The Dangerous Case of Donald Trump

by Bandy X. Lee

  Jennifer Contarino Panning, Psy.D., is a licensed clinical psychologist and owner of Mindful Psychology Associates, a small group practice in Evanston Illinois. She received her doctorate in clinical psychology from the Chicago School of Professional Psychology in 2003, and completed training at Northern Illinois University and Northwestern University. Panning opened her private practice in 2004, and now has three psychologists and a postdoctoral fellow on staff. She specializes in the treatment of mood disorders, eating disorders, college student mental health, stress, and trauma using an integrative approach of cognitive behavioral therapy, mindfulness, and dialectical behavioral therapy, and is also trained in clinical hypnosis.

  References

  American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association.

  American Psychological Association. 2017. “Many Americans Stressed About Future of Our Nation, New APA Stress in American Survey Reveals.” APA.org, February 15. www.apa.org/news/press/releases/2017/02/stressed-nation.aspx.

  Clarridge, Christine. 2017. “Mental Health Therapists See Uptick in Patients Struggling with Postelection Anxiety.” March 29. www.chicagotribune.com/lifestyles/health/ct-mental-health-postelection-anxiety-20170329-story.html.

  Gibson, Caitlin. 2017. “What We Talk About When We Talk About Donald Trump’ and ‘Gaslighting.’” January 27. www.washingtonpost.com/lifestyle/style/what-we-talk-about-when-we-talk-about-donald-trump-and-gaslighting/2017/01/27/b02e6de4-e330-11e6-ba11-63c4b4fb5a63_story.html.

  Glinton, Sonari. 2016. “Survey Says Americans Are Getting Stressed by the Elections.” October 15. www.npr.org/sections/the two-way/2016/10/15/498033747/survey-says-Americans-are-getting-stressed-by-the-elections.

  National Institute of Mental Health. “Any Anxiety Disorder Among Adults.” www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml.

  Norton, Aaron. 2016. “The Political Beliefs of Mental Health Counselors.” In Thought (blog), May 9. www.aaronlmhc.blogspot.com/2016/05/political-beliefs-of-mental-health-counselors.html.

  Sheehy, Gail. 2016. “America’s Therapists Are Worried About Trump’s Effect on Your Mental Health.” October 16. www.politico.com/magazine/story/2016/10/donald-trump-2016-therapists-214333.

  Silver, Nate. 2016. “Election Update: Clinton Gains, and the Polls Magically Converge.” November 7. https://fivethirtyeight.com/features/election-update-clinton-gains-and-the-polls-magically-converge/.

  Stern, Robin. 2007. The Gaslight Effect. New York: Morgan Road Books.

  IN RELATIONSHIP WITH AN ABUSIVE PRESIDENT

  HARPER WEST, M.A., L.L.P.

  As “Amelia”1 describes her husband’s behavior in my therapy office, it immediately strikes me as emotionally abusive, although she acts as if his behavior were completely normal.

  “Justin” can be harshly critical, calling her a “fat loser” and her home-cooked meals “a disaster.” If she asks even reasonable questions, he lashes out at her: “You’re always so negative and critical.” If she states a fact he disagrees with, he accuses her of making up “fake” stories. Despite Justin’s family and financial security, he is joyless and scowls much of the time.

  Amelia is mystified how the most minor disagreements seem to escalate into major arguments. I ask if Justin can apologize or admit fault. “Oh, never,” she says. “He’s very stubborn. It’s always my fault. I call him ‘Justifying Justin.’”

  Their most recent argument began when she asked if he had paid a bill. He became enraged and said he had paid it. She later learned that he had not paid the bill, but he refused to apologize for the lie, the ensuing argument, or his excessive anger.

  Justin has lied so frequently that Amelia has become concerned she is “losing her mind” or has a poor memory, a belief aided by the fact that Justin accuses her of these faults. He insists that she forget his mistakes, but he brings up her mistakes repeatedly during arguments.

  She describes Justin as being successful at business, very decisive, and a strong leader. She hesitates to confront him because she has learned that it leads to arguments escalating, with no resolution. She is always the one to compromise.

  Amelia reports high levels of anxiety, and fears Justin’s unpredictable reactions.

  This couple is a composite of many cases where the pattern of abuse ranges from subtle to glaring. Not coincidentally, this couple is an analogy for the current relationship between America and a psychologically unstable, emotionally abusive president.

  Domestic abusers and President Donald Trump share common personality traits because they share common human drives, emotions, and reactions. These characteristics negatively impact relationships, whether interpersonal or with an entire country, and they must be addressed for the health of those being harmed.

  Renaming Narcissists

  Some mental health professionals have associated Trump with a variety of diagnoses, such as narcissistic personality disorder, antisocial personality disorder, paranoid personality disorder, delusional disorder, malignant narcissist, and some form of dementia (Lenzer 2017).

  Some of these labels come from the Diagnostic and Statistical Manual (American Psychiatric Association 2013), which numerous authors have identified as an unscientific, arbitrary categorization system that overcomplicates and falsely medicalizes emotional and behavioral problems (“DSM: A Fatal Diagnosis?” 2013; Caplan 1995; Deacon and McKay 2015; Kinderman 2014; Miller 2010; Whitaker and Cosgrove 2015).

  To avoid this categorization system and to simplify and focus on the character flaw that is at the core of these personalities, I will call these types of people Other-blamers.

  The cause of their behaviors is low self-worth, which leads them to have poor shame tolerance. They learned in childhood to manage feelings of inadequacy by adopting unhealthy coping mechanisms to forestall or avoid shaming experiences.

  Poor shame tolerance causes behaviors associated with the just-mentioned DSM disorders, including vindictive anger, lack of insight and accountability, dishonesty, impulsivity, entitlement, paranoia, lack of remorse and empathy, self-importance, and attention-seeking. Trump is an extreme example, but “subclinical” versions of this behavior exist in millions of people, including domestic abusers.

  It may be difficult to discern the low self-worth of Other-blamers because they often adopt an aggressive, dominating persona to achieve emotional self-protection. They rarely admit feelings of inadequacy because they believe this would make them vulnerable to the same abuse and control they are perpetrating.

  As a psychotherapist, I see the victims of Other-blamers in my office every day. Less-severe Other-blamers cause high-conflict or estranged relationships. More-severe cases can engage in emotional and physical abuse of partners and children, criminal behavior, and addictive behaviors. I have often said we should not be diagnosing those who come into therapy but, rather, those who caused them to come to therapy.

  Despite their toxic behavior, Other-blamers rarely voluntarily agree to therapy because of their aversion to the shaming experience of self-awareness and accountability. Yet, they are quite often the subject of the therapy of others.

  Certainly, Other-blamers are aided to some degree by the deferential behaviors of individuals who employ two other types of shame management strategies: self-blaming and blame avoidance (West 2016).

  Other-blamers instinctively seek out those willing to be controlled, manipulated, or intimidated. This sets up relationships with submissive people who will not challenge, correct, or blame them. Dictators throughout history have surrounded themselves with a coterie of family members and sycophants who avoid questioning the leader for fear of his angry retribution.

  (For the sake of clarity, this article will refer to abusers as males, but both genders can be Other-blamers and abusers.)

  Causes of Other-blamer Behavior

  As children, Other-blamers were likely exposed to developmental or atta
chment trauma, such as abusive, shaming, rejecting, or neglectful parenting. Parents who are substance abusers or psychologically troubled often underfocus on a child’s needs. Parents may have exhibited narcissistic or Other-blaming behaviors that the child models. Another possible cause is parents who were permissive or conflict avoiding and did not hold the child accountable. Parents who overfocus on achievement or behavioral compliance can also encourage a fear of failure that may bring on Other-blaming tendencies.

  These experiences can cause children to feel unloved, unprotected, and inadequate. They may struggle to experience empathy for others and may develop an unhealthy hypersensitivity and overreaction to shaming experiences. While Other-blaming as a shame-management strategy may be adaptive in childhood, it causes difficulties for adult relationships at all levels, from presidential to personal.

  Emotional Reactivity with Fear, Shame, and Anger

  In all humans, survival fear overwhelms the deliberative, logical functioning of the cognitive brain (Pasquali 2006). Children exposed to trauma continually rehearse “fight-or-flight” reactions so that their brains become habituated to and easily hijacked by survival emotions (Anda et al. 2006). Chronic exposure to the fear response leads to anxiety-based behaviors, such as impulsivity, hyperactivity, irrationality, volatility, impetuousness, poor frustration tolerance, and poor concentration—all of which Trump exhibits on a daily basis. Trump’s incoherent gibberish may be a sign of his fearful, reactive emotional state; he cannot calm his brain enough even to form a complete sentence. One must be calm to be mindful of one’s thoughts, feelings, and experiences and to gain self-awareness.

  Although they are adept at hiding it, Other-blamers know a lot about fear. They spend their lives in an emotional survival panic, in terror of being judged and found unworthy. They are in a mad scramble to find some way to feel better about themselves or at least to protect themselves from feeling additional shame. That shame can lead to protective anger, as recognized in the aphorism “Anger is shame’s bodyguard.”

  For extreme Other-blamers, elevated “fight-or-flight” reactivity can lead to shame-driven rage and abusive violence. Domestic violence incidents are usually triggered when the abuser feels challenged, demeaned, or rejected by the partner. Abusers failed to learn to tolerate shame in healthy ways, so even minor or perceived slights to their weak self-worth, such as dinner not being served on time, may throw them into an uncontrollable rage.

  Trump’s first wife, Ivana, accused him of raping her in sworn deposition testimony, an accusation she later softened, as a part of a lucrative divorce settlement, but did not completely retract. This alleged violence fits with the personality of someone fearful of rejection and living with elevated anxiety who might be triggered into violent rage. Abusers can escalate to murder/suicide when a relationship is ending and they must face the humiliation of undeniable rejection. That some abusers will kill others or even themselves to avoid experiencing this emotion shows the power of shame.

  This pattern of escalating instability is concerning when considering Trump. As the pressures of governing and of the investigations such as that of alleged collusion with Russia increase, he may be overwhelmed by fear, which will further limit his cognitive and prosocial capabilities. His behaviors may become increasingly volatile and unpredictable.

  Healthy relationships require partners who are calm, thoughtful, and deliberate, not fearful and reactive. Fear-driven behaviors and a lack of insight are exactly the opposite of what we should expect of a safe, dependable partner or a leader.

  Lack of Accountability

  With shame and fear as the primary emotions driving Other-blamers, a lack of accountability becomes their most obvious and destructive character flaw.

  They have difficulty being introspective and acknowledging the effect of their behavior. This would involve gaining insight, admitting fault, and demonstrating remorse—actions that Other-blamers find devastatingly humiliating. In therapy, I get the sense that an Other-blamer wants to put his hands to his ears and sing “la-la-la” in an attempt to avoid hearing the truth. Other-blamers do not like to be held accountable because they do not hold themselves accountable.

  In general, Other-blamers do not believe they must play by the same societal or relational norms as others, which can be disorienting to partners. Trump’s refusal to release his tax returns or comply with ethics regulations is clear evidence of this thought process.

  Lack of accountability causes escalating arguments in couples because Other-blamers stubbornly refuse to admit fault, even if the facts are staring them squarely in the face. Or they admit fault reluctantly, but only after much lying and excuse-making. The betrayals of trust mount up, driving a wedge into the relationship.

  During arguments, Other-blamers frantically attempt to manage shame by shifting blame, making excuses, or denying behavior. One wife said about her emotionally abusive husband, “During conversations, he is not really listening, because he is trying to figure out how to make it not his problem.”

  Domestic abusers are notorious for their lack of accountability. They can go to extremes of rationalization. One abuser noted that while he had locked his wife in the closet for hours, thrown her to the floor repeatedly, and pointed a gun at her head, he had not punched her—as if this arbitrary demarcation excused his inexcusable crimes. The Other-blamer routinely blames the victim, as if a late dinner were worth a slap in the face.

  Unlike Harry Truman, who placed a sign on his Oval Office desk stating, “The Buck Stops Here,” Trump appears to be completely lacking in accountability. He regularly shifts blame to others and never seems to apologize for any of his lies or mistakes. Trump’s blame shifting is so predictable that he can barely make one statement without a deflection (Millbank 2017). His assertion, although false, that he does not settle lawsuits is an example of his distaste for being held responsible. Trump’s tendency to ridicule facts or the opinions of others is another way of avoiding dealing with a situation honestly.

  Because of their lack of accountability and resulting lack of insight, Other-blamers are highly resistant to change, leaving their partners with limited power to affect the relationship. In an interpersonal relationship, the partner can leave. Yet, as a country, we have little recourse other than faith that our democratic institutions will keep Trump in check.

  Unfortunately, abusers and authoritarians such as Trump do not like laws, which are ultimately about holding people accountable. This worldview is a danger to a democracy founded on the rule of law.

  In contrast, emotionally mature people can accept the boundaries others establish. When they violate expectations, they can apologize promptly and gracefully, which resolves arguments and repairs relationships. Healthy relationships require awareness of one’s faults; care for one’s impact on others; and an ability to handle mistakes, defeats, and criticism with equanimity.

  Lack of Prosocial Emotions

  An Other-blamer’s inability to apologize clearly signals to others a lack of conscience and empathy. Compassion, kindness, and altruism are prosocial traits and moral behaviors that are largely innate (Martin and Clark 1982). Yet, those described as sociopaths and narcissists (American Psychiatric Association 2013) are often noted for their lack of remorse, guilt, or empathy.

  Other-blamers lack these emotional traits for several reasons. Some did not experience warm interactions in early attachment relationships with caregivers. Perhaps they learned to be hurtful toward others through experiencing or witnessing abuse. Being raised in an environment of trauma increases one’s reliance on the survival responses of “fight-or-flight” and decreases access to “tend-and-befriend” responses, making one less inclined to aid others or even be aware of the needs of others.

  When in distress or cornered, people often lash out, especially if they have a model of relationships that may not include safety, comfort, or love. An abuser’s violent rage is an extreme version of a fear-based deficit in prosocial sentiment. An abuser may
say he loves his partner and claim he would never hurt her, but his emotionally reactive behaviors speak the truth: that, when dysregulated by fear and shame, he can care only about himself.

  For Other-blamers, it is their emotional struggle to protect their fragile self-image from shame that makes them lack consideration. Other-blamers become overwhelmed by their own emotional pain, so they prefer offloading it onto another, even if that means harming that person or the relationship.

  Even those with less-severe Other-blaming traits end up damaging relationships because they lack an ability to attend or respond to their partner’s emotions with kindness and caring. The resulting lack of emotional connection is a major reason relationships fail. In couples’ therapy, it is difficult to get an Other-blamer to pay attention to his effect on his partner. Even if his wife is crying, the Other-blaming husband may sit there unmoved or, worse yet, argumentative and defensive. He is so busy protecting himself from experiencing shame and blame that he has little capacity to be warmly responsive. Certainly, abusers are harming the relationship every time they react violently.

  Other-blamers often have difficulty attuning to the emotional status of others because, as one Other-blamer admitted in a rare moment of self-awareness, “I care more about being right than doing the right thing for the relationship.”

  And this is exactly what is happening in Trump’s relationship with America. He cares far more about sheltering his fragile psyche than doing what is right for the country. Trump’s lack of empathy has been on display for decades, with well-documented bigotry, greed, name-calling, intimidation, and vindictiveness.

  Because he is in emotional survival mode, Trump fails to notice that his ranting press conferences or bullying tweets are destabilizing. His goal is merely to lash out so he can feel better about himself in that moment. Trump has no concern that his divisive hate speech leads many to fear for their safety and liberty. He is unconcerned about the long-term effect on the country. He is too busy being right at any cost to notice that his lies and accusations are damaging his relationship with the citizens he is leading.