A Non-Psychiatric Assessment of Donald Trump

Republican presidential candidate, businessman Donald Trump, speaks during the CNN Republican presidential debate at the Rona
Republican presidential candidate, businessman Donald Trump, speaks during the CNN Republican presidential debate at the Ronald Reagan Presidential Library and Museum on Wednesday, Sept. 16, 2015, in Simi Valley, Calif. (AP Photo/Mark J. Terrill)

A TV producer called a few weeks ago to ask whether I would go on air to discuss Donald Trump's psychiatric diagnosis. I declined.

Because of embarrassing psychiatric pontificating that marred the 1964 presidential election, the American Psychiatric Association has an ethics policy that prohibits diagnosing-at-a-distance.

Liberal psychiatrists had scored cheap-shot points against the radically conservative Republican candidate, Barry Goldwater -- publicizing their "diagnosis" that he was suffering from a mental disorder that made him too sick to be a safe custodian of the nuclear button. They had no right to use a professional credential to slur Goldwater by medicalizing what was essentially no more than a political disagreement.

Similarly, no one should pin psychiatric labels on Trump. This would be unethical and also almost certainly incorrect. To qualify for a diagnosis of mental disorder, a person must present with a characteristic set of symptoms and behaviors -- and these must cause clinically significant distress or impairment. Trump is clearly a man singularly without distress and his behaviors, however outrageous and objectionable they may appear to others, consistently reap him fame, fortune and now political power. He has been generously rewarded for his Trumpism, not impaired by it.

Trump is a threat to the United States not because he is mad, but because he is bad. His breathtaking ignorance (whether real or foxy feigned) degrades what should be serious policy discussions into buffoonish circus performances. His blustery, bullying, bravado serves him well on TV, but as political leader would bring even more chaos to a world already spinning out of control. His tirades against vaccination make him a public health menace.

In his previous presidential flirtations, Trump fooled almost no one. He was widely regarded as an emperor with no clothes, a vainglorious clown. What is different this go around? Trump hasn't changed a bit -- it's just that the Republican party has rapidly descended to his level. And the media are shameleesly feeding on the ratings generated by the freak show. Grown up governance has degenerated into childish reality TV.

Andy Warhol and Marshall McLuhan would not be surprised. Rome pandered with bread and circus. We have Trump.


Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.