The Dangerous Case of Donald Trump

Social Contexts and Psychological Vulnerability

EDWIN B. FISHER, PH.D.

At nine o’clock, Tuesday morning, October 16, 1962, the special assistant for national security entered the living quarters of the White House with startling news: “Mr. President, there is now hard photographic evidence that the Russians have offensive missiles in Cuba” (Neustadt and Allison 1971). During the next thirteen days of the Cuban Missile Crisis,1 the world faced a horrible threat. Fewer than one in five U.S. citizens alive today is old enough to remember well the experience of those events, but the sense of possible doom was profound. Sitting in Mr. Capasso’s eleventh-grade History class, I thought that we all might not be there in a day or two. Spy satellite photos showed that the Soviet Union was within weeks or perhaps days of finishing the installation of missiles in Cuba capable of reaching major U.S. East Coast cities. As this is being written, many are calling the possibility of North Korea possessing operational nuclear-armed rockets capable of reaching U.S. West Coast cities within several years the greatest threat we face. Imagine if we were in the same position as in 1962: “Our military experts advised that these missiles could be in operation within a week” (Kennedy 1971).2

In reacting to the threat, President Kennedy brought together the “best and the brightest,” to borrow David Halberstam’s term for the Kennedy Cabinet and advisers (Halberstam 1972). They included the secretaries of state and defense, the UN ambassador, other senior policy advisers, the Joint Chiefs of Staff, and the president’s highly trusted brother Robert, the attorney general. They debated daily over the period, considering varied alternatives. There was only one problem with this “best” and “brightest” advice. They disagreed. Indeed, they disagreed sharply. President Kennedy was left to make the decision. As President George W. Bush put it, President Kennedy was “the decider.”

That the most powerful person in the world can be isolated and lonely in making fateful decisions dramatizes the importance of classic questions. How does the individual shape her/his world, and how does that world shape the individual? Research makes clear, for example, the fundamental value of social connections, that their absence is as lethal as smoking cigarettes (Holt-Lunstad, Smith, and Layton 2010; House, Landis, and Umberson 1988). So, too, the varied group of individuals who advised President Kennedy clearly influenced his perspectives and choices. On the other hand, President Kennedy shaped the variety of perspectives of that group of advisers.

This chapter examines two major themes. First, it examines the interplay among social contexts and individual characteristics as they were apparent in and around President Kennedy in 1962. The strategies, personal characteristics, and social settings that surrounded the president during those thirteen days pose important questions for our current evaluation of President Trump. The second theme is an emphasis on the patterns of behavior that result from that interplay of person and context. Emerging through that interplay, it is those behavior patterns themselves, not speculations about either their interpersonal or personal sources, that provide us confidence in a leader’s ability to make fateful, lonely decisions.

The 1962 Crisis

Many of the Joint Chiefs of Staff felt that air strikes and an invasion were clearly necessary. In arguments that sound very current in 2017, they argued that the incursion of Soviet missiles into our hemisphere could not be allowed to stand, that a line needed to be drawn, and that clear and decisive action was required. Others argued that there was little reason to respond aggressively. Secretary of Defense McNamara articulated one of the strongest arguments for a modest response, pointing out that nuclear warheads would kill just as many people whether they came from Cuba or somewhere else. Others encouraged diplomacy and working with the Soviets. Complicating this strategy was the fact that the Soviet foreign minister had clearly lied to President Kennedy in denying the existence of the missiles after the president already had the satellite photos showing their installation.

In the end, President Kennedy chose a firm response, but one that did not include a direct attack in Cuba. He established a naval quarantine that would not allow any ships carrying munitions to enter waters around Cuba. Soviet ships were on their way and not turning back. What would happen if they challenged the quarantine? In written exchanges, two messages were received from the Soviets. One clearly reflected the hard-liners in the Kremlin. A second, apparently written by Premier Khrushchev himself, was far more conciliatory. In an important model of wise negotiation, President Kennedy ignored the belligerent message and responded to the conciliatory one. At almost the literal eleventh hour, 10:25 a.m. on Wednesday, October 24, a message came from the field: “Mr. President, we have a preliminary report which seems to indicate that some of the Russian ships have stopped dead in the water … or have turned back toward the Soviet Union.” The world breathed.

President Kennedy’s Strategies

Especially striking in his brother Robert’s recounting of those thirteen days (Kennedy 1971), President Kennedy was determined to consider the position of the antagonists, Premier Khrushchev and the other Soviet leaders. Recognizing strong militarist forces in Moscow, Kennedy realized that “We don’t want to push him to a precipitous action … I don’t want to put him in a corner from which he cannot escape.” From their previous communications, he recognized that Khrushchev also did not want war and agreed that a nuclear war would doom the planet. In a letter reflecting a remarkably personal dimension of their relationship, Khrushchev wrote to Kennedy during the height of the tensions:

I have participated in two wars and know that war ends when it has rolled through cities and villages, everywhere sowing death and destruction … Armaments bring only disasters … they are an enforced loss of human energy, and what is more are for the destruction of man himself. If people do not show wisdom, then in the final analysis they will come to a clash, like blind moles, and then reciprocal extermination will begin …

… Mr. President, we and you ought not to pull on the ends of the rope in which you have tied the knot of war, because the more the two of us pull, the tighter the knot will be tied. And a moment may come when that knot will be tied so tight that even he who tied it will not have the strength to untie it … Consequently, if there is no intention to tighten that knot, and thereby to doom the world to the catastrophe of thermonuclear war, then let us not only relax the forces pulling on the ends of the rope, let us take measures to untie that knot. We are ready for this.

President Kennedy’s understanding of the other person’s point of view extended to his own advisers as well as international adversaries. In his memoir, Robert Kennedy noted that after the Russians agreed on Sunday, October 28, to withdraw their missiles from Cuba, “it was suggested by one high military adviser that we attack Monday in any case. Another felt that we had in some way been betrayed.” He goes on: “President Kennedy was disturbed by this inability to look beyond the limited military field. When we talked about this later, he said we had to remember that they were trained to fight and to wage war—that was their life.”

President Kennedy also cultivated allies. He recognized that a stand-off with the Soviet Union without allies would put the United States in a very weak position. He worked with the Organization of American States to gain endorsement of the U.S. position and was successful in its turning out to be unanimous. He cultivated European allies and gained a strong endorsement—“It is exactly what I would have done”—from President Charles de Gaulle, the assertively nationalist leader of France and its greatest World War II hero.

In cultivating his allies, President Kennedy was highly aware of the importance of his and the United States’ credibility. He was careful throughout the crisis to communicate honestly, with neither hyperbole nor minimization, about the facts on the ground and the U.S. response.

Finally, President Kennedy was a cagy negotiator. In the course of negotiations, Premier Khrushchev raised a counterdemand that the United States remove its own Jupiter rockets from Turkey. This was especially frustrating because President Kennedy had previously recognized their obsolescence and very modest strategic value and so, sometime before the Cuban Missile Crisis, had directed that they be removed. Now he was clearly willing to meet this demand of the Soviets, but not publicly and not at the same time as the removal of the rockets from Cuba. So, he promised their removal in the months ahead and, fortunately for us all, had cultivated enough good faith with Premier Khrushchev that this unsecured promise was accepted.

Illustrative of his broad reading, President Kennedy had found much of this negotiating stance in a book he had reviewed in 1960, Deterrent or Defense, by the British military analyst Basil Liddell Hart: “Keep strong, if possible. In any case, keep cool. Have unlimited patience. Never corner an opponent and always assist him to save his face. Put yourself in his shoes—so as to see things through his eyes. Avoid self-righteousness like the devil—nothing is so self-blinding.” Kennedy’s habits of mind, organization, administration, and leadership have been accorded substantial responsibility for the avoidance of catastrophe in 1962.

Taking advantage perhaps of a time of more common bipartisanship, Kennedy sought counsel from a wide group, including Republicans such as John McCloy, a former U.S. ambassador to the United Nations, and Dean Acheson, secretary of state under President Truman and a highly opinionated authority in foreign affairs. His own secretary of defense, Robert McNamara, had been a Republican and a CEO of the Ford Motor Company. Even though he was secretary of the treasury, President Kennedy included Douglas Dillon, for whose wisdom he had great respect. Dillon had also been President Eisenhower’s undersecretary of state. In addition to the highly respected “old hands” of McCloy, Acheson, and Secretary of State Dean Rusk, he included much younger individuals as well. McGeorge Bundy, a former Republican, had already been dean of the Harvard faculty when, at forty-one, he became special assistant for national security in 1961. Clearly, Robert Kennedy was a close, most trusted and apparently constant confidant, but beyond his brother, President Kennedy cultivated a broad and varied group of advisers, not an inner circle of three or four. President Kennedy was thoughtful not only in assembling these divergent views but also in cultivating them, such as by having his advisers meet without him so that his presence would not tilt opinions in his direction or stifle free exchange.

Actions such as those of President Kennedy are often attributed to the “great man,” to the remarkable or praiseworthy characteristics of the individual. President Kennedy’s actions in the Cuban Missile Crisis reflect his wisdom and skills but also the social relationships that surrounded him. That he took a hand in constructing and managing these relationships points to an important dialectic between the individual and the social, but diminishes neither.

Social Networks and Support

Many studies document the impacts of social relationships. One of the most provocative found that social connections with spouse, parents, family members, coworkers, groups or organizations protect against the “common cold” (Cohen et al. 1997). What was most important about this finding, however, was that it was not just the number of social connections that protected against symptoms such as a runny nose, but also their variety. Having many versus fewer friends was not protective, but having a variety of types of relationships with family, friends, etc. resulted in fewer symptoms following exposure to a cold virus. Similarly, the variety of social connections predicted death among older adults in a more recent study (Steptoe et al. 2013).

Why should the variety of social connections matter? One answer comes from work many years ago by the anthropologist Erving Goffman, in his study of “asylums” such as prisons and mental hospitals. Goffman observed that inmates or patients in such institutions have but one social role. The patient hospitalized in a psychiatric facility is seen by all (professionals and staff, family members, former acquaintances, and even other patients) as a patient with a mental illness, not as a spouse, child, friend, or coworker (Goffman 1961). Being stuck in one role limits our ability to buffer the stressors of daily life. This is because we often cope with stressors in one setting by complaining, getting advice, or simply seeking solace in another. We complain about our coworkers to our spouses and complain about our spouses, children, and/or in-laws with our coworkers or close friends. For the hospitalized schizophrenic patient, however, this is not possible. As all come to see her/him as schizophrenic, all complaints to or about family, friends, hospital staff, doctors, etc. are taken as expressions of schizophrenia, and thereby invalidated. The individual is isolated in only one role from which she or he cannot escape.

The importance of not being locked in one role, even as the all-powerful president, is reflected in a current book on the office of White House chief of staff (Whipple 2017). A recurrent theme is the importance of the chief of staff being the one person who can tell the president he cannot do something. President Carter’s initial decision not to have a chief of staff and then appointing one who was not an effective manager is suggested as a major cause for problems in his administration. Turning to President Trump, doubts about his trust in his chief of staff are frequently cited as key to problems in the execution of his plans during the early days of his administration.

Applying Goffman’s observations to the president of the United States is ironic. Goffman developed these ideas in observing and trying to understand the challenges of those stripped not only of their multiple roles but also of their independence and freedom. But the observation may also apply to those who become isolated in a single social role amid privilege. A concern one might raise about President Trump is his apparent choice always to be “the Donald.” Consider, for example, his making Mar-a-Lago an extension of the White House. Rather than preserving it as a place to which he can get away and separate himself at least somewhat from his role as president, he chose to go there weekly during the first months of his administration and to “bring his work home with him,” including his official visitors, such as President Xi Jinping of China.

A final important feature of social connections points also to the importance of varied perspectives. In examining how groups adopt innovations, sociologist and communication theorist Everett Rogers noted the importance of tight-knit, cohesive networks in quickly and effectively acting to implement a good idea (Rogers and Kincaid 1981). But where do the good ideas come from? One source of good ideas was observed to be “weak ties.” One member of a tightly knit group might have a connection to someone in another village, a sister-in-law who is a lawyer, or a job that takes him periodically to the “big city.” Such weak ties, not intimate or especially important in day-to-day activities, nevertheless provide exposure to innovations. The combination of new ideas plus a cohesive network to implement them provides the idea for and the execution of innovation.

The variety, provision of multiple roles, and availability of weak ties in social networks seem to fit well the social setting in which President Kennedy worked through the Cuban Missile Crisis. The variety of connections was clear. An important feature of his network was Kennedy’s preserving of his relationship with his brother, through which he could complain about his group of advisers, perhaps, but also seek an outside perspective in making sense of the advice he was getting. He also read widely and drew on that reading in his thinking. Barbara Tuchman’s The Guns of August, detailing how European leaders miscalculated and slid into World War I, was much in Kennedy’s mind. As noted, President Kennedy maintained “weak ties” with those with varied viewpoints through his wide reading, intellectual curiosity, and openness to a wide range of views.

Turning to President Trump’s social connections, an April 2017 article in the New York Times noted a “group of advisers—from family, real estate, media, finance and politics, and all outside the White House gates—many of whom he consults at least once a week” (Haberman and Thrush 2017). They include nine millionaires or billionaires (Thomas Barrack, Carl Icahn, Robert Kraft, Richard LeFrak, Rupert Murdoch, David Perlmutter, Steven Roth, Phil Ruffin, and Steve Schwarzman); the conservative television cable news host Sean Hannity; the conservative political strategists Corey Lewandowski and Roger Stone; Republican politicians Chris Christie, Newt Gingrich, and Paul Ryan; a financial lawyer, Sheri Dillon; President Trump’s sons; and his wife. Although the article says that President Trump “needs to test ideas with a wide range of people,” those in whom he confides are described as “mostly white, male and older” and were chosen based “on two crucial measures: personal success and loyalty to him.”

A somewhat more critical characterization of President Trump’s circle of relationships emerges through a recent article in The New Yorker, by Evan Osnos: “He inhabits a closed world that one adviser recently described to me as ‘Fortress Trump.’ Rarely venturing beyond the White House and Mar-a-Lago, he measures his fortunes through reports from friends, staff, and a feast of television coverage of himself.”

Quoting Jerry Taylor, “the president of the Niskanen Center, a libertarian think tank,” Osnos describes how “he is governing as if he is the President of a Third World country: power is held by family and incompetent loyalists whose main calling card is the fact that Donald Trump can trust them, not whether they have any expertise.”

As the noted constitutional lawyer Lawrence Tribe (2017) has put it, “He only wants loyalists.” Later, Osnos notes that:

it’s not clear how fully Trump apprehends the threats to his presidency. Unlike previous Republican Administrations, Fortress Trump contains no party elder with the stature to check the President’s decisions. “There is no one around him who has the ability to restrain any of his impulses, on any issue ever, for any reason,” Steve Schmidt, a veteran Republican consultant said.

Of greatest concern, Osnos (2017) reports that

Trump’s insulation from unwelcome information appears to be growing as his challenges mount. His longtime friend Christopher Ruddy, the C.E.O. of Newsmax Media … noticed that some of Trump’s associates are unwilling to give him news that will upset him … Ruddy went on. “I already sense that a lot of people don’t want to give him bad news about things. I’ve already been approached by several people that say, “He’s got to hear this. Could you tell him?”

Psychopathology

Although no firm conclusions should be ventured or considered possible without detailed, firsthand knowledge or examination of President Trump, categorizations of him that have been suggested have included narcissism, psychopathic deviance, and attention deficit/hyperactivity disorder (ADHD). Despite the impossibility of a conclusion, discussion of which one of these may best fit the president has been lively. The assumption that there should be one best diagnosis, however, is at odds with important trends in how we view psychopathology in general. In fact, 50 percent of those qualifying for one diagnosis meet criteria for an additional diagnosis (Kessler et al. 2011). Thus, the inability to reach agreement among speculative diagnoses of the president’s mental status may well reflect that several diagnoses may be pertinent. What is important is not a specific diagnosis but, rather, understanding the behavior patterns that raise concerns about mental status and that affect policy decisions and public welfare.

In addition to overlap among the categories, there is increasing recognition that the diagnostic categories of the DSM-V, the Diagnostic and Statistical Manual of the American Psychiatric Association (American Psychiatric Association 2013), are themselves flawed. For example, a diagnosis of major depressive disorder requires (a) either dysphoria or anhedonia (diminished ability to feel pleasure); (b) four of seven symptoms, such as insomnia, fatigue, decreased concentration/indecisiveness; and (c) the presence of these most of the day and nearly every day for at least two weeks (Ritschel et al. 2013). That means that one person with dysphoria and symptoms one through four and another with anhedonia and symptoms four through seven both meet criteria for the same disorder, even though they have only one feature in common. Similar problems exist with other diagnostic categories, each judged by the presence or absence of sufficient numbers of symptoms or characteristics from a longer list of possible symptoms or features.

A recent approach to categorizing psychopathology that has been promoted by the National Institute of Mental Health focuses on individuals’ strengths or deficits in more discrete categories of psychological function rather than the broad categories of DSM-V. Among these, for example, are acute threat or fear, potential threat or anxiety, sustained threat (such as in PTSD), loss, working memory, cognitive control, affiliation/attachment, social communication, perception/understanding of self and understanding of others, arousal, and biological rhythms (Kozak and Cuthbert 2016). The theme of this approach is that individual functions or groups of functions might account for patterns of aberrant behavior. In the case of President Trump, acute threat, cognitive control, affiliation/attachment, social communication, perception/understanding of both self and others, arousal, and biological rhythms are all functions that may be pertinent to a number of the concerns that have been raised about his behavior. From such a perspective, the issue is not which of such a group of psychological functions might be primary, but how they interact to lead to troublesome patterns of behavior that, in the case of the president, have substantial societal implications. So, an inability to identify “whether it’s basically perceptions of self or perceptions of others” is of little concern. Rather, recognizing the confluence of deficits in these functions as they build an alarming pattern of behavior becomes the basis for sounding an alarm.

If we are to focus on more specific behavior patterns that raise concerns about the mental fitness of President Trump, we still have an outstanding question. How do we judge that a particular characteristic is abnormal, pathological, or indicative of compromised mental fitness? The field of psychopathology and abnormal psychology has long wrestled with this question. When does a quirk or a distinctive personal style become the object of clinical concern and the basis for encouraging the individual to recognize her/himself as having a problem or, even, qualifying for loss of rights or enforced hospital commitment? Among the criteria that have often been proposed for identifying pathology are: resistance to change or to normal social pressure; an almost automatic repetitiveness; disregard for consequences or an inability to adjust behavior according to consequences; harmfulness to self or others; negative impacts on relationships, work, or key interests; and distortions of reality that are frequent, disruptive, and go beyond normal variation in judgments and perceptions. The criteria for identifying psychopathology might be applied to judging the fitness of the president to exercise his power.

For example, what is striking is the persistence of some of his behavior in spite of strong disconfirmation, such as in his arguments about why Hillary Clinton won the popular vote, the size of his inaugural crowd, or the assertion that President Obama had wiretapped him and his colleagues during the election campaign. So, too, he seems not to notice the harmfulness of his behavior, such as in his contradictory and self-indicting comments about the firing of former FBI director James Comey. He also appears to deny or ignore the aggressiveness of his behavior, as in his admonition to “beat the crap out of him” (referring to a protester being removed from a campaign rally) or in the Twitter threat to Comey about the possible existence of recordings of their conversations. Remarkably, these patterns persist despite their negative characteristics receiving broad attention and even though they may place President Trump in jeopardy of criminal charges or impeachment.

Another approach to making the judgment that behavior is a problem lies in the criminal law for judging innocence by virtue of insanity. In most jurisdictions, the criteria for innocence are an inability to appreciate the criminality of one’s actions and to conform one’s behavior to the requirements of the law. Whether this is by virtue of schizophrenia or depression or personality disorder or some other posited diagnosis is not critical. What is determinative is the inability to follow the law and understand how it applies to one’s own behavior. Clearly, many of the instances observed and widely remarked upon with regard to President Trump would suggest an inability on his part to recognize how his behavior is at odds with applicable laws, including the U.S. Constitution. In his disparaging comments about judicial decisions, and in his ad hominem attacks on a judge who presides over one of the cases in which he is a defendant, and in the comments indicating that he asked Comey about investigations of him during a conversation about Comey’s tenure as FBI director, President Trump manifests an apparent lack of recognition of how his behavior is at odds with law, the Constitution, and important precedents for the conduct of his office.

The judgment of “innocent by virtue of insanity” is a legal decision, a finding of innocence, not a finding of psychopathology. Expert opinion about possible pathology may be pertinent to the finding but is not determinative. This suggests considering the judgment of fitness for office as not a medical or psychiatric or psychological question but as a legal and political judgment. As James Gilligan noted at the Yale conference, “It’s not whether [President Trump] is mentally ill or not. It’s whether he’s dangerous or not” (Milligan 2017; Osnos 2017; and Gilligan’s essay in this book, “The Issue Is Dangerousness, Not Mental Illness”). Research and clinical knowledge about mental health may be helpful in making the judgment of dangerousness, but they do not themselves determine the decision. Abraham Lincoln apparently suffered serious depression, but few would say it compromised his ability to serve. Yet, the observations of experts in mental health and psychopathology suggest real liabilities in President Trump’s behavior. The question remains, however: does it matter?

One answer to that final question has recently been posed by strong voices on the conservative side of the political spectrum. Under the title “Trump Has a Dangerous Disability,” George Will wrote in the Washington Post, on May 3, 2017:

It is urgent for Americans to think and speak clearly about President Trump’s inability to do either [i.e., think and speak clearly]. This seems to be not a mere disinclination but a disability. It is not merely the result of intellectual sloth but of an untrained mind bereft of information and married to stratospheric self-confidence …

His fathomless lack of interest in America’s path to the present and his limitless gullibility leave him susceptible to being blown about by gusts of factoids that cling like lint to a disorderly mind.

Americans have placed vast military power at the discretion of this mind, a presidential discretion that is largely immune to restraint by the Madisonian system of institutional checks and balances.

Writing two days later, on May 5, 2017, also in the Washington Post, Charles Krauthammer articulated further the psychological dimensions of President Trump’s fitness to serve:

And this is not to deny the insanity, incoherence and sheer weirdness emanating daily from the White House …

Loud and bombastic. A charlatan. Nothing behind the screen—other than the institutional chaos that defines his White House and the psychic chaos that governs his ever-changing mind …

Krauthammer goes on to describe what he considers to be a blunder of threatening to make South Korea pay for a defensive missile system and to renegotiate trade agreements. He asserts that this blunder forces

lingering fears about Trump. Especially because it was an unforced error. What happens in an externally caused crisis? Then, there is no hiding, no cushioning, no guardrail. It’s the wisdom and understanding of one man versus whatever the world has thrown up against us. However normalized this presidency may be day to day, in such a moment all bets are off.

What happens when the red phone rings at 3 in the morning?

The Social, the Personal, and the President

Our culture tends to put the social and the personal in opposition. Echoing the tradition of the “self-made man,” or Governor Romney’s campaigning about “job creators,” President Trump himself has bristled at suggestions that his business accomplishments are not wholly of his own doing. Consider, too, the scorn of many for Hillary Clinton’s book title It Takes a Village, and contrast that title with Nancy Reagan’s admonition to “Just say ‘no.’” But a major trend in social and behavioral science of the past decades is toward an integration of the development and behavior of the individual with the contexts of culture, community, family, neighborhood (e.g., Fisher 2008). Among numerous examples, living in a neighborhood with only fast-food outlets and no supermarkets raises one’s chances of being obese far more than living in a neighborhood with only supermarkets, even after controlling for important factors such as education, ethnicity, and income (Morland, Diez Roux, and Wing 2006). Similarly, after controlling for other characteristics, community violence is associated with numbers of individuals with asthma and with the frequency of their problems with the disease (Wright et al. 2004; Sternthal et al. 2010). Thus, our social and community contexts have real impacts on our behavior and health. Key, however, to this perspective is recognition of the reciprocal nature of influence; just as the community may influence the family, so the family may influence the community, and the individual may influence both.

The interaction of the personal and the contextual can be seen in President Trump’s often-alleged narcissism and heightened sensitivity to personal insult. A common effect of these is an erosion of social connections as slights lead to aggressive responses that drive others away. The contrast with President Kennedy’s assembly of advisers during the Cuban Missile Crisis is not between one who is socially well connected and one who is socially isolated. President Trump clearly has a number of friends and social contacts. How his personal characteristics may limit the nature and variety of the advice he receives, however, may be a major difference. According to Robert Kennedy’s memoir, if President Kennedy became aware that some with alternative views had been excluded from meetings, he would often “enlarge the meetings to include other options … President Kennedy wanted people who raised questions, who criticized, on whose judgment he could rely, who presented an intelligent point of view regardless of their rank or viewpoint.”

The apparent extent of President Trump’s narcissism has drawn increasing attention. In varied meetings and interviews, his preoccupation with and exaggeration of the size of his Electoral College victory, his claims that voter fraud accounted for Secretary Clinton’s popular vote margin of over 3 million, and his claims about the size of the crowd at his inauguration have been remarkable. Central to narcissism is the self-referential defense. In response to strong condemnation of his sharing highly classified intelligence information with Russian foreign minister Lavrov and Russian ambassador Kislyak, his first tweet read, “As President I wanted to share with Russia … which I have the absolute right to do, facts pertaining…” Noteworthy is the primacy in the tweet of his role “as President” and his “absolute right.” Closely related, too, is the attention to power. Commenting on the choices to disclose top-secret information to the Russians, to be the first to congratulate President Erdogan for a disputed election victory that shrank democratic processes in Turkey, and to praise and invite to the White House President Duterte, widely blamed for thousands of extrajudicial killings in the Philippines, political commentator and journalist Eugene Robinson (2017) summarized it well: “He conflates power with virtue.”

Reflecting the interplay of personal and social, narcissistic concerns for self and a preoccupation with power may initially shape and limit those invited to the narcissistic leader’s social network. Sensitivity to slights and angry reactions to them may further erode it. Those left tend to be indulgent of the individual and to persist for other gains. Either way, the advice and counsel they provide are liable to be guided by their motives for persisting. Also, those who remain are likely to be constrained lest ill-considered words create a rift that distances them and compromises the gains they anticipate. A disturbing feature of this kind of dynamic is that it tends to feed on itself. The more the individual selects those who flatter him and avoid confrontation, and the more those who have affronted and been castigated fall away, the narrower and more homogenous his network becomes, further flattering the individual but eventually becoming a thin precipice. President Nixon, drunk and reportedly conversing with the pictures on the walls, and praying with Henry Kissinger during his last nights in office, comes to mind.

The shrinking of the network to those most loyal in spite of affronts and exploitative treatment applies to the relationships of the office of the president with national and international allies. A number of commentators have suggested that Republicans in the House of Representatives who voted for a new health care bill in early May 2017 would have given President Trump an opportunity to claim an accomplishment around the end of his first one hundred days in office, while giving themselves major problems in their reelection campaigns in 2018. So, too, much has been written about the international importance of trust in the president’s words. Especially as his own and his advisers’ descriptions of the firing of FBI director Comey have collided, and after his sharing of highly classified intelligence information with the Russian foreign minister and ambassador to the United States, writers have questioned the ability of President Trump to draw allies together in a major crisis if they are untrusting of his assurances or his characterizations of events. Writing in 1967, Robert Kennedy anticipated much of this concern:

[H]ow important it was to be respected around the world, how vital it was to have allies and friends. Now, five years later, I discern a feeling of isolationism in Congress and through the country, a feeling that we are too involved with other nations, a resentment of the fact that we do not have greater support in Vietnam, an impression that our AID program is useless and our alliances dangerous. I think it would be well to think back to those days in October, 1962.

Kennedy goes on to recount the importance of the support from the Organization of American States, the NATO allies, and critical countries in Africa (Guinea and Senegal), from which Russian planes might have delivered arms to Cuba, circumventing the quarantine. The trust and affirmation of all of these “changed our position from that of an outlaw acting in violation of international law into a country acting in accordance with … allies.”

The narcissism that is central to the shrinking networks of those who seek blind loyalty and flattery in their relationships leads also to a preoccupation with the credit and praise received. President Trump’s preoccupation with his election or the size of his inaugural crowd contrasts sharply with President Kennedy’s stance at the end of the thirteen days:

After it was finished, he made no statement attempting to take credit for himself or for the Administration for what had occurred. He instructed all members of the Ex Comm and government that no interview should be given, no statement made, which would claim any kind of victory. He respected Khrushchev for properly determining what was in his own country’s interest and what was in the interest of mankind. If it was a triumph, it was a triumph for the next generation and not for any particular government or people.

A fitting end to this chapter draws on the concluding words of Robert Kennedy’s Thirteen Days: “At the outbreak of the First World War the ex-Chancellor of Germany, Prince von Bülow, said to his successor, ‘How did it all happen?’ ‘Ah, if only we knew,’ was the reply.” Delicate are the dynamics and nuanced are the judgments that may keep the world safe or plunge it into the abyss. We are currently led by a man broadly flawed in his own person and supported by a truncated set of advisers. As the breadth and “vigor”—to use a word JFK favored—of advice sought by Kennedy in 1962 contrasts with that reported to surround President Trump, so the personal characteristics of President Trump leave us alarmed over the prospect of his narrowing further his network of advisers, leaving him few on whom to rely. The impulsive, ill-considered, narcissistic, reckless, and apparently intentional lies, threats, and bravado not only damage the country but may leave the president even more isolated. That President Trump might ever occupy the loneliness of deciding about a potentially catastrophic course of action is rightly our most urgent and greatest fear.

Coda

Apart from the contrasts drawn here, several similarities in their backgrounds and personal characteristics almost make Presidents Kennedy and Trump something of a natural experiment. Both of their fathers were highly successful in business, men who sometimes worked on both sides of the border of legality. Both were born to privilege. Both went to “the best schools.” Both, apparently, were “womanizers,” but also apparently cared much for their families. These similarities, along with the many contrasts in their behavior, point to the uncertainty in our understanding of all these matters. That uncertainty, however, leads us back to the wisdom of focusing on the actual behavior in question. Wisdom from the fields of psychology and medicine can illuminate our understanding of these problems, their social and personal sources, and the likelihood that they may change or be tempered by events, but judgment of them rests with us all.

Edwin B. Fisher, Ph.D., is a clinical psychologist and a professor in the Department of Health Behavior in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. He is a past president of the Society of Behavioral Medicine and editor of Principles and Concepts of Behavioral Medicine: A Global Handbook (Springer, 2017). In addition to community and peer support in health and health care, asthma, cancer, diabetes, smoking cessation, and weight management, he has written on concepts of psychopathology, including depression and schizophrenia, and on the relationships between mental illness and physical disease.

Acknowledgments

Thanks to Rebecka Rutledge Fisher, Ruth Salvaggio, Kathryn Skol, Barbara and Richard Vanecko, and to the editor, Bandy Lee, for their helpful comments on a preliminary draft.

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