No, your ex is not a psycho and why we shouldn’t diagnose Donald Trump

My ex is a psycho.

I’m so OCD about this project!

I Can’t Focus; It’s My ADHD.

You may well have heard similar expressions. And it’s not just in popular discourse. The extract below comes from a 2010 article, Politicians’ wives are not the story in the prestigious British newspaper, the Guardian:

Twentieth-century legislation giving women the vote, and much later the right to equal pay for work of equal value, has not prevented a schizophrenic attitude – at least in Britain – if you are the wife of a “celebrity”.

This article was subsequently amended. The use of schizophrenic contravenes the Guardian’s style guide, which states that this term should only be used in a medical context. It was replaced by two-minded. I think contradictory or ambivalent would have been better. Later in the same year the Guardian’s sister paper, the Observer, described TV presenter Gok Wan’s dress sense as “schizophrenic”. Pierre Lellouche, the French Minister for Europe described the UK Tory party’s approach to the EU as autistic. In an article for the Sunday Times, the writer Robert Harris described Gordon Brown and Richard Nixon as displaying “political Asperger’s syndrome“. The International Monetary Fund’s September 2011 World Economic Outlook characterised a volatile global economy as “bipolar”. There are many more examples. We say to commit suicide even though killing yourself is no longer a crime. Somebody who is angry is not ‘psychotic’. And finally I’m not wild about the use of phobia in xenophobia, homophobia and Islamophobia, suggesting some kind of medical condition.

In a sense psychiatry has become a victim of its own success. These terms have become part of the public discourse, like all that awful psychobabble, such as closure, in denial, co-dependency and issues.  The problem with using casual metaphors about mental conditions is that these words have real meaning, and you are trivialising and stigmatising them at the same time.  Just because someone likes to put their books in alphabetical order does not mean that they have OCD. The case of schizophrenic is particularly egregious. To put my pedant’s hat on, it is also being used incorrectly. Schizophrenic does not mean in two minds. It has absolutely nothing to do with multiple personalities. Schizophrenia does indeed mean split mind but the mind is split with reality, not itself. A 2007 study of the terms “schizophrenia” and “schizophrenic” in the UK national press found that 11% of references were metaphorical, with the broadsheets, see above, more likely to use the term in this way than the tabloids. In the US the figure was said to be 28%. By contrast, cancer was only used in this manner in 0.02% of cases. Likewise if someone puts four sugars in their tea we do not say, “Don’t be so diabetic!”

Here is a lovely video which explains all this:

It is, however, very difficult to stop humans from employing metaphors. It’s what we do. In a previous post, Living in a metaphor, I argued that metaphors are a fundamental part of how we communicate. Words change their meaning with usage and it is very hard to stop this. There is no Czar in charge of word meanings. I have been guilty of a number of the sins I have listed above. Nevertheless, it is a good thing to be aware of what we are saying. The Time to Change website has this section, where they critique the language of the media and provide some alternative suggestions:

Avoid using:

  1. ‘a psycho’ or ‘a schizo’
  2. ‘a schizophrenic’ or ‘a depressive’
  3. ‘lunatic’ ‘nutter’ ‘unhinged’ ‘maniac’ ‘mad’
  4. ‘the mentally ill’, ‘a person suffering from’ ‘a sufferer’, a ‘victim’ or ‘the afflicted’
  5. ‘prisoners’ or ‘inmates’ (in a psychiatric hospital)
  6. ‘released’ (from a hospital)
  7. ‘happy pills’

Instead try:

  1. ‘a person who has experienced psychosis’ or ‘a person who has schizophrenia’
  2. someone who ‘has a diagnosis of’ is ‘currently experiencing’ or ‘is being treated for…
  3. ‘a person with a mental health problem’
  4. ‘mental health patients’ or ‘people with mental health problems’
  5. ‘patients’, ‘service users’ or clients
  6. ‘discharged’
  7. ‘antidepressants’, ‘medication’ or ‘prescription drugs’

And we have the recent controversy about the mental health of Donald J. Trump. There is a lot of armchair psychologising going on. Whenever I hear Trump I think of what is known in psychology as the dark triad of psychopathy, narcissism and Machiavellianism. Recently there has been a petition at #DiagnoseTrump calling for mental health professionals “to come forward and urge the Republican party to insist that their nominee has an evaluation to determine his mental fitness for the job.”  According to the petition, Trump appears to exhibit all the symptoms of the mental disorder Narcissistic Personality Disorder (NPD).

The US magazine the Atlantic published a psychological evaluation of Trump, written by Dan P. McAdams, a psychology professor, who provides a firm diagnosis, despite the fact that Trump declined to be interviewed and did not give his authorisation for publication. This is grossly unfair and unethical; it goes against the Goldwater rule, AKA Section 7.3 of the American Psychiatric Association’s (APA) code of ethics, which states that professionals should not offer public opinions on people they have not personally examined:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

We need a bit of background here Barry Goldwater was the Republican Party’s nominee for president in the 1964 election. He was a controversial figure, who voted against the Civil Rights Act of 1964. He thought the parts that outlawed discrimination in hotels, restaurants, cinemas etc. were a violation of individual liberty. What is germane to this post is that in 1964 Fact magazine published the article The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater. The title was a bit of wordplay on Goldwater’s own book title, The Conscience of a Conservative. They polled psychiatrists about American Senator Barry Goldwater and whether he was fit to be president. He filed a libel suit in response to the article; he won $75,000 in damages. He was less successful in the election, suffering a landslide defeat to Lyndon Johnson, getting 38.5% of the popular vote and gaining only 52 votes in the Electoral College.

In another recent All in The Mind Podcast Dr Margaret McCartney criticised this way of diagnosing Trump. Like the casual metaphors above, it both trivialises and stigmatises mental health issues. I’ll leave you with McCartney’s own conclusion about Trump:

It s obvious that Trump is sexist and racist. He’s vile in his nastiness, undiplomatic, and offensive: a true dog’s dinner of a presidential candidate, if you really hated your dog. But none of this means that he has a psychiatric condition. It just means that he’s a horrible man.



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