The consensus as to Donald Trump's psychiatric issues is nearly unanimous. "Textbook narcissistic personality disorder," according to clinical psychologist Ben Michaelis, quoted in Vanity Fair. He is just one of many who have reached the same conclusion. Noting his motor mouth, chronic inability to pay attention and shockingly deficient impulse control, others diagnosed Trump as a severe case of Attention Deficit Hyperactivity Disorder. Tony Schwartz, Trump's ghostwriter for his 1987 bestseller, The Art of the Deal, reported that his client had no attention span and fidgeted "like a kindergartner who cannot sit still."

In an election cycle where a candidate has been accused of unprecedented misconduct, including the latest allegations of sexual assault by multiple women, psychiatrists are bypassing the long-held professional standard, called the Goldwater rule, which stipulates that no psychologist should make a diagnosis of a person he or she has not examined face-to-face.

As a stressed electorate tries to make sense of a campaign unlike any other, they're demanding to know: What is the root of Trump's bizarre displays?

Story continues below advertisement

Making inferences about someone's mental health is common sport with public figures. We don't have the same data a psychiatrist or psychologist might have, but as candidates' histories are revealed in biographical articles or books, and their behaviours are scrutinized in public forums, certain patterns become clear.

What we perceive as the adult personality often reflects compensations a helpless child unwittingly adopted in order to survive. Such adaptations can become wired into the brain, persisting into adulthood. Underneath all psychiatric categories, Trump manifests childhood trauma. His opponent Hillary Clinton evinces her own history of early suffering, even if milder and far more muted in its impact.

The ghostwriter Schwartz reports that Trump had no recollection of his youth. There is always a reason for such amnesia. People have poor recall of their childhoods when they found reality so painful that their minds had to push memories into the unconscious. "I don't like to analyze myself because I might not like what I see," Trump admitted to a biographer.

According to biographers, Trump's father was a workaholic, a ruthless, cold and authoritarian man who believed life is a competition where the "killers" win.

Donald's elder brother drove himself into alcoholism, a common escape from pain, and to an early death. The younger, favoured child is now self-destructing on the world stage.

Lying is such an endemic aspect of Donald Trump's personality that he does so almost helplessly and reflexively. "Lying is second nature to him," Tony Schwartz told The New Yorker. "More than anyone else I have ever met, Trump has the ability to convince himself that whatever he is saying at any given moment is true, or sort of true, or at least ought to be true."

How are such patterns compensations? Not paying attention, tuning out, is a way of coping with stress or emotional hurt. Narcissistic obsession with the self compensates for a lack of nurturing care. Grandiosity covers a deeply negative sense of self-worth. Bullying hides an unconscious conviction of weakness. Lying becomes a mode of survival in a harsh environment. Misogyny is a son's outwardly projected revenge on a mother who was unable to protect him.

Story continues below advertisement

Trump's opponent also appears to have learned reality-denial at an early age. Her father, too, according to biographic reports, was harsh, verbally abusive, and dismissive of his daughter's achievements. The opaque persona many now see as inauthentic would have developed as young Hillary Rodham's protective shell.

In an anecdote related by the former Secretary of State herself as an example of salutary character building, four-year-old Hillary runs into her home to escape neighbourhood bullies. "There is no room for cowards in this house," says her mother, sending the child out into the street to face her tormentors. The real message was: "Do not feel or show your pain. You are on your own." Over six decades later the candidate hides her pneumonia even from her doctor and from those closest to her. Repeatedly she has overlooked her husband's outlandish infidelities, defending him against disgrace – no doubt suppressing her own emotional turmoil in the process.

It is not surprising that when the Oxford University psychologist Kevin Dutton analyzed the candidates, he scored both Trump and Clinton in the upper quintile of self-centered impulsivity and coldheartedness. Trump rated high on traits of psychopathy, between Idi Amin and Adolf Hitler.

We Canadians are no strangers to political leaders whose childhood suffering formed their personalities and infused their policies. The journalist and Stephen Harper biographer John Ibbitson characterized our former prime minister as "autocratic, secretive, and cruel." A journalist described him as "chilly and inscrutable," while his former chief of staff recalled him as "vindictive, prone to sudden eruptions of white-hot rage over meaningless trivia." These traits, too, are uniformly markers of trauma. Unsurprisingly, Harper also resisted discussing his childhood.

No infant is born a bully, cruel or cold-hearted. Well-nurtured children mature naturally past infantile self-regard, develop impulse control and find empathy. They learn to feel and regulate their emotions. In the case of those who do not, there is pain they are unable or unwilling to confront. Their development was distorted.

A political leader in denial of his trauma may be so little able to bear his core pain, fear and weakness that he will identify with the powerful, disdain and attack the vulnerable. Or, behind a false persona, she vows to support the downtrodden while kowtowing to the rich and dominant.

Story continues below advertisement

What does it say about our society that such deeply troubled individuals frequently rise to the top ruling circles, attaining wealth and power and even the admiration of millions?

We need not be perplexed that a Donald Trump can vie for the presidency of the most powerful nation on Earth. We live in a culture where many people are hurt and, like the leaders they idolize, insulated against reality. Trauma is so commonplace that its manifestations have become the norm.

People are anxious, fearful and aggrieved and may be unable to recognize the flaws in those seeking power. They mistake desperate ambition for determination, see grandiosity as authority, paranoia as security, seductiveness as charm, dogmatism as decisiveness, selfishness as economic wisdom, manipulation as political savvy, lack of principles as flexibility. Trauma-induced defences such as venal dishonesty and aggressive self-promotion often lead to success.

The flaws of our leaders perfectly mirror the emotional underdevelopment of the society that elevates them to power.

Retired physician Gabor Maté is a Vancouver author and speaker. His next book, The Myth of Normal: Illness and Healing in a Toxic Culture, will be published in 2018.