Column: President Trump is a ‘world class narcissist,’ but he’s not mentally ill, says the psychiatrist who helped define narcissism

The New York Times published a letter signed by 35 psychiatrists, psychologists and social workers. The letter suggests Trump’s “grave emotional instability… makes him incapable of serving safely as president.” (Feb. 21, 2017)


I watched President Trump’s news conference the other day, and I thought: He’s kind of crazy. Not crazy crazy. But you know, just weird.

He is self-absorbed, unabashed about repeating falsehoods, and rude. He doesn’t listen to questions before launching into misguided tirades. He thought a reporter from a Jewish newspaper had accused him of anti-Semitism when the poor guy went out of his way to do the opposite.

So maybe he’s hard of hearing, too.

Anyway, the mental state of our commander-in-chief has recently been the subject of a fierce public debate.

Democratic U.S. Rep. Ted Lieu is proposing a bill that would require the White House to have a psychiatrist on staff. A petition accusing Trump of mental illness, and asking for his removal from office, has been signed by nearly 25,000 health professionals. The New Republic published a story this week speculating that Trump may have an untreated sexually transmitted disease that has led to a condition called “neurosyphilis,” characterized by “irritability, loss of ability to concentrate, delusional thinking, and grandiosity.”


On Tuesday, the New York Times published a letter signed by 35 psychiatrists, psychologists and social workers accusing the president of “grave emotional instability” that makes him “incapable of serving safely as president.” Though it is considered a breach of ethics to evaluate or diagnose public figures, they wrote, “We fear that too much is at stake to be silent any longer.”

This was too much for Allen Frances, a renowned psychiatrist, who dashed off his own letter to the New York Times in response.

“Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder,” wrote Frances. “I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill because he does not suffer from the stress and impairment required to diagnose mental disorder.” (Trump isn’t crazy; he makes other people crazy.)

“He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers,” Frances wrote. But, he added, “The antidote to a dystopic Trumpean dark age is political, not psychological.”


On Thursday, Frances greeted me at the door of the waterside condominium he shares with his wife, psychiatrist Donna Manning, and ushered me into their beachy living room, all light colors and floor-to-ceiling windows.

Palm trees swayed in the breeze of an absolutely spectacular day. The San Diego skyline was visible off in the distance. Frances, 74, was tanned and fit. Barefoot, in khaki shorts and a royal blue zippered pullover, he looked like he should be sailing on the bay.

Instead, we sat at his glass dining room table talking about why it is both an insult to mentally ill people, and dangerous politically, to speculate about the state of Trump’s mental health.

“Most mentally ill people are nice, they’re well mannered, they are decent, they are unselfish, they are good people,” Frances said. “Trump is none of these. When you lump someone who is bad with people who have mental illness, it stigmatizes the mentally ill population. Less an insult to him and more an insult to them.”

Frances is a former chairman of the Department of Psychiatry at the Duke University School of Medicine. He also chaired the task force that wrote the fourth edition of the “Diagnostic and Statistical Manual of Mental Disorders” or D.S.M-IV.

“When I wrote the criteria for narcissism, we were not thinking about its possible use in a political mudslinging contest,” he said. “The idea that this would be a vehicle for expressing disapproval or delegitimizing a president didn’t occur to us 40 years ago. If it had, I would have suggested leaving it out.”

Shortly after Trump declared his candidacy, Frances was approached by a producer for a national TV news show who asked him to come on air to analyze Trump’s motivations. “She wanted me to give him a diagnosis,” Frances said.

He refused, partly because that would be unethical and partly because he saw no evidence of a mental disorder.

“I told her, ‘I will come on your show if I can call him a classic schmuck.’ And she said, ‘Not newsworthy. Everyone knows that.’ ”

Personally, I have no problem with mental health professionals making judgments about a president whose behavior does seem erratic and who also has the power to blow up the world.

Of course we can’t forget about the swath of Americans who are delighted by Trump’s unpredictability and his follow-through, constitutional or not, on promises to keep “bad hombres” out of the country. They’ll probably come to their senses eventually. But we all may be speaking Russian by then.


Frances is not a typical partisan. He’s a Democrat, but only recently registered to vote. “My wife made me,” he said.

He grew up in New York in a household where his family would vote “for the person not in office on the grounds that it would take the new guy time to catch on to schemes and corruption.”

Until recently, he said, “I would not have felt wedded to either party, but my highest political principle is fairness. Republicans do everything to rig the system against fairness. I don’t have personal love for the Democratic Party, but it’s the last salvation against the Dark Age.”

Frances said he’s been getting lots of emails and tweets from people asking the same questions about Trump: “Does he know he’s lying? Is he doing it consciously, or does he believe the things he’s saying?”

He doesn’t think any of that matters.

“It’s irrelevant,” Frances said. “It doesn’t matter what goes on in his head; the goal is to tame this guy. We are not going to do it by analyzing his motivations. What we have to do is reduce his power — in 2018, which may be an uphill struggle, or 2020.”

As we spoke, Manning was typing away on a laptop. The pair are collaborating on a book for Harper Collins, tentatively titled “Trump’s Not Crazy. We Are.”

Frances and I laughed.

“Yeah,” he said, “because we’ve allowed this to happen.”

Twitter: @AbcarianLAT


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