Donald Trump’s temperament, grandiosity, and repeated falsehoods have led some to question his mental health. Given all that is at stake — not the least of which is his power to end human life on Earth in less than an hour — his psychology matters.

Observers ranging from prominent psychiatrists to several U.S. congressmen — even rocker Bruce Springsteen — have suggested that Trump is mentally unstable, possibly suffering from Narcissistic Personality Disorder (NPD).

However, just as the U.S. is divided in its politics, the country and the therapeutic community are split about the president’s mental health as well as the wisdom of diagnosing Trump.

Some argue that diagnosing Trump may increase the stigma about mental illness, increase shame in those with mental illness, and even dissuade people in need from seeking treatment.

Blogger Jacqueline Arnott, who acknowledges she has anxiety and depression, wrote, “When you scream that [Trump] has Narcissistic Personality Disorder, you are telling every person with Narcissistic Personality Disorder that they are just like him.”

On the political right, some warn that diagnosing Trump is reminiscent of how the Soviet Union used psychiatry to discredit political dissidents.

On the political left, others suggest that diagnosing diverts attention from the president’s actions. “Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy,” said psychiatrist Gail Saltz.

Diagnosing is different depending on who does it. For therapists, the standard is higher than for non-professionals. Various ethical codes for therapists caution against misusing one’s position when making public statements.

The most stringent ethical code in this matter comes from psychiatrists. The American Psychiatric Association warned its members against publicly diagnosing anyone without clinically interviewing that person and obtaining permission to share the diagnosis.

Some seek a middle ground. Minnesota professor and psychologist William Doherty began a petition that gathered 3,800 therapist signatures decrying the scapegoating of minorities, demeaning of critics, and appeals to fear and anger, all of which he termed “Trumpism.”

Yet Doherty warned against therapists diagnosing Trump, saying therapists risk losing credibility by being seen as partisan and political.

On the other hand, many mental health professionals argue that a responsible discussion of whether Trump may have a mental disorder provides a public service. If therapists do not enter the public discussion, diagnosing will fall to others who lack the training and skills to do so, argues therapy researcher Benjamin Caldwell.

Many mental health professionals have argued that despite the risks of speaking up, Trump represents an extreme case. Some have called his mental status a “clear and present danger” to the country.

Therapists in this camp argue that, just as they have a legal and ethical “duty to warn” others when they learn from a client of the risk of serious harm to someone, therapists need to warn fellow citizens of any dangers they see posed by Trump. To keep silent would be derelict, they argue. In addition, anxiety for many has increased since Trump’s election and one of therapists’ roles is to help alleviate suffering. Perspective from therapists on this issue may help some people’s anxiety.

For those willing to characterize the president’s mental health, a range of diagnoses are offered.

Some, including one of Trump’s biographers, have questioned whether Trump might have sociopathic tendencies. Others have raised questions about whether he has a mood disorder or ADHD.

Harvard professor Elizabeth Lunbeck suggests that Trump shows signs of several personality disorders including paranoid, histrionic, borderline, and narcissistic disorders.

Most often advanced is the thesis that the president suffers from narcissistic personality disorder, a disorder characterized by grandiosity, lack of empathy, and a desperate need for attention.

Prior to Trump’s inauguration, three Harvard and UCSF-affiliated psychiatrists publicly asked President Obama to facilitate a psychiatric exam of Trump. They did not offer a diagnosis but wrote, “His widely reported symptoms of mental instability — including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality — lead us to question his fitness for the immense responsibilities of the office.”

Earlier this year a group of nearly three dozen eminent psychotherapists wrote The New York Times stating that “too much is at stake to be silent any longer” about Trump. His actions, they argued, “demonstrate an inability to tolerate views different from his own, leading to rage reactions. His words and behavior suggest a profound inability to empathize. Individuals with these traits distort reality to suit their psychological state, attacking facts and those who convey them (journalists, scientists).”

The therapists also predicted that “these attacks are likely to increase, as his personal myth of greatness appears to be confirmed.”

Going a significant step further, psychiatrist John Gartner circulated a petition which now has more than 41,000 signatures from therapists stating that Trump “manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States” and asking that he be removed from office under the 25th Amendment to the U.S. Constitution.

Gartner has said Trump is a “malignant narcissist,” an extreme form of narcissistic personality disorder that includes aggressive and sadistic tendencies.

However, therapists disagree on whether Trump is a narcissist. Psychiatrist Robert Pyles, a Trump supporter, dismissed the NPD diagnosis, saying, “My liberal colleagues feel frightened and betrayed, so they go to this hysterical extreme of saying Trump has narcissistic tendencies, but what political leader doesn’t?”

Another psychiatrist and Trump supporter, Janis Chester, told Stat, a zine affiliated with the Boston Globe, “I see personality traits there that, if he came to me [for therapy], I wouldn’t be shocked.” She added, “He couldn’t be what people say and have kids who are so wholesome and so connected to him even after his divorces.”

Psychiatrist Allen Frances, who was part of the team that developed the NPD diagnosis in the psychiatric guide, the DSM, said that even if Trump takes actions that are similar to people with narcissism, he does not appear to be suffering or handicapped by it. Such suffering or handicapping is one criterion for a formal diagnosis or a personality disorder, so a diagnosis of narcissistic personality disorder cannot be applied to Trump, Frances argued.

The DSM says a personality disorder “leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Some would dispute Frances’ interpretation by noting that despite Trump’s obvious successes, looking from the outside we cannot know if Trump suffers distress nor whether his personal relationships, an important area of functioning, are impaired.

Some say that what matters most is Trump’s words and deeds, not a diagnosis. British psychotherapist John Barton, who interviewed Trump for a 2014 article in Golf Digest, argues that diagnoses like NPD were developed by psychiatrists for the purpose of treating mental disorders, usually through medication, not for labeling or pathologizing people.

Others argue that in Trump’s case, diagnosing is not necessary. Yale professor and psychiatrist Matthew Goldenberg wrote in 2016, “You don’t have to be a psychiatrist to know that there’s something seriously wrong with the candidate.”

To be certain, having a mental disorder does not necessarily mean someone cannot be an effective leader. Abraham Lincoln probably suffered from depression yet was one of our greatest presidents.

At the same time, recognizing the possible presence of a mental condition can help us understand a person’s actions, motivations and challenges. Given the marked increase in anxiety among much of the nation since the election, diagnosing Trump, if done responsibly, may provide some comfort by giving people one possible perspective from which to make sense of his unorthodox behavior.

© Copyright 2017 Dan Neuharth PhD MFT

Trump photo credit: Gage Skidmore/Flickr cc 2.0