In his column “Using medical terms to

mislabel Donald Trump won’t stop his mad presidency,” Allen Frances argues that mental illness and “bad behavior” are antithetical, with the suggestion that President Trump is “bad, not mad.”

We believe it does a disservice to public discussions of mental illness to create a false dichotomy between “mad” vs. “bad,” given that these kinds of behaviors and symptoms sometimes co-occur. It is certainly true that many individuals with mental illness do not manifest “bad” behaviors that harm others. Nevertheless, some mental disorders are characterized and even defined by behaviors that harm others — bad behaviors in Dr. Frances’ words.

This is true of “externalizing ” or “antagonism-based” conditions, including antisocial, psychopathic and narcissistic personality disorders, which tend to cause others harm and distress via aggression, cheating, manipulation and other antisocial behaviors.

These individuals often do not experience distress themselves. Ultimately, individuals, including politicians, can simultaneously cause serious problems for others and be mentally disordered (i.e., be bad and mad).