Diagnosing Donald Trump

A major part of my career as a practicing psychologist was diagnosing mental disorder. I assessed thousands of people, making recommendations for treatment or for security. I have, of course, followed with interest speculations in the media about the mental fitness of our president. His recent reiteration that he is a “stable genius” prompted me to comment.

In the 1964 presidential election, a number of mental health professionals expressed an opinion that Barry Goldwater was paranoid and possibly schizophrenic.  Subsequently, the Goldwater Rule was imposed by the American Psychiatric Association, prohibiting public comment about a candidate’s mental status.  For more than 50 years, until Donald Trump, that was accepted as appropriate ethically.

The primary issues were confidentiality and privacy to protect the mental health client.  There is, however, another important principle, that of “duty to warn” the public if threatening information was revealed. That reasoning was extended to the danger presented to the country by a mentally unstable president. Many professionals spoke up, and Dr. Bandy Lee organized a conference and published a book on the subject, The Dangerous Case of Donald Trump. The focus changed from diagnosing a mental illness to assessing dangerousness.  

It remains inappropriate to diagnose a mental illness without interview and testing information, but mental illness was never really the issue. Many politicians have functioned adequately despite having significant emotional problems. Dangerousness is assessed based on observable behavior. 

Dr. Lee is a professor at Yale who studied dangerousness and developed violence-prevention programs for Riker’s Island jail in New York City. Along with an array of respected professionals, she concluded that Donald Trump meets the criteria for several personality disorders and may have Attention Deficit Hyperactivity Disorder as well as developing dementia.

The personality disorders can often be diagnosed based solely on personal history and behavioral observations.  Most discussion centers on narcissism, and the president ticks all the boxes.  It is called malignant or pathological narcissism, as opposed to the ordinary level seen in politicians, because of the severity.  The severe narcissist does harm to himself and those around him.  He feels entitled to special treatment, he exploits others, and he has no capacity for empathy.

He also meets the criteria for Antisocial Personality Disorder, the largest single category seen in prisons.  He stands accused of numerous crimes, including sexual abuse, and displays characteristic behavior of lying and disregard for right and wrong. 

Of perhaps more concern is the possibility of neurological impairment. People who know the president well say that he seems to be losing his ability to speak with subtlety and complexity.  He is easily frustrated and angered.  Staff report that he repeats the same stories endlessly. It is not possible to diagnose dementia without extensive interview and testing information, but he displays what may well be a progressive impairment.

Many in the mental health community feel an ethical obligation to provide this information to the public. However, there does not appear to be a political mechanism for dealing with it any time soon. The Cabinet is unlikely to pursue 25th Amendment measures, and the Senate will almost certainly not vote to remove the president from office.  

Another view of Donald Trump is that most of what he does is an act. He is first of all a promoter. His bellowing, insulting style is very similar to the showmanship of professional wrestling. His incessant tweeting seems calculated to provoke distress and anxiety. Inside observers say he laughs about the outrage he provokes. Some question whether he is delusional, a potentially severe psychotic problem.  Others say he is simply a very practiced liar and he enjoys it.

A diagnosis of Narcissistic or Antisocial Personality Disorder does not imply a treatable mental illness. These are descriptions of personality traits that a person learned throughout his life. Psychodynamic explanations focus on early developmental neglect or trauma.  Armchair analysts speculate that Donald Trump felt pressured and unloved by his father and that his emotional development fixated in his early teenage years.

People with personality disorders can change, but most do not. Counseling or psychotherapy are of little help.Such people are usually too suspicious and manipulative to engage in therapy. Only when life circumstances crash into their belief systems do they begin to look at themselves as the problem. The term “antisocial burnout” refers to criminals who have finally given up on their fight with authority.

The warning from mental health professionals is not simply affronted liberalism.  There is science to the study of dangerousness, and Donald Trump raises their concern.  Narcissists can deteriorate to a psychotic level of impulsivity if sufficiently frustrated.  

An interesting  comparison is the case of Howard Stern, a disk jockey who built a career shocking sensibilities and challenging the system.  He and Donald Trump had a bond over many years, and in fact had quite similar personal histories.  Both became obsessed with gaining approval, and both used insults and bullying to accomplish that.

Recently Howard Stern says that he has changed. He came to realize that his behavior, although drawing huge ratings, alienated him from everyone close to him. He went to psychotherapy, and he now looks on his earlier antics as embarrassing. 

In my work in prisons, I saw even the most dangerous people with severe personality disorders gain some level of personal insight and empathy. For Donald Trump to change will require a radical revision of his worldview.  I hope, for his sake and ours, that he will.

Prison Reform in Alabama: A Personal History

 I first walked into an Alabama prison in March 1970, 49 years ago with a fresh B.A. in psychology.  Draper prison was the location of a federal research program designed to develop employment programs for inmates.  Inmates at Draper were younger than at the penitentiaries in Holman and Atmore.  In that same year, the ancient Kilby Prison recently had been closed.

At that time there was great interest in prison reform.  From John Kennedy to the Great Society, there was much optimism about improvement in human rights and justice.  Ramsey Clark, attorney general under Lyndon Johnson, continued the New Frontier policies of Robert Kennedy.  In addition to many civil rights actions, Clark sought to reform and professionalize law enforcement.  

With funds from the Law Enforcement Assistance Administration, police, courts and prisons were upgraded. Constitutional and professional standards were established.  Research and innovation were encouraged.  The Bureau of Prisons established numerous pilot program, including an entire facility designated for research in Butner, North Carolina.  

The research program at Draper was funded, not by the Department of Justice, but through the Department of Labor.  The purpose was to develop training materials and procedures for teaching basic education and job skills. The portion of the study that I worked in was more conceptual -- to develop a model prison social culture by means of behavior modification through a token economy.  

I spent five years with the Draper research project as a research assistant, working with great researchers.  I was encouraged to develop independent ideas for research and publication. I left to study clinical and correctional psychology at the University of Alabama.   As a doctoral student at Alabama, I first visited Tutwiler women's prison -- as part of a federal court-ordered investigation into abusive and neglectful treatment of mentally ill inmates.  Sound familiar?

My training at the University of Alabama was funded by the Law Enforcement Assistance Administration, as part of an effort to upgrade the quality of mental health services in justice agencies.  After graduation, I began a 20-year career with the federal Bureau of Prison, ending up back in Alabama at the federal prison in Talladega.

Five years ago, I decided for some reason to offer to help out with the ongoing problems at Tutwiler.  I spent only two months there, leaving because I could not ethically play a role in that situation.  I have seen many prisons and other asylums, but the culture of Tutwiler was vicious.  No significant education or treatment occurred, medical care was horrendous, and incompetent and sadistic administrators operated without restraint. 

Alabama prisons nearly 50 years ago were hard, but usually not vicious.  The dominant principle of prison was hard work.  At Draper, most inmates worked on the surrounding farm, supervised by guards on horses.If they arrived late to "deuce it up," to walk by twos out to the farm patch carrying hoes, then they were handcuffed standing by a chain link fence in the hot Alabama sun.  At lunch they were offered another chance to go to work.  More severe discipline might bring stretches of 21 days in the "doghouse," a four foot high box, also in the Alabama sun.  The lash had been outlawed a few years before.

Alabama prisons today seem to be motivated by vengeance.  Many in the public say the worse the better.  In historical perspective, what is occurring in Alabama prisons will be seen as barbaric -- only slightly removed from public hangings and mutilation.  But we are not  really so far removed from those times.  The Equal Rights Initiative lynching memorial demonstrates how recent and near that such things happened.  

I am often mistaken for a softhearted liberal because I support criminal justice reform.  but, I know more than most of the brutality of crime.  I have dealt with the worst I had friends imprisoned  and tortured for twelve days during a riot.  I saw coworkers murdered and assaulted by prisoners.  I once got too close to segregation unit bars to talk down an agitated inmate and was slapped silly.  I recognize fully that there are people who must be confined, some of them for life.

However, the great majority of people in prison are not as much dangerous as inept.  Most Alabama prisoners ar very poorly educated, have no job skills, and very many are drug addicted.  A few terrifying years in prison will not change that for the better.

My position on prison reform is about not using a very expensive hammer for every task.  Mass imprisonment is phenomenally wasteful of resources, but more important if is counterproductive to the original problem.  Most criminals simply do not need years of prison-level treatment.  community-based programs would cost much less, and would be more effective.

And then there is the moral issue.  I write this today because of what I have seen and cannot unsee. 
The jails and prisons of Alabama are dangerous and poisonous places.  Staff and inmates alike suffer 
PTSD.

I know there is a more sensible and rational approach.  I know there is a science of evidence-based 
correctional techniques.  State Senator Cam Ward is fully aware of the benefits of this approach, but 
Alabama’s one-party political system seems unlikely to give up the vengeance strategy to crime control.  

Recently Senator Ward made a statement that may help to change out political climate.He said,

And then there is the moral issue.  I write this today because of what I have seen and cannot unsee.  
The jails and prisons of Alabama are dangerous and poisonous places.  Staff and inmates alike 
suffer PTSD.

I know there is a more sensible and rational approach.  I know there is a science of evidence-based 
correctional techniques.  State Senator Cam Ward is fully aware of the benefits of this approach, but 
Alabama’s one-party political system seems unlikely to give up the vengeance strategy to crime control.  

And then there is the moral issue.  I write this today because of what I have seen and cannot unsee. 
The jails and prisons of Alabama are dangerous and poisonous places.  Staff and inmates alike 
suffer PTSD. If more people could see what I have seen, we would not have this political gridlock. 
 I have observed Alabama prisons for nearly 50 years, and I have never been more appalled by their 
injustice.

I know there is a more sensible and rational approach.  I know there is a science of evidence-based 
correctional techniques.  State Senator Cam Ward is fully aware of the benefits of this approach, 
but Alabama’s one-party political system seems unlikely to give up the vengeance strategy to 
crime control.  

Recently Senator Ward made a statement that might help to change out political climate. He said, 
" We profess to be the most Christian state in the country, but no Christian would allow their fellow man 
to be treated the way they are said to be treated." In modern language Deuteronomy, God says,
 "It is mine to revenge; I will repay." I think there is a valuable lesson in that.

Notes:

https://www.al.com/news/2019/05/judge-rules-alabama-prisons-fail-to-adequately-prevent-suicides.html

Thompson wrote that the ADOC demonstrated a “pervasive and substantial noncompliance with the interim agreement and other remedial measures that they agreed to implement.”



 https://www.al.com/news/2019/05/how-do-other-states-deal-with-overcrowded-understaffed-prisons.html

 Texas, in 2007, faced with a projected need for 17,000 new prison beds in five years, began pumping hundreds of millions into drug courts and rehabilitation and education for offenders. Texas has reduced its prison population by 30,000 and closed eight prisons.

The Alabama Legislature has done that too, at least to some extent, passing sentencing guidelines and criminal justice reforms that have dropped the prison population from about 25,000 in 2014 to about 20,000.

  A decade ago under former Gov. Nathan Deal, Georgia changed drug crime enforcement to emphasize accountability and treatment for offenders, not incarceration. Starting in 2009, the number of people going to prison dropped 15 percent over five years, including 19 percent fewer black men, according to the Atlanta Journal-Constitution.



 https://www.al.com/news/2019/04/alabama-senator-calls-out-christians-over-prison-conditions-sparking-reaction.html

 no Christian would allow their fellow man to be treated the way

The Caravan: A Slow-Moving Passion Play

The thousands of people walking from Central America to the United States border will be a major symbolic issue in the Nov. 9 election. The Caravan has come to represent, for both political parties, a vote on who is morally right or wrong. This election has become a census of of how divided we are.

The conservatives accuse the liberals of giving away our security, and the liberals can only see babies in cages. There is no middle ground. One side must win and the other side lose. Career politicians seem to be more motivated by personal gain than by public good. All of the big issues drag on for decades.

Political parties are much the same as individual people — when faced with a difficult and emotionally stressful problem, they look away, or blame someone else, or get angry and irrational. The Caravan should be a policy issue, but we are hearing no policy discussion. Instead, both sides retreat to extreme, emotion-loaded arguments the do not address the real problems in a productive way.

The vast majority of Mexicans and Central Americans have no interest in invading the U.S. They would much rather stay home. I have visited the region for decades, and I have learned that the people who live there deeply love their countries — their families and all their culture is there. Most migrants who work in the U.S. send their money home to build better lives for their families.

The crisis in Honduras, Guatemala and El Salvador is a humanitarian catastrophe. The Caravan is a mass demonstration of a plea for help. Criminal gangs in those countries have overwhelmed the ability of the governments to protect their citizens. There is a similar problem in the cartel-controlled areas of Mexico. We also must not forget that we contributed to those problems by military and economic intervention and our own epidemic of drug abuse.

The problem is that Honduras, Guatemala and other Central American countries have, because of poverty, become dangerously unlivable for huge numbers of their people. As a result, their economies are devastated, tourism has collapsed, and now the U.S. government is threatening to cut off current humanitarian aid.

The real issue is about neither politics nor morality, it is simply that our neighbors’ house is burning down and they are begging for help. The Caravan recalls the story of the journey to Bethlehem — the government was involved there, too. It also recalls the U.S. turning away shiploads of Jews fleeing Nazi Germany. How this passion play will act out will be decided by the election next week.

Currently, the largest voting bloc, the independents, are not being offered a choice that makes sense. Confronting desperate mothers and babies with military troops is absurd and barbaric. At the same time it is unrealistic to think a mass migration to the U.S. will solve all of the problems of Central America.

There is much that U.S.policy makers could do to address the root causes of the suffering of our neighbors. In some cases we must acknowledge that we caused the problem. For example, in many rural areas, local economies have been devastated by cheap, imported GMO corn. As a result, millions of peasants migrated to cities, where they were confronted by brutal gangs that originated in the U.S. The Caravan is running from that situation. It would be more economical and more humane to provide support to law enforcement and economic development in the home countries than to send soldiers to our border.

There are many practical ideas for strengthening our ties to our closest neighbors, but nothing can pass in the current political climate. There is a middle ground, if only we and our elected leaders will discuss it.

In the upcoming election, we must support candidates who reject extremism and endorse discussion and compromise. Perhaps the new Silent Majority is the reasonable middle ground. I eagerly await the results on election day.