Instability-in-Chief
My day job is seeing things people can't or choose not to see. In other words, I'm a psychiatrist. I don't say it to be boastful, but rather to illustrate my burden. While I take great pride in my service to my patients, I'm also forever incapable of turning off my clinical skills when I leave work. I notice speech patterns, eye contact, facial movements, tone, alertness, processing speed, linearity of thought, affect, mood, memory, insight, judgment, and risk of harm to self or others, in every single human interaction I witness or experience. I also can‘t help but recognize when people employ maladaptive coping skills and defense mechanisms in response to life’s challenges.
Needless to say, I have concerns about Donald Trump.
In my spare time, I use my thinking cap to process the latent psychosocial content in the politics of the day on Twitter. Ironically and somewhat tragically, I often de-stress best by doing a mental status exam on my news feed. I immerse myself in the painful public policy process to process the private pain disclosed in my office, but somehow it’s always felt like leisure instead of work. That was until Donald Trump announced he was running for president. Suddenly I find myself confronted with public behavioral disturbances that more closely resemble the DSM than they do politics as usual. I’ve written extensively about the political aspects of Trump’s many disqualifying attributes, from his peddling in the privileged politics of personal insult, to his disingenuous minority outreach, and his exploitation of the poorly informed; but now it’s time that we discuss his mental health.
I’m not here to formally diagnose him from afar, but I’d be lying if I said I wasn’t beginning to feel somewhat derelict watching an emergency unfold without meaningful, life-saving intervention taking place. I make my living treating acute and sub-acute mental and behavioral health emergencies, which means people don’t end up on my radar unless they’ve comported themselves in ways that are generally determined to be unstable and unsafe. In some cases it’s florid psychosis, dementia, or mania, and in others it’s severe depression and suicidality, or unbridled poly substance abuse or personality disorder. No matter the etiology, my duty is to determine if the mental status changes in question represent a lack of stability and/or portend a heightened risk to individual or public safety.
When I hear and see Donald Trump, I hear and see an emergency.