What’s the diagnosis: mad or bad?
The psychiatrists imply that Donald Trump suffers from narcissistic personality disorder
There is no novelty in observing that politicians are different from the rest of us. Former foreign secretary Lord Owen, in his much commented-on analysis of their physical and mental health In Sickness and in Power, claimed that Margaret Thatcher and Tony Blair (among others) showed signs of what he termed Hubris Syndrome – characterised by ‘‘unshakable selfconfidence, contempt for advice and inattention to detail’’ – that warped their political judgment, with consequences that are only too familiar.
By contrast, Jim Callaghan and John Major, he felt, were immune and, in an interview with this newspaper, he denied being afflicted by the syndrome himself.
The issue was further explored in the British Medical Journal this month, which questioned whether doctors have a duty to warn others if they believe a leader is ‘‘dangerously mentally ill”. Such questions have become a major issue in the United States since two professors of psychiatry at Harvard expressed their ‘‘grave concern’’ last November about the mental stability of the then presidentelect; his ‘‘grandiosity, impulsivity, hypersensitivity to criticism and inability to distinguish between fantasy and reality’’ led them to question his fitness for office.
Though they stopped short of making a psychiatric diagnosis, they clearly imply that the (now) president suffers from narcissistic personality disorder – recently described in the American Journal of Psychiatry as being associated with ‘‘significant functional impairment and psychosocial disability’’. There are apparently two variants, with Trump being of the thick-skinned overt type who can be ‘‘socially charming despite being oblivious to the needs of others and interpersonally exploitative’’. Not so, argues Allen Frances, Professor at Dukes University who defined the criteria for the disorder. Trump, he notes, may well be a world-class narcissist but that does not make him mentally ill. “He is bad, not mad” – a distinction the courts often struggle to make.
Burning question
This week’s medical query comes courtesy of Mr BH from Bolton, in his early eighties, who for the last three years has been troubled by a pulsating stinging sensation in different sites on his upper back that he likens to a Chinese burn. The sensation is brought on by relaxing on the sofa or lying down at night – but occurs even when face down, while gradually fading if he sits out of bed.
An X-ray found mild arthritis of the spine, but neither a course of physiotherapy exercises nor purchasing a new mattress has improved matters. “It is so intense it can wake me at night and is making my life miserable,” he writes.
Any suggestions would be gratefully received.
Oiling the joints
It is difficult to know how cod liver oil might ‘‘oil’’ the joints, but it certainly worked for a reader from Bristol with longstanding rheumatoid arthritis of such severity she could not turn off a tap, pour the tea or shake anyone’s hand. She was under the care of a specialist but, like many in her situation, looked elsewhere for help, until finally trying cod liver oil in milk. “Gradually, over a period of two months, the pain disappeared along with the swelling of the joints,” she writes. She describes her recipe as follows: “On getting up, shake together four tablespoons of milk and one tablespoon of cod liver oil to a slow count of ten and drink it. If the lips are wiped immediately, there is no taste other than of the milk. Then no food for 30 minutes, when I have breakfast, which is a round of toast.”