A book by President Donald Trump’s estranged niece claims he has psychological disorders. Trump’s niece is a clinical psychologist. We asked colleagues of hers about the book: Is it ethical? Is it accurate?

Armed with a doctorate in psychology, a piercing pen and a decades-old grudge, Mary Trump has attacked one of the world’s most powerful people.
The target is her uncle, the president of the United States.
Her new book about Donald Trump is decidedly unique in the annals of presidential biographies: the author purporting to probe the president’s mind not only has personal access to family gossip but also professional credentials as a clinical psychologist. 
There is deep debate in her field about the ethics of making public pronouncements on the mental health of a public figure especially one she’s never clinically observed.
In Too Much and Never Enough: How My Family Created the World’s Most Dangerous Man, Mary Trump describes the president’s father her grandfather as a high-functioning sociopath and blames him for instilling in his children the value of aggression and the notion that kindness is weakness.
She suggests the most damaged of the siblings is Donald Trump who, she said, suffers from a cocktail of psychological impairments: definitely narcissism, for which she says he meets all nine criteria, but probably other conditions. She lists as possibilities antisocial personality disorder, dependent personality disorder, a learning disorder and sleep disorder.
The president of the United States, in her opinion, struggles to control his impulses; tell the truth; learn new facts; apologize for mistakes; and lives in constant terror of having people perceive his flaws.
She said she was traumatized by his 2016 election win, and feared that her uncle was uniquely ill-qualified to govern in a crisis.
“It felt as though 62,979,636 voters had chosen to turn this country into a macro version of my malignantly dysfunctional family,” writes Mary Trump, whose immediate family has feuded bitterly with the rest of the Trumps ever since it was sidelined from the grandparents’ wills.   
“Donald’s pathologies are so complex and his behaviours so often inexplicable that coming up with an accurate and comprehensive diagnosis would require a full battery of psychological and neuropsychological tests that he’ll never sit for.”
She wrote that she hoped her book would put to rest the idea that Trump deploys strategies or has a tangible agenda when his only aim is to protect his own fragile ego and have others see him as strong and smart.
The White House press secretary has called her work “a book of falsehoods.” The Trump family lawyer has sued to try blocking its distribution, alleging violation of a nondisclosure agreement.
But on the broader issue of global public interest, the mental state of the U.S. president, what do Mary Trump’s colleagues say?
CBC News reached out to about two dozen psychologists at U.S. universities who study pathologies, and asked two questions:

  • Is it ethically permissible to write what Mary Trump wrote?
  • Do they agree with what she’s written about the president, based on excerpts they’ve seen from media reports on the book?

There’s a formal taboo in psychiatry against opining publicly on public figures, named after Barry Goldwater, a presidential candidate who successfully sued a magazine that ran a series of psychiatrist opinions on him.
Psychology does not have the same so-called Goldwater rule but also has professional standards discouraging public speculation about people’s mental health.
Nearly all the experts contacted by CBC News declined to comment, several citing various reasons: ethical considerations, fear of professional consequences and fear of harassment from Trump supporters. 
“All of the above,” said one clinical psychologist, who requested not to be named, when asked why people wouldn’t comment on the record.
She said people in her profession could face expensive lawsuits, or lose career opportunities with public organizations if they’re perceived to have a political bias, which she said would be “career suicide” for some. She also mentioned “intimidation.”
“I wouldn’t want someone coming to my house and saying, ‘How dare you say this?'” she said.
She did agree to speak without being named. Several others responded to a request for comment by offering the names of two colleagues quoted here, who have previously spoken publicly.
Here are their answers, which have been edited for clarity.
Is it ethically permissible to write what Mary Trump wrote?
Josh Miller, a clinical psychologist and director of clinical training at the University of Georgia, defended the author: “Does the Goldwater rule apply to psychologists, and does it make a great deal of sense in the modern day?… I think we sometimes privilege the idea that you can only make a diagnosis if you’re treating a patient. But psychiatrists make diagnoses after one 50-minute session, or three, or four, all the time. We surely all have much more information on Donald Trump at this point in time than a mental-health professional would after somewhere between 50 and 200 minutes. Then, a family member I think clearly has much more information than a mental-health professional ever would. The ethics? I don’t know I personally fall into the category that there is a duty to warn about potentially the most important person in the world and whether they have a pattern of personality traits that portend quite poorly.”
So did Donald Lynam, a distinguished professor of clinical psychology at Purdue University: “I don’t have a real problem with a trained professional who has access to lots of behavioural data on a person making an assessment like this. I personally think that there is more than enough longitudinal life-history data available on many persons in the public eye that would enable professionals to make such assessments. I think Trump is no exception. He has always been a very public figure. Many books and stories have been written about his behaviour.”
Another clinical psychologist who works in the Washington, D.C., area, and asked not to be named, offered a more nuanced view: “The only ethical concern I can see is when someone puts their clinical hat on to diagnose, treat or make clinical recommendations based on a personal story not rooted in data. That’s where, in my view, we run across some ethical grey zones. When we combine someone who has a title, and knowledge about a particular field, and offers an opinion, we can easily interpret that this is their professional opinion as opposed to a personal opinion. That can become very blurry. One of the reasons psychology is a science-based field is we root our conclusions in data, in scientific principles. [Otherwise] it becomes a question of opinion and that’s where biases can come from. If a patient comes into my office and I really don’t [like] them I still have to give them a fair and objective treatment, or I have to identify that I’m too biased to be able to evaluate them and refer out. That’s why we use questionnaires, and ink-blot cards we give people sometimes … [to] test a hypothesis. …There is also a very high risk of bias when there’s a particular family member who is not someone’s favourite.”  
Do you agree with what she’s written about the president?
Miller: “[On narcissism] I agree entirely. ‘Prototypical’ doesn’t describe the degree to which [Trump] meets the criteria for Narcissistic Personality Disorder. Many of us who study it say that if we [described a character like his in a paper] other peer reviewers would say, ‘You’ve made up too cartoonish of a case.’ They wouldn’t believe it would be possible. That’s how incredibly well he fits those symptoms. I’ve viewed Donald Trump as an example of narcissism going back 15 years. Long before he was running for president, long before he was associated with the Republican Party. Literally, going back into the mid-2000s at academic talks he was one of the pictures I would put up. This is hardly new. Narcissism is associated with aggression, in general, and specifically under an ego-threat. When someone has criticized you, we’re going to see lashing out. An inability to accept blame it’s always someone else’s fault. To not admit one’s mistakes …that inability to admit that one has ever been wrong is a really huge problem. I agree that we should not be distracted by his narcissism from his psychopathy. Search for the criteria for psychopathy. Look at traits and behaviours in the psychopathy checklist written by Hare
. Grapple with how many would he not fit there. And psychopathy is associated much more strongly than narcissism with behaviours that are particularly scary. It’s the callousness, irresponsibility, impulse-control problems, lack of remorse or shame.”
Lynam: “I agree that Trump meets most, if not all, of the criteria for Narcissistic Personality Disorder
…. He certainly meets more than enough to deserve the diagnosis. I am not sure that I would say he has other pathologies, but I would say that he appears to have some additional traits outside of the ones included in NPD that make him more ‘disturbed.’ I think he is reckless, impulsive, unreliable and dishonest. There are some stories that suggest a tendency towards antisocial behaviour…. I am hesitant to say this, but I think the other diagnosis that should be considered is psychopathy… I have seen some commentators refer to a similar construct to psychopathy with the term ‘malignant narcissism.’ The only part with which I might disagree with Mary Trump (based on reported details of the book) is that I am not sure it is possible to pinpoint causes for these traits. It could be due to his father’s treatment of him. It could be due to the genes he shares with his father. It could be due to a host of factors. I would not speculate on that.”
Anonymous: “[Mary Trump’s book is] informative, but it’s not surprising. Is it really surprising to many of us, the things that may come out of this book? Do we need a book? You just have to open the DSM
[the Diagnostic and Statistical Manual of Mental Disorders]. [Mary Trump] is a legitimate author. She is not a pop-psychologist. Again, her only bias is that she’s a family member.”