Saturday, October 5, 2019

The Unfit Presidency, Part 1.

Sometimes we encounter an essay that increases our understanding of our world by exposing connections that we had not imagined. This is such a document connecting history, politics, and clinical psychology.

George Conway III provides extensive evidence in The Atlantic that Trump is Unfit for Office.
Donald Trump’s narcissism makes it impossible for him to carry out the duties of the presidency in the way the Constitution requires.

Here’s what to expect.

  • Conway describes what the founders desired in a president and what they wished to avoid.
  • He provides, in narrative form, a compendium of Trump’s behaviors, both verbal and nonverbal, that bear on the question of fitness.
  • These behaviors are consistent with diagnoses of narcissistic personality disorder and antisocial personality disorder. Observations from public media agree with these possible clinical diagnoses.
  • Finally, Conway considers what remedies might be applied to remove Trump from office.

Below I provide excerpts consistent with the above points.

… Simply put, Trump’s ingrained and extreme behavioral characteristics make it impossible for him to carry out the duties of the presidency in the way the Constitution requires. To see why first requires a look at what the Constitution demands of a president, and then an examination of how Trump’s behavioral characteristics preclude his ability to fulfill those demands.

Though the Constitution’s drafters could hardly have foreseen how the system would evolve, they certainly knew the kind of person they wanted it to produce. “The process of election affords a moral certainty,” Hamilton wrote, “that the office of President will never fall to the lot of any man who is not in an eminent degree endowed with the requisite qualifications.” “Talents for low intrigue, and the little arts of popularity,” might suffice for someone to be elected to the governorship of a state, but not the presidency. Election would “require other talents, and a different kind of merit,” to gain “the esteem and confidence of the whole Union,” or enough of it to win the presidency. As a result, there would be “a constant probability of seeing the station filled by characters pre-eminent for ability and virtue.” This was the Framers’ goal in designing the system that would make “the choice of the person to whom so important a trust was to be confided.”

More than a diagnosis, what truly matters, … is the president’s behavioral characteristics and personality traits. And understanding how people behave and think is not the sole province of professionals; we all do it every day, with family members, co-workers, and others. Nevertheless, how the mental-health community goes about categorizing those characteristics and traits can provide helpful guidance to laypeople by structuring our thinking about them.

And that’s where the Diagnostic and Statistical Manual of Mental Disorders comes into play. The DSM, now in its fifth edition, “contains descriptions, symptoms, and other criteria for diagnosing mental disorders,” and serves as the country’s “authoritative guide to the diagnosis of mental disorders.” What’s useful for nonprofessionals is that, for the most part, it’s written in plain English, and its criteria consist largely of observable behaviors—words and actions.

One scholarly paper has suggested that accounts of a person’s behavior from laypeople who observe him might be more accurate than information from a clinical interview, and that this is especially true when considering two personality disorders in particular—what the DSM calls narcissistic personality disorder and antisocial personality disorder. These two disorders just happen to be the ones that have most commonly been ascribed to Trump by mental-health professionals over the past four years. Of these two disorders, the more commonly discussed when it comes to Trump is narcissistic personality disorder, or NPD—pathological narcissism. It’s also more important in considering Trump’s fitness for office, because it touches directly upon whether Trump has the capacity to put anyone’s interests—including the country’s and the Constitution’s—above his own.

… from the perspective of the public at large, the debate over whether Trump meets the clinical diagnostic criteria for NPD—or whether psychiatrists can and should answer that question without directly examining him—is beside the point. The goal of a diagnosis is to help a clinician guide treatment. The question facing the public is very different: Does the president of the United States exhibit a consistent pattern of behavior that suggests he is incapable of properly discharging the duties of his office?

… In a nutshell, while carrying out his official duties, a president has to put the country, not himself, first; he must faithfully follow and enforce the law; and he must act with the utmost care in doing all that.

… The president’s exceptional narcissism is his defining characteristic—and understanding that is crucial to evaluating his fitness for office.

The DSM–5 describes its conception of pathological narcissism this way: “The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.” The manual sets out nine diagnostic criteria that are indicative of the disorder, but only five of the nine need be present for a diagnosis of NPD to be made. Here are the nine:

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
  4. Requires excessive admiration.
  5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends)
  7. Lacks empathy: is unwilling to recognize or identify with the feelings or needs of others.
  8. Is often envious of others or believes that others are envious of him or her.
  9. Shows arrogant, haughty behaviors or attitudes.

You might wish test your own knowledge of what Trump has (and has not) done that might square with this list. “That’s Trump, to a T.” is how Conway thinks of the first three criteria. He goes on to expand on each with instances from Trump’s behaviors and claims.

Narcissism resides in each of us. But Trump’s NPD is off scale.

Experts haven’t suggested that Trump is psychotic, but many have contended that his narcissism and sociopathy are so inordinate that he fits the bill for “malignant narcissism.” Malignant narcissism isn’t recognized as an official diagnosis; it’s a descriptive term coined by the psychoanalyst Erich Fromm, and expanded upon by another psychoanalyst, Otto Kernberg, to refer to an extreme mix of narcissism and sociopathy, with a degree of paranoia and sadism mixed in. One psychoanalyst explains that “the malignant narcissist is pathologically grandiose, lacking in conscience and behavioural regulation with characteristic demonstrations of joyful cruelty and sadism.” In the view of some in the mental-health community, such as John Gartner, Trump “exhibits all four” components of malignant narcissism: “narcissism, paranoia, antisocial personality and sadism.”

Just as scary are signs of cognitive decline.

Mental-health professionals have raised a variety of other concerns about Trump’s mental state; the last worth specifically mentioning here is the possibility that, apart from any personality disorder, he may be suffering cognitive decline. This is a serious matter: Trump seems to be continually slurring words, and recently misread teleprompters to say that the Continental Army secured airports during the American Revolutionary War, and to say that the shooting in Dayton had occurred in Toledo. His overall level of articulateness today doesn’t come close to what he exhibits in decades-old television clips. But that could be caused by ordinary age-related decline, stress, or other factors; to know whether something else is going on, according to experts, would require a full neuropsychological work-up, of the kind that Trump hasn’t yet had and, one supposes, isn’t about to agree to.

To sum up:

… His “mental state,” according to Justin A. Frank, a former clinical professor of psychiatry and physician who wrote a book about Trump’s psychology, “include[s] so many psychic afflictions” that a “working knowledge of psychiatric disorders is essential to understanding Trump.” Indeed, as [John] Gartner puts it: “There are a lot of things wrong with him—and, together, they are a scary witch’s brew.”

What constitutional mechanisms exist for dealing with a president who cannot or does not comply with his duties, and how should they take the president’s mental and behavioral characteristics into account? One mechanism discussed with great frequency during the past three years, including within the Trump administration, is Section 4 of the Twenty-Fifth Amendment. That provision allows the vice president to become “Acting President” when the president is “unable to discharge the powers and duties of his office.” But it doesn’t define what such an inability entails; essentially, it lets the vice president and the Cabinet, the president himself, and ultimately two-thirds of both houses of Congress decide.

That’s a high bar.

… so it turns out that impeachment is a more practical mechanism for addressing the fact that Trump’s narcissism and sociopathy render him unable to comply with the obligations of his office. It’s also an appropriate mechanism, because the constitutional magic words (other than Treason and Bribery) that form the basis of an impeachment charge—high Crimes and Misdemeanors, found in Article II, Section 4 of the Constitution—mean something other than, and more than, offenses in the criminal-statute books. High Crimes and Misdemeanors is a legal term of art, one that historically referred to breaches of duties—fiduciary duties—by public officeholders. In other words, the question of what constitutes an impeachable offense for a president coincides precisely with whether the president can execute his office in the faithful manner that the Constitution requires.

… now that the House of Representatives has embarked on an impeachment inquiry, one of the most important judgments it must make is whether any identified breaches of duty are likely to be repeated. And if a Senate trial comes to pass, that issue would become central as well to the decision to remove the president from office. That’s when Trump’s behavioral and psychological characteristics should—must—come into play. From the evidence, it appears that he simply can’t stop himself from putting his own interests above the nation’s. Any serious impeachment proceedings should consider not only the evidence and the substance of all impeachable offenses, but also the psychological factors that may be relevant to the motivations underlying those offenses. Congress should make extensive use of experts—psychologists and psychiatrists. Is Trump so narcissistic that he can’t help but use his office for his own personal ends? Is he so sociopathic that he can’t be trusted to follow, let alone faithfully execute, the law?

Congress should consider all this because that’s what the question of impeachment demands. But there’s another reason as well. The people have a right to know, and a need to see. Many people have watched all of Trump’s behavior, and they’ve drawn the obvious conclusion. They know something’s wrong, just as football fans knew that the downed quarterback had shattered his leg. Others have changed the channel, or looked away, or chosen to deny what they’ve seen. But if Congress does its job and presents the evidence, those who are in denial won’t be able to ignore the problem any longer. Not only because of the evidence itself, but because Donald Trump will respond in pathological ways—and in doing so, he’ll prove the points against him in ways almost no one will be able to ignore.

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