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Duke Psychiatrist: America Is Having a Nervous Breakdown

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Duke Psychiatrist: America Is Having a Nervous Breakdown

Last winter, the former chair of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Task Force and the department of psychiatry at Duke University School of Medicine wrote a widely circulated letter to The New York Times affirming that as the man who “wrote the criteria” that define narcissistic personality disorder, Trump doesn’t seem to be suffering from it. Instead, as he suggests in his new book, 45 is just “a bad person.” Which is worse.

In his new book, “Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump,” Frances suggests that it’s America that’s the psychologically distressed party here — and offers his insights on what it takes to become “rational again.” He spoke to Salon recently about why we make bad choices and how the best results can come from the worst crises.

Mary Elizabeth Williams: You were working on this book even before the election; you have a lot to say about the disorder that we seem to be collectively suffering from as a nation right now. What changed for you, then, about this book and about the story after November eighth?

Allen Francis: Everything as a society that we were doing wrong, Trump accentuated in a way unimaginably worse than I could conceived. The problems that I spotted going into the election have become exponentially worse since.

MEW: You get called upon a lot as a person who is an expert on mental disorders, and particularly narcissistic personality disorder, to comment on Trump’s state of mind. You have bucked expectations about him and about diagnosing him. Tell me why that is?

AF: It’s a great mistake to confuse bad behavior with mental illness. Trump is one of the worst people we could possibly imagine as President, but that doesn’t mean he’s mentally ill. When we confuse the two, it’s a terrible insult to those people who really are mentally ill. They’re mostly nice well-meaning people who don’t do harm. He’s a bad person, not well-meaning, very selfish, who does lots of harm.

It also distracts us. Trump is a terrible political problem for America — in some ways the greatest threat to democracy that we’ve had since the Civil War. He is a terrible environmental threat to the whole world. Millions of people can die in the global warming that he’s encouraging. What we’re seeing with three monster hurricanes in just two weeks, this is just a signal, a warning of what the future can hold. We have billions of people living in low-lying areas that will be in harm’s way, and Trump is doing everything a human being can do to make global warming worse.

If we spend our time thinking about what’s his diagnosis, we won’t be focusing on what’s more important: How do we contain this guy? We have to have Congress, we have to have the courts, the press, and most importantly we have to have the people stand up to Trump and direct us back to national sanity.

MEW: One of the things that you say early on in the book — that is definitely not consoling to many of us reading it — is [it’s important to distinguish] someone who is mentally ill from someone who may just be a bad person, and, as you say, is not mature. What you’re really looking at is someone who has not matured and who is operating at a level of selfishness.

AF: I think the two best ways to understand the daily drama of Donald Trump — and this daily drama, by the way, has been going on his entire life; there’s nothing new in any of this. He’s the most transparent person maybe in the history of the world. You don’t have to be a psychologist to understand Donald Trump. The two best ways of understanding him are to think spoiled child. Think, a very selfish, spoiled four-year-old in a grown man’s body. The other thing that helps [with] understanding him is think, reality show impresario. Trump isn’t playing to the good-government crowd. He’s playing to the reality show crowd. The daily dramas get him amazing TV ratings [and an] incredible number of social network followers. He’s a man who loves attention, positive or negative, and he’s received more attention than any human being, perhaps in the history of the world, for doing outlandish things. They work for him. We shouldn’t expect rational government from a man who doesn’t care much about rational government, is too ignorant to provide it and has an unstable approach to life that has his latest impulse be his governing principle.

We shouldn’t label that “mental illness.” We should realize what it is, and the solutions to this won’t be removing him from office on psychiatric grounds, as someone suggested. It’s never going to work. The solution will either be impeachment, which I think will have its own set of problems, or Congress come into the play and containing him. We should have bills passed [that get] his fingers [off] the nuclear button. It shouldn’t be that he wakes up in the middle of the night and instead of tweeting, calls the general and starts a nuclear war. We need to have Congress make clear that there is a protocol for making vital decisions, that we can’t trust to someone with the immaturity of Donald Trump.

MEW: As you say in the book, crazy doesn’t matter. That’s one of the things that you make very clear. The crazy-not-crazy is not relevant to his performance or his actions.

I’m sure you have seen this a lot, much more than I, in the people that you talkto:This administration, and particularly this person, reminds a lot of us of people that we have known in our own personal lives. He’s creating distress in a lot of us on a very individual level, as a reminder of parents, of co-workers, of bosses. What do you say to those people who say, “But wait, but he reminds me of this terrible person in my past, and it’s bringing up a lot of stuff for me and a lot of my own distress?”

AF: I have to say that in my own personal life, which stands a lot of difficult people and many, many, many thousands of patients, I have never met anyone as disturbing as Donald Trump. I’ve never met anyone as selfish, as impulsive, as dangerous as Donald Trump. I think that most of us have experience with difficult people, but we should put him in a separate category.

I think that the best way to deal with the stress of Donald Trump is to act. Don’t get into arguments with the people who support him. Don’t sit around the TV set screaming.

Part of the motivation [for me in] writing the book, I’ve always been a political missing-in-action person. I’ve never done the right thing. I’m shamefully inactive in all the political turmoil in my life. This is not a moment to be a summer soldier. I think everyone in America, as a citizen, has the responsibility to save our country from what may be one of its most perilous moments, and to save our world from what may be a trigger point towards a global warming we won’t be able to reverse. People need to demonstrate, people need to see their Congresspeople, people need to prepare for the 2018 and 2020 elections. This is the most important moment in American history for hundreds of years. Sitting on the sidelines is not an option.

MEW: You really delved into how we got to this point in the book. That’s what a big part of this book really is. It’s about us as a nation and the onus on us, and how so much of our history has prepared us for this terrible moment that we’re experiencing right now.

You devote a whole chapter to the series of delusions that we operate under, and about our compulsion or our tendency towards optimism and how optimism can be a very dangerous thing.

AF: Optimism has been a wonderful thing in American history. It helped us to be the greatest country in the world. It can also blind us to the reality of our situation. The population of the world has tripled in my lifetime. Every single trouble spot in the world . . . whenever you read an article about a place that’s having a civil war, a mass migration or pestilence or famine, every one of those places in the world is troubled because the population has increased three or four times in just 50 or 60 years. We’re running out of resources. We couldn’t support seven billion people on this tiny little planet if we hadn’t discovered that we have energy power within oil 200 years ago, but that oil is running out. What’s going to happen when we don’t have that source of energy that’s cheap and readily available? We’re just spoiling our environment in every conceivable way, on land, in the sea and most dramatically in the air with the carbon load that we’replacing that’s insupportable.

Only the most irresponsible of parents can see the situation clearly and not worry about their children and their grandchildren when we hand off the world to them that would be much worse than the world that we inherited. I think the point of the book started well before Trump was [elected]. We have a responsibility to the future, to be thinking not just about our current selfish concerns. We have to be conserving the earth, conserving the air we breathe, conserving the oil and water that is necessary for our current population. We have to do right not just by the present but also by the future.

Trump is a consumer and an encourager of consuming, and every single policy of everyone who he’s appointed to office is directed towards making the worst decisions for the future because of opportunistic political gain in the present. The idea of the book before Trump was, let’s wake up and be responsible people. The idea after Trump is, he should be shock treatment. He can either be the tipping point to horrors in the future or he can wake us up to the irresponsibility of our past and current behavior. The post-Trump world can either be a dark age or one of renewed enlightenment.

MEW: You were very frank that you yourself didn’t fully understand how — you were looking at this campaign a year ago and wondering, how anyone could possibly fall for this guy? Howpeople wereactually buying what this guy was selling? It took you a moment to really step out of that and see what is the experience of people and what are the fears. Because that’s the other thing that is really triggering this moment in our history. It’s fueled by delusional hope that things will not get worse, but also fear that things are really terrible.

AF: He’s a con-man, a snake oil salesman and reality show host. He plays on people’s fears; he plays on people’s angers very successfully. People who think he’s crazy don’t realize that in many ways he’s crazy like a fox. He didn’t get there completely by accident. He’s totally incompetent as a President, but very competent in marshaling people who are upset with the way their lives were going. I think the most important message here is that the people who voted for Trump were absolutely right to feel the system was leaving them out. America used to be a worker’s paradise; it’s become a worker’s hell. The small towns in America are disappearing. Stores are boarded up. They can’t recruit doctors. They can’t keep school teachers. The country, a large part of it, is suffering greatly. The inequality in our country has become obscene.

The 20 richest people in America have more wealth than half the country. 20 people have more wealth than half the country. The message is real. The Democratic Party has been remarkably inept in connecting with its natural voters. The Republican Party has sold propaganda very successfully, and Trump is the epitome of someone who is the worst possible messenger for a reasonably important message. He’s a false prophet. Every move he’s made has betrayed the people who voted for him. I think that the hope over the next months will be that his falling popularity, from 45 percent to 35 percent, that we’ll see a gradual erosion of people who realize that he was not the man they thought he was. That the hope they rested in him [was] misplaced, a buyer’s remorse, and he will become more and more isolated in office and as a result, will be able to do less damage.

MEW: If you were looking at America as a single entity that is suffering right now and is in great emotional psychologicaldistress,if America were a patient, would you be able to say, “Yes, there is a course tohealing.There is a course to restore balance and some sort of mental equilibrium?”

AF: The best results I’ve gotten in my life have been in the emergency room, seeing people often for very brief periods of time in the worst crisis in their lives. Years later they would come up and say, “Doc, you remember what you said to me? That changed my life.” I’ve treated people for 14 years and had no impact. I’ve seen people for five minutes at a special time in their life where they could hear a message that previously they couldn’t hear, maybe they couldn’t hear the week later. I think our country is in distress. The cover of my book has an upside down American flag, a universal signal of lethal distress. Our country is in distress. My hope is that this will end the pattern of delusional denial that for these last 30 or 40 years has led us away from our responsibilities to the future, away from our responsibilities to the rest of the world.

The book also focuses on why we make bad decisions. We have wired into our brains the capacity to make the dumbest decisions. We’re very smart creatures. We can make remarkably dumb decisions and display remarkably selfish behaviors.If we can extend the altruism that’s in-built in the human constitution but usually focuses only on the family and the tribe, if we can realize that the world is now one tribe with the human species at risk and we do not gain by following “America first” policies that makes some other culture lose. It’s a game where if they lose we will ultimately lose as well.

If we can become rational again, if we can become generous to people and the rest of the world and to our children, I think there’s reasonable hope that this could be a turning point much for the better. I would much prefer to have Trump as the grotesque representation of radical right policies that control Washington than I would like to have Pence or Ryan. Impeachment in the short run has appeal because it takes his finger off the nuclear button. But in the long run, Trump is a grotesque representation of very, very dangerous policies, and the people who would replace him would be much more plausible in pursuing a course that would, in the long run, be terrible for America.

MEW: That we can, as humans, be more easily deceived, is what you’re saying, by someone who seems so overtly dangerous, that has the appearance of something more catastrophically dangerous. In some ways that garb can actually make us a little bit safer.

AF: Yeah, I think that wolves in sheep clothing are more dangerous than wolves in wolves clothing. Trump may just be the kind of shock treatment America needs.

MEW: I hope you are right, and I want to thank you so much for talking to me today doctor. The book is extremely sobering, but like I said, ultimately very hopeful. As a parent, I share your deep concerns and also your deep hope and this call to action that we are all called to. I really appreciate that you have taken the conversation in a direction of not laying blame or not looking for explanations, but really looking for solutions. That’s what I think this book is really calling us to do, so thank you for that.

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