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Sunday, June 16, 2024

Trump’s CPAC rant: Cornucopia for psychiatric diagnosis


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Trump walked out at CPAC and hugged the flag, for a second he rocked it back and forth as if he was dancing with it. I could say as if humping it but that would be rude.
If Trump planned to hug the flag prior to his entrance this would have a benign psychiatric explanation. If he did it on the spur of the moment I would wonder about his impulse control. If it was something in between and he got carried away and began to rock it back and forth a few times I’d begin to be concerned. This may seem to be a small thing, however, this is what clinicians look at when they do a psychological assessment. Unfortunately, the camera didn’t move to a close-up until he had started to hug the flag. Watch the video and see what you think.
The flag hugging and the bulls*it comment are making worldwide headlines. What must foreigners think of us?
As a clinician, I saw numerous signs of his deteriorating mental condition and this is just from the clips I watched. I can’t stand to watch the entire two hours.
Knowing he won’t ever get the Nobel Prize maybe he wants to get himself on Mt. Rushmore. I made two images before I decided to write a column to go with them.
Journalists watched the speech and selected choice segments to report on. They’re getting paid to do this. I’m not. So I admit my impressions came from the parts I’d seen and read about.
There is a cornucopia of clinical riches here from word salad to the looseness of associations. In psychiatry speaking in word salad “may describe a symptom of neurological or psychiatric conditions in which a person attempts to communicate an idea, but words and phrases that may appear to be random and unrelated come out in an incoherent sequence instead. Often, the person is unaware that he or she did not make sense. It appears in people with dementia and schizophrenia.Wikipedia

In psychiatry, loose associations (technically derailment, asyndesis, asyndetic thinking, knight’s move thinking, or entgleisen) is a thought disorder characterized by discourse consisting of a sequence of unrelated or only remotely related ideas. The frame of reference often changes from one sentence to the next.

“In a mild manifestation, this thought disorder is characterized by slippage of ideas further and further from the point of a discussion. Derailment can often be manifestly caused by intense emotions such as euphoria or hysteria. Some of the synonyms given above (loosening of association, asyndetic thinking) are used by some authors to refer just to a loss of goal: discourse that sets off on a particular idea, wanders off and never returns to it. A related term is tangentially—it refers to off-the-point, oblique or irrelevant answers given to questions. In some studies on creativity, knight’s move thinking, while it describes a similarly loose association of ideas, is not considered a mental disorder or the hallmark of one; it is sometimes used as a synonym for lateral thinking.” Wikipedia

I could go through the speech minute by minute and parse out examples of dangerous psychopathology.  I’ll never be put on an official panel to evaluate his fitness to serve on 25th Amendment evaluation because I’ve expressed too many public opinions about this, as have other mental health professionals like Bandy Lee, M.D., Lance Dodes, M.D., and John Gartner, Ph.D. the founder of the Duty to Warn group of mental health professionals, in which I was an early member.

If this speech doesn’t prompt a movement to invoke the 25th Amendment among Republicans I shudder to think of what has to do in order for them to recognize he is perilously close to making a decision that will have grave irrevocable consequences.

Afterword from Michael Gerson in The Washington Post: “What happens when a narcissist occupies the White House?

Most of our politics now consists of seeing the same horror from new angles. America has a president who respects no rule of morality, tradition or law that conflicts with his own immediate self-expression or gratification. His only self-limitation, apparently, is plausible deniability — a moral framework that seems to be based on old episodes of “The Sopranos.” This is narcissism that has slipped its leash, roaming wherever it wishes across the wide world, and in our heads.

Years ago, I posed the question: What happens when a narcissist who thinks he is at the center of the universe is actually placed at the center of the universe? We are seeing what happens. The whole apparatus of a political party — including its legislative and religious wings — is now dedicated to the defense of one man’s feral will.

Addendum 1: What may be the least unhinged and most strategic thing Trump may have said was that he had been joking when, at a press conference in July 2016, he encouraged Russia to find his rival Hillary Clinton’s missing 30,000 emails, and blamed the “sick” media for using it to incriminate him. Lame as it is, this is likely to have been a planned defense should he end up being impeached.

Addendum 2: What about the Goldwater rule which says it’s unethical for psychiatrists to publicly diagnose or assess a public figure?

I am not a psychiatrist and even if I were I would ignore this rule. The rule is from an association not a governmental body like a licensing board and is not binding. A psychiatrist who belongs to a professional organization has the option of quitting and it would be up to them if they did so to object to a rule they promulgated for their members. This would not affect their ability to practice.  I believe mental health professionals are justified in applying the duty to warn mandate they have with their actual clients to Trump because of exigent circumstances, i.e., his disorders make him unfit and dangerous to have the power of the president. I also believe mental health professionals are in a unique position by dint of their expertise to share their knowledge of psychopathology as it applies to a president like Donald Trump so laypersons can better understand what drives his behavior. Although I am not a psychoanalyst and not a member of their association I agree with their position on the Goldwater rule:

American Psychoanalytic Association Statement on “Goldwater Rule”New York – July 25th, 2017 – The American Psychoanalytic Association (APsaA) seeks to clarify statements made in a recent article in STAT. APsaA is an autonomous mental health professional association which represents psychoanalysts from all mental health professions and academia. Our members include psychiatrists, psychoanalysts, psychologists, psychotherapists, and social workers. In an email to association members, our leadership did not encourage members to defy the “Goldwater Rule” which is a part of the ethics code of a different mental health organization, the American Psychiatric Association (APA). Rather, it articulated a distinct ethics position that represents the viewpoint of psychoanalysts. The field of psychoanalysis addresses the full spectrum of human behavior, and we feel that our concepts and understanding are applicable and valuable to understanding a wide range of human behaviors and cultural phenomenon. Our position statement regarding commenting on public figures is available here. Some of APsaA’s members are psychiatrists, and some of these psychiatrists are members of the APA and other professional organizations.  Any member of a professional organization is responsible for following the ethics code of every organization they belong to.  APsaA has not made any statement that would intrude in the internal rules and governance of another organization.

UPDATE: Capitol Hill Blue is decidedly not the mainstream media.

Donald Trump’s CPAC speech was completely unhinged. Why didn’t media cover it that way? Mainstream media is downplaying Trump’s bizarre two-hour CPAC rant. Have they seriously learned nothing from 2016? Salon, Amanda Marcotte

Trump unleashed a two-hour-plus rant that sounded at times, more like the delusional ramblings of someone hopped up on drugs or suffering a mental breakdown than anything resembling a normal political speech.

If that sounds like an exaggeration informed by partisan bias — seriously, it’s not. Trump kicked the thing off by hugging the American flag, and that might have been the least strange part of the whole spectacle.


EXCERPT: Furthermore, assessing Trump’s psychology requires little speculation as we have available to us a life-long history of personal, romantic, business, and political relationships. With the exception of some of his predatory and criminal behavior, he has led his entire life in public. We know what he says and how he says it. Through his own words Trump has even let us in on what provokes him to act – primarily vengeance, vainglory, lust, greed, and an obsession with domination. It has been on this public stage, not behind closed doors, where we have witnessed him reward anyone who flatters him and punish those who fail to do so. His daily Twitter tantrums have constituted a kind of ongoing characterological EEG reading, as if the vicissitudes of his personality disorder produced brain waves that could be converted into a text form readable by all.

To discuss and explore his obvious psychopathology – a malignant narcissism and psychopathy that threatens us all – is not to adopt the Soviet-style use of psychiatric diagnosis in the service of political repression. Rather, as I will argue, it is understanding that can be put to emancipatory purposes. This is because knowing his psychology is central to the project of resisting his policies, and to the task of understanding his appeal to a significant plurality of Americans. If the central thesis of this essay is correct, that Trump’s pathology is isomorphic with his brand, then what may look to some of us as signs and symptoms of profound impairment is precisely what makes him the object of near delirious veneration on the part of his base. As he well understands, to them he can do no wrong. Or, rather, every wrong he commits is righteous.

UPDATE: Lawrence O’Donnell discussed Trump’s CPAC rant last night and quoted from the book “The Dangerous Case of Donald Trump.” Video story “bullsh*t” segment 6 minutes – this is only the first half of the segment.

UPDATES Mar. 6, 2019

REMEMBER, THERE ARE multiple reasons why Trump might cry foul and refuse to concede come 2020, and why he might also believe he could get away with it.
First, there is his personality. Trump is a malignant narcissist who values himself and his own advancement over everyone and everything else. Using and abusing his presidential powers to protect his prestige and position would be “very tempting” for him, to quote professor Bandy Lee, a forensic psychiatrist at the Yale School of Medicine and editor of the 2017 book “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.”
“When you have extreme narcissism,” Lee told me on my podcast, “Deconstructed,” last month, “the danger of it is that one can quickly go to resorting to violence and resorting to extreme measures to move away from the possibility of humiliation and to project force.”
Another article, this is from an Australian website owned by Rupert Murdoch:
Excerpt: “He’s become more aware of what needs to happen so he can continue to be what he is [US president].”
“And he’s just getting a little bit more wary of how he does that.”
She says Mr Trump, will always believe he is “Teflon man” because the malignant narcissist personality type always believes that it is the cleverest and is always right.
“Absolutely he thinks he’s cleverer than all of us, that he’s the cleverest leader of all and ultimately this will be revealed and shown,” she says.
Equally, the malignant narcissist goes on the attack with critics, and will “lie with ease” and reshape facts to suit themselves — hence, she says, Mr Trump’s term “fake news”, for anything he doesn’t want to hear or which paints him in a less than adoring light.
He believes he’s always right, and anyone who thinks otherwise is out to get him.
“Malignant narcissists are dangerous in that they say essentially say “it doesn’t matter what it costs, I’ll get what I want”, she said.
“They can be concerned and empathetic — as long as it benefits them.”

She says Mr Trump has his eye firmly on the next election.

Third: “Something is seriously wrong with Donald Trump: Let’s stop kidding ourselves about that” by Bob Cesca, Salon

Whether it was genuine madness or all an act, Donald Trump’s CPAC creepshow was evidence of profound crisis

TWO EXCERPTS: If you’ve only watched the clips and highlights from Donald Trump’s CPAC speech last Saturday, you’re not getting the full picture of the explosive horror show that is the worsening status of the president’s mental health. For reasons that defy comprehension, I decided to watch the whole thing live. At the outset, I tweeted that given the Michael Cohen testimony in the immediate rear-view mirror, Trump’s CPAC speech was going to be “next level crazy.” In hindsight, I feel like I low-balled it.
Before we continue, I’d like to emphasize that I’m not a mental health professional, nor am I an expert in the pharmacological effects of cognitive enhancers like Adderall or Provigil to make a judgment call on the specifics of what’s wrong with the president. However, I can say with confidence that something’s extraordinarily wrong with him, and it’s only getting more dangerous for the nation and by extension the world as time advances.
The normalization of Trump’s unpredictable, spasmodic presidency, as well as the fact that so many of us don’t have the stomach to tolerate two-plus hours of watching him, are perhaps the only reasons why more Americans aren’t gathered as we speak, devising how best to legally remove him from office. For what it’s worth, I propose here and now that this conversation must begin in earnest.
Trump’s obvious mental instability and emotionally erratic behavior has reached a harrowing new depth. They need to be addressed by our political leadership with the same urgency as the myriad investigations into his crimes. This has to begin now before it’s too late. He will clearly do and say whatever it takes to secure his status, and it’s the presidency alone that’s keeping him out of federal prison. He’s at least competent enough to understand this, and he might be crazy enough to do anything to avoid accountability. We’re in new territory. There is no road map, and what we do now will determine whether Trump is the last Trump, or possibly the first of many Trumps along the not-so-lengthy journey into a permanent form of lunatic authoritarianism. It’s time to take his madness seriously now before he levels-up again.


Psychiatrist on Trump: “The president deserves medical standard of care, and he is not getting it”

Yale psychiatrist Bandy X. Lee examines President Donald Trump’s recent outbursts

A member of the public asked, “When Donald Trump wrapped his arms around the flag, it evoked Lennie from Of Mice and Men squeezing the mouse until it’s dead. Is the president going to destroy our country?”

I didn’t tell her this, but my answer would have been that he is well on the way, as long as we let him. How are we letting him? By colluding on the most basic point: by telling ourselves that the mental unwellness we see is not what we are seeing. Allowing him to give as long a speech as he did, allowing him to continue on Twitter, allowing him to remain in his position, and allowing his staff to turn over so that he has no one left but those who enable his illness—all this is the opposite of the proper treatment that he needs.

Containment and removal from access to weapons, urgent evaluation, and then the least restrictive means of management based on the evaluation, is the medical standard of care.

Even the president deserves medical standard of care, and he is not getting it. The natural course of disease is that it will engulf the afflicted persons and lead them to destruction, if left without resistance.


March 7, 2019: “Donald Trump’s 2020 re-election strategy: Scaring white people with threats of violence” by Chauncey DeVega in Salon

“Mentally unwell old man hugs American flag; rants about ‘socialism’ and ‘baby killers.'”

That’s not a headline from a local newspaper somewhere in rural America. Instead, it is an entirely factual description of Donald Trump’s speech last Saturday at the political rodeo and hate festival known as CPAC.


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