COMMENTARY || Is Donald Trump bad, mad—or both?

We don’t need an armchair psychiatric diagnosis of the U.S. president to explain his bad behaviour, argues UAlberta psychiatrist.


Is President Donald Trump mad, mad and bad, or just bad? This question arises because of increasing speculation about whether or not President Trump is mentally ill. Recently, mental health professionals have weighed in—most notably in a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.

I think a clear case can be made that President Trump is bad, but he is definitely not mad in the sense of having a mental illness. However, he is frequently mad in the sense of being angry. Mental health diagnoses are widely misunderstood, as is the difference between being "bad" and being "mad."

People who carry out bad things are often talked about in terms such as "they must be crazy," implying the presence of a mental health disorder. It is true that at times individuals who are psychotic do bad things, but this is a tiny minority of such acts. And when they occur, they are usually widely reported. An example is the tragic episode involving a murder, beheading and cannibalization that occurred on a Greyhound bus in 2008.

One of the widely misunderstood issues is that mental health professionals will only make a diagnosis, such as psychosis, when any such beliefs are NOT compatible with those held by others, no matter how odd or unusual they may be. This means that people who belong to small groups with unusual beliefs do not receive mental health diagnoses. Thus, whether or not such beliefs are factually based is not the basis for a diagnosis. Even when people believe things that are clearly factually inaccurate, they are not "mad" or "crazy" in a mental health sense. If this were not the case, individuals who believe that Elvis is still alive, that cigarettes don't cause cancer, that 9/11 was a U.S. conspiracy, that humans didn't arise from evolution or that global warming is not occurring would meet the criteria for mental illness.

There have been concerns raised that mental health professionals should not try and make a diagnosis from a distance, and in the United States (but not in Canada) there have been specific guidelines to this effect. I am less concerned about this, as this has always felt inappropriate. If somebody shows evidence of mental health conditions that can be diagnosed from a distance, it will usually be highly apparent, such as somebody calling to police to shoot them or running naked in the streets. Additionally, we constantly make judgments about guilt or innocence of individuals on trial for a variety of offences based only on what is available in the media, and without understanding all of the evidence.

Therefore, while individuals can propound many beliefs that are not compatible with facts - of which President Trump is a good example - this does not make him "mad." Is he bad? There are many reasons to believe that his actions, beliefs, statements, instability, lying, bullying, misogyny and narcissistic behaviour would make most individuals believe that he is bad. So, President Trump is not mad and bad, just bad.

We should move on from looking for a mental health diagnosis to explain why President Trump is the person he is, and just recognize how frequently bad people occupy positions of power in many countries.

Peter Silverstone is a professor of psychiatry at the University of Alberta.

This article originally appeared in The Globe and Mail.