[Critical Culture] : Why DT's Mental Health Diagnosis Doesn't Matter

A week of unnerving events has brought the question of Donald Trump’s mental health front and center (again), prompting many in the media to openly question the reticence of both journalists and mental health professionals to speak candidly about what the public is currently witnessing.

As is by now widely known, mental health professionals are discouraged from diagnosing public figures they have not evaluated largely due to the highly personal nature of psychiatric diagnoses. However, as Trump’s behaviors grow increasingly bizarre and erratic and new allegations continue to emerge, the desire to nail down a concrete psychiatric diagnosis grows more pronounced and people are looking to mental health authorities for answers. People want to understand and make sense of that which seems to make very little sense, perhaps to allay the rising tide of anxiety that something isn’t quite right. The tendency to want to identify and label what feels incongruous, and therefore dangerous, is a common human response, as we find comfort in labels and in making the unknown known. However, the truth of psychiatric diagnosis is that there is very little that is concrete about it. Unlike medical diagnoses, such as those for cancer or diabetes, there is no blood test that confirms a mental health diagnosis. Psychiatric diagnosis is not an exact science, nor should it be given the highly complex nature of human beings. In fact, psychiatric diagnoses tend to be fairly arbitrary due to the fact that they are created by lumping together certain observable behaviors that are deemed “abnormal” and then identified as “Borderline Personality Disorder,” “ADHD,” “Major Depressive Disorder,” and so on. Anyone who has been to a psychologist or psychiatrist knows that what one may diagnose as a depressive disorder, another will diagnose as an anxiety disorder, and yet another will call a personality disorder. Indeed, there is significant overlap between the 400+ diagnoses in the current DSM-5 meaning there is very little that is “concrete” about a diagnosis and much that is simply subjective. The fact that the original DSM, published in 1952, had just over 100 diagnoses and that diagnoses have been dropped only to then be reformulated and added again in a later revision, speaks to the indiscriminate nature of a categorical approach to diagnosis that all-too-often misses the mark—applying to no one and everyone at the same time. The problem with such an approach is that it does not take into account the singular context of any given situation and often simply reflects prevailing social norms.  

Thus, what one professional would label as Trump’s diagnosis is not necessarily what another professional would diagnose. It is certainly possible and necessary to talk about disturbing behaviors and personality traits such as impulsivity and grandiosity that are readily identifiable, but beyond that, we enter a land of differing opinions. This is not to say that a fruitful conversation cannot be had about the current state of affairs, but rather that we do not need a mental health diagnosis from the authorities to know that something is not right in the Oval Office. As a people, our insistent call for a diagnosis is already evidence enough that we sense something is askew. We feel nervous about the incomprehensible language, the Twitter rants, the unmitigated claims to absolute power, the child-like demand for adoration, the blatant lies, and then the denial of the blatant lies. Even if it were possible, a confirmed mental health diagnosis is not necessary to recognize that increasing numbers of people feel unsafe and frightened by an alternate and ever-shifting reality. Our collective anxiety and confusion already speaks loudly. Continued calls for a specific diagnosis of Trump only serve to obscure what we fear, thus only perpetuating those fears by pretending a precise diagnosis could somehow alleviate the horror we feel as events continue to unfold. Rather than a discrete diagnosis, open discussions about our confusion and sense of dread and ways we can organize to effect the change we want would better serve us as we navigate these unprecedented times.