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  • Nassir Ghaemi

A First-Rate Madness in the Trump White House: Front Row at the Trump Show




Is President Donald Trump the right leader for these times of crisis? First the coronavirus pandemic; next nationwide protests against racism in the wake of another case of police homicide against a black citizen. In each case, the president has taken a combative approach that his supporters love and his opponents hate. Is he a good crisis president? Before the verdict of the upcoming election, I believe that psychiatric knowledge and historical experience can help predict the outcome.


It’s notable that political journalist Jonathan Karl wrote in his new book Front Row at the Trump Show that former White House chief of staff Mick Mulvaney recommended my book, A First-Rate Madness, to his colleagues—a sign that someone very close to the president recognized him the way I will describe him.


(Here is a link to an interview between Jonathan Karl and me on this topic.)


Scientific studies suggest that the best crisis leaders are often those who have a certain kind of mental illness. In fact, good mental health can be a drawback during periods of extreme danger. People with mild to moderate depression are often more realistic and more empathic than people without depression; people with mania can be far more creative and also more resilient to traumatic experiences.


I wrote my book on this topic years before Donald Trump ran for the White House. As I argued in it, mentally healthy leaders are more effective in times of relative stability and prosperity. They’re friendly and reliable; they keep things going as they are. But in times of crisis, we’re likely to do better with leaders who have manic-depressive illness. Realism, empathy, creativity, resilience: these traits form a recipe for a great crisis leader. The question now is whether Trump has these traits—and can use them effectively enough to improve his chances of reelection.


I’m aware that, in terms of the “Goldwater Rule,” psychiatrists aren’t supposed to make clinical judgments about public figures they haven’t personally examined. My view is that such judgments can be ethical if they’re based on objective information and politically unbiased assessment. For instance, if someone is captured on video saying he wants to kill himself, and then holds a gun to his head, it would be legitimate to make a clinical judgment of suicidality.


Defining mania as being high energy and sped-up in thinking and feeling—the opposite of depression—Trump, based on public facts, seems to have these classic manic symptoms: high physical and sexual energy, relatively little need for sleep, rapid speech and talkativeness, inflated self-esteem, marked distractibility, and, at times, impulsive behavior. Such manic traits can be seen often among business entrepreneurs.


I’m not saying that mania by itself explains Donald Trump. The Washington Post has documented over 16,000 false or misleading statements made by the president, but mania doesn’t make one lie. I am saying that we need to appreciate manic personality traits as necessary, though not sufficient (his upbringing and family background matter too), to understanding Trump.


Depression could be part of the problem. The weakness of mania by itself is a certain lack of empathy, which grows out of excessive self-esteem (“I alone can fix it!”), and a less realistic perspective than normal persons—a flipside of creativity. Creative people tend to be unrealistic, though sometimes this very lack of realism allows them to imagine something into existence. In a crisis demanding sober, even sad, realism, the manic leader can be dangerously optimistic.


Depressed crisis leaders like Abraham Lincoln and Winston Churchill saw through political fogs of denial. The depressed Churchill, for example, continually sounded the alarm as Adolf Hitler, whose evidence for bipolar illness I have documented in my book, consolidated power and rebuilt the German war machine in the 1930s—yet was largely ignored by British leaders. Had Churchill not been depressed, he may have been more prone to see things like his predecessor, Prime Minister Neville Chamberlain, who believed his non-aggression pact with Hitler would ensure “peace for our time.” Chamberlain seemingly saw events through the slightly rosy lenses of what psychologists call “mild positive illusion.” That illusion is fine for a citizen, but could be dangerous in a leader, especially in a time of crisis. Depressive realism is not just an intriguing psychological observation; it may be a necessity for a great crisis leader.


My analysis predicts that Trump would be more likely to be creative and resilient, if he’s manic, but less likely to be empathic or realistic if he hasn’t been depressed. Taking Trump at his word, that he’s “a very stable genius,” and thus never has been depressed, that could weaken his crisis leadership skills if it also means that he is less likely to connect with the pain of his political opponents, whether the victims of a virus that harms his reelection prospects or the non-white victims of racism.


Having a manic personality without any depression might help explain some of his unrealistic responses to the coronavirus pandemic. He floated the medically impossible idea that the crisis would end by Easter, complaining about public health restrictions, and hyping poorly proven—or even dangerous—treatments. At the same time, he has shown that he is willing to be bold, approving an economic plan that accepts the welfare-state-like concept of cash payments to individuals.


He initially held daily press briefings as the face of the government response, which could be interpreted positively as a sign of stamina in a crisis. Yet the briefings also provided more evidence of manic traits: self-importance (berating and demeaning reporters, answering medical questions in place of experts, bragging about his press briefing TV ratings), attacks on opponents, unrealistic instincts about the future (overhyping some medication treatments and overly optimistic timelines for ending quarantine), and talkativeness, and relatively little empathy for those who’ve suffered. An analysis of 13 hours of his briefings found that he spent about two hours attacking his opponents, 45 minutes praising himself and his administration, and less than five minutes giving consolation to victims of the pandemic. Contrast that with his political twin, U.K. Prime Minister Boris Johnson, who also seems to show manic personality traits (famously high energy with reported sexual affairs) and who has clinical depression in his family (his mother was hospitalized for it). After spending several nights in intensive care for COVID-19, Johnson spoke to the anxieties and pain of the public while explaining the need for the lockdown to continue.


Before this pandemic, as an impulsive president in a time of prosperity, Trump stoked social and political conflict that could have been tempered or avoided by another kind of leader. In the midst of nationwide racial tension not seen in half a century, he has taken an antagonistic stance toward protesters.


In another crisis a century and a half ago, with over half a million dead, another Republican president, who was depressed rather than manic, got reelected, and in his victory speech, he didn’t gloat. Rather, he expressed malice toward none, and charity for all.


If my analysis is correct, a president who was both manic and depressed, not just one without the other, would have been better equipped than the current president to give succor to the nation and to show charity for all, the absence of which has cost hundreds of thousands of lives.


PS: This essay has been difficult to publish, despite verified reporting from ABC News that forms its basis. It was rejected by many media sources, including one that initially accepted it but then rejected it at final editorial review with the claim that one could not prove that the president never had depression. This experience reflects, in my view, the harmful effect of the APA's Goldwater Rule in contemporary society, with an excessive muzzling of psychiatric discourse.

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