Thirty-five psychiatrists, psychologists and social workers signed a letter to the NY Times yesterday opining that “…the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.” In a letter to today’s Times, Allen Frances, another eminent psychiatrist, demurs. He warns against breaching “the usual ethical constraints against diagnosing public figures at a distance. “

Frances’s letter is curious. He says, for example, that while Trump “may be a world class narcissist,” he doesn’t meet the criteria for a diagnosis of narcissism. Frances doesn’t explain this paradox. It would be interesting to hear from him how he thinks Trump fails to meet standard definitions of narcissism like this one from the Mayo clinic:

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.”

Anyway, Frances’s main point is that Trump is not mentally ill,

…because he does not suffer from the distress and impairment required to diagnose mental disorder. Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy.”

Get it? Trump isn’t mentally ill because mentally ill people are self-destructive, while Trump is good for Trump; he’s only harmful to other people. But the previous health professionals’ letter hadn’t labeled Trump mentally ill; the writers only called attention to the features of his personality that make him dangerous in the White House. It’s not clear that Frances disagrees, since he, too, thinks that Trump poses a threat to democracy and should be denounced for his “ignorance, incompetence, impulsivity and pursuit of dictatorial powers.” So, you can’t help wondering: why did Frances bother to write his letter? Maybe it was to defend the mentally ill.  He laments calling Trump mentally ill partly because “It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).“ Or maybe Frances just wanted to see his name in the Times letter column.

The 37 mental health professionals whom Frances is criticizing should be thanked, not reproached. The threat posed by Trump to this country and to the world should trump (sorry!) normal ethical constraints against distant diagnosis.



How could I do a post without commenting on the clamorous news about Flynn and the Trump campaign’s contacts with Russian intelligence?  I’m not writing much mostly because I have little to add to the good stuff that others, like Kevin Drum and Josh Marshall, have written. I would just emphasize my own agreement with Marshall that Flynn’ s screw-up is only a small part of the real story. The real story is ultimately about Trump, and the possibility—for which there is now significant circumstantial evidence—that his lackeys were complicit in a foreign government’s efforts to influence the US presidential election. But if you’re really fascinated by the Flynn imbroglio, then you can peruse this excellent, if necessarily speculative, piece by Martin Longman.



  1. Jeremy Graham February 15, 2017 at 6:54 pm

    Because narcissistic personality disorder, unlike psychosis or depression, is never used as grounds for a legal decision, there are no predicates. It cannot be used successfully for removing him from office. He could, on the other hand, be impeached because of illegal actions he has committed. As we saw Bill Clinton, its almost always possible to find something illegal they have done. Whether there are enough votes to do this is another question. Off course I hope its done for something substantive as opposed to a ‘gotcha’.

    • Jeffrey Herrmann February 16, 2017 at 7:27 am

      The 25th Amendment enables the VP in concert with a majority of the principle officers of government to, in effect, remove the president whenever they find that “the President is unable to discharge the powers and duties of his office.”
      There are no Constitutionaly defined “predicates” that constrain the VP and other officers from making such a declaration. They could do it because he suffers from narcissistic personality disorder, which he clearly does under the definition in DSM-V, or because he spends too much time tweeting to the neglect of his duties, which he does.
      Impeachment is a separate path to the same conclusion.
      Most likely, in my opinion, is that the constant humiliation, ridicule and embarrassment he daily calls down on himself will eventually drive him to quit.

  2. Judy Brown February 16, 2017 at 10:03 pm

    There’s a clinical psychologist by the name of George S. Simon who specializes in manipulative people and has some interesting ideas on this topic. He was actually on one of the political shows during the presidential campaign talking about Trump (Lawrence O’Donnell’s show, if memory serves). He has written books, such as:

    And also has a website:

    He characterizes people like Trump as “covert aggressors” who are motivated in life almost exclusively by winning. He argues that such people are not suffering from a neurosis, they are not suffering at all, they are simply “character disturbed”. Such individuals do not take into consideration the rights or feelings of others the way a normal person with normal principles does. In his book “In Sheep’s Clothing” he identifies the recurring bad faith strategies such people use to coerce and control others in their constant quest to “win” (“Playing the Victim Role”, “Minimizing”, “Service to a Higher Cause”, etc). IMO, his take makes a lot of sense, and he offers a lot of concrete advice for the unfortunate victims who find themselves in intimate relationships with manipulators. Sadly, of course, all Americans are now more or less in a relationship with an aggressive, unprincipled manipulator.

    • tonygreco February 17, 2017 at 12:49 pm

      Thanks. It looks to me like Simon has made an important contribution to efforts to understand our president, but according to Frances, Simon should be quiet. Obviously, I prefer Simon’s position.

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