Sitting down to a dinner party the other day, I was asked by one of the guests whether I thought Mr Donald Trump is a narcissist. This was before he became President-elect of the United States after the Nov 8 election.
It is one of the occupational hazards of being a psychiatrist that you would be asked certain questions during such social occasions and where you are often tempted to pontificate to the point of pomposity and beyond what you know. But that evening, I side-stepped the question by invoking the Goldwater Rule.
During the 1964 United States presidential election which was fought between Senator Barry Goldwater and Mr Lyndon Johnson, a magazine polled more than 12,000 psychiatrists for their views on Mr Goldwater's mental state and personality. Of the 2,000 or so who responded, about half declared Mr Goldwater, the Republican nominee, as unfit to be a president, labelling him "unbalanced", "paranoid", "grandiose" and even "a dangerous lunatic".
After a crushing loss to Mr Johnson, Mr Goldwater successfully sued the magazine publisher. Subsequently in 1973, the American Psychiatric Association adopted what became known as the Goldwater Rule, declaring it unethical for any psychiatrist to diagnose a public figure's condition "unless he or she has conducted an examination and has been granted proper authorisation for such a statement".
The reasons are clear enough. Psychiatric diagnoses are often not easily made; most made remotely turn out to be wrong. Sometimes, it takes an experienced clinician many face-to-face sessions of deep probing and with as much information as possible from other sources before being able to make a definitive diagnosis.
The labels themselves can cause harm to the person - with the stigma of mental illness being what it is, the mere suggestion of mental instability can derail the career of anyone seeking public office. Also, such a slapdash and openly made diagnosis runs counter to the profession's commitment to confidentiality.
NARCISSISTIC PERSONALITY DISORDER
But what is a narcissist?
The term has its roots in Greek mythology. Narcissus was a handsome young man who was pursued by many but they were all spurned by him. One day, Narcissus came upon a pool of water in the woods. While leaning over to take a drink, he saw his own reflection for the first time, and immediately fell in love, not realising he was gazing at himself. Time and again, he tried to touch and kiss his reflection. Pining hopelessly for something he could not have, he stopped eating and finally died (in another version, he dove into the water and drowned).
It is from this fable that the word "narcissism" originates. It was first used in psychology in the last century by Sigmund Freud and other psychoanalysts.
In contemporary psychiatry, the concept of narcissism has been codified as a psychiatric diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders where it is known as narcissistic personality disorder characterised by "a pervasive pattern of grandiosity, need for admiration and a lack of empathy".
Narcissists are imbued with a staggering sense of self-importance and entitlement. They are given to self-aggrandising whatever achievements or talents they might possess, no matter how slight or non-existent.
Another feature is a preoccupation with "fantasies of unlimited success, power, brilliance, beauty or ideal love", and they expect unqualified admiration from others.
Underlying all these, however, is a profound sense of insecurity, low self-esteem and vulnerability. To stave off these feelings in the face of any opposition or rejection, they react with affected indifference, disdain or rage.
At its most extreme is what the psychoanalyst Otto Kernberg called malignant narcissism, which he posited to be the source of "much evil in the world".
People with such a disorder have a deficit of empathy and conscience that amounts to a total and callous disregard for the rights of others.
They react with spiteful and even murderous aggression towards those they imagine are against them.
Consider Anders Behring Breivik, who in a single day in July 2011 killed 77 people. Most of his victims were young people who he shot one after another at close range in a youth summer camp. Calling himself the "Grand Commander of the Knights Templar", he said he was waging a crusade to save Norway from Islam and multiculturalism.
Diagnosed with extreme narcissistic personality disorder, he was certified fit to stand trial, during which he showed no remorse. There was only one time in the trial when he wept and that was when his own video manifesto was played in court: He was moved to tears by the sound of his own words.
NARCISSISM IN POLITICS
Outside the clinical realm, narcissism has been embraced by popular culture, bandied about and applied liberally to a wide array of individuals - from an indifferent boyfriend to an overbearing boss, as well as to diverse groups of people, including power-hungry tinpot dictators, Instagram-obsessed millennials, limelight-seeking entertainers and hubristic corporate titans.
Nor are politicians spared.
As noted by journalist Kristin Dombek in her book, The Selfishness Of Others: An Essay On The Fear Of Narcissism, "narcissism is the favourite diagnosis for political leaders in whatever party opposes one's own".
It is probably a safe bet that there has been no other candidate in the US presidential campaign save Mr Trump who has been called a narcissist so many times. (Mr Trump, on the other hand, had accused Mrs Hillary Clinton of being "unbalanced" and "unhinged".)
When asked about Mr Trump's personality for an article in Vanity Fair magazine, psychologist and Harvard professor Howard Gardner replied: "Remarkably narcissistic."
"Textbook narcissistic personality disorder," echoed clinical psychologist Ben Michealis.
Psychologist William Doherty, from the University of Minnesota, posted an online manifesto against "Trumpism" which was signed by more than 2,200 mental health specialists.
In the welter of these professional opinions, the American Psychiatric Association felt compelled to caution members that breaking the Goldwater Rule "is irresponsible, potentially stigmatising, and definitely unethical". The psychologists, however, said that the rule applies only to psychiatrists and not them.
But as a recent commentary in the august British Medical Journal opined: "It is obvious that Trump is sexist and racist. He is vile in his nastiness, undiplomatic and offensive; a true dog's dinner of a president candidate, if you really hated your dog. But none of this means he has a psychiatric condition. It just means that he's a horrible man."
The presence of severe psychopathology in any commander-in-chief of the world's most powerful nation is, of course, a grave matter.
But it is a nuanced and complex issue, although there is usually no appreciation of these subtleties in the political arena where psychiatric descriptors are deployed against opponents.
The oversimplification and misrepresentation of mental health issues has the effect of stigmatising all people with different mental disorders as being unreliable and less than capable - which belies the fact that the majority of people with treated mental illness are certainly not impaired and are leading useful, productive and fulfilling lives.
In 1998, Norwegian Prime Minister Kjell Magne Bondevik publicly admitted to his depression, took time off to recover, returned to work, and was also re-elected.
No one is immune to mental illness, not even those in high office.
In a study published in 2006 in the Journal Of Nervous And Mental Disease, researchers from Duke University reviewed data from biographical sources for evidence of mental illness among 37 US presidents from 1776 to 1947 and found that 18 had some form of mental illness.
These include Thomas Jefferson, Theodore Roosevelt, Dwight Eisenhower and Abraham Lincoln, who scholars have consistently rated to be the greatest American president to date.
The writer is vice-chairman of the medical board (research) at the Institute of Mental Health.
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