President’s own self-diagnosis is spot-on — and disturbing

If mental health clinicians like me are to be constrained by the Goldwater Rule, invoked by the American Psychiatric Association against armchair diagnosis of an individual, should we not be equally skeptical of self-diagnosis by the putative “patient’’ — in this case, the president of the United States — whose psychiatric condition is the subject of universal scrutiny?

It would seem to me that Trump’s insistence that he is a “stable genius,’’ prompted by reported concerns about his cognitive and mental capacity in Michael Wolff’s book “Fire and Fury,’’ and in Bandy X. Lee’s book “The Dangerous Case of Donald Trump,’’ is in fact symptomatic of a personality disorder. In clinical terms, this disorder describes a rigid, unchanging character structure, both in style and substance, that remains “stable’’ over time, as opposed to diagnoses such as schizophrenia and mood disorders, which are understood to be biologically based.

The distinction is often described as “trait vs. state,’’ with the personality traits remaining stable throughout the life cycle, not easily treated with medication, and instead requiring long-term psychotherapy, cognitive behavioral interventions, and either the insight or the willingness to see how these disturbed personality patterns affect relationships and one’s ultimate capacity for happiness and ethical behavior.

Trump is indeed correct to self-describe as “stable,’’ because throughout his life and career he has demonstrated the same traits: narcissism, aggression, disregard for the truth, and a belief in brute force and imposition of his will through manipulation and threat.

That’s where the second half of his self-diagnosis comes in. Whether it is part of what clinicians suggest is his sociopathy, where ruthlessness and incapacity for empathy sharpen an intuition of how to play others for power — sexual, economic, and now political — Trump has demonstrated his genius: the salesman’s ability to pitch himself and his brand into the White House.

Emily Fox-Kales

Arlington

The author is a clinical psychologist, and a visiting scholar at the Brandeis Women’s Research Study Center.

Doctors calling out Trump are acting on ‘see something, say something’

Re “We aren’t diagnosing Trump; we’re sounding an alarm’’ by Drs. Leonard L. Glass and Brandy X. Lee (Opinion, Jan. 11): As a member of the medical profession, I agree that the psychiatry and psychological communities, as so-called witnessing professionals, have a duty to inform the public of dangers as related to the doctors’ areas of expertise. It is their ethical responsibility to society when they ask and answer: “Is (the person) harmful to himself or others?’’

While I am a proponent of the Goldwater Rule, I see no breach of ethics in the way that health professionals continue to educate and warn us about Donald J. Trump’s outrageous and dangerous behaviors, and of the repercussions that are sure to follow. The behaviors have been chronicled by journalists the world over and are observable, for heaven’s sake. While the behaviors could be diagnosable, the 27 contributing authors in “The Dangerous Case of Donald Trump’’ did not do that, and neither did Michael Wolff in “Fire and Fury.’’

In this year in particular, where people have been encouraged to say something if they see something, let us not silence the brave who hold the public’s safety at the forefront.

Joanne L. Pettengill

Billerica