The Narcissistic State
Trump’s imperial presidency
These posts examine modern psychiatry from a critical point of view. Unfortunately, mainstream psychiatrists usually react badly to any sort of critical analysis of their activities, labelling critics as “anti-psychiatry,” whatever that is. Regardless, criticism is an integral part of any scientific field and psychiatry is no different. As it emerges, there is a lot to be critical about.
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It was my birthday recently so the family gave me a book they knew I didn’t have: Regime Change – inside the imperial presidency of Donald Trump, by Maggie Haverman and Jonathon Swan. There was a reason I hadn’t bought it but it’s the thought that counts. Gritting my teeth, I am working slowly through it. So far, nothing new but it raises a point: every single person named in that book is not normal. What’s normal, you ask, because almost by definition, anybody who pushes hard enough to get a seat in the White House lies outside the bounds of normality. That’s the point: they’re not normal but, with one exception, they’re not “mentally ill” in any sense of the term. The only exception is the emperor himself who could possibly plead mental incompetence due to early dementia but the rest of them are just being their normal selves. That is, what we see is their personalities, all horrible, and at this point, we take off our psychiatric hats because psychiatry has no theory of personality and therefore no model of personality disorder.
The biocognitive model of psychiatry says personality is critically important, that it’s impossible to deal with people without a solid idea of what it means. Remarkably, DSM-5 doesn’t offer any definition or description of personality per se but launches straight into descriptions of personality disorders – on p.645, which tells you how they rate it. Personality disorder is an “enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture.” The disturbances affect emotion, interpersonal functioning, impulse control and cognition, meaning “ways of perceiving and interpreting self, other people and events.” It is pervasive across the individual’s life and causes “clinically significant distress or impairment in social, occupational or other important areas of function.” All good, but what is it? Just what is personality, how does it fit in the mental economy? Crickets.
They recognise eleven distinct categories of personality disorder but practically every study ever done says the categories are artificial. The word category says that the features of one group are distinct from the other groups with no overlap. Sheep and goats look alike but they’re different categories with no overlap. Human personality fails that test as normal blurs imperceptibly across to abnormal, with no natural cut off point. This is also true of each and every personality disorder. That is, categories of personality are not natural kinds, they’re wholly an artefact. The categories listed in DSM-5 are “separate and distinct” only by virtue of artful manipulation of the wording of each feature for each one (see [1, Chap 8] for more detail on this important point; essentially, it says the entire concept of categories of personality disorder is wilfully deceptive).
Psychologists have been aware of these objections for over a hundred years. They too don’t have an actual theory of personality or model of personality disorder, just because they don’t have a theory of mind, but they have a much finer sense of how it all works. They divide the totality of human behaviour into different classes or themes, and then give each person a grade on all of them. There can be a sociability theme, and an orderliness theme, a trust/mistrust theme and so on, where everybody gets a score from 0-100, and 50 is average. That is, personality is distributed along dimensions so that personality disorder is a matter of distance from the midpoint rather than islands of categorical abnormality. Most people cluster loosely around the middle on all the dimensions. People who are far from the middle on one dimension are also likely to be way out on many of the others, which is why psychiatry keeps finding people who meet criteria for two or more disorders (known by the meaningless term ‘comorbidity’).
How many dimensions are there? That depends on who you ask. One of the most influential personality theorists, Hans Eysenck (1916-1997) said there are three, extraversion, introversion and psychoticism. All human behaviour can be listed on one or other of these dimensions which, he believed, were genetic. He was determined to prove this but after his death, it became clear that he had been manipulating his research data to get the results he wanted. It was also shown that he had accepted the sum of £500,000 (about $5million) from the tobacco companies to “prove” that addiction to tobacco was due to personality defect, not to the addictive properties of tobacco (this is all part of the tobacco playbook, now being used by fossil fuel companies to discredit the notion of global warming). Like so many of the Big Names in this type of field, his reputation was kept aloft by his own efforts. The day he died, it crashed.
Much of Eysenck’s career was spent bickering with the biggest and most influential of the personality questionaires, the MMPI, which was first launched in 1943 and has been revised a number of times. The latest version asks the subject to respond to about 500 questions with true or false, as in “I am normally a social person” or “I rarely forgive people if they upset me,” etc. This has a strong statistical basis; analysis yields ten factors which give a more finely grained picture than Eysenck’s lonely three factors. Another widely used questionnaire, known as Raymond Cattell’s aptrly-named 16PF, puts the number of distinct personality factors at sixteen. I liked it but it suffered from some rather idiosyncratic names for the different factors. These tests all came from the 1940s or 50s; these days, we are enjoined to use five factors, known as OCEAN, or Big Five Personality Factors, which measure openness, conscientiousness, extraversion, agreeableness and neuroticism. How do these relate to our general understanding of personality and to mental disorder? Not very well, which is probably why it hasn’t caught on outside the research community.
But back to the White House which has one of the most remarkable collections of personality disorder (PD in modern talk) ever assembled in one room: how would they rate on any of these tests? The answer is we’ll never know because they would all refuse to do the tests as it would be too revealing. They may have severely disturbed personalities but, with the exception of the PD-in-Chief, they’re not totally lacking in insight. Trump himself shows an important feature: as dementia proceeds, it strips away the self-control and inhibitions until all that’s left is the raw personality disorder, exposed for all to see. His greed and dishonesty and grandiosity and intolerance just become more and more obvious until it’s embarrassing to the country. Like his stupid reflection pool disaster. He said somebody cut a big gash in the liner. Actually, he did it himself. When the pool was empty, he insisted on his motorcade driving down the centre of the pool. The “gash” is exactly where his 8 ton monstrosity of a car drove. But he never takes responsibility, it’s always somebody else’s fault.
More important is to understand what personality is so we can recognise disorder when we see it as they are very good at concealing it (see [2, Chap.8.2] for more detail). We start with the broadest possible definition: personality is the sum total of interactions between the individual and the environment throughout adulthood.That’s not very practical. First, it isn’t complete until the person snuffs it, which rather defeats the purpose of talking about personality: we want to know what he’s likely to do in the future. Second, it would be encyclopaedic, a vast list of events with no order. Yesterday, he was all sweetness and light but today, nasty and vengeful. How do we tie these together? Oh, seems he got on the booze last night and has a hangover.
So why do pleasant, obliging people drink when they know it will cause trouble? Because his cheerful and cooperative front is all front, which is what persona originally meant: the mask worn by actors in Greek dramas. Underneath his obliging exterior, he is quite seriously anxious, constantly worrying in case he makes a mistake or people criticise him. Periodically, the anxiety builds up so he turns to alcohol because it relieves anxiety and he feels so much better. So does he have an alcoholic personality type, an anxious personality disorder or a mental illness called GAD? Good question because the answer to it determines what treatment he gets. Except psychiatry can’t answer it. It has no idea because it has no theory of personality. In order to come to grips with the notion, we need to hone it down somewhat from the encyclopaedic version. We want to include the subject’s typical conduct and exclude the atypical, such as during illness or under psychological pressure, to read: Personality is the set of habitual patterns of interaction between the individual and the environment. Is she late to work today because something unexpected happened, or is she always late? We tighten it a bit further to read: the habitual patterns of interaction between the healthy, sober individual and the environment, in the stable, adult mode of behaviour.
That raises the important question of when we can consider the person has reached “stable, adult mode.” Most people will avoid making a personality diagnosis under 18, even though it may be clear that the teenager is on a bad path in life. Another important question is: can personality change in adulthood? The answer is yes, but that needs clarification. Moving on, the point of talking about personality is to distinguish between individuals, to emphasise their differences rather than similarities. For example, in a culture where people are pressured to drink on Fridays and fights erupt, are they all disordered personalities? How does religion fit with the definition? Language? We want to exclude common, culturally-determined elements, so the definition has to focus on the uniquely distinguishing elements of a healthy, sober person’s stable, adult mode of behaviour. That’s a good description, so how do we turn it into an explanation? This is what the DSM system doesn’t do, because they don’t know what generates behaviour, they have no model of mind. Because we’re talking about habitual modes of behaviour, there has to be something generating them, and in the biocognitive model, that something is a set of rules:
Personality is the total set of explicit and implicit mental rules (including attitudes, beliefs, etc) that generates the uniquely distinguishing habitual patterns of interaction between the healthy, sober individual and the environment, in the stable adult mode of behaviour [2, p110].
Personality is not a specific place in your brain or a hidden gremlin magically pulling your levers, it is simply a set of rules. We all have rules, lots of them, such as language and sport and cooking, but most of our personal rules are barely conscious as we learned them long ago, even preverbally. A good rule is: “The world is a pleasant place where I can get ahead if I work hard and treat people fairly.” Another common rule, often learned very early, is something like: “The world is a cruel hard place that will crush me if I step out of line and nobody will help. I can only survive by my wits so I must never let anybody know what I’m doing.” That’s one path to criminality but often well-concealed. Even more common is a rule like: “I’m a useless individual, I can’t do anything right, whatever I try will go bad and people will laugh so I’d better stay home and avoid any contact.” That’s often the primary rule in the life of the young adults, mostly men, who stay up all night playing computer games and sleep all day. Trouble is, they will often try to conceal this. If you ask people: “Are you anxious?” they will mostly say No, but if you come at it slowly, asking about specific fears, that will commonly open the floodgates.
Mostly, however, when we’re trying to assess personality, we just look at the behaviour and ask: “What are the possible rules that could generate this constellation of behaviour?” Look at one DJ Trump, who lies constantly, says one thing and does another, cheats on everybody and so on: his primary rule is “I can do anything I like because I’m so smart that I can fool everybody into believing whatever I say at the time. Anybody who tries to stop me is bad and deserves to be crushed. I don’t have to worry about consistency or honesty or any of that mimsy stuff” (see Garrison Keillor: “Consistency is the hobgoblin of little minds”). In The Origins of Totalitarianism (1951), Hannah Arendt said: “What convinces masses are not facts, and not even invented facts, but only the consistency of the system of which they are presumably part.” Because he was very wealthy (a millionaire at eight), Trump learned he didn’t even have to be consistent. Instead, he learned what has been known since ancient times: “Mundus vult decipi, ergo decipiatur.” The world wants to be deceived, therefore give it to ‘em good and hard.
That apart, Trump has no personality. He cheats at golf, he cheats on his wives, he cheats the taxman and in business because for him, being Number One is the only game in town. Being Number One is his motivation, cheating and lying are his stock in trade, his modus operandi, because how he gets to No. 1 is irrelevant. That’s why he puts his name on everything, comes up with stupid ideas then denies them, evades responsibility, surrounds himself with wealthy people, loves gold and so on. His niece, Mary Trump, a PhD psychologist, says of him: “I don’t care what his cult says, I know him personally. And here’s the truth: My uncle is the only person I know without one redeeming quality. Not a single one.” How did he get to where he is? Lying, cheating and stealing, and telling all the other rich people that, under him, there’d be lots of opportunities for lying cheating and stealing so they’d better fund his campaign.
We could go through the rest of his crew but the simple fact is this: They would not have got a seat at the cabinet table if they were decent, honest people. There were a few decent people in Trump’s first cabinet but they didn’t last long. Scoundrels can sniff each other out, they’re much better at smelling other crooks than ordinary people are. Some of them are open, such as the human Clostridium, Stephen Miller, who is obsessed with power and domination:
We’re a superpower. And under President Trump, we are going to conduct ourselves as a superpower. We live in a world in which you can talk all you want about international niceties and everything else. But we live in a world, in the real world…that is governed by strength, that is governed by force, that is governed by power…These are the iron laws of the world.
Personality is everything. It’s everything in politics, it’s everything in business, in family life, sport, entertainment, you name it. It is a sad fact of life that people who obey rules (the great majority) are easily fooled by people who are prepared to break them. That brings up the ancient question: how does a reasonable person deal with unreasonable people without becoming unreasonable in the process? The answer to that is: Set limits and stick to them. Overwhelmingly, people with disordered personalities will back down if they see their opposition is firm. This is the mistake the world is making with Trump. They should tell him: No, and no means no. He’ll squeal but he’ll back down.
Personality is also everything in psychiatry but has never been given its proper place. Psychiatry is about mental “illness,” about physical “diseases of the brain” but personality disorder isn’t an “illness” in any sense of the word; therefore drugs don’t work; therefore psychiatrists aren’t interested. I’ve outlined a case to say psychiatry is doing its best to rediagnose all cases of personality disorder as “mental illness” and put them on drugs, especially labels like bipolar, bipolar II, ADHD, ASD and a dozen others. The only valid treatment for personality problems is to discover all the rules that are operating in the background and bring them to light. This requires the person’s active cooperation but it isn’t easy as, very often, the rules are humiliating or embarrassing or just painful, but it works. People have to want to change but often, their rules are designed to conceal a deep sense of self-loathing.
At the core of personality resides the self-esteem, the sense of personal worth or, all too often, dislike of self. Self-esteem isn’t inherited, we’re not born with it any more than we’re born with a language already programmed in our little brains. It has to be learned, the result of life experiences. If early life experiences are painful, children have to draw whatever conclusions they can in order to survive. Very often, they’re negative conclusions that get buried deep inside but they do their daily quota of damage for decades. Generally, people don’t want to think about it until life hurts, but by then it may be too late. There is zero reason to believe drugs can ever change the rules of personality, any more than they can change, say, the rules of language. But psychiatrists don’t want to hear that, all too often, their self-esteem is built on dominating all the broken people. For the clown show in the White House, 30 months to go although who knows what damage they’ll do by then. As for the book, don’t bother, it reads like a gossip column.
References:
1. McLaren N (2007). The categorical system of diagnosis: Personality Disorder. Chapter 8 in Humanizing Madness: Psychiatry and the Cognitive Neurosciences. Ann Arbor, Mi.: Future Psychiatry Press.
2. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London: Routledge.
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My critical works are best approached in this order:
The case against mainstream psychiatry:
McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon (this also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).
Development and justification of the biocognitive model:
McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.
Clinical application of the biocognitive model:
McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.
Testing the biocognitive model in an unrelated field:
McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.
The whole of this work is copyright but may be copied or retransmitted provided the author is acknowledged.