A Most Dangerous Case
A Q&A with Vince Greenwood Ph.D. on the risks America would face if the psychopath Trump were elected again
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Trump’s a psychopath. He will never change. If he were to be elected again, America and the world would be in greater peril than we were the first time.
As readers of this newsletter have known since I first interviewed Dr. Greenwood in August 2020, diagnosing Trump as a Psychopath, based on the Hare Psychopathy Checklist — Revised (PCL-R), renders all other diagnoses obsolete—and should, theoretically, allow us to focus on the real problem.
In a follow-up interview in September 2020, Dr. Greenwood detailed why Trump’s diagnosis ensured that he would launch “even more outrageous assaults” on America if he did lose to Joe Biden. As Greenwood said then:
Psychopaths are frantic over the threat of losing status and would be remorseless in their attempts to prevent that from happening. I don’t think he will accept the results, even in the case of a clear-cut Biden victory.
The January 6th hearings have given us a clearer picture of just how far Trump was willing to go—and who he was willing to sacrifice—to cling to power. Now, both to distract from the ongoing hearings and to beat back the ascendancy of “Mini-Trump” Ron DeSantis, Trump is already making noises about announcing his 2024 candidacy.
With that in mind, I reached out again to Dr. Greenwood with a few more questions.
Q&A with Vince Greenwood, Ph.D.
Why is it possible to diagnose Trump at a distance?
It is possible to diagnose Trump at a distance for certain disorders—Psychopathic Personality Disorder (PPD) being one of them—because we have sufficient information to make a valid and reliable diagnosis.
You do need a great deal of information to make a diagnosis of PPD. The rigorous assessment process requires rating an individual on a range of emotional, interpersonal, and antisocial traits. Fortunately, you have a treasure trove of relevant information in the public realm with Trump. He may be the most well-chronicled person in history—67 biographies, many of them well-sourced, hundreds of interviews, his thousands of tweets, and so on. The quality, quantity, and type of information available in the public realm to assess whether Trump has this fateful diagnosis is much more excellent than you could secure from any series of interviews.
Now it is true that you would want an interview to diagnose other conditions such as dementia, clinical depression, or paranoia, where you would like to ask pointed questions about one's symptoms and evaluate their mental status. But to evaluate Psychopathic Personality Disorder for Trump, the extensive life history information needed to assess the presence of PPD is the necessary and sufficient data needed. So in the case of Trump, we have that data and don't need an interview.
By analogy, you don’t need a face-to-face interview to determine whether someone has blood cancer. You do need a blood sample that you then analyze with an electron microscope. Likewise, we don’t need a face-to-face interview to evaluate for Psychopathic Personality Disorder. However, we need the voluminous life history data to analyze it in relation to a set of operationally-defined traits and antisocial behaviors.
Furthermore, there is research that indicates that an interview is actually counterproductive in the diagnosis of psychopathy. Why? A core feature of psychopaths is deceitfulness. They lie casually and reflexively. They are not just unreliable reporters of their history but active dissemblers. Even if you could give a psychopath truth serum, their hard-wired traits of glibness, lack of insight, arrogance, and grandiosity would still lead you down a rabbit hole. Many of Trump’s coronavirus task force meetings and press conferences were head-exploding experiences for reality-based observers. The information gained from a psychopath during an interview is often worse than a distraction.
So, not only can you diagnose at a distance for this condition, you probably should.
Why does the Psychopathic Personality Disorder diagnosis trump all others?
This is perhaps the crucial point I am trying to convey in my writings. Trump clearly meets the demanding diagnostic criteria for Psychopathic Personality Disorder, and there is an ‘open and shut’ case that we should consider this his primary diagnosis since it accounts for virtually all his extreme, erratic, divisive, and dangerous behavior.
Let me try to explain. If, for example, one suffers from a specific form of blood cancer called Acute Myeloid Leukemia (AML), they display all sorts of complications and secondary diagnoses such as anemia, fatigue, unusual bleeding, and frequent infections. It is desirable to identify and diagnose these complications, but essential to underscore that Acute Myeloid Leukemia is the primary diagnosis, the governing disorder that accounts for all these features. If you could treat and cure AML, you would care for these other problems. But the opposite is not valid. Treating the features of AML is only a temporary stopgap to alleviate the symptoms of that underlying severe illness.
In psychiatry, particularly in personality disorders, the key features are not physical symptoms but destructive behavior patterns. Trump displays many problematic patterns such as mood swings, anger outbursts, hypomania, impulsivity, poor attention span, chronic lying, grandiosity, arrogance, entitlement, and callousness. It is therefore not surprising that a number of diagnoses have been put forth by mental health professionals, including major depression, bipolar disorder, paranoia, ADD, narcissism, and antisocial personality disorder. However, while there is justification for all these diagnoses because they are based on observable behavior, they are all secondary to his diagnosis of Psychopathic Personality Disorder. The severe pathology emanating from Psychopathic Personality Disorder, similar to the above example of Acute Myeloid Leukemia, accounts for all the symptoms and behavior patterns of those other diagnosed disorders. The essence of the disorder revolves around the three core traits of remorselessness, drive to dominate, and impulsivity. These determining traits are the fundamental source of all the aberrant behavior we have witnessed with Trump. Psychopathic Personality Disorder is, as it were, the ultimate Trump whisperer.
In your most recent article, you say a narcissist is more like a “preening peacock” while a psychopath is a “cold-blooded snake.” Why is it dangerous to apply the lesser “narcissist” diagnosis—or even the “malignant narcissist” label—to Trump?
The peacock/snake comparison is meant as a cautious analogy. I think a preening peacock is an apt symbol for a narcissist and a cold-blooded snake for the psychopath. Which one of these creatures would you rather come across in the wild? No contest, right?
Narcissists are driven to be admired for their superiority. They believe they are more successful, smarter, and better looking than the rest of us. They are grandiose and exaggerate their achievements. They are arrogant and feel entitled to special treatment. They have fragile self-esteem and feel wounded and then enraged when they don't get applause from others.
I know, I know, it sounds a lot like Trump. And he does meet the diagnostic criteria for Narcissistic Personality Disorder. He does often act like a preening peacock. But his narcissistic pathology pales in comparison to his psychopathic pathology. Underneath their narcissistic and often flamboyant behavior, psychopaths are not fragile and insecure but cold and remorseless. In contrast to narcissists, psychopaths typically display traits of dereliction, inability to defer gratification, recklessness, failure to accept responsibility, hostility, sensation-seeking, and callousness.
Most critically, narcissists are not dangerous the way psychopaths are, which is fortunate since around five percent of the population meets the diagnostic criteria for Narcissistic Personality Disorder. In comparison, less than one percent meet the diagnostic criteria for Psychopathic Personality Disorder. The difference in dangerousness between the two diagnoses really is on the order of comparing a peacock to a snake. Clinical narcissists have a conscience and some ability to form a loving bond with others. Psychopaths do not. Narcissists fear disapproval from others and limit their behavior accordingly. Psychopaths do not. Narcissists experience the inhibitory emotions of guilt, shame, and fear. Psychopaths do not. Both narcissists and psychopaths are very deceitful, but for very different aims: the narcissist to fuel his grandiosity to get acclaim; the psychopath to get his way and win.
As all the experts on psychopathy have noted, it is hard to fathom the remorselessness of the psychopath. They will strike at will without a shred of inhibition. They have no limiting concern for the welfare of others. They can blow off a global pandemic and focus only on how it might hurt their political fortune without guilt or shame. They are radically different. They are very dangerous in a cold-blooded, venomous way.
“Malignant narcissism” is not a formal diagnosis. It is a term that has been applied to Trump and other authoritarian leaders and is meant to depict a person with narcissistic features plus other destructive personality traits such as sadism, antisocial behavior, and paranoia. “Malignant narcissists,” as they are depicted, are no different than psychopaths. I think we would be better served by using the scientifically-validated term Psychopathic Personality Disorder.
You also state that the PPD diagnosis “rests on an empirical foundation firmer than exists for the great majority of disorders in DSM-V.” Can you elaborate on that?
There has been an enormous amount of research on Psychopathic Personality Disorder. By February of 2020, over 69,000 studies on psychopathy were documented by Google Scholar. Therefore, there is a high bar to meet the diagnostic criteria for Psychopathic Personality Disorder. But if you do, we can say a great deal about you, and we can say it with precision and authority.
We owe the good fortune of a detailed and empirically-based understanding of psychopathy primarily to the Hare Psychopathy Checklist. Published in 1980, the Checklist operationalized the key traits that were identified by the early pioneers who studied the condition. This comprehensive, valid, and objective measure of the construct of psychopathy quickly became the gold standard measurement tool used to generate so many reliable findings about the condition.
The Hare Psychopathy Checklist ensures a diagnostic process that is more extensive and rigorous than exists for most psychiatric disorders. All psychiatric disorders in The Diagnostic and Statistical Manual have been the objects of research, but few rise to the level of quality and quantity of empirical efforts devoted to Psychopathic Personality Disorder.
How does Trump's handling of the Covid pandemic confirm his PPD diagnosis?
Trump's disastrous response to Covid can best be understood by looking at it through the prism of his Psychopathic Personality Disorder and, specifically, the three trait clusters of impulsivity, drive to dominate, and remorselessness that define the disorder.
The impulsivity trait cluster reveals the psychopath is wired to be disinhibited, reckless, undisciplined, unruly, easily bored, disorganized and undependable.The federal nonresponse to Covid was thus preordained given Trump's PPD diagnosis. The crisis demanded discipline, attention to detail, and perseverance. Trump was overmatched. Golf weekends or coronavirus task force meetings? No contest. And, of course, the crisis required planning. We know Donald Trump has contempt for the kind of nose-to-the-grindstone planning that was necessary to generate a competent and coherent response to the Coronavirus. He brags about not reading briefing papers and scoffs about diving into the quotidian details of any project. But, as we look back, it is clear there was never even a plan of a plan. There was chaos and neglect all the way through. The impulsivity trait reveals a “don't give a damn” psychological infrastructure that pretty much guaranteed his irresponsibility and dereliction.
If Trump just had an impulsivity problem, he still could have delegated authority to others who were capable; or collaborated with public health officials or any number of think tanks that had detailed plans on how to manage a pandemic. After all, it would have made him look good. But his ‘drive to dominate’ trait dictated that would never happen. Collaboration is anathema to the psychopath. The psychopath is like a leopard who eschews traveling in a pack and relies solely on cunning to seek out their prey.
From the outset, Trump treated the crisis as a media spectacle that he was driven to dominate. So he barreled forward in the only gear he possessed: win-at-all-costs-political-domination. He refused to wear a mask and mocked those who did; he tweeted out support to protestors who flaunted social distancing guidelines; he doled out ventilators and protective equipment to governors based on their political leanings and sycophancy to him; he peddled exaggerations about the administration's achievements and bogus treatments; and he conducted rallies and White House events that became super-spreader events. His primary mode was to tell a story about the crisis that made him look powerful rather than actually manage it.
And Trump’s remorselessness trait sealed America’s poor outcome with the virus. This trait is marked by the psychopaths’ inability to experience feelings of threat, shame, and guilt.
Trump’s inability to process emotions related to threat situations helps us understand his sluggish response to Covid-19. In January, when he was getting alarming reports about the virus from the intelligence agencies and senior officials, he dismissed them. He compared the virus to the common flu and called it a “hoax.” In February, he took no action to develop testing or provide supplies for the looming health care crisis. He seemed blind to the scale of the risk. He was genuinely whistling past the graveyard, not out of fear but rather its absence.
Trump has no capacity for shame or guilt that might have served as a brake on his impulse to deceive and divide. We now know from Trump's interview responses to Bob Woodward for his book “Rage” that he was fully briefed in January of 2020 about the lethality and transmissibility of the virus. And yet he lied shamelessly to the public from the beginning about the threat (“the 15 people (infected) within a couple of days is going to be down close to zero, that's a pretty good job we've done,” “It's going to disappear. One day like a miracle, it will disappear,” “This is a flu. This is like the flu”). A core feature of psychopathic shamelessness is the refusal to take responsibility. This trait was on full display throughout America’s regrettable response to Covid, “Nothing more could have been done. Nothing more could have been done. I acted early. I acted early,” he blathered to Woodward.
We had a ‘psychopath-in-chief’ and, with Covid, we paid the inevitable price.
What about his behavior before and on January 6th?
Here again, Trump’s reaction to the election and his role in the January 6th riot are textbook examples of psychopathic functioning. We now have a number of well-sourced books that confirm the ubiquity of his destructive traits from election day through January 6.
His unyielding ‘drive to dominate’ trait ensured he would never acknowledge defeat. His shamelessness ensured he would do anything to get his way, regardless of the price the country might pay. Thus, late on election night, when the vote began turning against him, Trump shifted immediately into a defiant mode. He came on TV and claimed a fraud was being perpetrated and the vote must be stopped and thus, the “Stop The Steal” was underway. He launched a direct assault on our democratic system without a moment of reflection. The “Stop The Steal” campaign was off and running. It was win at all costs, by the psychopathic mode of lying and cheating.
As the clock ticked down to the certification of the election results, there was more bluster, more outlandish claims, more cajoling, and then intimidation of election officials in Georgia, Michigan, and Pennsylvania. He would bully and bluster his way to retaining the presidency. If that meant delegitimizing a duly elected president and taking a wrecking ball to our democracy, so be it. There were no embers of shame, guilt, or anxiety that might slow him down.
And we now know he was totally derelict in his other executive duties during this period. He had no concern or time for attending to any other business in the country. Instead, he surrounded himself with sycophantic conspiracy theorists. The demand for fidelity to his self-aggrandizement leaves the psychopath in a social world populated primarily by toadies and fellow opportunists.
January 6 itself revealed the depth of Trump's callousness and lack of empathy. We now know he was cheering on the mob with scant concern for the safety of the people or the destruction of our democratic norms. He could have cared less for the well-being of Mike Pence, members of Congress, or the police. This is the cold emotional world the psychopath inhabits.
This was such an important and shattering moment for the country. It is heartbreaking to think the pathology of a psychopath largely scripted it.
Why do you feel it is so important for mental health professionals to unite around the PPD diagnosis?
The main reason is that the diagnosis conveys the nature and level of Trump's dangerousness. Experts in the field of psychopathy have noted that even they fall prey to underestimating the danger of psychopaths. This, apparently, is one of their ‘malignant charms.’ So even with all the damage we have witnessed under Trump, we probably don't fully appreciate the peril we would face if he were re-elected.
To be clear, I believe there is strong evidence, which I provide in my lengthier essays, to support the primary diagnosis of Psychopathic Personality Disorder for Trump. Thus, there is scientific merit to uniting behind the diagnosis.
Also, uniting behind the diagnosis would enable us to communicate more effectively about the role of his psychopathology. In the last election cycle, mental health professionals served up a range of diagnoses and psychological explanations for Trump’s dangerousness. While overall I think this was an important contribution to the national conversation, it might have made it difficult for some to develop a clear and concise appraisal of Trump. The narrative of Trump’s psychiatric vulnerabilities and accompanying dangerousness, with so many diagnoses, was fragmented. Information overload kicked in, and, understandably, (some) people tuned out.
And, of course, it is important because of what we have been through and where we are at as a country. Highlighting Trump’s ‘malignant charms’ as a psychopath and his dangerousness won’t solve all our problems. It won’t vanquish tribalism or Fox News or the legitimate conflicts that have brought us to the current political crisis. But Trump has been an accelerant. The psychopath is preternaturally divisive, deceitful and callous. We see the results in our body politic.
By uniting around the key role his psychopathology has played in fostering our (so far) cold civil war, perhaps we can help move him to the sideline and thereby protect us from the damage that always follows in the wake of a clinical psychopath.
How grave are the risks for: a) Trump’s known “enemies”; b) the general public; and c) the world if Trump were ever to be elected President again?
Concerning his “enemies,” Trump, as a clinical psychopath, is wired to be vindictive and has no limiting concern over punishing others. This has been on full display for the past six years. Already uninhibited and remorseless by nature, if re-elected with renewed power, there would be no limits to his vindictiveness.
Concerning the general public and the world, I would make two points. First, Trump would basically be the same guy. Psychopathic Personality Disorder is an immutable and rigid condition. Trump would still be at the mercy of the trait clusters of impulsivity, drive to dominate, and remorselessness. We saw what that engendered during his first term. Whatever situations arise, that trifecta of destructive traits will dictate our fate.
But second, he would presumably have more power if re-elected. Certainly, it appears he will have the courts behind him. The psychopath is also ruthlessly opportunistic. So, yeah, it’s gonna be worse. Imagining a dumbed-down Putin on steroids probably only gets you halfway to the dystopia that is likely to unfold.
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