Donald Trump - The Role of Psychiatry

I'm not into politics, particularly American politics. I've often laughed at the whole election process over there. Obscene amounts of money thrown at huge campaigns, even rock stars get in on the act in efforts to persuade their fans who to vote for. Here in the UK it's very low key. On the odd occasion, we may see a minor scuffle outside a polling station on a damp and dreary Thursday ~ It's nothing compared to the firework displays and live bands performing for our American counterparts.

So, if I'm not into politics why am I using my free time on a Sunday to write a blog about Donald Trump?

Well, I'm finding him very interesting. I can't weigh him up though. I know he has a disdain for journalists and I know he tweets a lot. His tweets are causing concern for many as are his speeches, so much so that a number of mental health professionals are claiming that Trump’s speeches and actions make him incapable of serving safely as president. They claim that Trump is showing 'grave emotional instability.'

In a letter to the New York Times, no less than 35 health care professionals, led by Lance Dodes, M.D., claim that:

(Donald Trump's) actions demonstrate an inability to tolerate views different from his own, leading to rage reactions. His words and behavior suggest a profound inability to empathize. Individuals with these traits distort reality to suit their psychological state.

Let's take a look at this closer by using the Merck Manual of personality disorders.

According to the 35 health care professionals, Trump is showing:

- grave emotional instability - Another term for this, I guess, could be 'emotionally detached.'
- profound inability to empathize -

Schizotypal personality disorder
People with schizotypal personality disorder are emotionally detached. In addition, they have odd ways of thinking, perceiving, and communicating similar to those of people with schizophrenia. Odd ways of thinking may include magical thinking and paranoid ideas. In magical thinking, people believe that their thoughts or actions can control something or someone. For example, people may believe that they can harm others by thinking angry thoughts. People with paranoid ideas tend to be suspicious and mistrustful and wrongfully think other people have hostile motives or intend to harm them. Schizotypal personality disorder may be treated with antipsychotic drugs.

Fair to say that Trump, if the 35 professionals assessment of him is correct, would meet the criteria for someone having Schizotypal personality disorder.

But wait, there's more from the Merck Manual:

Antisocial personality disorder
Many people with antisocial personality disorder become frustrated easily and tolerate frustration poorly. As a result, they act impulsively and irresponsibly, sometimes committing criminal acts. In these cases, they act without considering the negative consequences of their behavior and the problems or harm they cause others. There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. Doctors may prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression

Furthermore:

Narcissistic personality disorder
This type is characterized by an inflated view of self-worth (called grandiosity). People with this disorder expect to be treated with deference and may exploit others because they think their superiority justifies it. Their relationships are characterized by a need for admiration, and they often think that others are jealous of or envy them. These people are sensitive to the reactions of others but only as far as the reactions relate to themselves. They are extremely sensitive to failure, defeat, and negative reactions from others, including criticism. Such reactions from others can trigger sudden rages or depression (including suicidal thoughts or actions). There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety drugs may be helpful.

Moving across to the Diagnostic Statistical Manual of Mental Disorders, we see Trump also meets the criteria (If the 35 health care professionals are to be believed) for:

Obsessive-Compulsive Personality Disorder
Empathy: Difficulty understanding and appreciating the ideas, feelings, or behaviors of others. In most cases, medication for this disorder is not indicated unless the individuals is also suffering from another psychiatric disorder. However, newer medications such as Prozac, an SSRI, have been approved for the treatment of obsessive-compulsive disorder and may provide some relief to individuals with the related personality disorder.

In fact, according to the 35 health care professionals, Trump also meets the criteria for Avoidant Personality Disorder and Borderline Personality Disorder, both can be treated with psychiatric medications.

So, my question to these 35 health care professionals is simple, however, I don't expect an answer.

If Trump was your patient would you prescribe him any of the medications listed above and let him continue in office?

I highly suspect the answer would be a defiant 'No' - not because they don't want him to continue in office, not because they believe that Trump is beyond repair either. Neither of these health care professionals would prescribe any psychiatric drug to Trump because of this one Tweet:

Military solutions are now fully in place,locked and loaded,should North Korea act unwisely. Hopefully Kim Jong Un will find another path!

— Donald J. Trump (@realDonaldTrump) August 11, 2017

Why would any psychiatrist or doctor prescribe an antipsychotic or SSRI to someone who throws out a gauntlet like this?

Which brings me nicely to the recent Panorama programme, 'A Prescription For Murder.'

James Holmes, despite telling his psychiatrist he had murderous thoughts, was prescribed the SSRI sertraline, known better by its brand name of Zoloft in the US and Lustral in the UK. Holmes, after taking sertraline for 6 weeks carried out those murderous thoughts regardless. Much was said in the defence of SSRIs prior to and after the airing of the Panorama programme. Those same critics who chastised Panorama are now in a wonderful position. Why not let them decide if a psychiatric drug, which they believe does not induce murderous thoughts, should be administered to President Donald J. Trump?

If they are so cocksure that the benefits of these types of medications outweigh the serious risks they can pose then I'm sure they will pull out their prescription pads and write him a prescription for some medication.

Given what we know about these meds, and what we have been saying for many years about these meds, this is one occasion where psychiatry can prove us all wrong.

I double-dare you all.

Bob Fiddaman