"Diagnosis is comforting, mainly for the diagnoser"by / March 14, 2017 / Leave a comment
Published in April 2017 issue of Prospect Magazine
Is your partner a psychopath? Is your partner a sociopath? Is Donald Trump suffering from a narcissistic personality disorder? My sister told me that eating the whole of an apple including the core means you are a narcissist. A psychiatric nurse told our seminar group that before studying psychoanalysis he’d always understood “personality disorder” to be a euphemism for arsehole.
If you do these quizzes on Facebook it always turns out that your partner is a psychopath or sociopath or narcissist. Diagnosis is comforting, mainly for the diagnoser. (America loves an all-encompassing diagnosis to dispel complexity, ADHD being a prime example). Ah, that’s the problem!
Of course, for the actual person in question, things are a lot trickier. His or her whole life has contributed to the behaviour currently being manifested and this label does not amount to treatment.
So if, as a group of psychiatrists writing to the New York Times last month claimed, the president is seriously mentally ill (as certainly seems to be the case), what then? It almost appears to be a way of jeering at him, of maliciously ridiculing him in precisely the way the mental health professions have spent decades trying to counter. Professor Allen Frances, the psychiatrist who wrote the criteria defining “narcissistic personality disorder,” replied, saying that Trump causes rather than experiences distress and might not, therefore, be mentally ill.
Personally, I would have thought that projecting your own distress on to others in order to rid yourself of it is a pretty classic symptom of a fragmented mind. Trump looks very disturbed indeed. His terrible isolation, frantic nocturnal tweeting, apparent inability to bear criticism, trouble focusing on subject matter or interlocutor, monstrous perception of “the other” and his straightforward objectification of women make him look chronically fragile to me. He’s a toddler, desperate to control everyone around him, terrified by his relative success in doing so, living in a constant frustrated tantrum, longing in vain to be taken seriously.
A friend of mine argued that the president’s perception of the outside world as hostile is correct, that anxiety is an appropriate reaction to a position of vast responsibility, defensiveness a response to open attack. Fear and anxiety, he said, are part of the human condition—if we’re not worried about the mammoth stampedes we’ll perish. So what is appropriate anxiety and what is mental illness?
Of course the world is a dangerous place, but I would suggest that Trump’s overwhelming anxiety about his own status, masculinity and ability to function gets projected outwards such that he perceives the world as far more attacking than it is in reality. He is externalising and mislabelling his internal fears as real threats (not that there aren’t also real threats, but his perception of these is warped). He forces the outside world to match his inner world, as so many of us do—the depressed look at the world for proof of the depressing, the afraid for danger, the confused for the confusing.
Yes, the president seems unwell, but labelling him with a slick psychiatric diagnosis doesn’t in any way address the complexity of his (or anyone else’s) personality or history. He needs help (though, like many, he’d probably refuse it), but neither he nor anyone needs ridicule about his or her mental health. Diagnostic labelling is often a way of fobbing a patient off with a quick-fix drug, of satisfactorily filing them, and this is what people clamour to do with Trump. Casually diagnosing him might help us with our own fear and confusion, but it does not help him with the vast complexity of his.
There is no short-hand for the real effort of understanding. Fact.