Donald Trump has 'dangerous mental illness', say psychiatry experts at Yale conferenc

[xjx388]

I think the last paragraph is the "Trump might be playing 4D chess" argument. I find that implausible.

My view is that Trump's behaviour is so odd that it raises warning flags, and that he should be subjected to an examination to see whether he is fit for office.

Whilst I accept that clinical psychologists would not diagnose someone without an examination,

Then you aren't that far off from my view.

criminal psychologists have to do something pretty akin to this, based on the evidence they have available, which would be far less than the evidence we have in the case of Trump.

But the evidence they have available includes the legal and medical history of the subject and almost always a personal interview with the subject and/or those close to the subject. Criminal profilers, who may not even know who the subject is, are not making clinical diagnoses; they are trying to glean whatever information they can based on the standards of their profession.

 

[jimbob]

There's a difference between people who make bad decisions and have a bad outcome and people who have bad outcomes because of a mental illness.

Yes, but the examples I gave, their behaviour was abnormal, and it eventually caused them problems (Nero included).

The thing was that there was a threshold, mostly of time before which their same behaviour and same underlying ... worldview hadn't caused problems, although the changes were outwith them.

If I believe a magic pixie tells me what cards to pick, and I gamble and win, and then I gamble and lose everything, I was still deluded at the start, even though I actually benefited from it.

I can see why mental illness is defined as causing harm or distress to the subject, but there are sufficient situations where I would say that such a definition is missing something, which a more colloquial definition of "mad" is not.

Did the Yorkshire Ripper suffer harm or distress until he was caught?

 

[blutoski]

I think the last paragraph is the "Trump might be playing 4D chess" argument. I find that implausible.

Well, it's more that I think his goal is to get rich, and that he's shooting from the hip on the president stuff. I'm not proposing there's any sophisticated planning.

My view is that Trump's behaviour is so odd that it raises warning flags, and that he should be subjected to an examination to see whether he is fit for office.

I totally agree. I think he's the most narcissistic person I've ever borne witness to. I think he's unstable. I think he's progressing dementia.

This doesn't make him medically diagnosable as specifically NPD, and secondly, it doesn't matter what I think medically, because I'm not qualified to diagnose.

Whilst I accept that clinical psychologists would not diagnose someone without an examination, criminal psychologists have to do something pretty akin to this, based on the evidence they have available, which would be far less than the evidence we have in the case of Trump.

Not sure what that distinction is... just as an example, my wife is an emergency intake psychiatrist. Patients come from whatever funnel they come through: some walk in voluntarily, some are brought in by the police. There's no special process for forensic patients.

If a patient refuses to participate in a structured interview, that alone is something they have interacted with the psychiatrist about, and then they are observed further, usually in isolation, but sometimes with other people (family, other patients) with an eye to what may constitute their casual behavior. There is always a direct observation and several attempts at interaction by the psychiatrist to justify diagnosis. It's especially critical if the occupation is reportable.

I asked my wife about BC reportable occupations, and she will come up with a list, but not sure if the information is on the web. These occupations have something called "reporting bodies." Examples from her recent memory are airline staff, police, military, medical doctors. The reporting bodies have a list of conditions they want reported, so not all professions want the same conditions reported. (which makes sense... airline pilots are probably allowed to have a toe infection unreported, but they want to hear about clinical depression due to suicide risk)

 

[xjx388]

Yes, but the examples I gave, their behaviour was abnormal, and it eventually caused them problems (Nero included).

The thing was that there was a threshold, mostly of time before which their same behaviour and same underlying ... worldview hadn't caused problems, although the changes were outwith them.

If I believe a magic pixie tells me what cards to pick, and I gamble and win, and then I gamble and lose everything, I was still deluded at the start, even though I actually benefited from it.

How do we know what you believe unless you tell us? How do we know that you aren't merely making an excuse after the fact for your bad behavior? This is where a psychiatrist/ologist comes in and examines the patient using the standards of the profession. There are plenty of people who lose at gambling and they aren't all mentally ill. IOW, the bad outcomes are not necessarily indicative of an underlying mental illness.

I can see why mental illness is defined as causing harm or distress to the subject, but there are sufficient situations where I would say that such a definition is missing something, which a more colloquial definition of "mad" is not.

Did the Yorkshire Ripper suffer harm or distress until he was caught?

I have no idea. I know he caused harm to others which might indicate an underlying mental illness. But I don't think we can say all murderers are mentally ill. They might be, but no one is in a position to say for sure or what their illness actually is until a professional examines them.

 

[Skeptic Ginger]

How is this a calculated political act and/or not bizarre?

Donald Trump gets a daily briefing all about how great he is

And this awkward staff meeting:

TRUMP APPOINTEES TAKE TURNS PRAISING HIM IN BIZARRE CABINET MEETING

The examples are numerous:

How Trump’s campaign staffers tried to keep him off Twitter - The trick? Making sure his media diet included a healthy dose of praise.

Not normal.

 

[blutoski]

Yes, but the examples I gave, their behaviour was abnormal, and it eventually caused them problems (Nero included).

The thing was that there was a threshold, mostly of time before which their same behaviour and same underlying ... worldview hadn't caused problems, although the changes were outwith them.

If I believe a magic pixie tells me what cards to pick, and I gamble and win, and then I gamble and lose everything, I was still deluded at the start, even though I actually benefited from it.

I can see why mental illness is defined as causing harm or distress to the subject, but there are sufficient situations where I would say that such a definition is missing something, which a more colloquial definition of "mad" is not.

Did the Yorkshire Ripper suffer harm or distress until he was caught?

Just to clarify... mental illness isn't 'defined' as causing harm &c. It's just that specifically in the case of NPD, it's one of several necessary but insufficient criteria, which is why I feel it can't be dismissed casually in this thread.

Regarding the pixie example, this is a good example of why a structured interview may be necessary... there is a difference between delusional versus misinformed. Consider if the gambler in question was a child (or mentally delayed adult), and she thinks a pixie guides her because her mom said. Perfectly healthy, quite normal. But you don't know until you engage directly with a few back and forth questions.

 

[Emily's Cat]

IOW present inappropriate evidence. (I told you, that is not the nursing commission's function.)

As for disputing my scope of practice, what are you basing your assertion on? Like I said, I posted supporting evidence that recognizing/diagnosing basic psychiatric disorders was indeed within the scope of family practice. Why you think NPD is so complex is another unsupportable assertion you've made.

How many cases of personality disorders have you diagnosed or treated?

Do you also consider epilepsy to be a simple condition that is within your scope as a Family Practice ARNP?

 

[BobTheCoward]

How is this a calculated political act and/or not bizarre?

Donald Trump gets a daily briefing all about how great he is

And this awkward staff meeting:

TRUMP APPOINTEES TAKE TURNS PRAISING HIM IN BIZARRE CABINET MEETING

The examples are numerous:

How Trump’s campaign staffers tried to keep him off Twitter - The trick? Making sure his media diet included a healthy dose of praise.

Not normal.

Why does someone have to be normal? That is a little bigoted.

 

[blutoski]

Why does someone have to be normal? That is a little bigoted.

It's also why there's a lot of heat surrounding the Cluster B "personality disorders." They're at the top of the list for examples of "medical overreach."

In principle, medicine is interested in relieving suffering caused by our bodies not working the way we want. This is what makes Chicken Pox a disease, rather than a 'rite of passage,' as some antivaxxers assert.

Their claim is extreme (that the suffering is cultural - why not celebrate the pus filled blisters!), but somewhere along the continuum I think there's a good case for "Did we just hand the medical establishment a license to treat... Dickery?"

Their toe in the door is that the patient may have the same jackass personality as his neighbour, but for some reason - in his family or social group or occupation or legal region or whatever - it's not working for him.

 

[blutoski]

How many cases of personality disorders have you diagnosed or treated?

Do you also consider epilepsy to be a simple condition that is within your scope as a Family Practice ARNP?

There was also that passage about how if the patient's occupation is at risk, it's out of scope not only for FP ARNP, but even for the psych specialists. Basically if a job is at stake, the nurses need to bow out and hand it over to an MD psych. I suspect that's part of the criteria for what excludes a condition from being 'basic'

But we really should defer to the authors; I hate wasting cycles on what I call "duelling interpretations" when there's an actual SME available.

 

[Fudbucker]

Wow, there are still people who don't think Trump's a narcissist?

"Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."
http://www.mayoclinic.org/diseases-...ality-disorder/basics/definition/con-20025568

Does that sound like anyone we know? Hmmm.....

 

[xjx388]

Wow, there are still people who don't think Trump's a narcissist?



"Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."

http://www.mayoclinic.org/diseases-...ality-disorder/basics/definition/con-20025568



Does that sound like anyone we know? Hmmm.....

Great. More doctoring by Google...


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[Fudbucker]

Great. More doctoring by Google...


Sent from my iPhone using Tapatalk

If someone on the subway is wearing a tinfoil hat and talking to invisible people, are you going to think, "Now, now, I'm not a doctor.."

 

[xjx388]

Pretty much. I'm certainly not going to speculate about which illness they have. I also won't vote for them if they run for President.


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[Steve]

Great. More doctoring by Google...


Sent from my iPhone using Tapatalk

The op in this thread provides the professional opinion of several doctors that Trump has NPD. xjx388, who is not a doctor and who acquires his information by googling, has spent 40 pages arguing his position that the doctors' opinion is not valid. Someone else, who is also not a doctor, expresses an opinion that is different than xjx388's. xjx388 dismisses that opinion because the poster is not a doctor.

See where this is going....?

 

[xjx388]

The op in this thread provides the professional opinion of several doctors that Trump has NPD. xjx388, who is not a doctor and who acquires his information by googling, has spent 40 pages arguing his position that the doctors' opinion is not valid. Someone else, who is also not a doctor, expresses an opinion that is different than xjx388's. xjx388 dismisses that opinion because the poster is not a doctor.



See where this is going....?

Please cite where I have made any diagnosis or performed any doctoring. I am discussing the ethical/social aspects of medicine's role. I have cited the ethical position of the APA as well as other doctors who have commented on the situation. I also don't want to live in a society where doctors have free reign to stigmatize their political opponents.

Your "summary" is a greater zinger, I'll give you that; too bad it doesn't reflect what the discussion is actually about.


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[blutoski]

Please cite where I have made any diagnosis or performed any doctoring. I am discussing the ethical/social aspects of medicine's role. I have cited the ethical position of the APA as well as other doctors who have commented on the situation. I also don't want to live in a society where doctors have free reign to stigmatize their political opponents.

And this is partly where I come from as well. I'm from the other side of the iron curtain. Classifying political opponents as mentally ill is a totalitarian tool. There's a prudent human rights reason the APA wants its members to resist the temptation to participate in partisan diagnostics.

Onesource link: [Political abuse of psychiatry in Russia]

 

[blutoski]

Wow, there are still people who don't think Trump's a narcissist?

"Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."
http://www.mayoclinic.org/diseases-...ality-disorder/basics/definition/con-20025568

Does that sound like anyone we know? Hmmm.....

Feels like a strawperson.

I may have missed it, but I don't think anybody said Trump isn't a narcissist.

I think critics of the OP have been saying the medical diagnosis of NPD is not confirmed.

 

[blutoski]

The op in this thread provides the professional opinion of several doctors that Trump has NPD. xjx388, who is not a doctor and who acquires his information by googling, has spent 40 pages arguing his position that the doctors' opinion is not valid. Someone else, who is also not a doctor, expresses an opinion that is different than xjx388's. xjx388 dismisses that opinion because the poster is not a doctor.

See where this is going....?

Not sure what you mean exactly. xjx388 has been saying that from what we can tell, these doctors are acting outside their scope of competence.

As skeptics, we make this type of evaluation all the time - it's part of our quackbusting mission.

I'll revisit the criteria I use for laypersons' evaluation of expert claims (from a 2nd year course in critical thinking):

• Is the claim within an acknowledged discipline? (yes, medicine)
• Is the claimant recognized as a member of this specialty? (yes, he's a licsensed psychiatrist)
• Is the claim consitent with a professional consensus? (it doesn't look like it)
• Is the claimant unduly biased / conflict of interest? (I think so)

Here's a proposed alternative structure, actually by a colleague of mine at Cap U of all places: [Assessing Expert Claims: Critical Thinking and the Appeal to Authority]

AsaysP.
Pis in A's area of competence.
Is P's claim particular or general?

If the claim is empirical/general, then we can ask whether the nature
of A's discipline is fractured or homogeneous?
If it is homogeneous, then
Is P a well-accepted claim in A's discipline?
If yes,
Why is P well-accepted?

If the explanation is plausible and intelligible, then P can be considered
knowledge.
If no, why does A believe P?
Intrinsic plausibility of claim.
The more implausible, the more evidence necessary.
Is the justification plausible?
Are the reasons for rejection of other positions plausible?
What are A's credentials relative to the discipline?
What are A's likely biases?

Prestige of A.
If discipline is fractured, then, weigh crediting of P according to:
Nature of discipline.
Intrinsic plausibility of claim.
The more implausible, the more evidence necessary.
Plausibility of the explanation.
Reasons for rejection other positions.
aarity versus vagueness.
Reported depth of evidence.
Apparent objectivity of A.
Prestige of A.
Is the expert's claim scrutinized by her peers?

 

[Skeptic Ginger]

It's also why there's a lot of heat surrounding the Cluster B "personality disorders." They're at the top of the list for examples of "medical overreach."

Looks like evidence you have another agenda here.

In principle, medicine is interested in relieving suffering caused by our bodies not working the way we want. This is what makes Chicken Pox a disease, rather than a 'rite of passage,' as some antivaxxers assert.

Their claim is extreme (that the suffering is cultural - why not celebrate the pus filled blisters!), but somewhere along the continuum I think there's a good case for "Did we just hand the medical establishment a license to treat... Dickery?"

Analogy fail.

Their toe in the door is that the patient may have the same jackass personality as his neighbour, but for some reason - in his family or social group or occupation or legal region or whatever - it's not working for him.

This POV misses the boat altogether.

Pathologic personality disorders differ from simply being eccentric or extreme in that they include components that are pathologic.

In Trump's case, he is incapable of not making everything about himself. And that's where the difference lies. His disorder controls him, that's why it is a pathology. He has a serious lack of empathy given he sees everything in terms of himself.

From Google/Wiki

Narcissistic personality disorder (NPD) is a personality disorder in which there is a long-term pattern of abnormal behavior characterized by exaggerated feelings of self-importance, an excessive need for admiration, and a lack of understanding of others' feelings.

Pathological Narcissism: Definition & Symptoms

In a clinical context, narcissism is significant if it is pathological, meaning that it is harmful or related to a larger problem....

a distorted sense of importance or ability. In clinical terms, they tend to have grandiose thoughts about their social value, particularly in relation to other people. For instance, a person with narcissistic personality disorder truly believes that they are more valuable and important than other people, that they deserve to be praised and admired, and that they deserve to be treated better than others. These beliefs are often accompanied by a lack of empathy for others, whom they believe to be insignificant.

Despite their many unattractive personality traits, narcissistic people are often very successful. This might be difficult to understand, but consider the level of confidence that it takes to achieve such high-ranking positions as politician and CEO. Nevertheless, narcissistic people do not tend to have many or any strong relationships, due in large part to the fact that the symptoms are usually very obvious and can be incredibly difficult to control.

Trump's relationships with his family may or may not be what it appears on the surface. That Trump wrote the response he wanted his grown son, Don Jr, to give regarding the meeting with the Russians in Trump Tower suggested a serious control issue. Trump more often than not appears more interested in how his family complements Trump rather than how highly he sees his children's accomplishments.

Beyond his family though, everyone around him is obviously aware of the need to constantly, effusively compliment Trump. If you don't think that reflects pathology, I suggest you aren't looking.

clinical narcissism is about more than just having a big ego or being a braggart. The two main characteristics are the grandiose sense of importance and a general lack of empathy for others. This manifests in the way that they talk about themselves, but it also has a strong effect on how they treat other people.

Trump's blaming of others for his failures is another symptom of pathology. He is incapable of seeing his own role in his failures. He doesn't just blame other people, he actually gets angry with people when it is himself that is at fault.

It's constant, it's consistent, it's classic pathology.