News & Views

Treating Trump

Eight Months into his tenure as president, we members of the psychiatric profession (and so many others)  know this man all too well. There is no mistaking his narcissism and the traits that go with it. We do not need diagnostic manuals to know him. Unfortunately we know how persistent and unremitting his problem, how treatment refractory to our pharmacological and relational ministrations. Donald is a plus perfect teaching case for young residents learning about narcissistic personality disorders. When Senator Diane Feinstein expects him to change and learn we, along with other students of human behavior, shake our heads in dismay.

I’ve seen too many people like Trump in my office to hold out much hope. They believe in themselves too much and underneath that unrealistic bravado lies painful despairing low self esteem. It is a deadly combination for a talking cure: challenge the inflation and you have a whining brat on your hands; ignore it and your bored for hour on end and wasting time.

Of course it is rare for individuals like Trump to seek help. It violates their first commandment, a variant of “I am the Lord God and there is None Beside Me.” If they come to a psychiatrist it is because they are temporarily indisposed around a divorce, a major family trauma, a business failure. Or because they see some temporary legal or interpersonal advantage in a few documented hours. But they rarely stay. Not with me, anyway. A few minutes in my office and they are  in full flight, attempting to devalue me and insist on their superiority–or both. And I know that will continue as long as I don’t challenge this first premise . And I know that if I don’t, nothing will happen.

I know I’m  really bad with individuals like Trump. They rarely pay their bills, they are no fun and they don’t change. So what’s the point.  There not   interested in themselves, certainly not finding out who they are, and without that commitment there is no way they can change. It   sounds harsh and at times I worry about missing the exceptions. So I devised the following test for guys like Trump.

My two Harvard diplomas and a couple more from UCSF are in my waiting room  not in my office.  When the first degrading comment comes, something like “Look, man. I don’t belong here. I can do what you do with both hands tied behind my back. And check out my net worth. When you come close to that big one I’ll listen.” There are variants of course but yes, they actually say things like that within a half hour of a first appointment. (Check out previous Dr. Scapegoat/CEO posts on this website) . At such time  I try to  look kindly and wise and  gently point them back to the waiting room.  “Check out the Latin diplomas, dude.” It’s a way of my saying, odds are strong that I’m way smarter than you here. Way. You might learn something   .And by the way  I don’t honor your definition of “net worth” If you can live with that you can stay.”

Honestly this ploy doesn’t work very often. I don’t expect it to. Being rejected by a shrink may be hard for them and they may even stay a session or two longer to cope with my refusal to see them. Rarely  they reflect on what I’ve said, check it out for themselves and maybe we get somewhere together.

Do I scapegoat potential patients like these? Do I negatively stereotype their ability to learn and grow from my  impressions of their self presentation? Could I spend months, perhaps years, soothing their low self esteem enough so that they would become interested in Plato’s transcendent maxim  “Know Thyself?” Do my comments actually reflect  jealousy of their”net worth.”?  All possible but rarely true. The Donald Trumps of the world may be good business men, or entertainers but they rarely change. Count on that, Dianne.