Presidential Psychopathology: Views from Clinical Psychology

In light of recent current events, including a pandemic, nationwide protests, and an upcoming presidential election in America, the issue of Trump’s psychological functioning has re-emerged. The publication Salon, on August 13, 2020, published an article in which a clinical psychologist offered his perspective on recent events. On the same day, Dr. Bandy Lee, MD, activist, expert, and author of The Dangerous Case of Donald Trump shared a YouTube interview she conducted with Dr. Mary Trump, Ph.D., Trump’s niece, doctor of clinical psychology, and author of How My Family Created The Most Dangerous Man.

Given the current cultural and sociopolitical interest in understanding the mind of POTUS and how his psychological functioning may or may not impact the lives of Americans, I wanted to ask Alan D. Blotcky, Ph.D., a licensed clinical psychologist in private practice in Birmingham, Alabama (who recently was featured in the aforementioned Salon article) some questions about psychology and psychiatry, Trump, and politics. Dr. Blotcky is also a Clinical Associate Professor at the University of Alabama at Birmingham.

Dr. Winarick: What is your opinion of the Goldwater Rule?

Dr. Blotcky: The Goldwater Rule is antiquated and outdated [in my view]. We have so much more data with which to evaluate a politician's mental health status. Now, we have access to tweets, statements, speeches, audiotapes, videotapes, articles, books, and many other forms of communication. I also think the concept of duty to warn is important and [can] overrule the Goldwater Rule.

I still think all mental health professionals need to be careful, deliberate, and measured in their public opinions. And I think mental health professionals need to couch their comments in the context of public health concerns. For example, Trump's [potential] pathology would need to be explained with regard to his botched pandemic response and his ongoing attack of democracy.

Dr. Winarick: What are the risks and benefits of discussing the psychopathology of the President of the United States (POTUS)?

Dr. Blotcky: The risk is that the public will not understand what mental health professionals are explaining to them. There is also the risk of overstating our opinions. Finally, mental health experts may differ—slightly or largely—in their opinions and this may be confusing to the public. The benefit is that the public will be educated and informed and aware. This will help the public make a better voting choice on November 3.

Dr. Winarick: In your opinion, do you think Trump meets the diagnostic criteria of "reckless disregard for the safety of others"?

Dr. Blotcky: His purposeful and willful inaction with regard to a national response to the pandemic is reckless, [in my view]. His continued denials and lies about the pandemic [could also be interpreted as] reckless.

Dr. Winarick: Do you think Trump meets the diagnostic criteria of "lack of impulse control" as well as "failure to plan ahead"?

Dr. Blotcky: Trump is notorious for being a transactional person. He lives in the moment. He does not think ahead. If he did, his response to the pandemic would [likely] have been far greater and better. Lack of impulse control? It is reported in the media that Trump's staff and cabinet members have to watch him so that he does not make quick, rash decisions. He has been accused of sexually predatory behavior by dozens of women, [which may mean] poor impulse control. Even as a youngster, Trump was [said to be] impulsive.

Dr. Winarick: Can you define psychopathy and explain how you view Trump in the context of that psychopathological construct?

Dr. Blotcky: Psychopathy is a larger and broader construct than [the related] antisocial personality disorder (ASPD). ASPD in DSM-5 is based almost entirely on behavior. Psychopathy encompasses behavior but also cognitions, affective states, and interpersonal features. It's difficult to address Trump's psychopathy because we don't have direct access to his affective states. But based on his behavior, cognitions, and interpersonal qualities, I would [argue that] Trump's psychopathy is quite high. It is a construct on a continuum.

Dr. Winarick: Anything else you want to add about Trump’s psychopathology?

Dr. Blotcky: I think it's important to address Trump's psychopathology as it relates to his behavior as president. It is not an abstract issue. His psychopathology is directly affecting his behavior regarding the pandemic and his attack on democracy. Those are the two areas where I think his psychopathology is compelling and the public needs to understand it. Just to say Trump is "unfit" and "dangerous" is not enough and the public will not understand. We need to tie his psychopathology to his presidential behavior in the observable, in the concrete. [In my view], his pandemic response and his attack on democracy are where his psychopathology is evident.