Local psychologist wades into debate about Trump’s mental health with a surprising diagnosis

San Diego Union-Tribune (CA)

Sept. 03--When it comes to narcissistic personality disorder, Dr. Allen Frances wrote the book.

So the 75-year-old Coronado resident and retired Duke University psychiatrist perks up when he hears the increasingly open speculation about whether President Trump has the disorder or some other form of mental illness.

His verdict: No.

But that doesn't mean he approves of Trump's behavior. Far from it, as he makes clear in a scathingly critical new book, "Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump," due out Tuesday.

"Blaming Trump for all our troubles misses the deeper, underlying societal sickness that made possible his unlikely ascent," Frances writes.

By societal sickness, he means the "delusions" that deny the impacts of climate change, overpopulation, resource depletion, income inequality -- problems that will "bequeath to our children an unlivable planet." He was concerned about those before last November's election.

"I don't think Trump is the problem," Frances said. "He's the symptom of the underlying disease."

His book comes out amid a flurry of discussion in government circles, the national press, late-night talk shows and social media about the president's mental stability and fitness for office.

On Aug. 18, Zoe Lofgren, a Democratic congresswoman from San Jose, introduced a resolution urging Trump to get a psychiatric exam to determine if he should be removed from office under a little-known section of the 25th Amendment. She pointed to an "alarming pattern of behavior and speech causing concern that a mental disorder may have rendered him unfit and unable to fulfill his Constitutional duties."

That followed a bill introduced in April by a Democratic congressman from Maryland that would -- also under the 25th amendment -- create a panel of doctors who would assess the president's ability to govern and could recommend removal. The bill now has almost 30 co-sponsors.

A petition for mental health professionals on Change.org declares that those signing it believe Trump "manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties" of the presidency. It asks that Trump be removed from office. More than 60,000 people have signed.

And about two-dozen mental health professionals are contributing to a book due out in early October called "The Dangerous Case of Donald Trump," which argues that the president is a "clear and present danger" to the nation.

Some see all this as political, not psychological.

"With all the 'medical opinions' out there, it's as if doctors have left their practices due to the Obamacare disaster and are now attempting careers in TV," White House press secretary Sarah Sanders said in a statement quoted by USA Today. "This is nothing more than another absurd attempt to attack the President. It did not work during the campaign, and it will not work now."

The doctor demurs

It's called the Goldwater Rule.

Adopted in 1973 by the American Psychiatric Association, it says offering a diagnosis of a public figure's condition is unethical unless "he or she has conducted an examination and has been granted proper authorization for such a statement."

The rule got its named from Barry Goldwater, the 1964 Republican nominee for president. During the campaign, a magazine called Fact published the results of a survey of psychiatrists. Almost 1,200 of them declared Goldwater "unfit" for office because of personality defects, including paranoia and a God-like self image.

Goldwater sued for libel and won $75,000, and in the fallout doctors pushed for the new ethical boundary.

Other groups of mental health professionals adopted similar restrictions, but that hasn't stopped members from weighing in publicly over the years about other presidents. Was LBJ narcissistic? Nixon paranoid? Clinton a sex addict?

Trump's volatile campaign and presidency have brought new attention to the Goldwater Rule, and sparked debate about whether it should be eased. In August 2016, the APA reiterated its stance that long-distance diagnosing is "irresponsible, potentially stigmatizing, and definitely unethical." Some psychiatrists resigned from the association in protest and others openly flouted the rule.

In February, 35 psychiatrists, psychologists and social workers sent a letter to the New York Times. "We fear that too much is at stake to be silent any longer," it read. "We believe that the grave emotional instability indicated by Mr. Trump's speech and actions makes him incapable of serving safely as president."

At home in Coronado, Frances read the letter and wrote a response. It was published under the headline, "An Eminent Psychiatrist Demurs on Trump's Mental State."

In the letter, Frances pointed out that he wrote the criteria for narcissistic personality disorder in the so-called bible of his profession, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. He said Trump doesn't meet the criteria.

"He may be a world-class narcissist, but this doesn't make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder," Frances wrote. "Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy."

The letter created a stir in psychiatric circles and beyond. Frances was quoted in the New Yorker ("We need to be looking in the mirror to see what's wrong with us that would allow someone so unsuitable for the Presidency to rise to the highest and most dangerous office in the world"). A columnist for the Los Angeles Times drove down and interviewed him in his living room.

And the book he was writing took on a new urgency.

A hypocrite?

Frances wrote "Twilight of American Sanity" for his grandchildren.

"It seems to me criminally irresponsible as parents and grandparents that we're handing on to our next generation a world so materially worse than the one we inherited," he said.

That's why the first chapter looks at global warming, population growth, resource depletion, income inequality, an expensive and inefficient health-care system, and other problems.

"The book was basically going to be about societal delusions and to wake us up to understand them," he said. "And to suggest a different, more rational, generous and sustainable way of running the world in the future. Then Trump came on the scene, and everything that was crazy about society before went on speed."

After the election, Frances couldn't understand "how so many Americans could possibly be so gullible." Then his wife, Donna Manning, also a psychiatrist, called him out as a hypocrite.

"She said it was easy enough for us to feel superior to the Trump crowd, because we were so insulated from the problems and dangers they were facing," he writes in the book. "Trump might be the worst of all possible messengers, but that shouldn't allow us to discredit his message or disrespect those who were sending it."

So he explores issues like the outsourcing of jobs, stagnant wages, immigration, rapid cultural change.

"I understand completely why people voted for Trump," Frances said. "They're suffering. They're angry. The system is not working for them. But they hired a fox to guard the hen house."

The book's cover is a photo of an American flag on a pole, flying upside down. According to the U.S. Flag Code, it's only supposed to be displayed that way "as a signal of dire distress in instances of extreme danger to life or property."

Dire distress -- that's a diagnosis, Frances said, that fits

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