NPD. If you think an alcoholic in denial is a tough nut to crack, you ain’t seen nothin’ yet. Though narcissism can appear across all social strata, it’s a cookie cutter disorder in that the behavior, reactions, and strategies, as NPD abuse victims know well, are identical. We think it’s important to study this and understand that there are strong reactions to be factored in to approaching anyone with NPD. We also think it’s it’s time to name things and call them what they are:

“Fake news is propaganda. The powerful demanding apologies from artists is censorship. Business dealings while in office are corruption. Threatening protesters and petitioners is authoritarianism. Declaring a minority an internal enemy and calling for militarized unity is fascism. Everything starts with naming these things in public. Resistance starts with plain speaking.” (From @AlexSteffan on Twitter)

From our perspective, we don’t feel the press or the public can afford complacency or submissiveness about the possibility of this scenario. The press and people who voted both for and against Trump have a right to understand the kind of person he is, and the kind of president he will be. From our hard-won experience, doing nothing, or tolerating negative behavior from a narcissist, does not protect you or keep the peace — it is an invitation for more bad treatment. So we feel the question of a president’s health — both mental and physical — merits asking. As our 26th president put it:

“To announce that there must be no criticism of the President, or that we are to stand by the President, right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public.” ― Theodore Roosevelt

If you stare at this map for one minute, changes are good that Donald Trump has tweeted another divisive and petty reaction to a perceived slight.

Update from the authors: We’ve heard from many readers who have come through experiences like ours. Please read a collection of excerpts from survivors of narcissistic abuse. We hope that you’ll share yours with us, too: katiegirl(at)gmail(dot)com