The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, edited by Bandy Lee, St. Martin's Press, 360 pages, $27.99
Thomas S. Szasz: The Man and His Ideas, edited by Jeffrey A. Schaler, Henry Zvi Lothane, and Richard E. Vatz, Routledge, 215 pages, $52
Is the president of the United States mentally ill, or is he just an asshole? That is the puzzle posed by The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. The question would have amused Thomas Szasz, the late psychiatric iconoclast whose legacy is considered in a new essay collection edited by Jeffrey Schaler, Henry Zvi Lothane, and Richard Vatz.
Szasz, who died in 2012 at the age of 92, spent his career calling attention to the ways in which "the myth of mental illness" (the title of his best-known book) muddles our thinking about troublesome people and problematic conduct. The sweeping, creeping medicalization of thought and behavior that Szasz decried is epitomized by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which is where "mental health experts" look when trying to diagnose Trump (or anyone else).
The most promising label mentioned by the contributors to The Dangerous Case of Donald Trump, edited by Yale psychiatrist Bandy Lee, is "narcissistic personality disorder." According to the DSM-5, the latest edition of that psychiatric bible, the symptoms of this condition include grandiosity, attention seeking, self-centeredness, "exaggerated self-appraisal," condescension, feelings of entitlement, lack of empathy, and relationships that are "largely superficial and exist to serve self-esteem regulation."
That seems like a pretty accurate summary of the president's personality. But what is gained by calling this collection of traits a "mental disorder" (and implicitly a disease, since psychiatrists are medical doctors)? Diagnosing Trump is a rhetorical trick that allows his opponents to medicalize questions about his competence, temperament, and policies, giving experts like Lee special authority to render political judgments that are supposedly beyond the ken of laymen.
"Possibly the oddest experience in my career as a psychiatrist has been to find that the only people not allowed to speak about an issue are those who know the most about it," Lee writes in the introduction. "How can I, as a medical and mental health researcher, remain a bystander in the face of one of the greatest emergencies of our time, when I have been called to step in everywhere else?"
Lee is alluding to the "Goldwater rule," which bars members of the American Psychiatric Association (APA) from diagnosing at a distance public figures whom they have not personally examined. It is so named because it was created in response to psychiatric critiques of 1964 Republican presidential nominee Barry Goldwater—in particular, a Fact article in which APA members described the candidate as "a dangerous lunatic," a repressed homosexual, a self-hating half-Jew, a paranoid schizophrenic, and "a mass-murderer at heart," just like "Hitler, Castro, Stalin and other known schizophrenic leaders."
Lee says she objects not to the Goldwater rule itself but to an excessively broad interpretation of it that prohibits psychiatrists from bringing their expertise to bear on an orange-haired menace who poses an existential threat to humanity. The truth that she and her colleagues are capable of revealing, she says, "could be the key to future human survival."
And time is running out. "As more time passes," Lee told Newsweek in January, "we come closer to the greatest risk of danger, one that could even mean the extinction of the human species. This is not hyperbole. This is the reality." Furthermore, she told The New York Times, people are clamoring to hear what she and her colleagues have to say. "The level of concern by the public is now enormous," she said. "They're telling us to speak more loudly and clearly and not to stop until something is done, because they are terrified."
Other contributors to Lee's book are equally breathless. They say Trump is "the most dangerous man in the world," an extreme sociopath whose presidency will "most likely be catastrophic," "a profoundly evil man exhibiting malignant narcissism," and "an American Hitler" with "the power to reduce the unprecedentedly destructive world wars and genocides of the twentieth century to minor footnotes in the history of human violence."
If you are not a fan of Trump but doubt that he is on the verge of killing us all, or if you view his antics as more funny than terrifying, Lee and her allies have a ready response: Where is your medical degree? Where did you acquire the mental health expertise that is necessary to read the president's mind and see the deadly danger lurking there?
Szasz's response to this sort of wild speculation and grandiose pretension was notably different from the APA's. That organization saw its members slapping psychiatric labels on a politician they'd never met and said, essentially, "Cut it out. You are making us look bad." According to the Goldwater rule, "it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement."
Szasz showed that the unethical conduct the APA condemned, which gave value judgments a pseudoscientific veneer, was fundamentally similar to the professional practices the APA endorsed. Psychiatric diagnoses, which equate things people say and do with diseases, are inherently subjective, cannot be verified by biological tests, and tell us nothing about etiology. Even if a psychiatrist talked to Trump at length and had him complete a battery of questionnaires before concluding that he suffers from narcissistic personality disorder, the diagnosis would not tell us anything important that we don't already know.
Richard Vatz, co-editor of Thomas S. Szasz: The Man and His Ideas, sees little evidence that Americans have taken to heart the renegade psychiatrist's point that mental illness is a metaphor and should not be taken literally. He notes that politicians and pundits still routinely cite mental illness as an explanation for outrageous acts of violence, even though it explains nothing, and describe drug addiction as a disease, which they take to be the enlightened and scientific view.
"The rhetorical refuge of attributing unusually horrible acts or simply unusual actions to mental illness has not noticeably abated since Szasz first questioned the existence of 'mental illness' over a half century ago," writes Vatz, a professor of political rhetoric and communication at Towson University. "The responsibility-denying rhetoric of mental illness, steeped in mystification and self-serving explanations of the difficult-to-explain, will perhaps forever successfully endure."
Such rhetoric is appealing because it is useful, even when it makes little sense. Consider civil commitment of sex offenders, which is authorized by about 20 states and the federal government. Under these laws, sex offenders who have completed their prison sentences can be confined indefinitely in "treatment centers." The Supreme Court approved that policy based on the premise that certain sex offenders suffer from "a volitional impairment rendering them dangerous beyond their control."
The theory is puzzling on its face, since these very same offenders were punished with prison terms based on the assumption that they could and should have controlled themselves. Stranger still, the mental illness that supposedly impairs their volition is defined by legislators rather than psychiatrists, and in some states it seems to be incurable, since the prisoners-cum-patients are almost never deemed well enough to be released. Supporters of civil commitment for sex offenders are untroubled by these contradictions, because the rhetoric of mental illness facilitates preventive detention of people they fear and detest.
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