Diagnosis: Psychopath

A clinical psychologist explains the one disorder that trumps all others

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Image via dutytoinform.org

He’s a liar. He’s a conman. He’s a cheat. He’s a narcissist. Or a “malignant narcissist.” He’s broken. He has no shame. He has Antisocial Personality Disorder.

Everyone has an opinion about what’s wrong with Donald J. Trump.

But as Vince Greenwood, Ph.D., argues in a recent Medium article, too many opinions have become the problem.

It’s like when Rick Perry called Trump a “cancer on conservatism” and every other Republican countered with their own assessments: “Con artist.” “Kook.” “Insane.” “Pathological liar.” “A textbook racist.” “A national disgrace.”

We discussed all the other diagnoses. And the cancer grew.

Dr. Greenwood believes that clinically diagnosing Trump as a Psychopath, based on the Hare Psychopathy Checklist — Revised (PCL-R), renders all other diagnoses obsolete—and allows us to focus on the real problem.

Seriously. We saw what four years of a cancer on conservatism did to the GOP. The cancer has metastasized. Stochastic terrorism is the new norm—we’ve seen the party shrug at the MAGA bomber, the El Paso shooter and now the Kenosha killer. We’ve seen the President exchange love letters with dictators, defend wife beaters, endorse pedophiles, and hail the success of QAnon candidates. Imagine what four more years led by a psychopath who no longer has to worry about getting himself re-elected would do to the country and the world.

With less than 10 weeks to the election, America is facing a choice: Divorce Trump. Or renew its vows. If America was your friend, and you knew it had married a psychopath, wouldn’t you urge it to get the divorce?

I invited Dr. Greenwood, who is a clinical psychologist and founder of The Washington Center For Cognitive Therapy, to answer a few questions. In addition to his presence of Medium, he has just launched a new website, dutytoinform.org. You can follow him on Twitter at @dutytoinform.

Q&A with Vince Greenwood, Ph.D.

We all know Trump’s not normal. The Dangerous Case of Donald Trump has already been a New York Times bestseller. 37 psychiatrists and mental health professionals have already offered opinions in that book alone. There have been numerous other books and articles. Why do we need a new, more definitive diagnosis now?

Definitive is the right word. Mental health professionals have offered several diagnoses of the president. They have done so usually to warn the public about his psychiatric vulnerabilities and dangerousness. They want to engage the public in a serious argument. And to be fair, the president does appear to meet diagnostic criteria for more than one disorder. However, by offering multiple diagnoses of the president, the impact and understanding of a particular diagnosis is compromised. Information overload kicks in, and people tune out.

Also, a more severe diagnosis deserves to be emphasized. Leukemia is more consequential than anemia.

One enormously consequential psychiatric condition is psychopathic personality disorder (PPD). It is significant because it conveys danger to others. The term psychopathy is used frequently and casually in our culture. But in the psychiatric world, it refers to a relatively rare, but well-researched and thoroughly validated condition. If one meets the rigorous diagnostic criteria for this disorder, there is a lot we can say about him, and we can say it with a good deal of authority.

And, indeed, Donald Trump does meet those criteria.

Why is it important that we see Trump as a “psychopath” and not just a “malignant narcissist” or someone with Antisocial Personality Disorder?

Let me take these one at a time. Antisocial personality disorder is a broader diagnostic category than psychopathic personality disorder. Approximately 4% of the population meets diagnostic criteria for antisocial personality disorder, whereas only 1% does so for psychopathic personality disorder. Virtually everyone who is diagnosed with psychopathy would meet diagnostic criteria for antisocial personality disorder. As the name suggests, antisocial personality disorder emphasizes the individual’s criminal and antisocial behavior. A diagnosis of psychopathy reflects such antisocial behavior but also testifies to the destructive personality traits that drive such behavior.

“Malignant narcissist” is a construct originally put forth in the 1960s by a renowned German psychologist, Erich Fromm, to explain some of the monsters of human history such as Adolf Hitler and Joseph Stalin. It is seen as a toxic brew of four personality conditions: paranoid, psychopathic, narcissistic, and sadistic. Some contemporary mental health professionals have made an eloquent argument that this construct captures Trump’s pathology.

Malignant narcissism may be an apt description of Trump, but it is not a formal diagnosis. Therefore, it is not tied to a wellspring of studies that could provide scientifically valid information on him. l think we can provide more clarity and fairness by focusing on the diagnosis of psychopathy, which rests on firm empirical ground and, on the score of dangerousness, is damning enough for someone holding the office of president of the United States.

How confident are you in your diagnosis?

Very confident. Because there is a rigorous, reliable, and valid diagnostic process that a trained professional must execute to arrive at the diagnosis. If one has had training in the process and instruments used to measure psychopathy, one can be confident in the diagnosis's objectivity.

Also, in the case of Donald Trump, there is abundant data on his life history that precludes the necessity of a clinical interview with him.

The first core trait of the Psychopath is the “Drive to Dominate.” How does that manifest in Trump’s behavior in life, business and politics? I’m guessing it also explains his attitude to Black Lives Matter protesters?

Yes, the drive to dominate is one of the driving forces of the psychopath. They cannot lovingly connect with others, and can only relate to others through the gear of domination. “Winning,” as Trump endlessly repeats, is everything. Nestled within this cluster of traits are arrogance, deceitfulness, and attention-seeking.

Trump’s bandwidth of emotions are limited to those associated with his drive to dominate others and prevail over his critics: anger, contempt, jealousy, feeling thwarted, mistrust, glee. These are the emotions depicted in the well-researched biographies of the man and his autobiographical writings. He is devoid of the more tender emotions that could engender solidarity, trust, or empathy.

Trump has treated the social justice movement as a media spectacle that he was driven to dominate from the outset. It is not in his makeup to reach out and collaborate. All of his emotional fuel is devoted to coming out on top.

The second core trait is “Remorselessness.” Again, how does that apply to Trump?

Remorselessness is perhaps the most consequential trait in the man. Psychopaths appear to be born with brain abnormalities that lead to a deficit in conscience and empathy. Our conscience—that inner voice of “I should”—motivates us to meet our obligations and commitments to both those we love and the broader community. When this fundamental concern for others is missing, what’s left is a focus on immediate, egocentric gains. Obligations mean nothing.

Trump has no moral fear of the consequences of his neglectful and divisive behavior. Feelings of shame and guilt are totally foreign to him. Two of the most frequent expressions of his remorselessness are his lack of scruple in lying, and shrugging off personal responsibility for actions that might be harmful.

Trump’s ease with lying has been well-documented (The Washington Post’s Fact Checker noted he has now surpassed 22,000 falsehoods during his presidency). Would he continue this pattern when the lies might have life or death consequences?  Of course, he has continued this pattern of lying throughout the Covid crisis.

Trump’s refusal to take responsibility for the harm his actions may have produced also flows from this deficit in conscience and empathy. A psychopath does not have the emotional infrastructure to care about children in cages or overflowing morgues. Trump’s choice to politicize the pandemic has added grievously to the death toll. Failure to take responsibility for this calamity is the hard-wired response of this remorseless creature.

The third trait is “Impulsivity.” Even his supporters would agree they see that in his sexual history. What dangers does impulsivity cause in a President?

Impulsivity is another one of the core traits of psychopathy. It appears to be associated with an underlying brain abnormality, probably in the prefrontal cortex area that integrates reason with rapid-fire impulses. As a result, the psychopath is wired to be disinhibited, reckless, undisciplined, unruly, easily bored, disorganized and undependable.

This cluster of traits has been on full display since we first heard of the virus in January. We know Donald Trump has contempt for the kind of nose-to-the-grindstone planning 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.

His disdain over the details of governance masks his inability to solve problems that require discipline, deliberateness, and focus. A foreign head of state described a 60-minute meeting with Trump as “60 one-minute meetings.” The recent spate of insider books on what it was like to work with Trump highlight his distractibility (“attention span of a gnat”); and paint a picture of a man who, while he clearly has skills in the political arts, exudes incompetency when confronted with a complex or thorny issue.

And dereliction. Trump didn’t attend coronavirus task force meetings and became bored with the daily press conferences as soon as it became clear they were hurting his poll numbers. As we look back over the past seven months, it is clear there was never even a plan of a plan. There was chaos and neglect all the way through.

You write that psychopaths are so focused on “dominance” and “winning” that they become extremely adept at it. How do you see that trait displayed in the way Trump approaches: a) press conferences; b) the 24-hour news cycle; and c) the election campaign?

Actually, all three of the core traits are on display in these areas and explain much of his norm-shattering behavior. The drive to dominate leads him to disparage others, call them third-rate journalists and nasty, and relentlessly tweet out attacks on his perceived enemies. It also leads him to cast himself as the hero (“I’d give myself a 10”).

His impulsivity leads him to say the next thing that comes into his mind that seems like it could “win the moment.”

And the remorselessness leads him to say whatever comes into his mind, regardless of how hurtful, divisive, or untrue it might be.

The election is weeks away. Amid the disaster he has created, what behaviors are likely to become more apparent as he becomes more and more desperate to win at all costs?

We need to be concerned. Seventy days out… and polls suggest that lying and dividing may not be enough for Trump to eke out another victory. Since the voters from his base may not be sufficient, and since he has forsaken swaying new voters to his side, he and his minions choose to cheat citizens who would vote against him out of their votes. And to cheat on a scale we have never seen before in American history.

Psychopaths—and Trump is a good example—are also adept at stoking grievances in others. Since they often feel aggrieved, they know how to tap into that feeling in others. They know the language of victimization. They are skilled in the art of trolling. They have exceptional talent in whipping up people’s resentments.

Finally, when you think deceit can’t get any more brazen, well, you just witnessed the Republican convention.

These behaviors are certainly not going to abate.

What behaviors do you predict if he does lose, especially knowing he faces the possibility of future “losses” via legal battles that could result in prison terms for himself and his children?

A man with no capacity for restraint or conscience is an alarming opponent. He will do anything to win, whatever the risk, whatever the collateral damage.

We need to recognize the political power of such remorselessness in our current predicament. We need to acknowledge that Trump has already won many significant battles. He has already delegitimized the election for a large swath of the country. He has successfully mounted an assault on the concept of truth. He has loyalists in crucial government positions who are abetting the weaponization of federal power. He has shattered the norm that it is unacceptable to operate outside the rule of law.

Any final thoughts for voters, other mental health professionals and the media as November 3rd approaches?

We need to be alarmed yet poised and intelligent. We need to stand aside from the chaos coming; and make strong, moral, and effective choices.

We need to not underestimate him.

We need to stay in the fight.


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