In the last three years, I’ve watched as countless pundits, armchair
psychologists, and journalists have kept missing the mark, using phrases
such as “malignant narcissism” and “narcissistic personality disorder” in
an attempt to make sense of Donald’s often bizarre and self-defeating
behavior. I have no problem calling Donald a narcissist—he meets all nine
criteria as outlined in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5)—but the label gets us only so far.
I received my PhD in clinical psychology from the Derner Institute of
Advanced Psychological Studies, and while doing research for my
dissertation I spent a year working on the admissions ward of Manhattan
Psychiatric Center, a state facility, where we diagnosed, evaluated, and
treated some of the sickest, most vulnerable patients. In addition to
teaching graduate psychology, including courses in trauma,
psychopathology, and developmental psychology, for several years as an
adjunct professor, I provided therapy and psychological testing for
patients at a community clinic specializing in addictions.
Those experiences showed me time and again that diagnosis doesn’t
exist in a vacuum. Does Donald have other symptoms we aren’t aware of?
Are there other disorders that might have as much or more explanatory
power? Maybe. A case could be made that he also meets the criteria for
antisocial personality disorder, which in its most severe form is generally
considered sociopathy but can also refer to chronic criminality, arrogance,
and disregard for the rights of others. Is there comorbidity? Probably.
Donald may also meet some of the criteria for dependent personality
disorder, the hallmarks of which include an inability to make decisions or
take responsibility, discomfort with being alone, and going to excessive
lengths to obtain support from others. Are there other factors that should
be considered? Absolutely. He may have a long undiagnosed learning
disability that for decades has interfered with his ability to process
information. Also, he is alleged to drink upward of twelve Diet Cokes a
day and sleep very little. Does he suffer from a substance- (in this case
caffeine-) induced sleep disorder? He has a horrible diet and does not
exercise, which may contribute to or exacerbate his other possible
disorders.
The fact is, Donald’s pathologies are so complex and his behaviors so
often inexplicable that coming up with an accurate and comprehensive
diagnosis would require a full battery of psychological and
neuropsychological tests that he’ll never sit for. At this point, we can’t
evaluate his day-to-day functioning because he is, in the West Wing,
essentially institutionalized. Donald has been institutionalized for most of
his adult life, so there is no way to know how he would thrive, or even
survive, on his own in the real world.
