Page 17 - Too Much and Never Enough - Mary L. Trump

outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—but the label gets us only so far.
I received my PhD in clinical psychology from the Derner Institute of Advanced Psychological Studies, and while doing research for my dissertation I spent a year working on the admissions ward of Manhattan Psychiatric Center, a state facility, where we diagnosed, evaluated, and treated some of the sickest, most vulnerable patients. In addition to teaching graduate psychology, including courses in trauma, psychopathology, and developmental psychology, for several years as an adjunct professor, I provided therapy and psychological testing for patients at a community clinic specializing in addictions.
Those experiences showed me time and again that diagnosis doesn’t exist in a vacuum. Does Donald have other symptoms we aren’t aware of? Are there other disorders that might have as much or more explanatory power? Maybe. A case could be made that he also meets the criteria for antisocial personality disorder, which in its most severe form is generally considered sociopathy but can also refer to chronic criminality, arrogance, and disregard for the rights of others. Is there comorbidity? Probably. Donald may also meet some of the criteria for dependent personality disorder, the hallmarks of which include an inability to make decisions or take responsibility, discomfort with being alone, and going to excessive lengths to obtain support from others. Are there other factors that should be considered? Absolutely. He may have a long undiagnosed learning disability that for decades has interfered with his ability to process information. Also, he is alleged to drink upward of twelve Diet Cokes a day and sleep very little. Does he suffer from a substance- (in this case caffeine-) induced sleep disorder? He has a horrible diet and does not exercise, which may contribute to or exacerbate his other possible disorders.
The fact is, Donald’s pathologies are so complex and his behaviors so often inexplicable that coming up with an accurate and comprehensive diagnosis would require a full battery of psychological and neuropsychological tests that he’ll never sit for. At this point, we can’t evaluate his day-to-day functioning because he is, in the West Wing, essentially institutionalized. Donald has been institutionalized for most of his adult life, so there is no way to know how he would thrive, or even survive, on his own in the real world.