Trump’s Narcissism and the Goldwater Rule

Donald Trump’s narcissism is a large concern, but so is the Goldwater Rule, which insists that we should ignore the 300 pound menace in the Oval Office.

Donald Trump’s Narcissism

We’re not supposed to talk about Donald Trump’s narcissism. This is not because Trump has bullied us into silence. Which, after all, is how he handles any criticism, by bullying.

No, we do not avoid Trump’s narcissism for fear of his low-brow reprisals. The reason we don’t talk about his narcissism is because there are actually professional injunctions against stating the obvious. Hard to believe, but true. It’s the First Amendment vs the bureaucracy; it’s truth vs political correctness.

The Goldwater Rule

The problem began with the 1964 Presidential campaign, when over a thousand polled psychiatrists declared Barry Goldwater to be unfit for the Presidency. The American Psychiatric Association (APA) objected to this behavior, and passed the ‘Goldwater Rule’: a psychiatrist should never offer a professional opinion on a patient she has not personally examined.

It was a nice ‘Catch 22’, because psychiatrists are also not allowed to reveal anything they know about a patient they have examined either, at least not without the patient’s permission. A bit of a problem, that: given the outsized egos and other dysfunctions of those seeking power and fame, knowledge of a candidate’s sanity might be even more important than, oh, say, knowledge of his tax returns.

I am no psychiatrist, so I’m not bound by the Goldwater Rule. I have, however, spent some years studying narcissism and the ‘dark tetrad” for my own writings on mental dysfunction in government throughout civilization. I wish to offer a different analysis.

The Importance of Healthy Priorities

First, it is critical to remember that the Goldwater Rule was written in response to a single instance of questionable behavior; it is important to remember that it is a professional injunction, not some universal law of physics. When it was written, the APA did not consider all possible ramifications of the rule, nor could it. For instance, the APA apparently did not consider exactly the problem that the U.S. Founders obsessed about, that an autocrat or a madman — and the case can certainly be made that Trump is both — might grab control of the republic. All of the Founders’ deliberations about the balance of powers was designed to prevent exactly what seems to be happening with Trump.

Which is important. The question here isn’t simply, Should psychiatrists render opinions on people they have not examined? The larger question is, What is the greater danger: Diagnosis at a distance? Or the future of our democracy, and possibly the free world? In treating dangerous conditions, doctors often find that we must choose among various evils. This is why complex conditions should not be assigned to clerical clinicians armed with inflexible rules.

This tension between priorities is exactly why a group of mental hygienists and other scholars have argued forcefully that Donald Trump represents an extreme, and unprecedented threat, one which endangers the modern world. The real problem here is simple: Trump warrants a serious reconsideration of the Goldwater Rule.

Arguing Against Trump’s Narcissism

Despite these psychiatrists’ warnings about Trump’s narcissism, another supposed expert in the field responded in a letter to the New York Times by arguing that Trump does not fit the criteria.

I say ‘supposed,’ because his letter presents puzzling arguments. For instance, he starts by claiming that “Most [italics added] amateur diagnosticians have mislabeled President Trump…” I seriously doubt there is evidence to support such a statement. That would be a picayune concern, except that it is exactly the sort of misstatement that an ‘amateur diagnostician’ would make.

The psychiatrist aggravates this early, minor error by them claiming that he wrote the psychiatric criteria for narcissism, i.e., for Narcissistic Personality Disorder (NPD). To invoke the more polite name for a popular card game, “I doubt it.” A committee wrote that criteria; the psychiatrist in question simply chaired the committee. This, too, would seem to be a minor problem, except for the itching irony: it suggests an unhealthy streak of narcissism, in an expert on narcissism.

The writer, unfortunately, then moves from these small concerns to a couple of stunners. First, he argues against Trump’s narcissism, insisting that the president does not qualify for NPD because “he does not suffer from the distress and impairment required to diagnose the mental disorder.”

If that is a necessary symptom, and this psychiatrist wrote the criteria, then why didn’t he include that in the diagnostic criteria?

The Goldwater Rule Works Both Ways

In a final bit of irony, the writer himself is violating the Goldwater Rule. By publicly declaring that Trump is not a narcissist, he is giving a professional opinion on a patient he has not examined. The APA has made it clear that the rule works both ways: a clinician may not offer a diagnosis of mental disease, nor of mental health.

I wonder how the APA responded to this violation? Because it appears that they responded aggressively to those arguing for Trump’s narcissism, (see addendum, below) but became tacit for someone arguing against Trump’s narcissism.

Having noted all of the above, I can easily show that the Goldwater Rule is unimportant in the current situation.

Narcissistic Personality Disorder

Various international professional bodies have issued differing (and sometimes contradictory) criteria for narcissism. The APA’s version for NPD lists the following nine diagnostic criteria:

• Grandiosity with expectations of superior treatment from others
• Fixation on fantasies of power, success, intelligence, attractiveness, etc.
• Self-perception of being superior,  unique, and associated with high-status people and institutions
• Needing constant admiration from others
• Sense of entitlement to special treatment and to obedience from others
• Exploitative of others to achieve personal gain
• Unwilling to empathize with others’ feelings, wishes, or needs
• Intensely envious of others, and the belief that others are equally envious of them
• Pompous and arrogant demeanor

To make the diagnosis of narcissism, at least 5 of these must be present.  To rule out narcissism, at least 5 must be absent.  Notice that there is nothing very hard to understand here, one does not need a psychiatric background to understand them, nor to apply them to Trump. So let the reader decide: try to eliminate 5.

No:  eliminate just one. 

And I challenge any psychiatrist in the world, I challenge the entire APA, to argue that a single criterion can be eliminated, without that psychiatrist becoming a laughing stock.

The Final Gauntlet

Here is my final gauntlet to drop before the APA: Should the Goldwater Rule have applied in 1930’s Germany? Would anyone argue that it would have been the psychiatrist’s professional duty to say nothing of Hitler’s mental condition… even as the founder of psychiatry was forced to flee Vienna for his life?

What about after Kristallnacht, would the Goldwater Rule have applied?  What about after the deportations to the death camps of Jews, Roma, homosexuals, and many others?^[1]I have a friend of mine who lived in Casablanca during WWII.  She said they were hearing about the death camps as far away as Morocco, and therefore insists there was no way the Germans had no idea … Continue reading  What about after the head of state launched a world war?

Should psychiatrists have kept their hands clean of judgmentalism, while blithely bloodying them in complicity with the deaths of over 50 million people?

How could anyone who claims to have dedicated her life to human health adhere to a clerical proscription such as the Goldwater Rule, as a madman inflicted global horror?

2019.03.21: I have updated this post to link to the most recent edition of the The Dangerous Case of Donald Trump. I attended the book launch for it at the National Press Club in Washington, DC. The event included a conference in which a blue-ribbon panel of diverse experts voiced extreme concerns about Trump (in the video, you can occasionally see my bald head at one of the front tables). For reasons which aren’t immediately clear, the media largely blacked out the event.  In addition, in response to the alarms from this book, the American Psychiatric Association—ironically, in what appears to be a authoritarian, even Trumpian fashion—brushed aside the concerns expressed by these highly respected scholars, and simply doubled down on their position, prompting some to refer to this hardened attitude as ‘The Trump Rule.’

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Picture courtesy of Max Goldberg.