Two hypotheses - if true - would explain America’s alarming descent into bitter division and moral confusion.

The first hypothesis is that President Trump’s divisive behaviour is a result of a narcissistic disorder. There is plenty of evidence to support this hypothesis. Just after the 2016 election, three psychiatrists wrote to President Obama expressing “grave concerns” over Trump’s “widely reported symptoms of mental instability—including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality.” This is a textbook description of narcissistic personality disorder.

More recently, Yale psychiatrist Bandy Lee edited a revised version of the book ‘The Dangerous Case of Donald Trump’ in which 37 mental health professionals warn that Trump suffers from a dangerous mental instability (I contributed a chapter describing how a strengthening of democracy is urgently needed as a defence against individuals with dangerous personalities).

Individuals with narcissistic personality disorder see themselves as history makers. They view themselves as great heroes who, unbound by the rules which govern lesser human beings, can bend history to their will and refashion the world in their image. Ian Hughes Author and Senior Research Fellow at MaREI Centre, University College Cork

Thanks in part to Donald Trump, many of the features of narcissistic personality disorder are now common knowledge, including those outlined in the letter to President Obama. Given the prevalence of this disorder, the assertion that Trump may suffer from narcissistic personality disorder is not an unreasonable one. Current estimates are that narcissistic personality disorder affects around 1% of the general population, meaning that there are over three million people in the United States with the disorder. Given their compulsion to seek positions in the upper echelons of society, individuals with this disorder are likely to be overrepresented in the corridors of power.

The second hypothesis is that this dangerous minority exercises a malign influence on society disproportionate to their numbers. This hypothesis owes its origin to Polish psychologist Andrew Lobaczewski who coined the term ‘pathocracy’ to describe the situation when individuals with dangerous personality disorders predominate in positions of power. Lobaczewski formed this hypothesis based on his painful experience of living under the regimes of both Hitler and Stalin, as each took turns at occupying and destroying his native Poland.

In the half-century after Lobaczewski formulated the concept, pathocracy did not become mainstream thinking. One major reason for this is that there was no clear mechanism through which a toxic individual could come to influence an entire society. In the absence of such a mechanism, the idea of pathocracy remained fanciful to many. Now, thanks largely to Donald Trump, that is no longer true. In the last few years, the mechanism through which an extreme narcissist can influence an entire society has become clear.

The key to understanding this dynamic is what is called ‘the toxic triangle.’ The basic idea is that it is not simply the toxic leader that matters. In order to come to power, such leaders need both a core base of followers and an environment that is conducive to their rise to power.

The dynamics of the toxic triangle work as follows. Individuals with dangerous personality disorders are always present in society and are always seeking power. Such individuals are trapped within a narrow range of extreme thoughts, feelings and behaviours that focus on rage, arrogance, self-importance, denigration of others, scapegoating, disregard for the rights of others and a propensity towards cruelty and revenge.

The majority of us who do not have these disorders can, of course, also exhibit the thoughts, feelings and behaviours that characterise dangerous personalities. But we can also exhibit a much wider spectrum of thoughts and behaviours including empathy, cooperation, compromise, curiosity about and compassion towards others, and openness to changing our minds. Under normal circumstances, therefore, toxic individuals find it difficult to attract sufficient support to be elected to power.

The difficulty arises when the context within which we live changes in ways that make us begin to think and feel in the way that toxically disordered individuals think and feel. This can happen when we face acute economic hardship, when profound cultural changes occur with which we personally disagree, when we feel threatened by crime or violence, or when we feel that the political system under which we live has failed us. Under such circumstances, we too can come to feel angry and vindictive, leading us to search for scapegoats on which to focus our disappointment and rage.

When the mood of a sizeable proportion of the population shifts in this way, it creates the conducive environment for toxic leaders to rise to prominence by “capturing the public mood.” Of course, they are not capturing the public mood at all. They have always felt arrogant, angry, vindictive and scornful of others. All that has changed is that a lot of us suddenly agree with them. They are not prophets; they are simply angry hatemongers whose time has come.

When this shift in public mood occurs, a second stage in the social dynamic kicks in. We have seen that over three million people in the United States suffer from a narcissistic personality disorder. Add to this another twelve million people who are estimated to suffer from a paranoid personality disorder, which makes them prone to seeing enemies everywhere. As Lobaczewski observed over half a century ago, many individuals with these disorders - whose psychology chimes with that of the toxic leader - now emerge in every walk of life and in every part of the country to actively support their leader, repeating his lies, cheering his prejudices, condoning his cruelty and normalising his pathological worldview. Their collective psychopathology brings about a sudden transition to a post-truth world in which scapegoating and aggression replace compassion and reason.

Once in power, individuals with narcissistic personality disorder see themselves as history makers. They view themselves as great heroes who, unbound by the rules which govern lesser human beings, can bend history to their will and refashion the world in their image.

If there is hope in our present situation, it lies in the fact that the current occupant of the White House, in attempting to do just that, is opening our eyes to the reality that individuals with dangerous personalities can plunge entire societies into division and moral confusion. Creating a collective understanding of this fundamental truth is the first essential step to recovery from the collective madness.

• Ian Hughes is the author of Disordered Minds: How Dangerous Personality Disorders Are Destroying Democracy and contributing author to The Dangerous Case of Donald Trump. He is a Senior Research Fellow at the MaREI Centre, Environmental Research Institute, at University College Cork in Ireland

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