Apologies to Caravaggio

With all the talk of Donald Trump’s mental health status, I’ve decided to do something I’ve put off for a while: write a diary that shows he is a textbook case of Narcissistic Personality Disorder (NPD), and spell out what that means in terms of what to expect from him and how to deal with it. Certainly the term “narcissist” is being applied to him a lot, but most people don’t know the entirety of what that means, psychologically.

I am not a psychiatrist or psychologist, but for personal reasons I have educated myself about NPD. It generally conceals itself and is little understood—but has a devastating effect on the lives of others close to the narcissist or to organizations he is involved with. Knowing NPD creates a coherent picture that explains Trump’s behaviors. That will help you not only understand Trump, but enable you to spot people with NPD who want to enter your life, organization, etc., so that you can act accordingly. This is an educational moment in history. It is very rare that the symptoms of NPD are on such massive public display.

If you find yourself completely baffled by Trump’s behavior, that’s because mentally-healthy people generally find NPD-rooted behaviors incomprehensible. The narcissist violates social norms that healthy people hold instinctively and therefore assume (usually correctly) that others hold—while at the same time he creates a semblance of normalcy, because being able to do so is part of the disorder. Because the rest of us cannot relate to, often cannot even imagine how a narcissist thinks and feels, it seems outside the realm of plausibility, and so his semblance of normalcy will fool us. Not only Trump voters but fellow Republicans and even Putin have shown signs of buyer’s remorse with Trump. That’s because he fooled them all. Narcissists can do that.

So, since he’s a textbook case, let’s hit the textbook. The Diagnostic and Statistical Manual of Mental Disorders (DSM) – the American Psychiatric Association’s guidebook for mental health diagnosis – gives diagnostic criteria for all mental illnesses. Between the fourth and fifth editions, the criteria for NPD changed, so I am going to use both to paint a fuller picture. If you’ve been following the presidential news for the last few months, you’ll likely be able to think of at least one and probably several examples of Trump demonstrating every single diagnostic criterion below.

From DSM-IV:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. 1. An exaggerated sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) 2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love 3. Believes he is "special" and can only be understood by, or should associate with, other special or high-status people (or institutions) 4. Requires excessive admiration 5. Has a sense of entitlement 6. Selfishly takes advantage of others to achieve his own ends 7. Lacks empathy 8. Is often envious of others or believes that others are envious of him 9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes

From DSM-5

A. Significant impairments in personality functioning manifest by: 1. Impairments in self functioning (a or b): a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem. b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations. AND 2. Impairments in interpersonal functioning (a or b): a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others. b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences, and predominance of a need for personal gain B. Pathological personality traits in the following domain: 1. Antagonism, characterized by: a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others. b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

President Obama and others who have observed that Trump’s behaviors arise from an underlying insecurity are right, as per DSM-5 criterion A.1.a. above. Kossacks and others have figured out that the way to get under his skin is to is to point out how unpopular he is, because that works on narcissists. In fact any criticism does, because narcissists can’t handle criticism at all, cannot help but take it personally, as per DSM-5 criteria A.1. a & b both.

How else does this translate into behaviors?

Let’s start with the persona narcissists create. Because they lack empathy, they have to learn how to appear normal, which they do by rote-learning expressions and mannerisms from normal people around them. In fact, they are good at being charming; they learn what people want to hear and say it without regard to whether it is true. Because they are without moral qualms, they can come across as decisive, which normal people interpret as confident, and spontaneous, which normal people interpret as authentic. This is how Trump played the crowds at his rallies. None of it, however, is sincere; it is only for personal gain. There is no such thing as loyalty from narcissists; loyalty arises from the social norm of reciprocity, which is based on empathy, which they don’t have.

Next: falsehood. Honesty is also a social norm based on empathy, so narcissists feel no need to hold themselves to it. Falsehood serves two functions: 1) manipulating people into furthering the narcissist’s aims (e.g. making promises he never intends to keep); 2) maintaining his own delusion of superiority, e.g. insisting he is liked more than he is, or rebutting good arguments with false ones. The media is debating whether Trump’s tales of a record-breaking inauguration audience and 3-5 million illegal votes are lying or delusion. Knowing what I do of NPD, I would say it’s delusion. Trump will cling to it and keep it in the news even at the risk of damaging his own credibility, because it engages his central, very strong motivation, and he lacks the empathy to see how it will damage his credibility.

Because narcissists are so insecure at heart they can be control freaks, and the male of the species in particular can be authoritarian. Hence, executive orders that are likely unconstitutional as well as absurd. In a “love” relationship (because narcissists lack empathy, which is central to love), he can seek to dictate every aspect of his partner’s life, including that she conform to his standard of beauty. Thus he feels free to wander into the dressing room of a teen beauty pageant to “inspect the goods,” and you’ll see a certain uniformity among the Trump women in style of dress and even length of hair. I think he is likely giving them strict orders.

At the same time, there will be impulsiveness, moodiness and disorganized thinking. A narcissist is really a six-year-old in a grown-up body, lacking reason and ruled by emotion; recall Melania Trump’s comment that she had to look after two boys, one being Barron, the other, Donald. People have suspected Trump’s reversals and word-salads could indicate ADHD, but these are indicators of NPD, too.

In his exploitiveness, the narcissist violates social norms concerning appropriate boundaries, whether those boundaries are codified in conflict-of-interest prohibitions, investment loan contracts, business contracts, sexual assault laws or what-have-you. The narcissist basically feels that rules are for him to set, not obey. This includes even the rules of logic, such as “base your decisions on facts.”

Projection characterizes how narcissists describe people who oppose them. They will “project their own negative introject,” in Freudian terms, i.e. ascribe their own wrongdoing and faults to other people, whether it be criminality (“crooked Hillary”), lying or a rigged election. I have come to assume that whatever Trump accuses someone else of doing, he is doing or has done himself.

Competitiveness and envy result from others apparently outdoing the narcissist, e.g. President Obama drawing large inauguration crowds. He, and everything he’s touting, has to be the biggest, the best, the huuuugest.

Rage and vindictiveness result from the narcissist’s wishes being thwarted which, of course, life does fairly often, quite naturally. It is a primal rage, like a child’s; hence Trump’s angry style of speaking and noted obsession with getting even. One reason the golden shower story went so viral; Americans have come to know Trump well enough to see it is plausible. Rage translates into hate, which can manifest as racism, sexism, and homophobia.

So how to deal with a narcissist? To put it very bluntly: don’t. There really is nothing to do with these people but to disassociate with them. They bring nothing but harm and suffering. However, if you are stuck with one, there are ways to handle it:

1) Avoid being disillusioned: have very low expectations. Here are things never to expect from a narcissist: honesty, loyalty, reciprocity, change due to the gravity of a position, reasonableness in negotiation, learning through experience, maturation, adaptability, courage, ability to handle adversity, aspiration to genuine excellence, genuine altruism, humility, guilt or shame for wrongdoing, equanimity, sincere gratitude, sincere appreciation, sincere praise, admission that he is wrong, returned favours or improvement of the condition. In Trump’s case, you can’t even expect normal laughter or a smile that goes up to his eyes. Prognosis is poor because narcissists think all problems are caused by other people and so generally don’t seek treatment. Many people, even ones as smart as President Obama, expected Trump to settle down some once he was president. I knew he wouldn’t. He actually is not capable of doing so.

2) Do not normalize. Healthy people have a tendency to give the benefit of the doubt, in part because they simply can’t believe a narcissist is the way he is. It is standard operating procedure for him to use that to gaslight you; normalizing is gaslighting yourself. Recognize and accept that he is the way he is, that it’s due to mental illness and that he will not change. This is what the mainstream media most needs to learn about Trump.

3) If you are trying to figure out why he would do something, ask yourself, “How might it be motivated by a need to feel significant or important?” Discount all other motivations. Your questions will be answered.

4) Keep interactions distant. Don’t depend on a narcissist for anything; never make yourself vulnerable to a narcissist. Don’t loan him money or do work for him without 100% payment upfront.

5) Expect those around him to be damaged. They are either brain-washed into being extensions of him, parroting his thoughts, or faking same for personal gain, or bewildered by the madness. Expect chaos in any organization he leads: good people will resign in disgust or be fired, while marginal people ascend to powerful positions.

6) Do not attempt to reason with or educate him. It doesn’t happen.

7) Manipulate him by using his disorder. Flattery will get you everywhere; convince him that your idea was his brilliant one and he’ll run with it. Trump’s campaign staff learned to do this. But if you’re too honest for that:

8) Get rid of him as fast as possible. How?

a. Stop giving him what he so desperately needs. Once a narcissist realizes someone is no longer a source of approval, admiration and adoration, he’ll be off like a shot looking for the next sucker.

b. Expose him. Narcissists also tend to flee when they realize people are onto them. I am actually expecting Trump to flame out fairly soon, perhaps within weeks, because he is revealing that his condition makes him unable to deal with losing the popular vote, drawing a small inaugural audience, being mocked by SNL or greeted with protests wherever he goes. The media are beginning to talk openly about his mental illness; how will he handle that? [Update: Obviously I was wrong about this. I think I underestimated the degree to which holding the presidency and thinking of himself as president would offset the negative (to him) effects of criticism, and overestimated his grip on reality re the inauguration.]

The central thing to understand about narcissists is that their need for “narcissistic supply” – feelings of being significant, important and adored – overrides all other considerations, including empathy and all the human norms that arise from it, because their delusion is to equate narcissistic supply with survival—same as a drowning victim might drown their rescuer. Some narcissists, having flashes of realism as some of them sometimes do, have described narcissistic supply as a far stronger addiction than heroin.

It’s a throwback to the helplessness of early childhood, where not being considered important and lovable by parents is a genuine threat to survival. Thus a narcissist is always trying to soothe an all-encompassing internal terror, and no amount of narcissistic supply can ever soothe it entirely. This is the inner hell in which Donald Trump lives, and which he now has the ability to externalize onto the United States of America and the world.