Letter to the Editor of the Boston Globe by Henry J. Friedman

Speculation and controversy over psychiatrists and psychologists attempting to diagnose President Trump are well outlined in the column by Sharon Begley. What is missed is the necessary distinction between our ability to comment on Trump’s mode of thinking and the act of making a diagnosis by any psychiatric criteria. When an individual continually overestimates the degree of danger coming at them or, in this case, at us as a nation; when danger is seen in everyone, including courts and judges and Mexicans; and when dissidents are all denounced as potentially dangerous, we are observing a form of paranoid thinking.

Such thinking, when linked to grandiosity, can radiate to the public and cause people to feel threatened and insecure about the danger that may result from our president’s character style. This is readily observable by any clinician who can attest to the increased anxiety and fear in their patients in the first three weeks of the Trump presidency.

It is important to respect the “Goldwater Rule” and avoid diagnosing public figures in general and this president in particular. However, it is essential that such an avoidance of diagnosis on the grounds that Trump fails to meet psychiatric criteria of showing dysfunction or discomfort shouldn’t be used to divert those of us trained in psychiatry or psychology from observing a mode of thinking that has characterized destructive totalitarian leaders in other countries.

There is no need to use a diagnostic label for an individual when what we are seeing with our own eyes can be seen clearly as disturbed and distressing thinking patterns.

Dr. Henry J. Friedman

The writer is an associate professor of psychiatry at Harvard Medical School.

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