A world-class narcissist

Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and written to The New York Times suggesting Mr Trump is incapable, on psychiatric grounds, of serving as president.

Most amateur diagnosticians have mislabelled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill: he does not suffer from the distress and impairment required to diagnose mental disorder. Mr Trump causes severe distress, rather than experiencing it, and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatising insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Trump (who is neither). Bad behaviour is rarely a sign of mental illness, and the mentally ill behave badly only rarely.

Psychiatric name-calling is a misguided way of countering Mr Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers. His psychological motivations are too obvious to be interesting, and analysing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological. Allen Frances, professor emeritus of psychiatry at Duke University School of Medicine