Should We Diagnose Donald Trump?

Dan Kriegman, PhD
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In her article “The President’s Fitness: Can Professionals Help Decide?“ Dr. Paula Caplan cautions us about using psychiatric diagnoses to make decisions regarding people, including our “narcissistic” president. If that sentence sounds like I tacked on a diagnosis of sorts at the end, that’s because I did. In fact, I think Dr. Caplan also diagnoses him. The point is that, though I agree wholeheartedly with Dr. Caplan, the issue about labeling folks requires a great deal of nuance. And though I believe that Dr. Caplan is quite aware of the issues involved, I thought it might be helpful to spell them out in the context of our current political situation.

First of all, categorizing and labeling the world enables us to communicate. Dr. Caplan’s article itself is full of labels. Indeed, Dr. Caplan appears to have created her own diagnostic system when she noted that one must “distinguish between two kinds of ‘mental impairment.’” The first kind is “emotional impairment” such as “believing oneself to be Jesus Christ [if one is not].” Sounds like a diagnosis to me: Emotional Impairment, delusions of Jesus type.

The problem isn’t labeling per se. It’s what labels are used for. And by whom, how, and why.  In addition to the fact that labeling our world is necessary for any communication at all to occur, labels are especially useful to the human, social animal when attempting to obtain power and control over others. In fact, isn’t that what Dr. Caplan was attempting to do? By entertaining the notion that Trump might have a mental impairment of the second type (“cognitive impairment”), she was suggesting that there might be a valid, diagnostic procedure to be used when considering the removal of a president from office.

Diagnostic labels become especially pernicious, however, when (1) folks in power apply them to others who are much less powerful and/or are having problems elucidating their own perspective and being heard, (2) the labelers derive significant advantage from getting others to agree with their labels (their view of the world), and (3) the labels present a fundamentally false view of the world, which with psychiatric diagnoses almost always includes the claim that the labels have a high degree of validity. In fact, all three are true in the extreme when psychiatric labels are typically employed. And, as I explored elsewhere in more detail (“A Phenomenological View of Madness and Medicine”), the damage thus created is also extreme.

If this comment sounds critical of Dr. Caplan, it is important to reiterate that I agree with her. When making social decisions, labels should focus on problematic behaviors and impairments in functioning that, to the greatest extent possible (there is always some bias in human perspectives), can be assessed by folks with or without credentials, titles, and their associated pseudo-expertise. Consider the following for an example of how diagnoses can contribute to the obliteration of justice and reason when dealing with emotionally troubling social issues.

In Massachusetts, a man who has committed a sexual offense can be civilly committed for the rest of his life as a “sexually dangerous person” after he has finished serving his criminal sentence, that is, after having undergone the “punishment that fit the crime.” Though a sexually dangerous person can have his commitment reviewed by a court about once every three to four years, the typical one-day-to-life, civil commitment consists of 10 to 25 years of additional imprisonment. If the criminal sentence he received was a harsh sentence—which occurs quite frequently—we evaluate, diagnose, and then predict the offender’s future behavior often many, many years after any sexual misconduct. I recently testified in a commitment review of a 71-year-old man who had been in prison for 45 years for a crime he committed when he was 26.

At the initial commitment and each of the reviews, one of the elements that must be proved “beyond a reasonable doubt” is that the man suffers from a mental abnormality that impairs his ability to control his sexual behavior and makes it likely that he will commit another sexual offense. Given what we know about diagnoses, can you imagine that? That is, can you imagine being able to prove beyond a reasonable doubt that a psychiatric label not only validly applies to a man but that, by dint of the diagnosis we can know (almost for sure) how he is likely to behave in the future long, long after the last incidence of the problematic behavior?

In fact, in a recent article, I proved conclusively that the degree of hubris inherent in such an enterprise is seriously delusional, i.e., that the “sexperts” who make these predictions under oath are either quite delusional or lying. (Pardon me for diagnosing and labeling them, but as you can see in my two-part article—Part I and Part II—the evidence is in.)

I believe that evaluative labels—including diagnoses—can facilitate both communication and good decision making when (1) the labeled parties are able and allowed to present their own world views, (2) the conflicts of self-interest inherent in the use of the labels are transparent and are carefully assessed and taken into consideration, and (3) all parties have access to the evidence that can be used to assess the validity of the labels for themselves (i.e., they are not forced to rely on caliginous “expertise”). In the typical use of psychiatric labels when treatment (e.g., medication) and control (e.g., commitment) decisions are made, these conditions are rarely present.

And though none of these conditions is ever completely present, when they are mostly true, I believe that Dr. Caplan would agree with this view. At least that is my understanding of her warnings about the typical use of psychiatric labels followed by her call for the application of transparent, common sense when describing the actions and behaviors of President Trump.

Indeed, I believe that some psychiatric diagnoses with a modest degree of validity could be used to describe our president in a manner that enhances our understanding of our current political situation. My colleagues and I presented just such an example of the application of diagnostic labels. We carefully avoided violating the aforementioned rules for using descriptive terms in a manner that facilitates understanding and prevents an abuse of power.

First, the party we labeled has had an unparalleled ability to present his own view of reality. It might be fair to say that no one in all human history has had more attention paid to his worldview. So, in labeling, we certainly did not engage in an abusive use of a power imbalance.

Second, the conflicts of interest were quite transparent; indeed, they have been rendering the United States of America so divided as to be dysfunctional. Because of this, the inherent conflicts have received virtually endless acknowledgment and discussion. The audience of our diagnostic claim should themselves have the ability to weigh our words in light of the inevitable bias that, like all human viewpoints, ours possesses.

And third, we presented links to the research that offers the empirical basis for our understanding as well as, for an example, our beliefs about our subject’s behavior.

Thus, though we felt that our claims were transparent, fair, as well as helpful in developing a better understanding of our terribly troubled world, our readers had the information necessary to make their own judgments.

Above, I suggested that such use of diagnostic labels is rare in the field of mental health. That was an understatement. I have been involved in hundreds of commitment hearings in which psychiatric diagnoses were crucial. In that context, I have never witnessed the presence of all three factors: (1) the transparent (honest) use of diagnostic labels (which includes the acknowledgment of the inherent biases built into the labels as well as their highly limited validity), (2) allowing full voice to and full acknowledgment of the labeled person’s view of reality, and (3) using the labels in a manner that produces a useful understanding, which in standard mental health practice would require that the understanding produced by the use of the labels be significantly more beneficial to the labeled person rather than the labeler.

Ultimately, it’s that very last part that is so troubling in its absence when psychiatric diagnoses are typically utilized.

55 COMMENTS

  1. “The point is that, though I agree wholeheartedly with Dr. Caplan, the issue about labeling folks requires a great deal of nuance.”

    I will read the article in more detail, and comment, but this is akin to saying blacks should accept slavery, and to keep them as slaves, you need to use more nuanced forms of persuasion or deceit.

    Who are those people you refer to as “folks”?

    Why don’t you begin and end by explaining why you “wholeheartedly” agree with her article?

  2. Here is Obama’s moral argument for destroying a whole country (Libya):

    https://www.youtube.com/watch?v=VwPi3jK-kRw

    “Gadaffi declared he would show no mercy to his own people. He compared them to rats and threatened to go door to door to inflict punishement …”

    Here is what Gadaffi actually said:

    https://www.youtube.com/watch?v=gILP12qdIl0

    “We must fight these enemy rats who will be defeated in armed combat. Young people of Tripoli, fight them from street to street, ally to ally, house to house, with guns and pistols they will be neutralized …”

    Instead this gentleman with a PhD wants you to concentrate on this:

    “I didn’t say a date….I said it’s going away and it is going away.”

    A statement Trump made in relation to the corona virus.

    I can see why Dan Kriegman refers to his readers as “folks”.

    • Interesting how he brings up psychiatry’s power to punish people for being sex offenders without taking any actual crimes into account. Who gives a rip about what you actually DID? Lol.

      The shrink says you’re a monster. The public will believe him.
      Why I got kicked out of college.

      Punish innocent people for crimes they might commit in the future. Great way to rehabilitate ’em.

      The “sex offender” analogy sickens me. “Mental health” frequently lumps harmless eccentrics and the suffering in with perverts and murderers. I don’t think this is an accident either.

      Scaring the public and whipping them into a frenzy against the alleged monsters in their midst is great PR for psychiatry as Torrey and Murphy know.

      Label a law abiding citizen as “bipolar” or “schizophrenic” and you can treat them worse than a convicted murderer. My label ruined my life. No apologies coming from any of Kriegman’s colleagues.

      I loathe psychiatry.

      He doesn’t address any of us. Speaks over us to his esteemed colleagues and peers. Appears to think MIA is a respected site for scholarly articles endorsed by the APA.

      Kriegman is in for a rude awakening.

      • Excellent analogy with “sex offenders.” A sex offender has committed a CRIMINAL ACT, and his/her label is based on that act(s). This is defined by law and enforcable with known penalties. A person who “has a personality disorder” is so labeled based on a general opinion of what some people have decided is a “problem personality.” Such a label does not require ANY specific act, it is NOT defined by law, or actually by even any objective meausrement at all, and the penalty can be whatever the people in charge want to assess, including incarceration on a more or less permanent basis, enforced drug-taking, public shaming, discouragement, being discriminated against in employment or education, and on and on. It is not in any way a legitimate analogy.

      • Schizophrenia, when the “diagnosis” was coined by Bleuler, had very little to do with what most people think it means today. It was seen as a “spectrum”, and was essentially characterized by chaotic thought processes. Hallucinations and delusions were seen as secondary. Today, in order to frighten the general public, the emphasis has completely shifted. It’s a way for the psychiatric profession to legitimize prescribing their so-called “antipsychotics”. Prescribing the “antipsychotics” indefinitely is a very devious (evil?) way to then be able to claim schizophrenia is a devastating brain disease.

  3. ” .. using the labels in a manner that produces a useful understanding, which in standard mental health practice would require that the understanding produced by the use of the labels be significantly more beneficial to the labeled person rather than the labeler …”

    “Ultimately, it’s that very last part that is so troubling in its absence when psychiatric diagnoses are typically utilized.”

    Given the huge market and interests of the pharmaceutical industry, and it’s influence on politics, it should come as no surprise to anyone that this is the case. Psychiatrists rely almost solely on pharmaceuticals to “treat” their patients. It’s quite consistent to conclude psychiatry labels and treats for their own benefit aided by marketing and questionable research from the pharmaceutical industry. A kind of symbiotic relationship to the detriment of the patient.

  4. Boans sings “Man gave names to all the animals, in the beginning…….”

    Subtle sleight of hand with the sex offender reference there Doc. I’ve got no ‘skin in this game’ (not being in a democracy but a totalitarian State can be a benefit at times) so don’t really care what names your president gets called by slanderers and frauds. Because minus any “validity” thats all these labels are. A bunch of stuff people don’t like attached to a word, and then that word attached to people who you want to slander with the negative connotations.

    • Does WRAP and such still hand out those lists of famous people with [email protected]#!R? We should stop outing people. It makes Trump a fellow survivor and we ethically aren’t allowed to bad mouth our own, but as they say here, “no skin off my buns!”

      Until we change hearts we won’t change tongues. Consider the power of creative malevolence? My parents sat us down for the holy Euphemism talk (yes I still put a hard emphasis on HO and EU) only to have it backfire because we started using everything and anything as a swear word once we knew how. Any word can be a slur. I hear there is a whole blue bible of euphemisms to choose from.

      I don’t care what you call me. The labels say more about the maker and the tone-tweaker and the righteously-indignant-on-my-behalf-one than the accused.

  5. I object to this entire article. Take it to Huffington, or to the DNC. I’m sick of MIA being used as a political tool to get at Trump (something which is obvious and transparent) while ignoring the Democratic Party, which is literally crawling with systemic racists and war criminals.

    We just had this discussion, twice. Is this one of those deals where sheer repetition is supposed to have the cumulative effect of inculcating a “Trump is mentally ill” mentality in MIA readers?

    I suggest not validating these tired arguments by engaging them.

  6. Well, you’re dealing with a guy who consumes a gram of caffeine/day and lives on a diet of Big Macs and Fish Witches. I don’t know if the guy has a diagnosis, but I do know why he stays up at 3AM sending Tweets to the universe at large, in circumstances where I wouldn’t expect deep thoughts to be revealed or linguistic brilliancies to be uttered.

  7. My concern is not with fairness or unfairness to Donald Trump per se. My concern is that allowing “professionals” of any stripe to “diagnose” public figures reinforces the idea that “mental illnesses” CAN be objectively “diagnosed” and that these professionals have some inside knowledge that makes them more capable of validly assessing the capacity of a particular person to continue in the office of President. It empowers the DSM and its adherents in a way I find unacceptable, regardless of the reasons given. Since the author acknowledges early in the piece that the DSM “diagnoses” lack any sort of validity, the labeling process he is describing is no more nor less meaningful than any lay person getting together with another lay person and saying, “I think Trump is crazy!” Or “I think people opposed to him have ‘Trump Derangement Syndrome.'” Sure, any psychiatrist or psychologist has the right to come up with a descriptive label of Trump’s or any other President’s behavior or conduct, just as any other citizen has that right. We still have freedom of speech in the USA, last I heard. The question is, why should their label carry any more weight than the guy in the machine shop or the woman serving her country in the armed forces or the teenager trying to figure out what politics is all about? Why should a Ph.D. or M.D after someone’s name privilege them to provide a “professional” opinion regarding labels which the author himself admits are essentially fraudulent?

    • I have no argument against any of the above. My issue is this gut feeling I get that this is another example of taking action only when people with power are affected. Like quick action during COVID hurts. It hurts because it means something. It sends a message about people vrs. non-people. Trump will survive a stern labeling. He doesn’t need protection. Where was the outrage when we were labeled?

    • Besides,
      “mental” “disorders” afflict a huge proportion of the population. Which of course means that “a “percentage” of psychiatrists themselves are “afflicted” (well I knew that)
      But psychiatrists, nor trump step inside the chamber of being slandered “officially”.

      Yet, for the general public, slanderous talk between “doctors”, even about someone in ER.. WITHOUT a client stepping into the slander chamber, actually is as good as a “formal diagnosis”….serving the same slanderous purpose.

      Of course they argue that it is an “educated opinion”. It is time for “educated opinion” to not matter. Opinion that matters can ruin someone’s whole life.
      Should anyone have that power?

      I strongly feel that people should be warned on TV, somehow. That it really is just SLANDER.
      It’s not “STIGMA”. It is “SLANDER”. Slander officially recognized as valid by our politicians.

      Of course that whole percentage thing is laughable.

    • Totally agree. It empowers the DSM. Truth is that psychiatrists cannot get into people’s minds and know what’s going on there. They just think they do. Psychiatrists can have conflicts of interest and refuse to believe a patient about what is going on in their life, and instead choose to label them as suffering from psychosis. Been there, done that. The fraud of psychiatry was never so clear to me as it has been ever since that experience.

    • Precisely.

      The DSM gives psychiatrists the right to treat harmless eccentrics and sufferers of Lyme Disease the same as pedophiles.

      They spread the word on TV, newspapers, social media about how “The reason this man kidnapped and murdered all those children is because he was a bipolar.” Doesn’t take a genius to put two and two together and decide all “bipolars” are serial killers.

  8. This is the vote outcome for H.R. 748, which is the CARES Act (Coronavirus Aid, Relief, and Economic Security Act):

    https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=116&session=2&vote=00080#top

    Do you see any “nay” votes? None. Zero. There were a few who didn’t vote, but that was because they were in self-quarantine and didn’t have access to remote voting.

    So the largest transfer of wealth upward was done with bipartisan Senate support, sending the economy into a tailspin that we’ll likely never recover from. The money is going to the oligarchs. And while we’re distracted, environmental regulations continue to be rolled back and now the United States is discussing testing nuclear weapons for the first time in 28 years.

    As poverty covers the land, making us weaker and weaker and unable to fight back, psychiatry and the police state will become more powerful than ever to keep us in line.

    The United States is a failed empire. Trump is a symptom, not a cause.

    It’s unfortunate that MiA continues to waste time on Trump bashing instead of looking at the system that placed him in office and all of the shock-doctrine activities that are going on while our attention is focused elsewhere.

    But then again, when you repeatedly give the microphone to MDs and PhDs and leave out the voices of grocery store workers, delivery people, warehouse workers, and other low-paid essential workers, this is what you get – articles written by “professionals” busying themselves with nonsense because they have that luxury.

    At least they do for now.

  9. Hello, Daniel Kriegman. This is Jeffrey, the same “crazy” Jeffrey you… corresponded? With in the 2000’s quite a bit. The one that once blew your mind regarding something to do with emails. Anyway, I’ll be publishing my personal story soon. Sorry that this is off topic, but it’s about to be not-so; I see that as always, your writing is incredible and must be “studied”, or analyzed. Michigan also has a law for “sexually delinquent persons”, and I ranted about it once on a blog that I don’t think exists anymore. I didn’t have any followers and was just yelling at a cloud, so to speak, and on many issues.

    I’m glad you’re still alive, and hope you are doing well. I am better than ever, and pushing farther every day. Trying not to waste my time anymore. I’m checking out a property that I think has real potential as a safe house for people – https://youtu.be/ZBxQqeGVLtc

    If I can’t get it through my father, then I hope I may be able to find some other “investor”; someone passionate about creating a safe place for mostly young adults and psychiatric survivors who need to break free from psychiatric shackles and work on aways to find independence.

  10. I don’t see the point of reading a book about a book.

    I didn’t know I was lower class until I had dinner with people who were high enough class to point it out. Classy!

    My grandfather wouldn’t let anyone with a university degree drive the million dollar combine, but the 14 year old neighbor kid could. I’m starting to see why.

    Endless regurgitation. Retweets of retweets. Research of research. Years spent learning to think critically are useless without practical skill and the humility needed to get stuck in.

    People need physical extrication and opportunity, not another game of “would you rather…”

    • O.O.

      “My grandfather wouldn’t let anyone with a university degree drive the million dollar combine, but the 14 year old neighborhood kid could.”

      CHOICE!

      Your writing style rocks!

      “Endless regurgitation. Retweets of retweet. Research of research. Years spent learning to think critically are useless without practical skill & the humility needed to get stuck in.”

      I am also getting tired of outrunning the papered & credentialed. A woman young enough to be my daughter called me “intellectually disabled,” because she thought I had a “mental illness.” But SHE went to law school.

      Again. I never told her I was a “survivor.”

      (are we supposed to be putting that in quotes now, too? I am unabashedly Anti-Psychiatry, but I still look to oldhead to help me with the terms; he changed my life)

      I never even brought it up that I was a “survivor.”

      People know you’re an alma mater of the street, the prison system, the public mental health system, and the drug rehab programs with apps. on their smart phone now. Does this mean that *everyone* on this site is on one of the list/s???

      Not sure. Ed where are you? Snow. DEN.

      In my case, one my 4 handlers (MK Ultra word) approached this woman, in the hopes of roping me back into the MHS.

      It’s going to be harder for you, for me, to express ourselves with A.I. Big Brother…

      but,

      I just want to say, you have a gift for writing (a psychiatrist once told me I had the delusion I was going to write something important one day)….

      so I thought my opinion of your gift would mean more to you coming from someone like me…someone outrunning the TRILLION-dollar-combine-papered-and-credentialed psychiatry apologists…

      HAH!

      • Thanks.
        I have the notes kept from my last ER certification stint almost done being edited into a book, but then i get thinking all the things i learned in treatment like my place. Like they’ll kill me if i publish this. Like who do i think i am?

        It means much more coming from someone with your credentials. I will get back to work on it. Thanks.

        • Who would really want to live in a place where the truth can’t be spoken? Not me, and the people who interupted me being killed for speaking it? Of course what I have found since is that they were not good Samarians, they were simply taking the wallet from the people who beat me up and took my wallet. They have no concern for the person laying on the side of the road injured. And to find a good Samarian would require travelling because this is Australia. Look at how we care for those in our community, ask an Aboriginal. Oh wait, don’t. Ask our political leaders, they’re good at telling people how good they are, and ensuring the truth is concealed. And they then devalue the narrative of anyone who they wish to silence. Ask our ex Minister for Mental Health who stated regading the sexual assault of patients in ‘care’, “you can’t listen to them, they’re mental patients”. ( I wonder how many if thise assualts the Mental Health Law Centre covered up for their ‘meal ticket’? Yes Minister my new Porsche takes a lot of fuel, can we reconsider our funding for the Centre?) Our current Minister uses the same type of slanderous remarks regarding any complants. Though I guess those that listen to them do so for their own gain and not because they actually believe them, the truth is funny like that. The knives will be out when the Minister no longer serves the purposes of those who have the dirt on him. Which shouldn’t be too long now, Euthanasia Act check, conceal prescriptions for ADHD drugs from public check, allow ECT of children check, allow forced sterilization of children without parental consent, on hold until the world isn’t looking. Pass as amendment to Mental Health Act pending.

          Write your truth O.O. I did ask someone with an ability to write to assist me, they looked at the documents I have, confirmed the human rights abuses, spoke to some ‘authorities’ and threw me under a bus again. Not even standing by agreements to return the fraudulent set of documents to me should I request them. They will win in the end, or at least that’s how it will appear to them. But your a long time dead my mother used to say. And a lot of places to hide a body in the bush police tell me.

  11. Please stop “diagnosing” Donald Trump. It’s just labelling, a rhetorical device, and the fact that so-called “experts” apply the label is just window dressing. Do you agree with his policies? Do you think he treats people with respect? Do you think what he does or says can have dangerous consequences? What do you believe is important for human beings, their survival and flourishing? Do you think he advances or hinders what you think needs to be done?

    Talk about those things. Calling him a “narcissistic personality,” or whatever, is just a disguised form of name calling and advances nothing.

    • Psychiatric “diagnoses” are glorified name calling. As scientific as insults by the playground bully.

      A lot of shrinks get upset at people joking about feeling “bipolar” or complaining about a “schizophrenic” coworker. They complain that only They–the leading medical experts have the right to call people these things.

      Reminds me of some skit I saw on TV where a bully on the schoolyard yells at his toady that only he (the bully) has the right to call the other kids “stupid idiots.”

      You COULD argue that names like “smelly poo poo head,” “dummy,” “slowpoke” and “ugly” are scientifically valid. Some people are dumber, slower, and uglier than others….Not sure how such names will help. But Bullies don’t want to help. Only show their supremacy and lord it over the other children.

      • I was watching the Simpsons last night Rachel777. Couldn’t help but laugh at the school bullies selling lunchtime and morning break packages. Nelson Muntz and friends discussing their chosen profession sounding a lot like a team meeting to discuss the latest admission to the ward.

        The kid Millhouse taking a drug called Represso to blunt the trauma of being bullied lol.

        Sometimes the truth can be a little hard to package in anything but comedy.

      • Been a breakthrough in the Malka Leifer case.

        https://www.bbc.com/news/world-australia-52811744

        “In January this year, a panel of psychiatrists found that Ms Leifer was faking her mental illness to avoid extradition”

        66 court cases and then a panel of psychiatrits say she is faking a mental illness? What about all the reports written about her mental illness that have stopped the process before this?

        I must admit that I have problems with people brining court actions until they get the result they want but …… I think there is something to be said about the way psychiatric diagnosis can be used in the courts. May have done herself a disservice because its usually the victims of molesters that are slandered with labels.

        Psychiatrists saying people are faking something that is fake?

        I wonder how this diagnosisfest will play out if she is ever brought back to stand trial? Lawyers throwing psychiatrists at each other at 20 yards? I know in my instance it was shop around till they got the diagnosis they wanted from a ‘friendly’ doctor.

        • SO FUNNY Boans.
          “Psychiatrists saying people are faking something that is fake? ”

          If someone wanted to leave, a shrink would say they are “mentally ill”
          If someone wants to stay, it’s the opposite.

          Ohh I get it, they just say the opposite of what we say…I guess they call that reverse psychiatry.

          • Yes Sam, I find all this talk about access to mental health sevices due to cornona virus and isolation concerning.

            I must admit that I was wondering about how many people would be effected by the isolation and have mental health concerns. I was worried about my own sanity and if it wasn’t for my collection of singing potatoes I think I may have gone mad (credit to writers of Red Dwarf lol).

  12. Should we diagnose Cheeto? Absolutely not. Psychiatry is more dangerous than he is, and it will become impossible to control, if we allow it to topple the most powerful person on earth.

    There are better ways to rid ourselves of Disaster #45, starting with this year’s election.

    VOTE FOR BIDEN!!!

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