When it first appeared on Substack in August 2020, "Diagnosis: Psychopath,"my first interview with Vince Greenwood, Ph.D., quickly became one of the best-read and most-shared articles in this newsletter's then-brief history.
In that interview, Dr. Greenwood explained that while the term psychopathy is used frequently and casually in our culture, in the psychiatric world psychopathic personality disorder (PPD) refers to a relatively rare, but well-researched and thoroughly validated condition.
In a second interview in September 2020 entitled "The Frantic Psychopath," Dr. Greenwood discussed how Trump's PPD diagnosis explained his callousness and dereliction in the midst of the then-raging Covid-19 pandemic. He also predicted extremely accurately how Trump would behave if defeated in the 2020 election by Joe Biden:
Psychopaths are frantic over the threat of losing status and would be remorseless in their attempts to prevent that from happening. I don’t think he will accept the results, even in the case of a clear-cut Biden victory.
In July 2022, I interviewed Dr. Greenwood again in an article titled "A Most Dangerous Case." At that time, he explained why it is important that mental health professionals unite around the PPD diagnosis—and label Trump a "psychopath"—because it is the only diagnosis that truly "conveys the nature and level of Trump's dangerousness."
With the election less than a year away, there is now much talk about the country's accelerating slide toward authoritarianism, the GOP's growing acceptance of violence—and the published plans by the likes of the Heritage Foundation to literally end America as we know it.
But despite these fascist intentions on full display—alongside Trump's growing rap sheet that includes rape, business and tax fraud, inciting insurrection, stealing classified documents, and more—the corporate media is still normalizing and excusing his abhorrent behavior.
I reached out to Dr. Greenwood for another email interview. The first part is below. But before that, I want to remind you that Greenwood is the psychologist who convinced Tony Schwartz—Trump's "The Art of The Deal" ghostwriter—to stop using terms like "malignant narcissist" and call Trump what he is—a psychopath.
This quote is from a now-paywalled Medium article Schwartz wrote in May 2020:
Here's the first part of my new interview with Dr. Greenwood. Part two will be published tomorrow.
Q&A with Vince Greenwood, Ph.D.
Q: One year out from the next election, does anything surprise you about where the numbers stand today? As in: a) Trump’s poll numbers; and b) the number of indictments he’s facing.
A: Trump’s poll numbers, like so much of what surrounds that disturbed political creature, are shocking but not surprising. Not surprising because the significant part of the electorate that is represented by the current GOP is indistinguishable from MAGA. And make no mistake, MAGA is a formidable movement, in both numbers and intensity. MAGA is all about who you are against, who you resent, who you define as morally depraved and an enemy of America. Which, of course, is the Democrats.
Owning the libs is the animating force of the GOP. The whole point of MAGA is to bring the battle to what they perceive as these evil-doers. And who better to do that than Donald Trump? He is the master craftsman of the politics of grievance and resentment. It is just a sad fact that a significant part of his effectiveness flows from his diagnosed psychopathic personality structure: the pathological lying, the shredding of norms without regard to the damage they have done to our democratic institutions, winning at all costs, and the fomenting of polarization. These dangerous traits constitute the “malignant charms” of the psychopath that enable Trump to poll well with those who have suffered a loss of status, felt cheated out of the American dream, and are disgusted with the political class and educated elites.
The number of Trump indictments (91 criminal charges) is not the least bit surprising. It is an inevitable outcome for someone who is wired deeply to be a cheater and liar; has no limiting concerns for norms or rules; is undaunted by the fear of punishment; and has an inability to inhibit impulses or reckless behavior. Cheating and deceit are the psychopath’s (Trump’s) natural calling cards. He has no problem doctoring the accounting, gaming the tax system, stiffing contractors, paying hush money, shredding the Constitution’s emoluments clause, trashing classified information, undermining election integrity, or inciting a violent coup against the government.
What is surprising is that he doesn’t have more indictments. No doubt he has been protected by his wealth, connections, and cadre of lawyers. Also, you can get away with more in the business and political arenas. But it has caught up with him. His disdain for the truth, attitude that rules are for chumps, and contempt for the judicial process are not going to play well in the courtroom. As one legal pundit wryly put it,”Being an inveterate liar is a major liability in litigation.”
Q: Are Trump’s gag-order defying social media (and public) outbursts a calculated strategy, are they evidence of his psychopathy—or both?
A: This is an interesting question. The easy answer would be to say both. But the more accurate and elegant answer is that such behavior can be accounted for solely by the deep structure of his psychopathic psychopathology. Let me try to explain.
Most of what comes out of Donald Trump’s mouth and Truth Social feed is self-serving and aimed to dominate the moment. It can seem like it is calculated and strategic. But it is not calculated in the way you or I understand the word.
Because Trump, like any common psychopath, has virtually no choice, no real agency in how his mind operates or how he behaves. He is at the mercy of his hard-wired psychopathology, particularly the three defining traits of a relentless drive to dominate, remorselessness, and impulsivity. He is unable to grapple with any issue that doesn’t serve his immediate, egocentric interests.
"Trump, like any common psychopath, has virtually no choice, no real agency in how his mind operates or how he behaves," says psychologist Dr. Vince Greenwood.
The psychopath’s attentional field and impulses are limited to a “What’s in it for me?” and “How do I win the moment?” boundary. Trump’s attention is tethered to the immediate frustrations, provocations, and opportunities of the moment. The sizing up of the situation along the lines of his egocentric needs is automatic and natural. It is not complicated by other factors such as deeper aims, accommodating to other people’s interests, or worries about future consequences. His recent boasting about classified documents and lying about matters that will easily be exposed in court are not helpful to him. But he can’t help it. He is like a puppet dancing to the strings of his destructive traits.
One way to think about Trump with this disorder is that he is nothing but calculated strategy. But do not confuse that with any kind of decent executive functioning. Rather it is rigid and superficial. He has basically one aim: "just win baby," primarily through deceit and exploitation. He has one gear: impulsivity. He acts out his egocentric impulses quickly with no hesitation or restraint. An impulse, for the psychopath, does not mark the beginning of a process of weighing, deliberating, and mindful choosing, but the short-circuiting of it.
Trump’s mental operations and verbal utterances can best be described as incontinent. We have many richly sourced, insider accounts of Trump’s chaotic White House that spell out his fecklessness, disorganization, inattention to detail, failure to plan, low frustration tolerance, and dereliction. Michael Wolfe, author of Landslide: The Final Days of the Trump Presidency, had significant insider access to the Oval Office in the last few months of his term. He observed that all those interacting with Trump were exposed to “an unmediated firehose of verbiage,” unfocused, manic and transparently self-serving rants, all related to his claim the election was stolen.
"Trump’s mental operations and verbal utterances can best be described as incontinent."
What Trump lacks in reasoned calculation he makes up for with an instinctual cunning. Also, while there is no intelligent method to his madness, there is a singular aim: to regain power and wreak vengeance on his enemies. Trump is explicit on this point. It is depressing that one third of the country finds this acceptable, if not thrilling. It is ominous that there are plenty of intelligent, deliberate people and right wing think tanks, such as Project 2025, that are doing the planning and detailed work to implement an authoritarian game plan if he wins.
Q: Along with his criminality, corruption, immorality and incompetence, most rational people accept the idea that Trump is a “psychopath” or something close to that. Do you believe it remains important for the mental health community to unite around the PPD diagnosis and educate the public about it?
A: Shortly after Trump’s election in 2016, many mental health professionals spoke out about the new president’s unfitness for office. They elucidated Trump’s behaviors with distinct psychological patterns that result in harm to others. Two mental health advocacy groups sprung up to disseminate information on Trump’s dangerousness. The World Mental Health Coalition, under the supervision of Bandy Lee, M.D., and Duty To Warn published edited volumes of appraisals of Trump’s dangerous psychopathology. The public seemed to have an appetite for insight into Trump’s psyche, as evidenced by the rise of The Dangerous Case of Donald Trump, published by The World Mental Health Coalition, to the New York Times bestseller list.
There is respectful debate among mental health professionals over what Donald Trump’s primary diagnosis should be. This is not surprising since he displays a wide range of disturbing thoughts, feelings and behaviors. I believe that Psychopathic Personality Disorder should be Trump’s primary diagnosis based on the following three arguments:
* Psychopathic Personality Disorder (PPD) is one of the few conditions that we can make a formal and thorough diagnosis without the requirement of interviewing the patient (Trump). That is because there is a strongly validated and reliable tool — the Hare Psychopathy Checklist — to diagnose this condition. The diagnostic process for PPD is rigorous and requires advanced training for the mental health professional. It is fair to say that the demands placed on the evaluator of PPD are greater than those involved in diagnosing most conditions in our current diagnostic manuals. The administration of the checklist requires access and analysis of a great deal of life history information. However, if sufficient archival and informant data is available (as it is for Trump), then the assessment can be completed without a clinical interview.
* PPD is a robust diagnosis. Since the diagnosis of PPD is precisely defined and arrived at through an empirically-validated assessment procedure, it has generated much research (over 70,000 studies, according to Google Scholar). As a result, it is one of the best understood, most precisely delineated, and thoroughly validated conditions in the field of psychopathology. There is a high bar to meet diagnostic criteria (Trump meets this high bar) for this condition (less than 1% of the of the population does so). But if you do, because of the impressive research conducted, there is a great deal we can say about you and we can say it with a great deal of authority.
* The unique and defining characteristics of PPD help explain and account for Trump’s wide range of flamboyant behaviors and aberrant symptoms. The psychopathology of PPD is grave and governs the psychopathology associated with other significant, but less severe disorders such as Narcissistic Personality Disorder and Paranoid Personality Disorder. See here for a more detailed discussion of this point.
While there is some debate on his diagnosis, there is significant agreement in the mental health community that Trump suffers from a psychiatric disability and is a serious danger to others. Indeed, because of our knowledge of Psychopathic Personality Disorder and because he qualifies for that diagnosis, it is fair to say that Trump is more dangerous than even his strongest critics exclaim. He has already wreaked much damage on the country and possesses no embers of shame, guilt, or reflection that might slow him down in the future.
Q: Beyond his psychopathy, many people (including the NYT) are noting that Trump’s most recent speeches are more rambling, incoherent and gaffe-filled than ever. People speculate about reasons for this, including drugs, stress from his legal troubles, or cognitive decline or dementia. Do you have any thoughts on what could cause those clearly observable issues?
A: The NYT and Washington Post have recent articles noting his possible cognitive decline and I have seen some of the video mashups of his recent verbal slips, such as saying he ran against Obama in the general election, and George W. Bush (rather than Jeb) in the Republican primary. There is no shortage of rambling, even incoherence in his speeches.
It would take an examination and testing by a neurologist to determine if there was any significant decline in his cognitive functioning. Of course, a bit of a decline for someone of his age would not be unusual. But count me skeptical of any major decline in his cognitive functioning. I think this is just Trump being Trump, albeit somewhat untethered.
In the White House, he was somewhat protected from these unhinged moments because he was mostly surrounded by people who dwelled in the world of consensual reality. He had aides who would give him talking points and (gently no doubt) fact-check him. He would also occasionally use a teleprompter. Now it appears he only deals with sycophants and conspiracy-minded influencers.
Still, from insider accounts, it appears there were many deranged moments in the Oval Office behind the scenes. The journalist Michael Wolfe who interviewed many of Trump’s close associates in the White House, noted they often felt exposed to a barrage of self-serving long-windedness, “an unstoppable sequence of passing digressions, gambits and whims, more attuned to the rhythms of his voice than to any obligation to logic or, often, to any actual point or meaning at all and hardly worth taking notice of.” Taking care that we take seriously his calls for a fascist takeover of the government, that description seems apt for most of his current public utterances.
Again, we need to emphasize the severity of pathology with Psychopathic Personality Disorder. Psychopaths are careless to the point of recklessness, place no guardrails on the truth or level of harm in what they say, and are at the mercy of their “what’s in it for me?” and ‘always be closing’ impulses. Fact-checking? Logic? Guardrails? That way of being is for losers. Winning the moment and impressing others, whatever embellishment that takes, is for winners.
Take the example of implying he beat George W. Bush rather than his brother for the Republican nomination. Trump did disparage W. In front of Jeb at the debates seven years ago. Now he (instinctively) wants to let us know he disdains both of them and, effectively, whupped both of them. Facts of the situation are irrelevant to his boastful claims. Facts are for losers.
Part two of this interview is available here.
Subscribe to Unprecedented
Subscribe to the newsletter and unlock access to member-only content.