Trump: Not Psychotic, Psychopathic

The distinction is important.

Observing Trump’s behaviour, we are forgiven for questioning his mental health. A seemingly bizarre array of executive orders and decisions together with a never ending barrage of seemingly unhinged comments and social media posts is easily interpreted as Trump losing the plot.

There has also been very legitimate questions about his memory and general cognitive ability. Again, given he is not a bastion of health, is markedly overweight, and is certainly not what you would call a young 78, questioning whether his brain is healthy or not also seems justifiable.

Within all this reasonable supposition, I would issue a note of caution. This pertains to intent.

We do, in the public sphere, throw around the terms “delusional” and “psychotic” a bit too loosely. In the clinical sphere we are much more careful with these terms. Delusional is typical a break from reality. This relates usually to quite wild beliefs that are fixed and unchangeable. Believing you are Elvis or a CIA operative, for example. Typically these breaks in reality come with a diminished responsibility for actions taken based on such delusional beliefs. It is an illness.

When describing Trumps mentation, I would advise a more cautious interpretation. Not because we must fear his reproach but because we must fear giving him any sort of diminished responsibility.

For the record, and based purely on information gleaned at a distance, there are no factors I can see worthy of diminishing his responsibility for the harm he has caused individuals in his life nor the country as a whole.

His mental function is subpar, or, in terms of old, subnormal. I am quite sure if you put him through a functional MRi brain scan it would be abnormal. But not abnormal in the sense that he has a disease that is causing damage to his brain, nor even a disease that causes abnormal dopamine responses (as occurs in delusions or psychosis). More, we would see signs of an underdeveloped higher brain. We would also see the classic neurological signs of psychopathy and dispositional greed - again, an impairment in the functioning of the higher brain. This though, is not the same as delusional.

There is also some concern as to whether dementia is an issue. Again, we are probably more cautious with this term in the medical field. Someone may have “cognitive impairment” but not meet the threshold for dementia. Equally, one can retain mental capacity to make decisions but still have significant cognitive impairment to be incompetent and dangerous in their job. The distinction is crucial.

Psychopathy is different. Not classed as a disease, most psychopathies are deemed personality traits or disorders. For example, a considerable number of prisoners (particularly violent offenders) suffer from some form of psychopathy. They achieve no special dispensation for having such a personality trait. My point: neither should Trump.

He is neither crazy nor suffering a degenerative neurological condition. While, as is typical for psychopathy, he will be unable to mentalise the harm he causes to others, he remains fully aware that his actions are harming others. He may be unable to feel others pain, but he is fully knowing of the fact he is causing pain through his decisions.

In short, he isn’t delusional, doesn’t have dementia, and is fully aware that he is harming his fellow Americans through his decisions. Almost certainly he does suffer a psychopathy (probably a narcissistic sociopath) and it would be of no surprise at all if his mental faculties were subpar, impaired even. An increasing frail, narcissistic sociopath, yes. A elderly man with dementia, no. A mentally unwell, deluded man, no. He is more intentional in his harm to others, albeit easily confused and lacking the ability for moderately complex reasoning.

I could be wrong. Perhaps he genuinely believes he is the second coming or the king of the world. Maybe he believes his ear can heal from a gunshot in only a few days. It seems far more likely, he is more bad than mad!

As such, and the point in writing this, we should take greater care in how we describe him so as not to diminish his culpability in relation to the consequence of his decisions, albeit he is likely not the sharpest tool in the box, and undoubtably not fit enough to be president of a book club let alone a country.