Until recently, the debate over our president’s mental health has focused on questions of
psychological pathology: Do Donald Trump’s flamboyant narcissism, hedonism, and self-delusions add up to a malignant personality — or a malignant personality
disorder?
Scores of psychiatric professionals
say the latter. Some of their peers — and a large number of laymen — have insisted that the matter can only be settled by a psychiatrist who has personally, privately evaluated the president. That argument has always struck me as nuts.
There is no diagnostic blood test or brain scan for
narcissistic personality disorder; there’s just a
list of observable traits. A mental-health professional simply studies a patient’s modes of reasoning and patterns of behavior, and assesses whether they fit the checklist of symptoms for NPD. It’s absurd to believe that a psychiatrist who has spent a couple of hours talking to a patient in an office is qualified to make this diagnosis — but one with access to hundreds of hours of a patient’s interviews and improvisatory remarks, along with a small library’s worth of biographical information and testimonials from his closest confidants — is not. To insist otherwise is to mystify psychiatric practice; it’s to pretend that there is some shamanistic knowledge that mental-health professionals can only access once you provide them with a co-pay.
Further, whether we choose to label any given psychological profile a “disorder” is always, on some level, a value judgement about what it means to function healthily in our society. If an inability to concentrate on tests can qualify one for psychological dysfunction, then it’s hard to see why Trump’s manifest incapacity to subordinate his hunger for affirmation and attention to basic social norms would not. If a middle-school boy displayed Donald Trump’s level of impulse control in the classroom, there is little question that he would be considered psychologically unhealthy.
Regardless, in recent weeks, concerns about the commander-in-chief’s cognition have turned to the more mundane, and objectively determinable, question of neurological decline. The president’s
slurred speech when announcing his decision to recognize Jerusalem as Israel’s capital; the exceptional incoherence of his
most recent interview with the New York Times; and increasingly erratic (
and Freudian) tweets all brought our president’s frontal lobe to the forefront of public discourse.
