Saturday, February 18, 2017

Degradation Ceremonies and the Goldwater Rule: A note on clinical diagnosis, community, and moral indignation.

My vigilance and preoccupation with the incompetence, bluster, and threat pouring from the White House is exhausting.  I should have better things to think about.  Worry and outrage coerce my attention, stink like dog shit I can't ignore or avoid. It needs to be cleaned up.  

I am a clinical psychologist with license to diagnose and a citizen now over-disposed with indignation. No doubt Trump comes across as deeply disturbed, but my provoked distraction is that he's so god-damned disturbing. Although it may be ethically problematic for me to diagnose from afar, I'm on firm moral ground writing about my disdain and disgust.  Frankly, a diagnosis might suggest disability, a sort of excuse that lets Trump off the hook. I don't find that satisfying or adequate when it comes to our President. (I just avoided the impulse to write "so-called" but that fits the degradation ceremony I have in mind).

Two years back, writing about monsters and evil, I wondered about the differences of moral, legal, and clinical language. This is relevant now.  Earlier, I wrote, "Clinical language is appropriate when the goal is to avoid the moralistic stance of blame and to facilitate empathy. We appeal to clinical language when we examine the personal history of the character in question. This can help our understanding. It provides the mitigating facts. It facilitates psychotherapy, disclosure, and confession. We use clinical language to explore a performance under the guise of not being judgmental.

But at times judgment is called for. Clinical and moral language may cover the same performance but with different intent and significance.  Moral language is appropriate when blame is at stake and where agency is treated as irreducibly given. Moral language is employed when we judge a person's place in our community. We employ concepts such as evil when we make the judgment that a person's actions reveal they are not, and perhaps never were, one of us in good standing."  

On February 13th, a letter to the New York Times, co-authored by an old classmate of mine, Lance Dodes, and signed by 34 other mental health professionals argued that, 

"Silence from the country’s mental health organizations has been due to a self-imposed dictum about evaluating public figures (the American Psychiatric Association’s 1973 Goldwater Rule). But this silence has resulted in a failure to lend our expertise to worried journalists and members of Congress at this critical time. We fear that too much is at stake to be silent any longer.

Mr. Trump’s speech and actions 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...."

The next day, that letter provoked a response from Allen Frances, the chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV. Frances replied,

"...Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.

Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. 

..... Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.

His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological."

It is arguable whether Trump "does not suffer from the distress and impairment required to diagnose mental disorder."  I don't have first-hand clinical data, but I stand with shared certainty when Frances writes, "Mr. Trump causes severe distress..." And when he points out, "He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.... The antidote to a dystopic Trumpean dark age is political, not psychological."   

Here's what I think. The sterile, ostensibly nonjudgmental use of clinical language, the diagnosis of narcissistic personality disorder, misses the point, whereas my judgmental and degrading appraisal of Trump as a thin-skinned, ignorant, self-absorbed, entitled asshole doesn't. This doesn't violate the Goldwater rule. I can make that judgment based on the effect of his public performance, regardless of the state of his psyche. Clinical language gets in the way of confronting his effects on others.  A more honest option, moral condemnation, directly addresses his standing in community. The place of moral language is when judgments of disgust and indignation, of community violation and outrage are appropriate. This our call. 

We are all in a position to assert, as an act of community, an affirmation of the essential shared values of truth and justice.  As a
community of Americans, apparently still a majority, we have the standing to witness, denounce, and judge this vile perpetrator. Regardless of whether Trump eventually requires the legal language of "treason" and "impeachment", for now moral language fits. It does the trick. It brings us together.

Degradation and accreditation ceremonies require a community that honors shared values required to remain a member in good standing. Isolation and lonely preoccupation are insufficient, inadequate as antidote when the dilemma "is political, not psychological".  And community is essential not just to address the political but as a remedy for the psychological.  We are facing an extraordinary psychological stress. With the possible exception of the days that followed the Kennedy assassination, and maybe during the Watergate hearing, I've never witnessed this much anxious attention and preoccupation with the state of America and American leadership. The point of good governing is to be free to attend to other things. Many of us are not.

For far too many, America does not feel like a safe place.  When those in charge who should be adult look mad and incompetent, the unresolved vulnerabilities of childhood awaken. This vulnerability stokes personal fears and traumas and an unsettled memory of mine.  

An October midmorning in 1962, I was twelve and scared, pacing the playground and refusing to go back to class, needing to listen to the transistor radio I'd brought to school after hearing the factory my father worked, Lithium Corporation of America, was a potential target of rockets headed for Cuba. This last month I've felt glimmers, uncanny resonances from that day. 

The bombardment of lies, absurdity, and threat has been relentless since January 20th. The signal to noise ratio hard to decipher. With friends, family, and clients, I've never seen so much preoccupation or defensive avoidance.  A tense sense of necessity undermined by helplessness. Only a month in, and already many of us face exhaustion, demoralization, or numbed indifference. So what can we do? 

I avoid crowds. I don't like to be in the midst of large groups of strangers. I love fireworks but spending a 4th of July on the Esplanade is now unthinkable. But the Saturdays of the Woman's March and the demonstration that immediately erupted in the wake of the Muslim ban offered me comfort and joy, hours of restoration. A companionship of strangers sharing the vitality of united indignation. One sign in particular evoked laughter and hope, "Listen asshole, we can do this every week!"

Demonstrations are not enough, but a necessary first aid. Demonstrations also scatter seed crystals that can organize larger, stronger structures. We need many structures, communities of separate and overlapping interests to harden rock-like to smash the threatening tyranny. Action, participating in what we intrinsically value, provides satisfaction. We'll need a lot of that to resist and persist.  

Here's a practical guide to community action: INDIVISIBLE

Take part. As Woody Guthrie said, "Take it easy, but take it."

All together now, Sing!

I take this a bit further in The Personality Disorders are Different. A note on moral and clinical language and Presidential psychopathology.
Some related thoughts On Choice, Sickness and Evil  and on Degradation Ceremonies.


  1. Excellent.

    Still, his behavior isn't just immoral. Above all there is his classic distortion of reality. I see a man with serious deficits in reality testing confronting a very hard reality. What does he do? Insists on his own reality, where his crowds were the hugest, his margin of victory the hugest, with illegal voters by the millions, and other figments of his imagination running wild.

    Does his pathology bring him any moral absolution? No. Maybe he's too addled to have recognized that the job was beyond him, but I don't think so. And early on in his campaign I realized that he wasn't running for President, he was running for fascist dictator. Consider:

    50 seconds in Trump says of three protesters, "These are not people, just remember that."

    You may be a narcissist. You be challenged in reality appraisals. But to publicly call out your political opponents as "not people" is nearly as bad as degradation gets. And to do that is evil.

  2. Trump's apparent inability to see the world from more then his limited point of view is a degradation for us community witnesses. But of course we are all more than witnesses in a democracy. Our rights are to be status assigners to our leaders but if our leaders ignore and thereby degrade this position then we suffer status loss and if this loss is threatening to us in profound ways, then depression, anger, rage can result. When working with anxious clients, I would suggest that "Action is the antidote to Anxiety". Taking some kind of action, even doing something like watching one's favorite satirist, or calling a representative, or marching in protest (or blogging on the internet), can all be helpful. By taking action, we reassign ourselves the status of status assigner and if we ally ourselves with others who form the opposition then we are validated in even stronger ways. Ethically, I have to watch my "p's and q's" by trying not to claim expertise when I do not have access to the more personal observations of Trump I would have if he were my client. But as a citizen and as someone who studies how individuals as well as political states can degrade, demonize, and liquidate its citizens, I have a strong moral platform from which to speak out.

  3. I don't need to have a diagnosis to know that something is very wrong with the man. And I don't even need that to watch the video I posted above and be very afraid. What to do? Action, you are right. I feel like I should be on the line at Standing Rock, but now is not the time for me. So I try do my work and recover my health. And with my health insurance in danger, I'm seriously considering a job offer in Berlin that would gain me immediate permanent residence in Germany. (Germany has had universal health care since Prince Bismarck established it in 1883. It's a radical new left-wing idea!) If I can get a firm floor of survival underneath me again I'll be in a position to do more than sing and speak out. Or, failing that, put myself on the line again and let the cops and mercenaries have their way with me. But being vocal is still something - enough young people are listening to make a difference.

  4. Great piece, in which you are willingly rejecting the role of societal expert and the gravitas that typically attends to it, by abandoning technical jargon and appealing to plain sense and common decency. In doing so, you are abdicating the position of special status accorded to the doctor of the mind whose specialized training and knowledge can be sought after and relied upon at times of utter chaos and maximal ambiguity – to provide cogent explanations, or at a minimum, create the illusion that someone out there knows something about what is going on, so us common folk can sleep at little easier at night. Paradoxically, the very act of stripping off your professorial trappings and abandoning the associated tools of the professional diagnostician enables your critique to resonate so powerfully. By coming down temporarily from the lofty perch of academic psychiatry to deliver your astute observations, you describe our New Emperor’s garb in a graphic and compelling way, avoiding pseudo-explanations, professional conceits and the artifice inherent in the use of arcane clinical terminology and concepts. Well done.