The Dangers of Psychiatrists Diagnosing from Afar

A Marxist review of The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, edited by Bandy Lee, M.D., M. Div., St. Martin’s Press, New York, 2017

As a practicing neurologist, as well as a Marxist and socialist feminist, Dr. Bandy Lee’s best-selling anthology caught my eye.  I have learned over many years how oblivious contemporary American psychiatry and psychology are, with some heartening exceptions, to the role capitalism plays in the production and circulation of mental illness.  I wondered if this book would do better.

Sadly, it does not.  In fact, if Donald Trump is as dangerous as the authors claim, then their volume is at least as dangerous, because both their analysis of and solution to the problem, if taken seriously, can only make matters worse.  They do not question the very social foundations which have without a doubt led to Trumpism.  They treat Trump the symptom without touching the underlying disease, and even then their remedy is a small dressing over a gaping and festering wound.

The authors’ discussions are entirely in the liberal tradition.  They clearly support progressive causes, like opposition to racism, sexism, homophobia, and xenophobia, but they do not once question the underlying capitalist system which aids and abets these social crimes.  They do not consider that it was precisely the mass disillusionment created by a combined liberal-conservative assault on working peoples’ standard of living which put Trump in the spotlight.  More of the same assault will only replace Trump with another disaster.

The only way to truly find a solution to Trump the mentally ill president is to thoroughly question the sick socioeconomic system which produced him.  The only way to finally cure the disease is to radically transform that system into one which has no economic generators of mental illness.  Happily, it will be one which also has no economic compulsion for war, racism, sexism, homophobia, and xenophobia.  It will be a socialist system, run democratically by ordinary people throughout the world.

Who knows how much of what we currently identify as psychopathology will then simply evaporate?  Yet whatever remains, we will address compassionately and caringly.

It is not enough to reply that until such a radical transformation has triumphed we at least need to address the immediate problem of Trump’s specific psychological illness.  However urgent this may be, and it is certainly obvious that there is something not quite right with this president, what we really need to address is Trump’s political program, because many politicians who are considered quite normal, whose sanity is not called into question, endorse exactly what he is trying to accomplish.  They are working with him and he with them.  He’s not in this alone.  And they’ll still be around once he is gone, still leading us to the brink of disaster.  We could be left with a Mike Pence running the show.

And then what?

Trump’s mental illness:  diagnosis and treatment

The main focus of the book, of course, is Trump’s severe mental illness and the danger it poses for the country and the world.  With some minor variations on the theme, President Trump, we are told, is afflicted with malignant narcissism.  The specific traits and behaviors associated with this condition include bullying, lying, and grandiose thinking, among many others.  He lives in an alternate reality of his own making.  He is incapable of healthy empathic thinking.

The profound political danger posed by this condition, we are told, is the inability of a president so afflicted to engage in cool, calm, and rational thought when deciding whether or not to activate the nuclear codes and drop the big one.  Media commentators voicing the same theme have warned that we are only a “temper tantrum” away from a nuclear holocaust.

The proposed solution, expressed directly by several of the authors and in so many words by the others, is twofold.  First of all, we need an urgent, if not emergency mental status evaluation of the president to assess his fitness to serve.  Second, we need to set up a panel of mental health experts to similarly screen all future presidential and vice presidential candidates.

So, to combat the danger posed by a severely ill president, whose cold and irrational finger is itching to click on ‘bombs away’ with his mouse, the authors prescribe a dose of — election reform!  The contrast between an admittedly profound and alarming problem and a strikingly simplistic and mundane solution cannot be more glaring.

It should be fully appreciated that the authors’ position in no way questions the U.S. nuclear program or a U.S. initiated nuclear war.  These are not the problems.  It is that a deranged human being is currently in charge. ((Two of the twenty-seven authors do write that the real problem is not Trump’s mental illness, but rather his dangerousness.  Then, of course, the question they should address, which unfortunately they do not, is whether he is, in fact, significantly more dangerous than the other politicians running the country, and what that greater dangerousness is due to, because if it is only due to his mental illness, then we are back to square one.  If it is due to his political program, then that’s what we need to address, as I point out in this review.)) If any of the individual authors do oppose the U.S. nuclear arsenal or the role of U.S. nuclear power in the current world order, they do not even hint at conveying that message to the reader.

It goes without saying that the proposed solution isn’t guaranteed to remove Trump, and even if it did, it probably wouldn’t be any time soon.  Given the alleged urgency of the problem, what would the authors propose we do in the meantime?

We have to conclude from the logic behind the authors’ reasoning that the real problem lies not so much with Trump himself but with a very repairable little leak in our otherwise ingenious democratic plumbing.  The founding fathers, it would seem, did not go quite far enough in their system of checks and balances to preclude the possibility of us electing an outlier situated so many miles off the sanity curve.  That only proves, of course, just how democratic we are, that it really is true that in America anyone can become president, even a psychopath like Donald Trump.  Not to worry.  It’s nothing a little patch can’t fix.  We can keep the pipes from bursting.  And we can thank the mental health profession for coming to the rescue.

What will we have when the leak is fixed?   Obviously, we will all be able to go to bed secure in the knowledge that only a sane president now has the power to blow up the planet.

This is precisely, and without exaggeration, what the book is all about.

The deeper questions

In not going beyond Trump himself, in fact, in not going beyond his mental illness, the authors come across as if they are completely oblivious to the deeper and more important questions prompted by their own conclusion.  The two most important questions are:

  • How did we get to this precipice in the first place?
  • How much will having a sane president in the oval office reduce the risk of the button being pushed?

Neither of these questions is even raised, yet answering them is so obviously crucial to finding an effective, sustainable, and definitive solution to the problem of a mentally ill finger on a nuclear trigger.

Virtually every single contribution from the twenty-seven mental health professionals addresses Trump’s psychopathology without once discussing the history of U.S. capitalism or imperialism.  These words themselves appear nowhere in the book.  Social theory, Marxist or otherwise, is non-existent.  The expression ‘U.S. democracy’, on the other hand, fills the pages.

What does this mean?  It means that the socioeconomic foundations of the United States are taken for granted.  They are a given.  Even more, they are accepted as legitimate.  The notion that capitalism has something to do with why we are in such a predicament and why even an allegedly sane president will not make us any safer is safely kept in the dark, as if it does not even exist or is not up for discussion.

The theme that the fundamental aims of U.S. foreign policy are legitimate runs throughout the book.  I stopped counting how many authors were concerned that Trump is alienating “our allies” and taunting “our enemies”.  We read more than once about the sane and wise John Kennedy and how he was able to successfully beat back the Cubans without resorting to nuclear war.  There is praise for the likes of the CIA and FBI.  Kissinger and Brzezinski get favorable treatment.  One author tells us not to worry because even if you oppose the pro-Zionist Trump, you can continue to love Israel.

The implicit endorsement of capitalism can be seen in one author’s comments on Steve Jobs, the founder of Apple.  We are told that Jobs exhibited traits quite similar to Trump’s, and could easily have been diagnosed with the same disorder.  But he gets a pass on this because, as a creative capitalist, he was not dangerous.  Instead, he accomplished great things, like inventing I-pads and I-phones.

Being a successful capitalist, in other words, trumps mental illness.  The likes of a Steve Jobs does not need mental status screening.  For that matter, the likes of a Donald Trump gets a mental health clearance as long as he is only growing his vast fortune, even being a racist in the process, and not residing in the oval office.

But if we extend the logic of the fundamental problem, shouldn’t Lee and her contributors advocate a mental status screening of every single person who is in a position to cause great harm?  Why do we only start in the White House?  Why not also in the boss’s office at the sweatshop factory?  Why not in the luxury mansions of oppressive dictators the U.S. government has decided are valuable political and economic assets?  Why not in the CIA torture chambers?

No discussion of nuclear war

The very rationale for the U.S. nuclear arsenal is questioned nowhere in the book.  This is one aspect of the book’s overall failure to consider the larger social context within which the problem they identify has arisen.

The dropping of atom bombs on Japan is also not addressed, despite numerous, presumably sane historians pointing out that the incineration of vast numbers of innocent Japanese civilians was carried out by the U.S. primarily in order to send a message to the Soviet Union that the U.S. was in charge of East Asia – and that we had the bomb.  Was Truman sane when he ordered the attack?  Is that not a question worth discussing in a book about mental health and the nuclear trigger?  If, in the authors’ opinion, Truman would have passed their mental status test, and if his dropping of the atom bomb was a crime against humanity and an entirely unnecessary move even from a military perspective, then their overall argument about the Trump danger falls apart.  There should have been at least one chapter carefully analyzing this episode in U.S. history.

But such a chapter is nowhere to be found.  In focusing virtually entirely on Trump the mental case and virtually nothing else, as if there is no larger context, the only consolation is that we are at least given an opportunity to learn how to recognize the dead end of liberal thinking.

Understanding the larger context is indispensable if we are to even minimally grasp what this problem is all about.  It is precisely the imperialist character of U.S. foreign policy, carried out jointly by Democrats and Republicans, together with “our allies”, and whose aim is nothing short of complete domination of the planet for the benefit of private corporate wealth, which has fueled the creation of the world’s most destructive nuclear arsenal.  This nuclear arsenal is a key weapon in the defense of this imperialist world order.  Those struggling for liberation know what they are up against.

Dropping a bomb is not the only way to use it.  Just threatening to use these weapons, as the U.S. has done, constitutes using them, in the same way that a thief on the street demanding your money has used his gun even if he doesn’t pull the trigger.  It would seem that the authors are not concerned with this manner of using nuclear weapons, only with detonating them.  Either that, or they once again haven’t fully thought through the problem they have collectively chosen to analyze.

The U.S. emerged from World War Two as the world’s dominant economic and military power.  Who can say with a straight face that what we think of as sane U.S. politicians, Democrats and Republicans alike, have not repeatedly lied to the public since then about U.S. military adventures?  Korea, Vietnam, Cuba, Grenada, Afghanistan and Iraq – the list goes on and on.  With the U.S. supporting a who’s who of the world’s worst dictatorships over the years, who will say that the nearly one thousand U.S. military installations around the world, many nuclear armed, are all about defending democracy rather than Wall Street?  The capitalist politicians before Trump are responsible for this state of affairs.  Yet these are the very same politicians who would command the nuclear arsenal in the world of Lee’s authors.

The danger posed by Trump must be seen in the context of an already dangerous world.  It is a grave mistake and sheer political naivete to think that the U.S. is not the leading culprit in creating this danger.  Furthermore, it has done so with politicians and military men whom not one single author questions as mentally unstable.

Trump entered the White House with the margin for error in U.S. politics already dangerously narrowed.  When a pitcher has walked three batters only to then give way to the bullpen, who is responsible for the four runs scored when the reliever gives up a grand slam?

A comment on sanity

So what about the notion that having a sane president will reduce the risk of an indefensible nuclear war?  To the extent that a president like Trump operates entirely on his own, and has sole control over the trigger, this is probably correct to a certain degree.

However, the risk reduction may be quite small, small enough, in fact, to make it essentially negligible, or small enough to at least acknowledge that mental status screening is far from an adequate solution to the problem.  The issue of risk reduction due to having a sane president is not at all taken up by any of the authors, not even alluded to, yet it is precisely the crucial question, for if the reduction is insignificant, that is to say incapable of achieving the desired goal, then the argument for mental status screening is completely without force.

The authors might have done well to consider the views of the psychologist who came up with the diagnosis of malignant narcissism in the first place.  Erich Fromm, in a 1964 book ((Erich Fromm, The Heart of Man, American Mental Health Foundation Books, New York 2010 (1964).)), introduced malignant narcissism as a disease of intense evil.  Yet despite that characterization, he pointed out that “The ordinary man with extraordinary power is the chief danger for mankind – not the fiend or the sadist.” ((Ibid, p. 18, emphasis original.)) This observation deserves discussion.

Unlike Freud, from whom he, of course, adopted his basic paradigm, Fromm recognized a social science operating independently of human psychology.  From this difference of opinion we can appreciate that Freud reduced all social behavior to psychology whereas Fromm pointed to the limits of psychological explanations of social phenomena.

Thus, Freud famously wrote that “sociology, too, dealing as it does with the behaviour of people in society, cannot be anything but applied psychology.  Strictly speaking there are only two sciences:  psychology, pure and applied, and natural science.” ((Sigmund Freud, New Introductory Lectures on Psycho-Analysis (Standard Edition), W.W.Norton, New York, 1989 (1933), p. 222.))

Fromm, on the other hand, rejected this type of thinking. Here is a powerful statement of his position, from the book where he first elaborated on the very diagnosis which Lee’s authors attribute to Trump:

Yet there exists the danger that the sense of powerlessness which grips people today – intellectuals as well as the average man – with ever-increasing force, may lead them to accept a new version of the defeatist view that war cannot be avoided since it is the result of the destructiveness of human nature.  Such a view, which sometimes prides itself on its exquisite realism, is unrealistic on two grounds.  First, the intensity of destructive strivings by no means implies that they are invincible or even dominant.  The second fallacy in this view lies in the premise that wars are primarily the result of psychological forces.  It is hardly necessary to dwell long on this fallacy of “psychologism” in the understanding of social and political phenomena.  Wars are the result of the decision of political, military, and business leaders to wage war for the sake of gaining territory, natural resources, advantages in trade; for defense against real or alleged threats to their country’s security by another power; or for reason of the enhancement of their own personal prestige and glory.  These men are not different from the average man…. ((Fromm, loc cit, pp. 17-18, emphasis added.))

Not only does Fromm not reduce sociology to psychology, he regards social forces as stronger than psychological ones.  It is precisely this which allows for the possibility that an “average man” can become the agent of social events which appear quite un-average.  And it means that psychological forces, especially in the case of war, take on the characteristics demanded by the social system:

But just as one needs weapons in order to fight a war, one needs the passions of hate, indignation, destructiveness, and fear in order to get millions of people to risk their lives and to become murderers.  These passions are necessary conditions for the waging of war; they are not its causes, any more than guns and bombs by themselves are causes of war. ((Ibid, p. 18.))

Thus, in recognizing the power of social forces over psychological ones, Fromm conveys the extremely important point that the pressures exerted by the former may be powerful enough to overwhelm even the best intentions of an “ordinary” leader and an “average man”.  It is for this very reason that we can’t be fooled into thinking that because a leader is sane the situation is as safe as possible.  The social system, in the end, is what most influences social behavior, at least in the case of war and other mass behaviors.  If the system becomes unsafe, so will be the behavior of the sane politician who acquiesces to it.

Marxism identifies the economic infrastructure of society as operating according to laws which are independent of human will, though the will can decide how to respond to the situations created by those laws.  One very important example of this is the crisis of overproduction which capitalism inflicts on everyone periodically.  Nobody wills this.  Nobody wants this.  No worker wants to be unemployed and no privileged capitalist willingly abandons his fortune.  Yet the crisis arrives anyway, not because of human aggressiveness or some unresolved unconscious psychic conflict, but for reasons Marx elucidated quite clearly, reasons which have to do with how social value is produced and circulated in capitalist society.  Once the crisis makes its entry onto the playing field, capitalists and workers alike are compelled to deal with it according to their own, socially influenced needs.

An orthodox, sociologically empty, strictly psychological Freudian analysis would say that fascism arose in Germany because a psychopath whose name happened to be Adolf Hitler came to power.  A Marxist sociological approach would say that fascism was the solution the sane German capitalists found for their extreme economic crisis, one which threatened their very existence.  They made a decision to aid the coming to power of a psychopath who would be willing to carry out their sick, but in their eyes necessary, program of capitalist salvation.  And how sick must capitalism be to find in fascism the emergency tonic for its own survival.

Still, one might argue, getting rid of Trump for mental health reasons is a necessary and urgent matter, even if all these various observations about social reality are correct.  Let’s put together a panel of mental health experts while still getting on with the task of replacing capitalism with socialism.

Fine, yet even this is not without its own problems, because defining ‘sanity’ is fraught with dangers.  There is a large scholarship on this, in fact.  And the problem, once again, is the existence of a social system whose laws are independent of individual psychology.

When a slave master whips and rapes a slave, is that merely bullying?  Of course not, unless one is completely blind to the social context in which it occurs.  If slavery doesn’t enter the explanatory equation, then that explanation of the bullying behavior is embarrassingly inadequate.

When a capitalist factory owner speeds up work on the assembly line with no regard for the safety of the workers, is that merely meanness and lack of empathy?  Of course not.  When an idle multimillionaire admires himself in the mirror and considers his privileged fortune to be justly deserved, all while his fellow human beings labor, suffer, and starve, is this merely the psychological illness of grandiose thinking?  Of course not, again.

Yet the state authorities go along with all this, and they do so precisely because the state is a tool of the class which rules the economic system.  The state treats these cruel behaviors and cognitive distortions of reality as if they are perfectly normal, perfectly legitimate, and perfectly sane.  It supports a culture which reinforces these ideas.  It has no other choice because its function is to maintain the system on behalf of those whom the system materially privileges.

It is precisely the social system, through the state, which normalizes and sanitizes behaviors.  What appears sane today may not be seen that way tomorrow.  Indeed, after the system is replaced via a revolution, the masses of people may look back and wonder how such a state of affairs could have possibly existed.  How could human beings do that?  How could human beings have allowed that to happen?  We will one day wonder the same thing about racism, sexism, homophobia, xenophobia — and capitalism.

So the mental health professionals assigned to Lee’s committee had better know what sanity is before they hammer out their screening protocol.  Consider, however, that if one of Lee’s authors is to be taken seriously, no socialist will pass the test, because believing in the worldwide spread of the socialist revolution is yet another example of grandiose thinking.

Referring to the singularly extraordinary power of the U.S. presidency, comedian Jerry Seinfeld quipped that no human being who actually aspires to occupy such a grandiose throne could possibly be sane.  This is arguably correct as it applies to all those politicians, not just Trump, who would use the power of the presidency to defend the privileges of a sliver of humanity against the interests of the vast majority.  At last count, that would include every president from Woodrow Wilson to the present.  To the extent that this is the gist of what Seinfeld is saying, his observation is certainly more insightful than all those of the authors of Lee’s book put together.

The Chomsky epilogue

The book ends with an epilogue by Noam Chomsky.  Considering Chomsky’s world-renowned reputation as a left wing critic of U.S. domestic and foreign policies, and after reading twenty-seven essays filled with patriotism, praise for the likes of the CIA and FBI, sighing over Zionism, adoration of John F. Kennedy and his actions opposing the Cuban revolution, and many similar points, I asked myself if Chomsky had even read the manuscript which he agreed to contribute to.

Editor Lee explains that she approached Chomsky because of his status as a leading political thinker.  Her aim is to promote a discussion “across disciplines.”

She notes that Chomsky has criticized both Democrats and Republicans, conveying, I guess, that his views are non-partisan.  He’s willing to critique whoever deserves it.  She does not point out, though, that he did give critical support to Hillary Clinton’s presidential bid against Trump.   This was certainly due to Chomsky also regarding Trump as uniquely dangerous.  Though Lee does not discuss this point, it likely played a role in Chomsky agreeing to add his voice.

Perhaps another reason Chomsky was asked to contribute, or that he agreed to contribute, is that he, like Freud, dismisses social theory:

I don’t think there’s any such thing as literary “theory,” any more than there’s cultural “theory” or historical “theory”….   In fact, it’s extremely rare, outside of the natural sciences, to find things that can’t be said in monosyllables; there are just interesting, simple ideas, which are often extremely difficult to come up with and hard to work out….  But the “theory” will be extremely thin, if by “theory” we mean something with principles which are not obvious when you first look at them, and from which you can deduce surprising consequences and try to confirm the principles – you’re not going to find anything like that in the social world. ((Noam Chomsky, Understanding Power, W.W.Norton, New York, 2002, p. 229.))

Of course, this is not the place to argue that a scientific social theory can be empirically defended.  I would submit, though, that revealing and explaining the source of a capitalist’s profit in the labor process cannot be stated in monosyllables.  In any case, I am simply pointing out that Chomsky’s world views dovetail nicely with the implicit perspective of the book.

The epilogue is hardly the discussion Lee desires. Chomsky simply pasted together a few of his previously published paragraphs about Trump, none of which addresses any of the specific political points made by the book’s authors.

Not being a mental health professional, Chomsky’s epilogue makes no mention of malignant narcissism or any other psychopathologic diagnosis.  The main danger he cites is not Trump’s mental illness, but rather that Trump, if cornered, could resort to “some kind of staged or alleged terrorist attack”.

It would be wrong to conclude that such an attack, should it happen, was due to Trump’s psychological illness or that it in any way confirmed the main point of the rest of the book.  The U.S. has a long history of staging or alleging terrifying actions in order to justify catastrophic behavior, and this under both Democrats and Republicans.  The Maine, the Gulf of Tonkin, and Saddam Hussein’s weapons of mass destruction are only a few of the very many examples we have of this sort.

And what does dialogue “across disciplines” mean?  Is the working class a “discipline”?  Or are only academic departments at universities considered to be ‘disciplines’?  Maybe Lee’s words constitute a Freudian slip.  They reveal a lack of understanding of class, class struggle, and how to solve the problem she has identified.

Whom should we be trying to have a dialogue with anyway?  Which social force can accomplish real, long-lasting, and truly positive change?  Is it academics dialoguing through publicly invisible technical journals or workers debating the issues in their union halls?  I venture to say that if working people and unionists could be drawn into a discussion of the Trump danger, their solution to the problem would involve far more than election reform and convening a panel of mental health experts.  Sadly, bringing their discussion to working people for critical feedback is not part of the book’s message.

But if it was, that would be a major step in the direction we need to go.

Dr. Steven Strauss practices Neurology in Baltimore, Maryland and is a diplomate of the American Board of Psychiatry and Neurology. He is a member of the Freedom Socialist Party and can be reached at Email him at: Read other articles by Steven.