Part XV. What is Delusional Disorder? Why is it so Difficult to Grasp? How does it Apply to Trump?

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In the late summer, an eerie quiet spread across the land caused by Trump-News-Fatigue, based not on apathy in caring too little, but on avoidance in caring too much. Many felt a sense of powerlessness and simply wanted to get back to living their lives. From the “eye of Hurricane Trump,” the prediction proved to be accurate that the tail of the hurricane would arrive with an intensification of the Robert Mueller investigation. On October 30th, indictments were issued to Paul Manafort, Trump’s former campaign manager, and his associate. Last week, Michael Flynn pleaded guilty to a lesser felony in exchange for cooperating with Mueller, producing gale force winds in the White House which are certain to reach hurricane status, with well-publicized accounts of Trump’s irrational, furious words and actions.

It is therefore timely to revisit the diagnosis of delusional disorder, emphasizing not only what it is, but why it is so difficult to grasp and what is its relevance to Trump. In February, from the DSM-5, I published a complete list of symptoms for delusional disorder. I reiterated that list in a chapter in The Dangerous Case of Donald Trump. He arguably meets each and every criteria. My intention was to allow people to make their own judgments from the simple, very easy to understand list.

What is delusional disorder?

It must first be recognized that delusional disorder, DSM coded 297.1, is an actual diagnosis, not something made up for the sake of argument. It is defined as a very rare psychotic disorder, involving an unseen “profound loss of contact with reality” despite the appearance of normalcy. Delusions are “beliefs held with absolute certainty, despite indisputable factual evidence to the contrary.”

Why is it so difficult to grasp?

* First and foremost, it is all but impossible, even for experienced professionals, to conceive of someone whose core psychotic delusions can be so utterly masked by a convincing, ongoing appearance of what can be high achievement, charm, charisma, and even humor. The stealth delusional core only breaks through under circumstances of extreme stress when the delusional beliefs are challenged. The gaping discrepancy between an inner psychotic core belied by outer appearance makes this condition virtually unfathomable.

Delusional disorder may be compared to asthma. The asthmatic seems perfectly healthy to all appearances. But their condition can deteriorate rapidly and dangerously when the underlying illness is triggered by environmental factors, causing the person to become very sick, very fast.

*Second, the delusions are defined in DSM-5 as non-bizarre in nature (the country is being infiltrated by murderous Mexicans and Muslims) as opposed to the bizarre and all-encompassing delusion of the schizophrenic (the country is being infiltrated by murderous Martians). In Trump’s case, the delusions are clearly grandiose (I am superior to all in every way, the very best of the very best) and paranoid (enemies are everywhere who would do me harm). It is a black-or-white virtual reality in Trump world, populated exclusively by admirers who recognize his incomparable superiority, and enemies who wish to bring him down.

*Third and very misleading, the person’s words and actions are consistent and logical if the basic premise of the delusion is accepted (Because I am superior to all, it follows that I am never, ever wrong, so there is never a reason to apologize). His delusional words may carry a wisp of plausibility as though he is talking metaphorically or with seemingly obvious exaggeration (I know more than all the generals). Every single word must be taken literally.

What is the evidence that Trump is delusional, at his core though not in appearance?

I began studying Trump intensively from the moment he declared his candidacy in June, 2015. Like most in my profession, I saw Trump merely as cruel, manipulative, astronomically self-centered, impulsive, dangerous, reckless, and given to violence. I saw him as a brazenly dishonest person who would lie and steal “as easily as he breathes,” who “knew” he was above the law. Despite some puzzling past behavior, it never occurred to me that he might be psychotic.

I now am convinced I was wrong.

Everything changed in my assessment the morning after his inaugural as I watched, in stunned realization, Trump’s 15 minute speech to the CIA, where he brought along 40 raucous staffers in front row seats, desecrating the hallowed Memorial Wall bearing stars for 117 anonymous agents, killed in the line of duty. Twelve minutes into the speech, he made three separate delusional statements, despite absolutely irrefutable evidence to the contrary, immediately available by a quick glance at a smart phone. These were not strategic lies but rather delusional falsehoods. Please view this very brief two minute video to get the full impact of what I am saying.

*In the first 38 seconds, he vehemently proclaims that Fake News has falsified a “feud” between himself and the CIA, whereas he was “1000%” behind them. Not one word of truth, as his innumerable tweets demonstrate his contempt for the intelligence community.

*In the ensuing 64 seconds, Trump proceeds to fabricate how God looked down on him as he began his speech and stopped the rain that was falling, parting the clouds in bright sunshine, before making it “pour” immediately after he finished his speech. Irrefutable evidence by video from the day before contradicting every aspect of this delusional belief.

*Lastly, in the final 40 seconds, he insists that he saw that “the crowd was packed all the way to the Washington Monument.” Factually, demonstrably false in all photographs.

As opposed to his delusions, Trump’s actual lies are strategic in nature. They are designed to get him out of a tight spot (I don’t know who David Duke is; I wrote the condolence letters over the weekend, but they may not have been mailed yet) or to promote a scam (Trump University is a fabulous opportunity).

Delusional falsehoods are not strategic. Far from serving a purpose, other than promulgating his distorted vision, they make him look foolish. They lead people to scratch their heads and think he can’t possible believe that. Because they are non-bizarre, people shrug and give him a pass. But if we look at his delusional body of work over time, we see other instances in which he unabashedly insists on something that is demonstrably false:

*He continues to insist that the Central Park Five are guilty, despite the perpetrator having come forward with a confession and matching DNA. Irrefutable evidence to the contrary.

*He bellows that “thousands and thousands of Muslims” in Jersey City celebrated as the World Trade towers collapsed. It simply didn’t happen.

*He reportedly has claimed for years to own the original Renoir painting “Twin Sisters.” He’s been told it hangs in the Art Institute of Chicago, but that has made no difference.

*He publicly rated his response to Puerto Rico’s devastation as a “10” despite the ongoing deplorable conditions where the vast majority have no electricity, running water, medical care, or shelter. Overwhelming facts to the contrary.

*He has described his victory as the greatest electoral landslide since Reagan, and that Clinton’s 3,000,000 popular margin comprised illegal voters. Irrefutable evidence to the contrary on both counts.

*On the paranoid side, he believes that Muslim and Hispanic immigrants pose a dire threat to our society, with no supporting evidence whatsoever.

*He tweeted that the “bad (or sick)” Obama Administration had wiretapped his personal phone, not merely the phones of Manafort and Flynn. Simply not true.

*He has expressed admiration and closeness with many sick, despicable conspiracy theorists like Alex Jones who, among dozens of other conspiracies, asserts that the Sandy Hook massacre was staged.

In addition to this list, in light of his delusional body of work, we also have to seriously consider that he actually believes his claims to know more than all the generals, that he will be the greatest president in history, etc. etc. etc. Please see this short video which gives a feel for his level of grandiosity. I now believe he was not lying, again based on his extensive delusional body of work.

Because Trump clearly believes the non-bizarre delusions in his CIA speech, his Central Park Five fantasy, that Muslims celebrated 9/11, and that he possesses an original Renoir, we must take seriously that he actually believes all of his other seemingly innocuous boasts.

Like the healthy-looking asthmatic who suddenly is triggered by environmental influence, as Mueller continues to meticulously tighten his noose, we must be prepared for a psychotic breakdown that is desperately delusional and dangerous beyond measure.

We should be far more afraid than we are.

Chicago, IL

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