Though I am not and never have been employed by a correctional facility, as a psychiatrist I am also quite familiar with the machinations and mayhem of megalomania. I work in clinical settings that regularly bring me into meaningful and (most importantly) relatively safe contact with people our society generally labels deviant and delinquent, under the hopeful pretense that I might possibly be of behavior-modifying assistance to them. As such, I’ve readily become privy to the hidden vulnerabilities and insecurities of the bullies, jerks, thugs, and predators who by all outward appearances don’t seem to have any. In the weeks preceding Trump’s inauguration, I penned a tweetstorm about my experiences with these patients, and the parallels between sociopathy at the individual level and Republican austerity as it has manifested itself in American culture. It’s entitled “Divided States of Sociopathy: The Traumatic Roots of American Socioeconomic Dysfunction” and it has become eerily evergreen as the nefarious behavior of Trump and the Republican Party that unleashed him takes center stage.

While I lack the necessary diagnostic testing of his mind and body to comprehensively pinpoint Donald Trump’s multifaceted pathology in more formal terms, I also know a textbook sociopath when I see one. From Wiki:

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others. Individuals with this personality disorder will typically have no compunction in exploiting others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people, achieving this through wit and a facade of superficial charm, or through intimidation and violence. They may display arrogance and think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude to those they have harmed. Irresponsibility is a core characteristic of this disorder: they can have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.

I know his characteristic lies, his lack of respect for social norms and laws, and his refusal to take responsibility for the negative impact his actions have on others. I know his two-faced charm, and the artful trickery involved in every “deal” he makes. I know his belief in the righteousness of his abuse, and the insidious aggression that boils just below the surface of his masked face. I recognize the ire and anxiety he makes me feel internally, and the lack of public safety engendered by his mere presence in a room. I am appalled by his callous disregard for living things, be it the women he’s claimed to have “grabbed” or the planet he’s now damned to destruction. I am embarrassed by his behavior and appalled at the thought that his character pathology will somehow be attributed to me and my fellow Americans simply because he now “represents” us on the global stage.

Perhaps I have this in common with Fred and Mary Trump, who sent 13-year-old Donald to military boarding school in now evidently futile hopes of holding their bad actor accountable for his juvenile delinquency. If only it had been reparative. It’s now 57 years later and we are subjected to the same pervasive pattern of malignant dysfunction that his school and family could never “fix,” sitting on pins and needles hoping that this time things will improbably be different.

The APA's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR), defines antisocial personality disorder (Cluster B): A) A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three or more of the following: failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest; deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure; impulsivity or failure to plan ahead; irritability and aggressiveness, as indicated by repeated physical fights or assaults; reckless disregard for safety of self or others; consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B) There is evidence of conduct disorder with onset before age 15 years.

Unfortunately as prison wardens, judges, prosecutors, forensic psychiatrists, victims, and affected families can attest, these patterns rarely change, and neither do the most malignant of sociopaths. Personal responsibility is rarely if ever taken, and it inevitably falls to society to pick up the pieces in the aftermath of disaster to set appropriate boundaries that prevent future destruction and dysfunction. Collectively we are now faced with holding our elected deviants and delinquents accountable, not just for the sake of law and order, but our own preservation as a people and nation.

Military school and decades of legal proceedings and bankruptcies didn’t “fix” Donald Trump. His criminality and lack of remorse for his unlawful actions have not changed in 70 years, therefore a wave of brazen corruption and scandal follows him everywhere he goes. The truth is this was a well-documented reality of his private existence long before he ever took the oath of public office. Sooner or later we must find the courage to acknowledge that his sociopathy is not unique or new in America, and he remains so steadfast in his bad behavior precisely because his dysfunction has recklessly been rewarded with absolute power.

Beware of not only the American Sociopath, but the society that enables, coddles, and glorifies him, too.