The Harms of Social Media

 Social media is a miraculous invention:  a way to stay in touch with friends and family, to share thoughts and pictures and videos and common interests, at any moment with perfect convenience, literally with the push of a button (actually, even the force of pushing a button is not actually required, it's just touching a piece of glass!).  

It is an electronic extension of ancient modes of human communication: instead of sharing stories and starting conversations around a campfire with a group of fellow hunter-gatherers or villagers, we have an electronic campfire, which allows 24/7 contact with almost everyone in the whole world.  

Human interaction and communication is a need, and our brains are designed to be very sensitive to social stimuli.  

There are many benefits of using social media, but it is in my opinion very harmful, both on an individual level and as a national or worldwide community.  

Social media companies of course want you to spend more time on their apps.  The algorithms are designed to feed you information that would interest you more, and keep you looking for longer.  But this isn't necessarily good or healthy!  It's the same mechanism that feeds addiction or any unhealthy habit.  It's like candy for the brain.  The algorithms are not designed to give balanced information, or to help people avoid getting sucked into rabbit holes of misinformation, or to stay healthy, or to foster harmony in communities, they are simply designed to optimize time spent on the apps.  

So people are spending huge amounts of time surfing on social media or other scrolling information sites.  "Doomscrolling" is a very common activity.  For children, there are clear psychological harms--Jonathan Haidt's latest book "The Anxious Generation" is a good place to start reviewing the data on this.  Especially for children, the social comparison that is fed by social media is almost guaranteed to at once absorb attention, but also make people feel bad about themselves.  This could result in an increased rate in mental illnesses such as depression and anxiety disorders.  

And there are secondary costs, as Haidt has also shown:  every hour spent on an app means one less hour doing some other healthy or meaningful human activity, such as playing outside, going for a walk, doing a hobby, studying, conversing with friends in person, or reading a book.  App use fosters both psychological harm and damage to physical health as well, by reducing the amount of exercise we're getting, sometimes interfering with sleep (people are often up late at night looking at their phones; aside from the psychological component driving this, the bright light from the screens further interferes with normal sleep).   

I spent a few years using Twitter.  I am thankful that I stopped using it by the time it had changed names a few years ago.  There were many positives of Twitter for me, professionally:  it was a way to stay informed about the ideas and research of numerous experts in various fields of interest, and to hear their ideas instantaneously, rather than waiting for journal articles to come out (sometimes years later).  At times one could interact directly with the experts.  And one could add on other peripheral or hobby interests, and just feel better informed every day.  During the pandemic I felt Twitter was a good way both to follow news of critical matters daily, but also to contribute a public message as a professional.  

But I ended up spending more and more time on Twitter.  Even during a hike outside, I would find myself pulling out my phone and checking.  Hours were spent on the app that could have been spent reading a book or a journal or a newspaper, or doing some fun activity.  And as I discovered over time, many of the interactions on Twitter were frustrating -- often you couldn't really have a conversation with people.  It was rare for an expert to actually interact with you.   The app created an illusion of connectivity, while very little was actually there.  The one advantage it did have was convenience, and efficiency in terms of cultivating a community of like-minded peers.  Such a community can sometimes be useful, but at worst this feeds the worst tendencies in society, of polarization and division.  

From a psychiatric point of view, I believe it is important to assess internet and social media use.  It should be an essential component of any psychiatric history.  

Consideration should always be given to weaning from social media, to try a few months entirely without it.  You may experience "withdrawal" from it, but after this passes you may feel more free.  If you fear that you'll become less informed, remind yourself that you can just read magazines or newspapers once a week, or once a month, and most likely remain as informed, or even more, compared to doomscrolling.  

On a societal level, I understand that one of the principles at play here is freedom of speech.  If governments were to regulate social media companies this would be seen as interfering with freedoms.  But if we consider that social media and many other internet sites are analogous to addictive products, such as cigarettes or alcohol, maybe we could increase the amount of regulation about how these products are marketed or accessed, especially to children.  

One of Haidt's ideas is to insist that children in school should not be allowed to have their phones during school hours.  I think this is very good idea.  Of course, modern education often makes use of electronic media, but this could be provided in schools using other devices that would not allow kids to be surfing social media during their classroom hours.  

This idea could be extended into adult life, to invite people to set their phones aside much more often.  

Grocery Shopping & Mental Health

 Good nutrition is essential for physical and mental health.  

But changing one's diet is probably not going to cure depression or make your anxiety go away.  In fact, I'm concerned about various trends in health care which exaggerate the effect of dietary change.  For example, there are programs run by professionals with titles such as "food as medicine" in which patients are taught about healthy dietary practices.  But the therapeutic value here is very modest, especially if compared to a well-controlled placebo condition.  It may be beneficial to have nutritional education, dietary change, and regular supportive meetings supervised by a professional, but there would be a lot of nonspecific factors involved here, including a benevolent structure, group support, empathy, and focus on general healthy lifestyle habits other than nutrition, which contribute to clinical improvements.  And sometimes these programs end up recommending various supplements or "alternative" nutritional habits which have a very questionable evidence base.  

The basics of healthy nutrition, however, are simple.  There is a lot of room for individual differences in preferences or restrictions, but the foundation of a healthy diet is vegetables (especially fresh green vegetables); fruit; nuts; whole grains and other complex carbs with high fiber; beans, lentils, and other legumes; lean protein; healthy fats such as olive oil; fish; and much less red meat than the average North American consumes.   High-sugar and simple-carb foods such as pastries, cookies, cakes, candy, etc. should be greatly reduced--often if you've reduced these a lot, you can enjoy the occasional sweet treat even more, without needing to have as much.  One should cut back on the amount of salt.  Ultraprocessed foods, such as chips, processed breakfast cereals,  instant noodles, soft drinks, and fast foods, should be avoided.  

These basics do not lead to some kind of unpleasant, spartan lifestyle, these are the foundations for a wonderful, sensually pleasing diet in which every meal can be a joy of life, with no end of variety possible, from simple snacks to daily meals to gourmet adventures.  The enjoyment of this type of diet involves not only the nutritional benefits, but also the process of shopping (for example at farmers' markets, produce shops, or berry picking) and meal preparation (in the kitchen).  These activities touch upon basic joys and skills of life that have been part of human ancestral history for thousands of years.    

When wandering through a major grocery store the other day, I was struck by how hard it can be to make healthy choices.  These stores have incredible variety.  It's easy to find all the perfect, healthy foods listed above.  But the problem is that junk food, ultraprocessed foods, candy, etc. are all marketed aggressively.  Whole rows of the grocery store are dedicated to junk food.  Shelf after shelf of chips, cookies, soft drinks, or even "fake health foods" such as sugary cereals or "vitamin water."  At the cashier, there is yet another opportunity to buy chocolate bars and other candy.  Even in the areas with healthier foods, such as the produce section or the aisles with baking products, there is often a display of some kind of ultraprocessed food or junk food on special.  Even health-oriented grocery stores such as Whole Foods feature similar marketing.   It's the same even at pharmacies which sell food products.  And even in a hospital, whether it be at the cafeteria or at vending machines, there is an endless supply of junk food.  Lunches served at schools, or food provided after sports events, often consist of pizza, burgers, and cake.  When my own children were going to elementary school, I noted the common practice of parents sending their kids to school every day with a lunch box containing a chocolate bar, a bag of chips, and either a juice box (filled with sugary fruit juice), chocolate milk, or even a Coke.  

Junk food is designed to be enjoyable to eat, so that people will buy more of it.  In this way it is comparable to addictive products such as cigarettes.  Unlike cigarettes, there are no restrictions about how they are marketed.  And the companies manufacturing these products, and the grocery stores selling them, are earning billions.   So we have a whole generation of people, including young children, who are basically addicted to junk food.  The health consequences of this include much higher rates of obesity, as well as a likely lifelong, chronic decline in physical and mental health.  Another consequence is a decline in culinary culture--many people just aren't interested in the artistry of food, if they are addicted to processed products.  

One of my interests this past year has been learning Chinese, and as part of this I like to watch Mandarin language movies and TV series -- the Chinese culinary culture has probably been the healthiest one in the world, and likely is a factor contributing to better health and longevity in this population.  But even in China it appears that ultraprocessed foods are disturbingly common.  In modern Chinese movies, we often see the characters eating pizza (it seems a common North American chain restaurant is popular there) or visiting a grocery store, the shelves stocked floor to ceiling with bags of chips and instant noodles etc.  So even in the healthiest culinary culture in the world, the bad nutritional habits of the West have crept in.  

What can be done about this?  Aside from individual education on this matter, and striving to make healthier choices, I think that public measures can help.  Other countries in the world are experimenting with having taxes on sugary foods, ultraprocessed foods, etc., and restricting marketing, especially to children.  It's a similar approach as we used to help reduce cigarette smoking in the population--it didn't require banning anything (and taking away anyone's freedom), it just required restrictions on advertising, display, marketing, and introducing a tax on the product.  Another public measure that I would love to see is a subsidy on healthy foods such as vegetables, so that everyone could afford them more easily.  This would have benefits not only for individual health and nutrition, it would also be beneficial for the environment, for farmers, and would be economically more efficient.  

Navigating Chaotic Times

This is a sequel to previous posts dealing with some of the changes we are seeing in world events in the past months.  

The chaos we are seeing is totally expected, given the deep behavioural, cognitive, and personality issues of the leader causing these new problems.  

I am disappointed that news media does not seem to adequately grasp the enormity of this problem.  It is important for journalists to report on the terrible policies and consequences of these policies, but the overarching problem is something worse than any collection of policy events:  once again, we are in a position analogous to having a mean-spirited, capricious, unintelligent, unskilled, humorless, and vindictive middle-school bully take over the piloting of a jumbo jet.  This time, the bully is in a mood to play with the controls of the aircraft, and he may find the fearful response of the passengers to be entertaining.  Many of the safety features of the plane have now been removed.  I really think there is almost no limit to how much harm can be done as this situation continues.  

Of course, this situation is doing great harm to mental health, in a variety of ways.  For starters, there will be economic hardship and a lack of security that will dampen morale. 

One of the most common causes of psychological stress at this point is compulsive or excessive consumption of news, often coming from news streaming sites or social media.  Some of us are spending many hours a day “doomscrolling” — this is tiring and depressing, and does nothing helpful.  This is a contagious phenomenon, since even if you stop “doomscrolling” it may be that your friends or family have not stopped, so every conversation gets tainted by a cloud of doom from the daily news events.  

So I recommend, as a mental health intervention, that we all severely restrict “doomscrolling” behaviour, or other similar phenomena such as having a news channel playing in the background of your home at all times.   While it is important to be informed, I think that it is adequate to follow news once every 1-4 weeks, preferably by reading a few different physical newspapers or news magazines, rather than by obtaining news from social media or from your phone.  The “doomscrolling” is a behavioural addiction.  And furthermore, this form of news propagation is one of the reasons this situation has developed in the first place, since electronic media make it easier for people to form “echo chambers” of like-minded people, often leading to worse and worse polarization and extremism.  Unfortunately the economics of news propagation is such that echo chambers and behavioural addiction, with all the malignant polarization that follows, is profitable for the news companies.  

What else can be done?  I think this is a difficult question.  But one insight from history is this:  if we receive only a negative or catastrophic piece of information, especially one example after the next, then we are likely to be demoralized, tired, perhaps infuriated, perhaps resigned.  But if whenever we take in negative news, we also receive a message about what can be done about it to help, then the process can be quite different — it can be energizing, and motivate people to take positive action.  So I encourage you, whenever you are watching the news, to always ask yourself what you can do to help.  If you can’t think of what to do, consider what Mr. Rogers said, “look for the helpers.”   Actions could involve letters to political leaders; peaceful protest;  and changing consumer behaviour so as not to reward companies or individuals associated with the negative world events, and to communicate to companies to encourage them to take positive leadership steps to stand up to the problems going on.   Of course it is absolutely crucial that we all vote, and do our best to encourage others to be well-educated about the issues, and then to vote themselves.  

Another piece of strong advice — and this follows many of my other posts in the past years, including those about the pandemic: we humans are intensely tribal by nature.  It is an evolved trait that causes humans to form strong communities; these communities can then thrive, economically and culturally.  As I’ve discussed in other posts, and as many great psychologists have discussed (such as Jonathan Haidt and others), our tribal nature causes us to form “ingroups” containing people who share similar beliefs, histories, political leanings, language, culture, religion, and appearance.  These ingroups are extensions of our biological families, and historically were in fact more likely to consist of extended relatives in a village environment.  Loyalty to these ingroups is like loyalty to family.  This is a normal and often beautiful thing, but the dark side of it is that ingroups become impervious to influence by outgroup members, even when the ingroups are engaging in destructive or bizarre behaviours, and becoming more and more extreme or even cult-like.  But all of us are tribal, and our natural reaction to dealing with another “tribe” is to defend ourselves, and to attack the other.  But this is just a recipe for a spiral of escalating conflict.  

In this case, we cannot just stick to our ingroups in dealing with this problem.  While it is important to energize our voices, to rally our own “ingroup,” and to gather and motivate peers and fellow citizens who are similarly concerned by the events going on, we must also reach out to those on the other side of the political and ideological divide.  There should be gentle efforts to understand why people on the other side of the ideological divide (that is, those who enthusiastically chose the bully to fly the jumbo jet) continue to believe or act as they do.  The interactions should take place with dignity and respect.  If such respect is provided, those on the “other side” are more likely to listen to other arguments, or to hear evidence about the bad things that are happening.  Without such respect, ideological opponents may simply double down with their previous beliefs, and may either not look at any evidence of the bad things going on, or may think that the evidence is “fake news.”   If you use social media regularly (such as Facebook or X) be careful that you are not simply interacting with others who share the exact same view, and that you are not simply attacking or mocking those who have a different view — instead, always be mindful about whether your contributions and involvement in social media could have a positive impact to engage those people who are on the other side of an ideological divide.  In any case, we all need to be taking positive action, rising to this difficult occasion with gentle, dignified strength and respect, while resisting the temptation to let our anger dominate our actions in harmful ways.   

I am hoping to see more leadership in this regard, and even heroism, from other parts of society.  Unfortunately the situation may be sufficiently dire at this point that individuals or companies who desire to do the right thing, by standing up to what is going on, may face some risks of economic or other repercussions.  But such is the nature of being a hero, to be brave in the name of doing the right thing and helping others.  As I’ve said before, I wish that the psychiatric community could come together to make public statements about the dangers of psychopathy and malignant narcissism in a group leader (in this case, the group being an entire nation).  I wish that there could be leadership from small and large corporations to stand up to support the best of their nation’s values in light of what is going on.  I wish that companies involved in news media could do much more work to address the problems of extreme tribalism, propagation of false information, and addictive news consumption.  I wish that religious leaders could come forward to speak compassionately to their followers, to support the best values their religions offer, including grace, wisdom, compassion, altruism, kindness to strangers, and humility: these are the values that will guide us together safely through these difficult times.  

Narcissistic & Antisocial Traits in Public Leaders: Part II

 This is a sequel to my last post (https://garthkroeker.blogspot.com/2024/09/narcissistic-antisocial-personality-in.html)

It is possible for a charismatic person with narcissistic and antisocial traits to gain widespread popularity, and ultimately to gain positions of public leadership.   There are many psychological causes for this, which I've discussed in other posts:

https://garthkroeker.blogspot.com/2023/05/foolproof-by-sander-van-der-linden.html

https://garthkroeker.blogspot.com/2022/07/how-minds-change-by-david-mcraney-book.html

https://garthkroeker.blogspot.com/2022/03/belief-bubbles-delusions-and-overvalued.html

https://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html

https://garthkroeker.blogspot.com/2023/08/the-power-of-us-by-jay-van-bavel.html

Here are likely consequences for the nations that must suffer under such leadership, and for the world: 

1) "Greatness" will decline, for many reasons.   By "greatness" I mean cultural, moral, technological, and economic leadership.   If such a country is of sufficient size (in terms of population and economy) the whole world will be adversely affected.  

2) Other nations will take over the world's moral, cultural and technological leadership.

3) I am reminded of Shakespeare's insights about the impact on a nation of corrupt leadership.  When the king is corrupt, the whole nation becomes corrupt.  The leader can define the character of the entire country, in the eyes of the world, and in the eyes of its own citizens.  Other corrupt forces in a country are emboldened.  Corruption becomes a norm.  When a bully is the leader, other bullies all over the country become more powerful as well.  Other bullies and tyrants across the world will rejoice.  A cloud of gloom and fear is cast upon the entire country.  We see this as a common theme in the most popular novels and movies, such as "Lord of the Rings."  

4) In this case, a mitigating factor in the past was incompetence, which was oddly protective.  The world was dealing with an almost cartoon-like figure, who lacked the intellectual skills, curiosity,  or fund of knowledge to do too much damage.  It was like a middle-school bully came to be in charge of flying a jumbo jet.  But in the past there were robust protective factors, such as the plane's automated systems, the other staff on the plane, the preoccupation of the bully with playing on his phone rather than playing with the plane's throttle, etc. As a result, the plane survived the trip, even though the pilot was unstable, mean-spirited, and incompetent.    In this case, the bully is now 8 years older, and has been learning the ways of bullying all this time.  And the bully is now angry and vindictive, with added health and cognitive issues due to age.   The bully will have fired or replaced the plane's staff.  The bully will have gathered around him a team of other bullies, who are more extreme and unstable than ever before.  Scientists who designed the plane's safety systems will have been fired or will have resigned to find jobs in more stable countries.  And most alarming of all is the fact that the plane in this case is now flying into very dangerous, stormy conditions requiring the expertise of a good pilot; 8 years ago, through pure luck, the plane was flying in comparatively calm conditions.

5) Medical care will be severely damaged, since health policy leadership will be taken over by individuals who have bizarre beliefs unhinged from scientific progress or wisdom.  It will be demoralizing to health care professionals in this country, and also other professionals across the world.   One aspect of the nation's "greatness" was the capacity to attract the most brilliant people from all over the world; this attractive quality will fade.  Not only will the nation's leadership in technology fade, but others would not want to live there anyway, due to the atmosphere of gloom and even the overt risk of violence.  

6) The nation's and the world's environment will be damaged, since policy will likely reverse or impede progress to reduce pollution.  

7) If there are religious groups that have supported such a leader, the moral and religious leadership of these groups will steeply decline.  It is jarring for a religion whose sacred texts teach values involving love, compassion, redemption, integrity, honesty, forgiveness, wisdom, peace, respect for outsiders, etc. to devolve into support for a villainous figure who has no interest whatsoever in any of these values.  Many stories or lessons in religious texts warn that people of faith can be led astray -- into a desert if you will -- causing terrible harm to themselves and to others.  

8) Political groups that have supported such a leader will lose their association with previous noble values, associated with justice, law & order, dignity, family values, loyalty to global allies, and personal freedom.  

9) For individual young men who have supported this leader, they will likely see a decline in their happiness and prosperity.  If such young men desire to be attractive to women, or to have a satisfying relationship life, this has a much lower chance of happening for them, since support for bullies, and becoming a bully oneself, is not an effective strategy for finding or attracting a mate.  Thankfully, the vast majority of young women do not support narcissistic or antisocial leaders.  

10) One of the typical features of bullying that we can expect in coming years is mockery or frank persecution of people who disagree with or are suffering under the coming leadership.  Bullies and those who support them will mock or belittle those who disagree with them, and even enjoy observing the distress of perceived opponents, even if these opponents are their fellow citizens, doctors, technological experts, musicians, artists, or loyal coworkers. 

What is the role of psychiatry with regard to this issue? 

There will be a lot of depression, anxiety, and even traumatic experience that people will suffer as a result of these political changes, so mental health professionals will have to prepared.  Many of the people who will suffer most are those who supported and voted for the bully in the first place.  

I continue to be upset that the psychiatric community did not organize itself to warn the public about these issues.  Finally I find it a failure in duty to serve and inform.  This did not have to involve talking directly about any particular individual or political group, etc.  But there should have been frequent discussion and urgent efforts to warn about the dangers of narcissistic or antisocial personality traits in positions of power.  This could have started with discussion of personal or family relationships of this type (a phenomenon most psychiatrists would see clinically in the course of an average day), but also discussion of the psychology of persuasion, false information, tribalism, internet use & addiction, and propaganda.   Other peripheral issues could have been discussed as well, such as how to evaluate cognition or competence.  All the major journals and conferences could have frequently addressed this theme in the past year.  Unfortunately, as a professional community psychiatrists more or less stood by and did next to nothing.  I hope that in the future there will be more education and advocacy coming from the professional community about this.  Companies involved with news or social media also did not do enough to address or improve these problems, despite having the technological tools and competent leadership to do so. 

One interesting policy idea in the future could be to require neuropsychological testing for political leaders, at the very least to determine intellectual competence.  It would be useful to know if a major political leader had shocking deficiencies in basic fund of knowledge about the world, capacity to learn new information efficiently, severe attentional problems or tendency to have extreme fluctuations in intellectual capacity determined by a volatile emotional state.  

As always, there will be forces of kindness and good which will ultimately prevail.  We see the spirit of this in many of our favourite movies, such as "The Lord of the Rings."    In that movie the heroic characters struggled a lot, had many losses, and were often tempted to give up.   So we will likewise have a difficult journey ahead.

Narcissistic & Antisocial Personality in public figures: the role of mental health professionals

The norm in mental health practice has wisely been to stay out of politics for the most part, except when it comes to mental health advocacy.  

It would obviously be problematic if individual mental health experts (such as psychiatrists, psychologists, social workers, nurses, etc.) or groups representing professionals (such as specialist associations, editorial boards from journals, etc.) were to endorse or criticize political figures, with a goal to influence elections.  

But sometimes there needs to be an exception to this neutral policy.  

Mental health professionals have a great deal of experience recognizing and dealing with individuals who have behavioural and relational problems such as narcissistic and antisocial personality.  And the most valuable experience mental health professionals bring to this issue is work with patients whose partner, spouse, close friend, parent, boss, or other family member has narcissistic or antisocial traits.

Narcissistic personality traits or disorder include selfishness, self-absorption, boastfulness, need for admiration, arrogance, exploiting others, and lacking empathy.   Antisocial traits or disorder include disregard for others, frequent lying, impulsiveness and poor self-control, aggressiveness, lack of remorse, and criminal behaviours.  While we should always have an attitude of attempting to help people with these traits, it is first necessary to ensure that people with these problems are not in a position to harm others.  It is especially dangerous when a person in authority, such as a parent, boss, or political leader, has moderate or severe traits of this type.  In some ways it is comparable to allowing a small child who has behaviour problems access to a piece of dangerous machinery or weapons. 

If a patient is in a close relationship with someone having narcissistic or antisocial traits, there can be many reasons why the patient has a hard time escaping the relationship.  The relationship may be all they have known for many years.  The relationship may initially have been exciting, passionate, and positive, perhaps an escape from some other adversity, before the narcissistic and antisocial problems showed themselves.   Other people in the patient's life, including important figures such as family or church leaders, may insist or encourage that they stay.  The patient may not recognize or frame the problems in the relationship as abuse, and may instead normalize the behaviours they suffer or which they observe.  Others may be trapped in relationships of this type for economic reasons.  They may fear leaving, due to concerns not only about risk of violence, but also of social or economic isolation.  Others may experience periods of being cared for at times by their narcissistic or antisocial partner, and/or cared for by the social network which supports this relationship, despite the overall toxicity of the situation.   

Sometimes people with antisocial personality lie so often to the people around them, that everyone starts to believe the lies are actually truth, through sheer repetition.  

These factors are similar to the cognitive biases I have described in other posts -- interpersonal or group affiliations can be so strong that they keep people locked into certain choices or behaviours due to group or "status quo" loyalty, even when the experiences they are having are very harmful to themselves and others.  In such entrenched situations, people will selectively attend to data that supports the status quo, and reflexively reject information that encourages change, even if there is a very strong and compelling level of evidence.  

At present, there are important choices in global elections coming up, and a shocking proportion of people appear willing to vote for a person whose behaviour is laden with very serious and dangerous problems.  Not only are there severe narcissistic traits, shocking mean-spiritedness, and vitriolic, hateful, divisive language evident on an almost daily basis for many years, there are frank antisocial traits including criminal behaviour in multiple domains, as well as other very troubling features including an obvious lack of intellectual skills, fund of knowledge, interpersonal warmth, humour (except for mockery),  patience, balanced capacity for judgment, or intellectual curiosity.  There is often frank thought form disorder evident during orations.  Furthermore, there will be a team of other people supporting or working with this person who share similar traits, behaviours, and attitudes, in an ever more exaggerated way compared to 5-10 years ago.  

Other problems in this case include a lack of fundamental cognitive or intellectual skills, a lack of emotional self-regulation, and a lack of principles that might guide wise, effective, or compassionate decision-making.  Instead, I suspect that this person's decisions would often be guided by vindictiveness and attempted self-aggrandizement rather than the good of the country or the world.  Attachment to policies supported by particular groups, such as church groups, would only be used as a tool to advance himself.    Some individuals with narcissistic or antisocial personality can suppress or hide the narcissistic behaviours quite well, and therefore sneak into positions of power before others have a chance to detect the problems.  But in this case, there is a frank display of narcissism almost every time the person speaks, and perhaps a lack of insight or care about it.  Most disappointing and shocking to me is that there is such a large segment of the population that laps this awful behaviour up, makes excuses for it, minimizes it, or disregards it as unimportant.  

It would be quite straightforward to evaluate this person's intellectual capacity.  He is a person who boasted about passing a dementia-screening test as though he thought it was a measure of intelligence.  A simple high-school level fund of knowledge test would be interesting, even to identify places on a map of the U.S. or of the world (such as "where is Poland?" or "where is Nebraska"), or to say a little bit about the cultures or histories of different U.S. states or cities or different countries in the world.  A short quiz about how the economy works, or about even the most basic science (such as "what is gravity" or "what is electricity" or "what is the air made of") would be quite revealing.   A standarized situational judgment test, such as the Casper, often a requirement for applicants to professions requiring interaction with people as part of the work, would be really interesting in this case.   My prediction about these things is that the person in question would score a shockingly low percentile on all of these things, and if this was publicized he would as usual surely blame this somehow on the testing being unfair or stacked against him or a product of "cheating" etc.  

Another frequent egregious and alarming behaviour in this case is something I've described before:  projection.  A rhetorical tactic almost always is to use extreme language to denounce other people, or accuse them of some horrible thing, lying all the way through, yet very often the very things he is accusing others of are obvious features of his own behaviour, character, and history.  

It is especially shocking that certain groups whose personal and group culture is devoted to devout faith, moral purity, law & order, and personal freedom, would double down in their support for this person whose behaviour is in extreme contradiction to these values.   In many religious stories or scriptures, a recurring theme has to do with people of faith being misled or enamored by dark forces--there are many stories where the faithful have lost their way, figuratively or literally, but without having insight or the willingness to change until a lot of harm had been done.  These texts encourage people to humbly reflect and be willing to refocus themselves on their values.    In this case, I think many people including those with strong, honourable moral values and faith,  have very much lost their way in their support of a dangerously unfit leader who is poised to do great harm to their country and the world, in service to himself.  

Of course, it is true that unless a detailed assessment were to be done, we could not have the confidence to make a formal psychiatric diagnosis. But in the realm of narcissism and antisocial personality, most of the actual evidence for such diagnoses comes from collateral information of the patient's behaviour.  In an actual interview, particularly a single individual interview, many people with problems of this type can present themselves in a seemingly normal way (though in this particular case I think there would be many simple ways in an interview to demonstrate some of the problems unequivocally, especially intellectual weaknesses and almost cartoon-like unsuppressed narcissism).   

In any case, this situation reminds me of trying to help a patient (i.e. a large segment of the public) who is in a dangerously abusive relationship with a partner, yet who insists on staying and who might get angry or upset at the suggestion that they could or should think about leaving.  The "patient" in this case is a group numbering 40% or more of the population in certain areas.  

The role of a mental health professional with a "patient" of this type would involve compassionate and empathic exploration of the history, help with treating symptoms of pain or suffering, but also there would need to be movement towards encouraging change or leaving the relationship, warning about the risks of staying, but with a message of hope for a better, happier, more prosperous, more peaceful future after leaving.    Here, a motivational interviewing framework would be needed, since simply encouraging or pushing for change could be very counterproductive if the person does not desire this.  Other ideas for helping include tactics similar to what is described in David McRaney's book "How Minds Change."  (see my post about this book).  

One of the most compelling agents of change or healthy persuasion in this case is to emphasize the role of ingroup members who are speaking out.  In this case, there are many examples.  When an ingroup member speaks out, people are less likely to dismiss the concerns as simply being the product of political opponents.  

Another role of mental health professionals could be to discuss the issue of narcissism, antisocial behaviour, and abusive relationships in a public setting, as an educational endeavour to help people recognize and avoid such relationships in the first place, to be informed about how to get out of such a relationship safely, and to be in a position to help others.  

I have felt that the mental health community has not spoken out appropriately about the current public figure issue I have been alluding to.  I understand the principles behind the reserve, i.e. staying neutral in politics, but this is such an intensely important issue impacting individual and public well-being that something needs to be said about it.  Also, professionals, professional organizations, and editorial boards from journals need not spell out specific opinions about a particular case or a particular person, rather they could simply speak out about recognizing narcissism, antisocial behaviour, entrenched attachment to abusive relationships, the extreme dangers to well-being involved with such situations, the psychological factors preventing change, and things we can all do about it, without spelling out any particular individuals.  

I wish there could be psychiatric journals for the month of October where the issue would be devoted to a review of the research and current state of knowledge about recognizing and dealing with narcissistic and antisocial personality traits in relationships with loved ones, bosses, or community leaders.  In the absence of this, I at least encourage people to explore the issue themselves at a library or online.  

Links: 

Garth Kroeker: How Minds Change by David McRaney: a book review and discussion

Garth Kroeker: Political polarization, propaganda, conspiracy theories, misinformation, and vaccine hesitancy: a psychiatric approach to understanding and management