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Thursday, 21 June 2018

Trump II

Back to Diagnosis:
I mentioned above, that the psychodynamic diagnoses, even the ones I entertained, did not convince me. There are several reasons; the most important was that they do not take in consideration the mental and cognitive anomalies Trump kept revealing more of every day. In other words, no psychodynamic diagnosis could explain the other none psychodynamic pathologies his behaviour revealed. I did not have any explanation for the glaring deficiencies in Trump’s psychological life, even before the nomination for the elections. However, Dr. Jackson’s suggestion of neuropsychological testing kept ‘teasing’ my thoughts. I never administered a neuropsychological battery in my clinical psychology career. I know very little about them, but some of the symptoms I mentioned above fall within the known famous battery of test in my time The Halstead-Reitan Neuropsychological Test Battery. Only when I though seriously about that possibility I remembered a radio interview and discussion of more than twenty year ago with a young woman who wrote a book about her autism. I still remember my amazement that autism is so many degrees and of several types and not only the typical condition of childhood disintegrated intellectual faculties. She also indicated that she had moments or sort of periods when she was in touch with “your reality” but still was unable to have full contacts with US. I compared Trump’s symptoms to this case and others that I reviewed to prepare for my post. I was more comfortable with the diagnosis of autism than any psychodynamic diagnosis. What encourages me to stick to that possibility is what is known about Winston’s Churchill’s known diagnosis as a child of being autistic. One of the Nobel prize winners (Dr. Nash was a severe case of autism). My internet part of my survey brought to me a memory of a grandmother who told me about her autistic grandson. She said that he sometimes had what looked like clear up of his autism for a couple of hours. During that period, he liked to draw and she showed me some of his drawings. They were of apartment buildings and streets that were very neat and had unusual details. On one of the pages in an article on autism there a drawing by an autistic person which was very similar to that child’s drawings, both in the subject and the details of the subject. I think the young woman’s statement of being in our reality explains the drawing of the autistics: they sometimes get fully if not intensely immersed in external reality. The review of the recent literature on autism gave me the impression that trump could easily fit in this category of psychopathology, but even explain many contradictions in his image as a normal person.
My suggestion that Trump could have a degree or a type of autism which gives this unusual clinical picture is not based on positive neuropathological signs but on the insufficient presence of psychodynamic signs that could also take care of his mental and cognitive symptoms.
3.     Trump the Misfit that Fits Perfectly:
Trump’s inability to navigate a thinking process, to realize the necessity of taking definite positions from the reality he is facing, and his innate limited affective life are truly handicapping factors in his performance as the president of a country with size and importance of the USA. There is no way to avoid two questions: What could that historical anomaly mean in general terms? How could we understand such gross historical mistake?
The election system in the US is not strait forward one person one vote.  There are certain other provisions related to an early (historical) reservation that required creating a checks and balance way to avoid a simple one person one vote system. As a result, Trump did not get the majority votes but was elected by the power of his party. To put it bluntly, according to one person one vote principle Trump did got the presidency the common meaning of the term democracy.  Coincidentally, this result is logical under the general circumstances. I mentioned before that there is another factor in social movements beside the nature of the leader that determines the outcome. At a time when history is at a major general turning point the political succession in the different parts of the world seem to happen in a predetermined way, where the change in political authority gets more systematized according to stable dialectical system.
Since the end of the second world war the world was reorganizing it self in a way that evades world wars again. In a very brief note: the world got organized on the principle of networking instead of hierarchy. There are few large political constellations of countries that are relating globally without the old notion of a leading nation (the principle of empires). The short form of it: for five or six decades the USA was at the summit of the world: the leader of the ‘good’ nations. Now, the USA is one of a worldwide net of nations. This fact is not sitting well with the US political leadership that maintained that the US is the leader of the ‘free world’. The political administration before Obama entered two unjustified wars to exercise its influence. The two wars did not give the desired result. The outcome was electing the antithesis of bush, a savvy internationalist president who endeared the US and himself to the world. Eight years of that was not enough to turn the US around, and the US is back to the phantasy of “America Great Again”. There came the misfit who fitted this idea perfectly. Trump exemplifies and personifies the US reaction to historical change: a muddled up mind, a white house in disarray, an administration that survives on denial and autistic thinking. Americans stumbled over the best leader for the moment. However, the consistency of historical evolution gives us some clues to what to expect next.
There are some political Taboos in the life of the average America citizen that hinders making changes in the status quo.  There are also some Totems that are worshiped and it would be blasphemous to get rid of or replace. The term working class was a taboo because it was associated with the labor parties in the rest of the world, which were left wing and liberal Thus they were against Americans idealization of individuality and some traditional thought related to ‘moral values”. But, unemployment and wages showed that is called middle class is actually a working class. Lately, the word socialism was mentioned with some difficulty but it is no longer a taboo. The clear defined aspirations of the youth in the states is also a sign of the death of another taboo which is the need for more political parties in a country as vast as the US with its population diversity. Till now there are factions in the two parties that seem to be clearly ignoring the social, political, and ideological taboos. The Totem of the forefathers seem to be losing is absolutism and sanctity. There are significant questions raised about the rights of the individual and the authority of the government in regard to social versus moral conflicts.  
Trump is fit for this stage in American and Global change. He is so imposing to let us forget what should be done. Whether the antithesis of Trumpism will com in two years or six is not easy to predict.
What about psychoanalysis!  
Because this posting is written with psychoanalysis and psychoanalysts in mind I wish that what I am concluding from politics (in the US in particular) can be applied to the crisis of psychoanalysis: it has taboos and Totems that need to be examined so we get ourselves rid from our self-imposed chains. We need to get rid of the taboo of training and adopt the natural idea of education. We should get rid of the taboo of personal analysis as therapeutic necessity and accept it as a didactic step in the formation of the analyst. We should get rid of the taboo that the psychoanalysis is a profession of psychotherapy and look at it as a human science instead. We should get rid of the Totems of the old schools and avoid forming new Totems of the new forming schools. We should get rid of the Totem of the training analysts and accept the fact that analysis is not transmitted from generation to generation through ‘master’ but thorough teaching systems.
We should accept that we are not a special breed of professionals because we a closed community of practitioners; no autism.

Monday, 18 June 2018

This posting has two more parts

               Trump outside the circle of psychodynamics.

For a none American who knows the USA reasonably well watching what is happening there, for the last two years, is unsettling. I thought that I can fairly understand historical events if I meant to analyze them, but I am not sure anymore. The election process in the USA with Trump’s role in it, ending being elected by a twist in the process, backed by minority popular voters who became the only recognizable political force in the country, succumbing the will of the Republican Party to its will, creating a cult of Trump, and changing the balance in democracy in the country is too much to fathom. All that need acrobatic political analytic efforts to explain. Understandably, mental health professionals directed their attention to Trump the person. He is a glaring case of “strangeness” that is also difficult to make sense of. They did not ask the question: how on earth could that man-whoever he is - be the president of such an impressive country, accepted by millions of Americans, and become an unchangeable political power. They tried to understand him to understand and explain the phenomena, instead of understanding the phenomenon first to explain him.

I want to explain my basic stand about social evolution. There is no leader (from Moses to Ghandi and Mao) that could initiate a people’s movement which could change the course of history. Those historical movements create leaders or find them and make them lead the people to achieve their aspirations. Germany of after Versailles looked for a Hitler to avenge their humiliation and chose the Jews to project on them their sense of isolation and helplessness. There is another factor that I will mention by the end of the posting which is equally decisive in having a wider view of matters.  Trump looks like that kind of leader. He-as an individual- is of no real qualities to lead the USA anywhere. But what the US aspires to achieve seems to need a period of “Trumpism”. The USA stumbled over him by mere chance. However, there is no doubt that Trump as an individual is a fascinating pathological specimen.

1.     The Problem of Diagnosis:

Mental health professional, and psychoanalysts in particular, have a inclination to giving psychodynamic explanations to human phenomena. They usually get away with that-without any demands for justifying themselves- because human phenomena are engendered by psychical dynamics, which is the domain of their expertise. Sometimes the ease dictates taking this venue in understanding, but most of the time this tendency tempts to overlook or disregard important non-psychodynamic issues in the phenomenon which could be more significant. Trump is a model of this case. He is amazing in magnifying some of the purist psychopathological conditions which analysts and psychiatrists know well. Even a beginner could still get few things right about his personality because of that. As an analyst, and watching experienced colleagues trying their hand in that ‘attractive’ exercise I also tried-mostly silently- to participate. I did not have anything new to add. I was not completely convinced that Trump is just a case of psychopathology of psychodynamic nature. I had two reasons for my doubt. My initial feeling was that he is a facade of a social phenomena that is brewing in the USA, thus working on the individual forecloses on the phenomenon. He seemed to have come-unexpectedly- as a suitable leader for social change. The second is purely professional. As a clinician I was tempted for a long time to use the obvious to categorize Trump. but all my attempts failed to give me a satisfying result.
There is no arguing about the mental unwellness of Trump. Even his ardent supporters could not find in him any signs of mental stability to counter the attack on his mental condition (that is why he is more of a social phenomena than an individual case). Even the notion that he is acting erratically as a strategy did not hold much water because he got himself confused by his own erratics. However, the two main areas of psychopathology the professionals focused on were narcissism and character disorders emanating from narcissism. Trump’s speeches and his compulsive depiction of himself in self-aggrandizement terms made narcissism jump the line in the choice of diagnosis.  However, Dr. R. Jackson was one (to my knowledge) who thought of neuropsychological testing because the man exhibited unmistakable features of lack of contact with external reality, even his own. The man was incessantly talking nonsense about himself to his political base (a bad case of arrogant ignorance, and self-centeredness) with no sign of being aware of what is happening outside his opinions regarding local and international affairs. His opinions were considered by him and by his supporters as realities. All his speeches even those pertaining to important issues were always and quickly turned into personal issues (I said to myself !!!!).

To make it easy to discuss this feature in Trump I will mean by reality ‘issues’. He is totally unable to discuss issues; they instantly change to opinions, his off course. Opinions about issues then become the reality of the issues: “We have the greatest recovery in history”, “this is the worst agreement ever been reached”.  A second feature is the instability of those realities.  Although his realities [opinions] are totally his creation they are unstable and change easily because they are not formed in relation to a real situation in the first place. Trump, and the white house never admit making mistake because in actuality there was nothing right or wrong with the issue; it was only an opinion not a fact. After the fiasco of the G7 meeting he said that he does not care that the relationship with the seven allies has deteriorated and that they are now terrible. The following day, as a reaction to a journalist suggesting that he alienated his best allies, he immediately denied that there is any problem with the relationship with the allies and that they are 10. Changing an issue into an opinion and holding on to the opinion as the substitute for ‘reality’ gives Trump a feeling that whatever he says is real (not noticing that he is not talking about reality). This is what the press and critiques call lies!! It is important to emphasize that this happens not as strategy political maneuver but come as an authentic assessment of matter.
This is the material we clinicians use to reach a diagnosis. It is evident that the only certain and assured element in this picture is its uncertainty and unpredictability of Trumps responses.. 

2. Narcissism and Character Formation

Trump has a difficulty-almost an impossibility- in dealing with anything that is not him. For the last two years he did not discuss, explain, justify one of his grand statements about what he accepts or rejects. “the Iran agreement is the worst agreement ever”. He did not say what was wrong with it, He always followed those kinds of statements with complementing statements about his unmatched ability to do better. The important part in this unfailing observation turns any subject into a personal matter. He changes what is not him into him or his in order to be able to talk about.  I mentioned in another place that Trump does not lie or contradict himself because whatever he says is not coming from judging something that existed outside him but only something different that he ‘now’ considers true. To lie one has to know the truth of what he intends to change, but if he changes it first and then talks about what he changed as the fact you would not be lying.  A lie is an intentional conscious distortion of what is real, thus Trump is incapable of truly lying because he does not know or have any reality. The most vivid moments in his encounters with the media is when asked about his Russian contacts. He vehemently denies the existence of that matter because it seems to him that it did not happen. What confirms this ‘ridiculous fact’ is the lack of intention or preparation or thinking of lying. His so called lies come spontaneously as reactions to the issue raised at the moment. The two features of the absence of reality and the absence of intentionality in Trump’s comportment refute the diagnosis of narcissism or character disorder, but strongly suggest a rather alarming psychopathology of another kind.

Narcissism is an unconscious behavioral condition that in some cases could become compulsive behavior. The narcissist does not talk about the qualities that constitute his narcissism; he lives those qualities preconsciously, but mostly unconsciously. A narcissistic woman who thinks she is pretty carries herself as a beautiful woman; seldom would she mentions that verbally. A narcissist would have an image of himself and develops an affective relationship with that image and lives it instead of living his real life. Narcissism is getting captivated by an image of the self and loosing contact with the true self. This is why there is narcissistic self- hate like the man who is obsessed by his image as a short person. The narcissist has an image of himself and believes others see it and evaluate it the same way he does. Trump has no such narcissistic image. He describes for himself an image of him of him and keep repeating it in order complement his loss of identity. He even describes that image to others to see, almost like someone who is not sure people will notice him spontaneously. No narcissist would tell others “I am so rich, I am a genius, I bet you are so happy that God gave you me to be your president.”. A narcissist would like to hear people say that bout him, though not say it himself. No narcissist would lower himself by telling people what they should see in him because he believes that his narcissistic qualities are self- evident. Trump is not sure of how people see him or even if they see him at all. He keeps painting that picture nonstop. One of the related feature in Trump is the exaggerated adjectives he uses all the time to assure himself that he will be seen as real.

Character formations happen over the time of growing up as defensive mechanisms against external pressures (the parental and social demands) and internal pressures (sexual and aggressive). Character structures reveal the basic childhood experiences and their interplay in structuring the intrapsychical formations. Previously, when the psychoanalytic theory included the psychosexual modality of development, analysts were able to notice the workings of a stage of development (oral for instance) in the formation of a character type (oral personality). Freud has an interesting and thought-provoking paper on that subject (Libidinal Types. 1931).  This way of looking at character formation is long gone. Yet, what replaced it (Ego, Self, Projective\Identifications, Enactment), etc. did not do much more than distorting the concept. Any suggestion of a character formation that describes Trump in those new contexts will face the problem of defining the character. The man has no definable character. Moreover, if he is a mixture of charters we will not be able even to settle on that because the mixture is not even stable enough to allow predictability. Therefore, I have to say that any diagnosis of Trump’s character misses the obvious: the man has no definable stable character formation. The old explanation of character formation would tell that Trump did not deal with neither external nor internal pressure to develop and require a charter formation. This goes well with what we noticed before about his handicap in dealing with reality of any sort. We also noticed his substandard ability to control his inner pressures and act them out uncontrollably, whether with lawyers, women, colleagues, etc.

If Trump is not able to deal and mange reality, and has no character formation that gives him a stable place in the society, at least as a predictable entity, what is the psychoanalytic diagnosis of such condition? We might encounter all those features in any psychopathological condition because they indicate absence and lack of what should be there and not the presence something that could be defined.