Political extremism poses a challenge to the mental health professional. What’s a therapist to do with someone who aims to overturn society as we know it? The person may prove no immediate danger, but from a certain perspective the desire for radical change can seem destructive, threatening at any moment to tip into violence. From attempts by the government to create psychological profiles of likely terrorists to the persistent criminalization of drug use, it has become commonplace to pathologize any rejection of the established order: as a contortion of rational thought, a chemical imbalance, or as acting out against the symbolic father. It takes the status quo as rational, and the rational as the status quo.
Two recent books from mental health professionals about contemporary politics—one assessing the fitness of Donald Trump for the presidency, and the other the mental state of America—exhibit precisely this prejudice. The Dangerous Case of Donald Trump is a collection of short essays by twenty-seven mental health experts who feel that the danger of Trump’s power exceeds professional stipulations against speculating on the state of people not under psychiatric care. Psychiatrists have avoided medical judgments of national politicians since the establishment of the “Goldwater rule,” a directive created by the American Psychiatric Association in 1973 after a survey of mental health professionals concluded that Barry Goldwater was unfit to be President in 1964. This interference in a campaign, the Association determined, transgressed the ethical norms of the profession by diagnosing someone who had not been formally examined.
The book, which arose from a conference at Yale, dramatically sets aside this ethical concern for a supposedly greater one: the duty to warn that Trump’s behavior signals a potentially dangerous outcome for the American people. (This same group has come into the spotlight in recent days after reported conversations in Michael Wolff’s book Fire and Fury reopened the question of Trump’s sanity.) “Did Nixon’s psychotic deterioration, for example, lead to more carnage in Vietnam?” wonders one clinical psychologist. “Did Nixon make decisions of state while drunk?”
It is a strange premise for a book. Focusing on the defects of Trump’s character, whether as a racist, a misogynist, bipolar, or a narcissist, has proven so ineffective in the past two years that it is somewhat confounding that this group has chosen to set aside their professional reticence and speak out now. It is a political act for them to do so, not a medical one, as they do not appear concerned with the patient at all, but rather with the state of the country and the population. The material they rally to their cause is mostly analyses of political speech, though some reach back into Trump’s history to examine his relationship with his job, and with his father. As one clinical psychologist writes,
[Trump] insisted that he will “bomb the shit out of ISIS” and order our soldiers to kill their presumed families. He repeatedly goaded supporters to rough up hecklers at his speeches and pontificated that NFL players who refuse to stand for the national anthem should find another country. He quoted Mussolini’s “Better to live one day as a lion than a hundred years as a sheep,” and he expressed genuine bewilderment why we build nuclear weapons if we don’t use them.
In this sense—and to their credit, some of the authors acknowledge this—they speak as citizens and not as professionals: citizens who have special knowledge of what might make a person irresponsible or dangerous in a position of power. But as a text by citizens, the book doesn’t add much weight to the rote arguments we’ve all been subjected to. We are all worried that Trump will start a war with North Korea, and we are all mortified that he said he grabbed women by the pussy. The problem is not that we aren’t worried; the problem is that we can’t use these arguments against him to any demonstrable effect.
The diagnoses laid out here—narcissistic personality disorder, sociopathy, Alzheimer’s, Trump-as-Hitler—will not result in treatment or removal from office. They assume a rational population that needs only to have the cause laid out for them. The problem confronting America is not a dearth of facts; the problem, rather, is that most people want the benefits of a system whose logical extreme—Trump—they can’t tolerate. Trump’s recent tweet regarding bragging about the “biggest” nuclear button, to take one example, says less about the man than the system he inherited. The tweet reopened discussion about whether Trump should be allowed on Twitter, as a person with so little inhibition and so much power. But should we be angry about Trump’s Twitter account, or the consolidation of nuclear power to a single elected position? Is the true crime an ominous tweet, or the fact that a single person has the capacity to annihilate the planet, if he so chooses? Trump challenges us with the madness of the system he inhabits.
More helpful than assessments of the man himself are the accounts of and by those who have dealt with Trump directly. Tony Schwartz, ghostwriter for The Art of the Deal, first wrote about his experience with Trump earlier this year in The New Yorker. Here, he expands on the process: “Even 30 years later, I vividly remember the ominous feeling when Trump got angry about some perceived slight. Everyone around him knew that you were best off keeping your distance at those times, or, if that wasn’t possible, that you should resist disagreeing with him in any way.” Schwartz’s most recent interaction with Trump came after Trump was called by The New Yorker’s fact-checker: “I just want to tell you that I think you’re very disloyal,” Schwartz recalls Trump telling him, before abruptly hanging up. “Disloyal” figures like Schwartz—who are willing to both disagree with Trump, and make sure Trump is aware of that disagreement—are an anomaly. The stream of resignations and firings surrounding Trump notwithstanding, the White House staff has stood by Trump, attempting to stay in his favor, along with Congressional Republicans and much of his base.
Thus the American population’s relationship with its own country. The last third of the book deals with the impact of Trump’s presidency on the general population, and in some cases, the therapists’ own patients. One chapter, called “In Relationship with Abusive President,” suggests that the specific diagnosis doesn’t matter; it’s how we end up being affected by our proximity to someone of this ilk. In another chapter, a licensed clinical psychologist coins a common reaction: “Trump Anxiety Disorder,” a variation on General Anxiety Disorder, but marked with its own particular characteristics, including a “tendency toward excessive social media consumption.” While Trump has had a profound psychological impact, this seems like a gutless effort to explain an entire era as a Trump-induced stress disorder. It will take more than pathologizing to understand the relationship the nation has toward social media and its President.
When Trump talks about the “biggest button,” it is rhetorically ridiculous but existentially honest: the nuclear button he controls is, metaphorically but truly, the biggest in the world, capable of the most severe annihilation possible. But we react to the rhetoric rather than to the reality. Why? Thomas Singer has the most compelling explanation in the book. Singer lays out a theory of “extinction anxiety” he believes motivated both the conservative decision to back Trump and the liberal reaction against him:
Extinction anxiety exists both in the personal and group psyche and is based on the fear of the loss of supremacy by white Americans of the United States, the loss of America’s place in the world as we have known it, and ultimately the destruction of the environment and the world itself. One might think of extinction anxiety as the cultural psyche’s equivalent of death anxiety in the individual. For instance, climate change deniers on the right may be seen as denying the very real possibility of the planet’s destruction as a way of defending themselves against the fear of extinction. Aligning himself with this attitude, Trump offered to dispel extinction anxiety by denying it is real and appointing a well-known climate change denier as head of the EPA. Denial, whether at the individual or group level, is the most primitive defense the mind employs to protect itself from psychic pain.
This explanation is encouraging because it means that we can treat conservatives and climate change deniers not as aliens, but as counterparts: equal to the left’s urgency over the survival of the planet is the right’s anxiety and willingness to deny it. But the impetus is the same: a “primitive defense” to an existential and psychological attack on our very being.
“If we want to get sane, we must first gain insight about ourselves,” writes Allen Frances in Twilight of American Sanity. Frances, who started his book well before the election, is a psychiatrist who played a major role in establishing the diagnostic criteria for the most popular lay Trump diagnosis, narcissistic personality disorder. Frances briefly expresses disdain for the rush to call Trump a pathological narcissist. He rightly points out that everyone has some level of narcissism; it can only be classified as a disorder when it interferes with living a normal life—that is, functioning. Since Trump did reach the highest office, Frances chooses not to speculate on whether Trump is a functioning individual (or “a very stable genius”). Instead, he asks a question of the rest of the country, from Trump voters to gas guzzlers: Faced with the destruction of our planet, why aren’t we rational? We see it coming, most of us, but we may not be able to stop it.
To this endlessly fascinating and important question, Frances couldn’t give a more boring answer: evolutionary psychology, he says, is why humans are greedy and selfish and procreating all the time. He paints in unbelievably broad strokes: “Nearly every war and civil war,” he dashes off, “is a battle between overpopulated, patriarchal tribes (continuing to multiply fiercely) fighting neighboring tribes (also multiplying fiercely) for rights to rapidly diminishing land, food, water, and other resources.” Compared to the individual blame ascribed by Trump-haters, this is a full 180. Blissfully blind to the gruesome specifics of American history, Frances delivers himself into the arms of an essentialist fantasy, in which our psychological primacy is secondary to our primitive instincts. “It is no fun,” he writes, “losing center stage in a universal passion play and instead having to settle for a bit part as just another primate species.” No fun, indeed. But we still have a chance, maybe after reading this book, to change our fate: “The winner in the perpetual conflict between rational cortex [sic] and emotional limbic system will determine the fate of mankind.” This portrait of primitive, brutish humanity, in Frances’s account, is as uncomplicated as homo economicus: whether self-preserving or benefit-maximizing, the perfect specimen of humanity is always rationally calculating his best means for survival.
Frances’s argument reaches an all-too-familiar level of nonsense when he expresses his support for birth control and other prophylactic measures not for reasons of women’s rights, but for the purpose of population control. Without population control, his extinction anxiety writes, we are doomed. He deduces from this argument that women, having failed sufficiently to back Clinton, have led us helplessly into a future overwhelmed by evangelical babies: “A small cabal of old white men have [sic] exerted their extremist control over the reproductive rights of millions of young women—and in the process, have put our world on the course to a devastating Malthusian crash. In their inexplicably tepid support for Hillary Clinton, women allowed Trump to steal the presidency.” That modifier, “inexplicably,” is full of resentment. Frances could not, apparently, explain women’s voting patterns with Darwinism, so he stopped there.
How ridiculous it is, finally, that the most effective route many have found for opposing Trump is to call him (or us) mentally unfit. Mental illness has long been used not only as an excuse to take power away from people, but as an absolution of that person’s history, or the history of our society. The same goes for Trump. In worrying about his fitness, we actually say less about him, to say nothing of the branch of office he occupies, or the people he governs. No need to stop at Trump or Americans in the pathologizing game. Start thinking of institutions as unfit, and then we’re getting somewhere.
What are psychiatrists good for, in the political sphere? On the evidence of these books, not much. It’s like a Greek play with the evil and dangerous tyrant, whose power protects him and the chorus of prophetic psychologists who sense a bad thing coming but must watch the tragedy play out. The chorus has a “duty to warn,” but the warning is never heeded. The help that therapists of any ilk can offer comes from changes to the self, not changes to society. A therapist can’t offer to give you more money, or literal freedom, but they can teach you to tolerate your lack of it without acting out. They can help you to function in society as it is. This is a crucial function, and what the books bring us: a bit of foresight, but not a diversion from our fate.