Why We Hesitate to Label Trump “Mentally Ill” 

thNOTE: This post does not reflect my political views, but is merely a discussion of Donald Trump’s personality. Some people believe psychologists should not “diagnose” celebrities or others without assessing in person. However, I do not believe there is such as thing as “mental illness”  that can be or needs to be “diagnosed.” Rather we all as humans can assess the behavior, character, morals, and personality of our fellow humans. This blog is doing just that. 

During this long, strange trip of a presidential campaign, Trump’s character and personality have  become more and more apparent. For years, Donald Trump’s behavior has been widely considered “narcissistic.” We even call him “The Donald” as a shorthand for his grandiosity.

However, articles pointing out these obvious traits are just becoming more common in the media.

Recently Trump has been called personality disordered in general.  Scott Barry Kaufman in Scientific American Mind says Trump’s real ambition is a search for “glory,” which tracks with the self-aggrandizement often associated with narcissists.  Trump’s co-author on “The Art of the Deal,” Tony Schwartz, called him a sociopath.

These traditional psychological diagnoses certainly fit Trump, with their descriptions of behaviors that include bullying, grandiosity, lack of empathy, and feelings of entitlement, among others.

But what took so long for these character flaws to be directly discussed, when Trump’s behaviors were so blatant for so long?

I believe this delay in stating the obvious about Trump points a spotlight on a fundamental failure of the Diagnostic and Statistical Manual of Mental Disorders. The DSM-5 is the latest edition of psychiatry’s attempt to categorize and describe human behavior and define “mental disorders.” 

For decades pharmaceutical companies, supported by psychiatrists and their DSM, have spent billions of dollars on research and marketing campaigns to convince the world “mental illnesses” are supposedly biological diseases that need medications to be managed, but can never be “cured.” This hoax, completely unsupported by facts and research, has been so successful that it is now a culturally entrenched belief: “Anxiety, depression, bi-polar disorder, ADHD, personality disorders, etc., are caused by a permanent imbalance in the neurotransmitters of the brain and must be treated with medicine.” 

Psychiatry’s insistence on calling human behaviors “illnesses” implies that there is a bright line between healthy and “ill,” when in reality there is no such thing. A growing number of mental health professionals and those harmed by the profession have spoken out against the DSM and psychiatry’s attempt to medicalize certain normal emotional and behavioral patterns. 

The DSM has many faults, which are further explained in my book Self-Acceptance Psychology and by numerous others. 

How Trump’s Behavior Highlights the Problems with the DSM and Psychiatry

Trump’s situation points out another major problem with the DSM. Its medicalized labeling system stigmatizes a person as “mentally ill.” Mental illness becomes an all-or-nothing construct. 

Additionally, the DSM has been made intentionally intimidating, with its complex descriptions and pseudo-medical and jargonized Latin naming system (dysthymia, schizoaffective, agoraphobia). People feel that as untrained medical professionals, they do not fully understand these terms and certainly cannot make that big of a call as to label someone “mentally ill.” Even if the behaviors are extreme and obvious, as they are with Trump.

It can become difficult to label someone as having “Narcissistic Personality Disorder,” because that seems like a big, shaming leap to take.

Instead, the public may avoid discussing the very clear facts about a person’s behavior and thereby lose an ability to recognize fully what is going on. As a result, very dysfunctional behavior goes unremarked upon until it reaches a level of severity that becomes untenable. 

What if the very construct of “mental illness” were exploded and we began to look at human behavior under a different framework? What if we had another system that could describe and identify behaviors and help us gain insight into the real reasons for those behaviors? 

Perhaps we could then address inappropriate behavior in a more timely and realistic manner. We wouldn’t ignore someone’s emotional and behavioral issues for fear of “diagnosing” them with an alleged medical disease that harshly labels and stigmatizes them.   

The Toxic Results of Shame Intolerance

Self-Acceptance Psychology explains that most “mental disorders” can be understood as natural and understandable results of common emotions, experiences and behavioral reactions. Whereas the DSM alleges that many human behaviors are the result of a “diseased brain,” most behavior actually makes perfect sense when understood through a paradigm that is based on well-researched and well-accepted psychological concepts.

Imagine a fictional child — let’s call him Don — who is raised by parents who are distant and cold. The father is a driven workaholic who is critical and over-focused on Don behaving correctly. The parents lack warmth and emotional expressiveness. Don is left alone a lot or with nannies. Perhaps his parents were preoccupied with their own problems with anxiety or depression. Perhaps they argued a lot or drank too much. All this leaves Don’s parents unable to connect emotionally to Don in a way that provides Don with healthy experiences of his own emotions and thoughts, and therefore of his very self. 

Understandably, Don never feels deeply accepted by his parents and fails to gain self-acceptance and self-awareness.

This forms a relationship pattern Don then uses to construct a schema of his future adult relationships: “My parents did not love me and rejected me. Perhaps I am deeply unlovable. Perhaps I should be deeply unaccepting of myself. Other people also cannot be trusted to provide me emotional safety and acceptance. I’d better be on guard for being emotionally hurt, shamed and rejected.”

Maybe Don also experienced a trauma — say a beloved grandparent died when he was young, leaving him even more alone, or he was bullied or molested or witnessed a crime. This also taught Don to be on guard for his physical, social and emotional safety. 

All of these rejecting and fearful experiences led him to a feeling of low self-worth. 

As a result, he also developed a difficulty in tolerating the emotion of shame. Even as an adult, shaming experiences trigger his feelings of inadequacy. 

All humans learn ways to manage shame. Some can result in behaviors that the DSM labels as “mental disorders,” but which are, in fact, completely understandable as emotionally helpful and adaptive in childhood and on an individual level. However, these same behaviors can be very harmful in adult relationships and behaviors.

Self-Acceptance Psychology Explains Shame Management Strategies

Self-Acceptance Psychology, offers outlines three counterproductive shame management behaviors:

  • “Other-Blaming”
  • “Self-Blaming”
  • “Blame Avoiding” 

Self-Acceptance Psychology would identify Trump and those like him as “Other-Blaming.” 

The simple way to understand these behaviors is the answer to this question: How does the person handle criticism? 

The key behavior of “Other-Blamers” is lack of accountability. When criticized, they experience shame. When added to an existing low self-worth, the experience is so uncomfortable they respond in ways to reduce their fear and emotional distress.

Trump appears completely unable to admit to faults or mistakes, but instead makes excuses, rationalizes, and blames others. He cannot tolerate dissent

A child who learns to make excuses and blame others for his problems gains a feeling of self-protection and (false) self-worth from this practice. But in adulthood, these behaviors at the extreme turn into Donald Trump’s complete inability to be accountable. 

Underlying Trump’s narcissistic braggadocio, bullying and impulsivity is almost certainly a deep feeling of inadequacy or low self-worth. External criticism or humiliation can be overwhelming to those like Trump, leading to an inability to tolerate shame. 

So when he feels attacked he lashes back— such as personally attacking the parents of a Purple Heart winner. Then when called to account for his mistake, he is unable to admit he was wrong or stand down from his statements. 

In contrast, those with self-acceptance can tolerate shame, have accurate perceptions of critical messages from others, and have appropriate emotional and behavioral reactions. They can be accountable for their behaviors. 

Characteristics of Other-Blamers

Let’s take a more in-depth look how shame intolerance plays out for Trump and Other-Blamers. 

Other-Blamers lash out at others to prevent, defend against, or attack against criticism. This allows them to avoid experiencing additional shame.

Lacking in accountability: Other-Blamers have very little capacity to admit fault, be remorseful, or apologize. 

Unlike Harry Truman who placed a sign on his desk stating “The Buck Stops Here,” Trump appears to be completely lacking in accountability.  This trait, not just his mammoth ego, is the defining characteristic that makes him fundamentally unsuited to the presidency.

Intolerant of dissent or criticism, close-minded, opinionated, stubborn, “black-and-white” thinking: It should go without saying that a president should be open to nuanced thinking, the opinions of others, and challenges to his or her ideas.

However, because of their insecurity Other-Blamers have a great need to look smart and be correct. This leads them to act as if they understand every issue and know every answer. Complex or subtle issues — which are largely what a president will face — frustrate Other-Blamers who have a fear of appearing weak or unintelligent. 

I suspect that this characteristic is a major reason many of Trump’s business ventures have failed. He was afraid to hear criticisms of his ideas, so he shut down realistic feedback.

Trump is well-known for having difficulty handling questions. He often lashes out in personal attacks at the questioner, most notably denigrating Megyn Kelly. 

To Other-Blamers, almost any question is “nasty,” because to be challenged signals a possibility of being wrong or looking uninformed— a proposition loaded with the potential for shame. 

Fear-based behavior: Trump is notoriously thin-skinned, quick to anger, and impulsive. Tony Schwartz considered Trump to be “pathologically impulsive and self-centered.” 

Although they are clever at hiding it, Other-Blamers are highly fearful, on guard for incoming shaming messages. Other-Blamers rely on the emotional “survival brain,” not the deliberative, logical cortex. The resulting elevated “fight-or-flight” reactivity leads to shame-driven anger that is volatile and irrational. 

Fear also leads to anxiety-based behaviors, such as poor frustration tolerance, short attention span, and poor concentration, which Trump is well-known for. 

Approval seeking: Lacking healthy self-acceptance, Other-Blamers need to gain attention and approval from others to feel good. Trump’s bragging and grandiosity are extreme and long-standing. Jane Mayer in The New Yorker noted that Tony Schwartz “saw Trump as driven not by a pure love of dealmaking but by an insatiable hunger for ‘money, praise, and celebrity.’  … Schwartz told me that Trump’s need for attention is ‘completely compulsive.’”

But beyond this classic narcissistic behavior, the need for approval may drive Other-Blamers to form unhealthy coalitions with those who feed their need for approval. 

Emotionally healthy people do not seek the approval of others to fill an emotional void.

Lying: “‘Lying is second nature to him,’ Schwartz said. ‘More than anyone else I have ever met, Trump has the ability to convince himself that whatever he is saying at any given moment is true, or sort of true, or at least ought to be true.’”

Lying is tied to the need to exaggerate achievements to seek approval and to the need to deflect blame and shame. When caught in a lie, they lie some more. 

Deception is second nature to Other-Blamers because they lie to themselves constantly. To routinely shift blame to others takes extremes of self-deception. 

An inability to be self-reflective, learn or change: Extremely defensive Other-Blamers have learned to avoid, ignore and deny feelings of guilt, shame or embarrassment. These pro-social emotions were formed by evolution to help us learn from relationship mistakes, admit fault and change our bad behavior. Although shame feels uncomfortable, that discomfort is designed to move us toward moral conduct. 

Other-Blamers lack self-reflection because it might stir up feelings of inadequacy, which they assiduously avoid. This leaves them unlikely to change.

Wise leaders are very self-aware, able to hear about their faults, and learn from their mistakes. 

Dominating others: Other-Blamers try to dominate others to keep criticism at bay and thereby forestall feelings of inadequacy. They try to control, manipulate, or intimidate others to set up relationships with people who will be submissive and will not challenge, correct, or blame them. Trump’s well-documented behaviors of bullying, demeaning, name calling and scapegoating exemplify this. A leader who surrounds himself with submissive “yes men” is hardly likely to hear a balanced range of opinions and facts. 

Entitlement: Other-Blamers often fail to conform to social norms, will violate laws, and feel above the law. These behaviors also arise due to an inability to tolerate shame. Trump’s business dealings and bankruptcies offer numerous examples. Yet rather than be contrite about his bankruptcies, Trump continues to brag about them.

Let’s Throw Out the DSM

With its arbitrary and arcane categories such as “Bi-Polar Disorder II,” the DSM hinders our ability to educate the public about the real reasons for human behavior. 

Self-Acceptance Psychology, however, provides a more accessible paradigm that privileges an understanding of behavior as normal, natural, self-protective responses to life experiences. 

It is time we threw out the arcane and arbitrary DSM, with its false disease model of human behavior. It is time to adopt a more sensible, fact-based system that truly assists all of us in understanding all human behavior without the shaming, isolating psychiatric stigmas attached to the DSM.

Self-Acceptance Psychology also offers up a description of what healthy emotional and behavioral functioning is — which the DSM does not do. 

Using the presidential campaign as a template, it is clear that emotionally healthy leaders exhibit self-awareness, accountability, humility, thoughtfulness, equanimity, patience, an appropriate balance of deference and assertiveness, and compassion  — traits that derive from self-acceptance and good shame tolerance. 

Why I Started Self-Acceptance Psychology — To Start a Revolution!

psychiatry5By learning self-acceptance and how to tolerate shame, I transformed my personality in large and small ways — 22 ways that I detailed in my last two blogs – here and here. My experience provided me with solid anecdotal evidence that developing self-acceptance works.

My experience also revealed that I not only have a talent for self-transformation, but I seemed to have good skills for helping others with their emotional and behavioral struggles. 

So I decided to become a clinical psychologist. But even before I started undergraduate or graduate psychology studies I recognized that the labels used by the psychiatry profession — “depression,” “bi-polar,” “OCD,” etc. — were arbitrary and largely meaningless. Intuition and common sense told me that human behavior was more easily defined and understood by looking through a lens that considered natural, primal reasons for these human choices and reactions. 

After I graduated and completed my clinical training, I began work as a psychotherapist, wrote an award-winning book on related topics, and continued to refine these ideas.

The more I understood about the mental health profession, the angrier I got seeing people mislabeled and stigmatized and even drugged for what were merely normal reactions and adaptations to their life experiences. 

Every case showed ways that the current system failed through its fundamental mischaracterizations. 

Because I never bought into the propaganda that mental disorders were caused by brain malfunctions, I easily saw things through an entirely different lens. 

  •  Kids raised by angry and anxious parents developed angry and anxious behaviors that were labeled as “ADHD” or “Oppositional-Defiant Disorder.”
  • Teens emotionally neglected or rejected by alcoholic or emotionally withdrawn parents grew up “depressed.”
  • Many people who failed to get loving, nurturing, warm care as children failed to learn to trust the secure bonds that should come in human relationships. Not surprisingly, they struggled in their adult relationships with uncertainty, disconnection, loneliness, anger, or jealousy. They then felt anxious and depressed because they also naturally craved normal human emotional connection, acceptance and understanding.

As I refined these ideas I studied extensively about five key concepts: 

  1. The Primal Threat Response or “Fight-or-Flight”
  2. Fear of Social Exclusion
  3. Shame as an Attempt to Prevent Social Exclusion
  4. Developmental Trauma
  5. Attachment Status

(If you want to jump right into learning all the details about Self-Acceptance Psychology ideas, such as these Five Causative Factors, click here.)

I was amazed that traditional psychology training did not address any of these topics in any depth. In fact, I didn’t learn about any of these topics in psychology graduate school.

Yet I continued to see the powerful influence of these ideas and kept wondering: Why weren’t more people talking about how these five ideas work together to explain human psychology?

Well, certainly authors and researchers are talking about ideas such as self-compassion, trauma, attachment, and shame. However, because of the academic system, individual researchers study one topic or even a small subset of a topic. It seemed as if no one was tying these concepts together, which to me was the answer. 

Researchers are forced to use the current DSM diagnostic categories and grant funding ties them to hold onto the traditional biomedical or disease model.

Perhaps a clinician needed to propose a solution to the DSM and its ills. Psychotherapists see people every day and see the many ways their behaviors are influenced by their psychosocial environment and experiences. We see the big picture, where researchers may not be able to. 

At first I hesitated to speak up: I’m not an expert, after all. And these ideas seemed so obvious that surely others must have considered them before. 

But I finally gave up waiting for others to speak up. I had to take a risk to address this very important problem that affects millions of people. 

Since training as a psychologist, studying huge volumes of material and working with clients, I am even more convinced that the labels used in the DSM are not only inaccurate and misleading, but downright harmful. 

What if there was a system for understanding human emotions and behaviors that:

  • was more useful and accurate than the current psychiatric diagnostic model of the DSM?
  • could bring about a real understanding of the causes of human behavior?
  • could improve relationships with others?
  • could improve the relationship you have with yourself?
  • could lead to real, permanent change — bringing contentment and an improved sense of connection to others and to yourself?

I finally decided to propose a simple, but powerful new paradigm for understanding emotional difficulties called Self-Acceptance Psychology. In stark contrast to the disease model, Self-Acceptance Psychology is based on five well-accepted and well-researched psychological concepts, which, when considered together, provide a powerful new framework to understand and promote permanent change in mood and behavior.

Self-Acceptance Psychology reframes emotional problems as adaptive and self-protective responses to experiences of fear, trauma, shame, and lack of secure attachment.

Critics may state that these five ideas are not new. But combining these ideas and using them as a paradigm to confront the current mental health diagnostic and treatment system is new.

I believe we must tie these Five Causative Factors together to really give us a weight of evidence with which to fight the medical model and DSM. 

To dispel other critics: I’m branding and packaging this as Self-Acceptance Psychology to give it the weight needed to directly combat the DSM diagnostic system — not just as a method of making money for me personally. Quite frankly, this project is a risk for me professionally — there are far more financially profitable ways for me to spend my time and effort than on this campaign! 

Because of my transformation and what I see happen to my clients every day, I knew I had to speak up. Self-Acceptance Psychology does more than help those who have minor emotional or personality issues, as I did. It provides a paradigm shift for how society and the mental health profession can view “mental disorders.”  I feel compelled to speak up because I want to prevent any more children harmed by ADHD medication and blamed for their behaviors, teens labeled with “Major Depressive Disorder” and stuffed full of brain-damaging drugs, or an adult labeled as “Bi-Polar” and told they have an incurable, lifelong “illness.” Mental-Illness_5

My goal is outrageous, but essential — to start a revolution in how we define and treat mental illness. I had to fight against the current system that labels, stigmatizes and over-medicates people who are merely having normal, natural emotional reactions. 

Why should we blindly accept the falsehoods promoted by psychiatrists and pharmaceutical companies who merely want to make money from suffering? 

Don’t stop learning about this powerful idea! Join the Self-Acceptance Psychology revolution and help change the future of mental health! Read more in “Self-Acceptance Psychology“, sign up for email updates, and follow me on social media.

Be kind to yourself…

Psychiatry again rearranges deck chairs on the Titanic

 

Edward Shorter’s blog on Psychology Today attempts to parse the difference between supposed differences in types of depression:  melancholic and one that is a mixture of “anxiety, dysphoria, fatigue, insomnia and somatic symptoms” or “non-melancholic depression.” This exercise in futility is yet another example of how psychiatry continues to rearrange deck chairs on the Titanic.  

The profession is sinking under the weight of its nonsensical and nonscientific diagnostic labels and its continued pill-pushing, yet here it is having extended discussions about unimportant diagnostic fine-tuning. 

Shorter says this debate about two types of depression is “The Big Divide in US Psychiatry.” Actually, the more important divide is between psychiatry, which continues to believe in some alleged “disease model” of “mental illness,” and those of us who have read the research and have correctly concluded that “depression” and other purported illnesses are merely normal, natural emotional and behavioral reactions. There has never been proof that depression, anxiety, bi-polar, ADHD, etc., etc., are functional brain diseases or neuro-chemical imbalances. 

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From Self-Acceptance PsychologyTM

“In clinical settings, low self-worth, loneliness and the fear of being excluded underlie nearly all complaints of anxiety, depression, obsessive-compulsive disorder, and other psychological conditions. Psychiatrists Jacqueline Olds, M.D., and Richard S. Schwartz, M.D., writing in “The Lonely American,” note that they began to notice that their patients’ suffering was related largely to isolation and loneliness, irrespective of diagnostic label. Yet it was difficult for the patients to talk about their isolation, because the feeling filled them with deep shame.(Olds, J.M., & Schwartz, R.S., 2009, The Lonely American: Drifting Apart in the Twenty-first Century. Boston: Beacon Press, p. 4.)

It is clear that in many instances a person’s internal or external shaming experience leads to a reaction of fear that causes:

  • emotional over-regulation (depression, social avoidance, schizoaffective disorder, etc.) or 
  • emotional under-regulation (which the DSM labels as ADHD, anxiety, oppositional defiant disorder, mania, etc.) 
  • a mix of under-regulation and over-regulation (bi-polar disorders, borderline personality disorder)

“It is a mistake to view depressed feelings as a ‘disease.’  Instead, it is merely a kind of unhappiness that involves helpless self-blame and guilt, a belief of being undeserving of happiness, and a diminished interest in life.” (Breggin, P. R., 2001,  The Anti-Depressant Fact Book. Cambridge, MA; Da Capo Press, p.14)

If shame and the threat response are so clearly linked in physiology, why does the DSM not address the emotion of shame as a root for diagnoses such as generalized anxiety disorder and depression? …

It is clear: Shame is a major driver of human behavior, leading to depression and anxiety. Why is this fact completely ignored in the DSM? Why should the emotion of shame be considered a “mental disorder?

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So, psychiatry debates new subcategories of “depression” But how does this help? Does it lead to new, improve treatment options? Does it help explain why people are “depressed?” Does it provide any clinical utility whatsoever? 

The power of Self-Acceptance Psychology is that it offers numerous benefits, because it: 

  • explains human emotional, cognitive, and behavioral patterns as natural, predictable responses to real threats or perceived fears
  • normalizes and de-stigmatizes thoughts, feelings, and behaviors as adaptive and self-protective
  • improves the likelihood that clinicians will view clients as normal and not disordered
  • encourages client accountability
  • directly addresses the emotion (shame) and cognition (low self-worth) that lead to most “mental illnesses”
  • is based on common sense, facts, and scientific research, so is more accurate and reliable than the DSM
  • is a simple, transparent, and understandable conceptual framework accessible to clinicians and the public
  • uses behavioral explanations that lead directly to case formulation and to effective methods of therapeutic intervention and self-help
  • provides hope for permanent change through research-proven strategies of mindful self-compassion leading to self-acceptance
  • interventions are harmless, unlike medications, and provide hope for permanent change.

Let’s stop tweaking, as Shorter’s blog does, with a fundamentally broken system of the DSM and the “medical model” of mental illness.” Let’s develop a new system that is based on real facts and science. 

Lots more in Self-Acceptance Psychology!