Ignorant, incompetent, impulsive, and dictatorial, but not crazy


Until this morning, I was inclined to agree with those, like Andrew Sullivan, who think Trump is a narcissist whose psychiatric competence to lead the western world is a legitimate matter for journalistic inquiry. A distinguished psychiatrist’s letter to the New York Times persuades me this is wrong.

Most amateur diagnosticians have mislabeled 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, because 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 stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).

Not crazy. Just evil.

Allen Frances is an emeritus professor of psychiatry at Duke University’s medical school. He chaired the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV). Read his full letter here.

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