"One does not have to diagnose to recognize pathological or toxic narcissism," Dr. Bandy X. Lee, a psychiatrist who has taught at Yale and authored the new book "Profile of a Nation: Trump's Mind, America's Soul," told Salon by email. "This is behavior, not a diagnosis — and the media need not fixate so much on 'the Goldwater rule,' which applies to only 6% of practicing mental health professionals (that is, members of the American Psychiatric Association, the only association in the world with this rule)."
The so-called Goldwater Rule holds that "it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement." However, the rule does not apply to describing obvious narcissistic behavior in a public figure, any more than it would disqualify someone from describing celebrities who spend most of their days drinking liquor as having an alcohol problem.
"Those with pathological narcissism are abusive and dangerous because of their catastrophic neediness," Lee explained. "Think of a drowning person gasping for air: a survival instinct just may push you down in order to save one's own life. In the manner that the body needs oxygen, the soul needs love, and self-love is what a toxic narcissist is desperately lacking. This is why he must overcompensate, creating for himself a self-image where he is the best at everything, never wrong, better than all the experts, and a 'stable genius.'"
Dr. Ramani Durvasula, a licensed clinical psychologist and professor of psychology who is noted as an expert on narcissistic personality disorder and narcissistic abuse, agrees that Trump is narcissistic and believes this makes him very dangerous.
As Durvasula explained, many of Trump's seemingly inexplicable actions as president make sense when viewed through the lens of a "narcissistic or antagonist personality style." These include "validation and admiration seeking," as manifested by his "endless campaign rallies despite the associated danger, needing to be taken on a ride around the hospital when he had COVID-19 so people could wave to him, repeatedly requiring validation on the number of people present at his inauguration." Trump also displays denial, as seen by his response to the pandemic, and vindictiveness, as demonstrated by his obsession with reversing Barack Obama's legacy "seemingly just to punish him" as well as by his threat to "withhold federal funds from California for wildfire destruction because he perceives the state is against him."
In addition, Durvasula pointed out that Trump shows extreme sensitivity to criticism through the erratic and malicious content he frequently posts on Twitter, but at the same time reveals a lack of empathy through "his discourse about the diverse citizenry of this country – racial and ethnic minorities, specific religious groups (e.g. Muslims), women, and separating families at the border." Trump, Durvasula said, is also manipulative, as he panders to a constituency that he appears to "have contempt for." Durvasula cited his gaslighting, too— meaning trying to alter or deny memories of basic facts — is revealed in how "he has often been caught by fact-checkers in his lies, and denies things he actually said."
Perhaps the most ominous of the symptoms that Durvasula identified, though, is "triangulation." As she explained, "this is the infliction of chaos created by turning groups against each other. Doing this centralizes the power in the narcissist and creates a blind alliance between some of the polarized groups and him; the country is terribly polarized on numerous dimensions, to the point where families are bearing a toll of divisiveness based on the antagonistic rhetoric."
Lee explained that narcissists who cannot get the love they crave will frequently seek adulation as a substitute. Because no amount of adulation will ever satisfy them, though, "the usual course of an unconstrained pathological narcissist is to seek positions of ever greater power and celebrity." Yet, as Lee explains, because "reality never matches one's fantasy, dissatisfaction grows at greater pace."
Therefore, if Trump loses to Biden, as seems likely, the outcome could be be "frightening."
"Just as one once settled for adulation in lieu of love, one may settle for fear when adulation no longer seems attainable," Dr. Lee told Salon. "Rage attacks are common, for people are bound to fall short of expectation for such a needy personality—and eventually everyone falls into this category. But when there is an all-encompassing loss, such as the loss of an election, it can trigger a rampage of destruction and reign of terror in revenge against an entire nation that has failed him."
She added, "It is far easier for the pathological narcissist to consider destroying oneself and the world, especially its 'laughing eyes,' then to retreat into becoming a 'loser' and a 'sucker' — which to someone suffering from this condition will feel like psychic death."
In a sense, the best analogy is that of a narcissistic family member abusing other family members. Metaphorically, Trump has already abused America. "This personality pattern has taken a toll on this country, and been quite abusive," Durvasula says. "It has eroded trust, left a nation confused and unsupported, and deeply divided and insecure. These same adjectives can be used to describe a marriage or a family which is suffering the challenges of a difficult narcissistic personality in its midst."
If Trump loses, Durvasula says it will be like watching a three-year-old refuse to go to bed.
"They will just stand there, poignantly in their Superman pajamas and say NO, I am NOT going to bed, and drop to the ground and scream," she explained. "Plan on an adult version of that. As is often the case when a difficult personality style like this faces disappointment we tend to see a cascade of reactions – oppositionality, denial, rage, despair, paranoia, more rage, entitlement, victimhood, and vindictiveness."
The next question, then, is what Trump could actually do in his vindictive rage to punish an America which he may believe has consigned him to "loser" status. (Indeed, one-term presidents are usually regarded as failures — and Trump would be the first one-termer in 28 years). As political activist and former Green Party presidential candidate Ralph Nader wrote in August, Trump could pressure the Justice Department to issue bogus subpoenas in order to punish his critics and opponents, pull out of contracts with businesses and individuals who he feels wronged him, refuse to work with Biden's transition team in handing over power and (of course) "intensify the use of the Justice Department and his personal lawyers to challenge in every frivolous, obstructive way the results of the election in selected states, no matter what the margin of his defeat."
Trump could also pick winners and losers in terms of who receives federal help during the pandemic and recession, helping those who sided with him and exacting vengeance against those who did not. He could egg on his supporters into committing acts of violence or, at the very least, do everything in his power to make sure they do not accept the legitimacy of a Biden presidency. He could pressure the Federal Reserve to try to drive up interest rates and stop supporting the stock and corporate bond markets, actions that would tank the American economy (and which Trump would most likely attempt to blame on Biden).
Most ominous of all, a narcissist like Trump could simply refuse to leave office when his term ends on January 20, 2021. America has never had an incumbent president flat-out defy the results of an election — John Adams, John Quincy Adams, Martin Van Buren, Grover Cleveland, Benjamin Harrison, William Taft, Herbert Hoover, Gerald Ford, Jimmy Carter and George H. W. Bush all overcame their disappointment and accepted that they had lost.
If Trump refuses to leave because of his narcissism, it will be unprecedented. It will be abnormal. And it will all have been very, very predictable.