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Can Trump change his spots?

President-elect Donald Trump's surprising victory has galvanized both those inspired and devastated by his win. (Video by Algerina Perna/Baltimore Sun)

By any criterion, Donald Trump is a pathological narcissist. This means that he over-identifies with a self-created, rigidly held self-image, which is usually credited to a defense against a serious psychic insult that occurred early in life. In the attempt to make his day-to-day experience match that ideal image, Mr. Trump has become the center of his own world where everyone else is a mere satellite. His kind of narcissism is considered pathological because his lack of concern for anyone but himself leads him to think, feel and act in ways that diminish and damage everyone and everything he touches.

During the election, Mr. Trump put on what could be considered a "clinic" of pathological narcissism. From his opinions, he created his own facts. Truth for him is what it needs to be at any given moment. A day later, the need may be different so that what was "true" before takes a180-degree turn. To some extent, we all create our own worlds, but Mr. Trump does so with little or no regard for the effect his actions will have on others. Only he counts. We have had narcissists at all levels of government before, but none so virulent as this man has shown himself to be.

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In February 2015, at the start of his campaign for the presidency, Mr. Trump told a reporter that, as president, he would act differently than he had as a businessman, reality TV mogul and presidential candidate. But how differently?

The gracious Donald Trump we saw and heard on election night was a winner, if unexpectedly. But how would he react if, as president, he lost a major battle with Congress, or was humiliated by a foreign power? Could he authentically handle the kinds of insults to his self-image that would typically require him to make a highly destructive response in the effort to salve his narcissistic wound? Mr. Trump's tenuously held sense of self depends on a constant external reaffirmation of the rigid self-image that is at the core of his being. He withers without attention, particularly media attention. Could he survive the major setbacks that are inevitable in any presidency?

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The "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) considers pathological narcissism a personality disorder, which is defined as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." The key word here is "enduring." In the process of a continuous self-creation, pathological narcissists repeat a habitual pattern of thought, emotion and behavior as they interact with others and deal with events they encounter. This pattern, according to the DSM-5, is characterized by grandiosity, need for admiration and lack of empathy. (I should point out that there are healthy iterations of narcissism.)

That said, what we know about the psychobiology of the self tells us that we are psychologically and biologically "plastic," which is to say capable of changing. Pathological narcissism is a deeply entrenched distortion of the self, but one that is always played out with others. The change in environment that Donald Trump will experience when he becomes president in January offers him possibilities for positive change.

Once in the White House, Mr. Trump could discover a higher purpose. This epiphany would require a structural change in his being: a shift from the kind of self-gratification that focuses only on his needs to one that benefits others and the world. So far, everyone and everything in Mr. Trump's life has been about serving and gratifying Donald Trump. But he cannot succeed as president if his behavior continues to be shaped by his narcissistic template. He will not get away with short-selling the United States and other nations, or reneging on promises he made during the campaign to certain groups (blue collar workers, blacks, Latinos).

We — and Donald Trump — are in uncharted territory. No one knows the limits of what Friedrich Nietzsche called the "will to power," our capacity to use our freedom to accomplish a desired goal. The question is, now that, for the first time, Mr. Trump is explicitly being asked to work for others and not just pursue his own enrichment and gratification, will he rise to the challenge? Even a moderate overcoming, and blunting, of his narcissistic pathology would mean better lives for us all.

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René J. Muller is a psychologist and the author of "Doing Psychiatry Wrong." His email is mullerrenej@aol.com.

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