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I’m going to give a long answer to a short question: Is Donald J. Trump competent to serve as president? No way. He has Narcissistic Personality Disorder (NPD), and it renders him incompetent to be president and a danger to us all. That’s not the long answer. Keep reading.

I’m not talking about strategy here, whether it would be wiser to impeach him or invoke the 25th Amendment now, or after the Special Counsel releases his report, or after the midterms, or when. This is long enough without that.

Talking about mental illness is often fraught with misapprehensions and flat-out prejudice, so a few important points are in order before I continue.

1. When I say Trump has a mental illness, I don’t mean he is unintelligent, immoral, cognitively impaired, erratic, or an asshole. If I want to say those things about him, I’ll say them in those words. What I am saying is that he has a mental illness.
2. I am not stigmatizing those with mental illnesses. I suffer from one myself, as do many, many people I love and admire. We so often shame people for mental illness, and there is nothing shameful about it. People with mental illness–chronic or occasional, mild or severe–deserve profound respect, and can function very well in all manner of jobs.
3. As with non-mental illnesses, the difference between being incapacitated by a mental illness or not often rests on treatment. Trump does not appear to be getting effective treatment for NPD, if any. He probably hasn’t sought help, because it’s the cruel nature of the disorder to make its sufferers certain that everyone else is the problem, not themselves. Or, as Psychology Today politely puts it, “Treatment for narcissistic personality disorder can be challenging because people with this condition present with a great deal of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and vulnerabilities.”
4. Having a mental illness should not disqualify one from public office. I don’t doubt that almost all of the previous 43* presidents had mental illnesses at some point during their terms, and many served with excellence just the same. Lincoln almost certainly had depression, and he was probably our greatest president. Having a mental illness whose symptoms interfere with the basic functions of the job, and not getting effective treatment: that’s where the problem enters in.
5. Saying that someone is mentally ill does not absolve him of all responsibility, nor does compassion require us to allow him to continue in his position.
6. NPD is not simply “having a big ego” or “thinking a lot of oneself” or speaking highly of one’s own abilities. It’s arguable that one couldn’t survive 24 hours as president without a lot of self-confidence, and even if having higher-than-average self-confidence were a problem, it’s not what I’m saying about Trump.

I am no psychologist, but I can read and reason, and here are the criteria for NPD:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or autonomic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

(source)

Do I need to quote cases of Trump “requir[ing] excessive admiration”? Or give examples of his being “interpersonally exploitative” and “lack[ing] empathy”? I’m not asking rhetorically. Maybe you have practiced better internet habits than I and haven’t read umpteen statements indicating that Trump “is often envious of others or [I’d say: and] believes that others are envious of him,” in which case, just ask in the comments and I’ll supply the quotes. Likewise, there is abundant evidence that Trump “exaggerates achievements and talents” and “expects to be recognized as superior without commensurate achievements,” and “believes that he or she is ‘special’ and unique and can only be understood by, or should associate with, other special or high-status people.”

Two friends of mine who do have the professional credentials I lack–one is a therapist and the other a PhD in psychology whose dissertation was on NPD–both, after the caveat that they can’t diagnose someone at a distance, say that hell yes, this guy has a screaming case of NPD.

Unfortunately, most of us don’t have that expertise, and so early in the Trump fiasco, progressive folks were giving entirely too much credence to a letter to the New York Times by an expert on Narcissistic Personality Disorder, Dr. Allen Frances. In fact, he is not only an expert, he was described in reprint after reprint as “the man who defined NPD.” And he argued that Trump doesn’t have it. However, there are two enormous holes in his argument.

One, it is based on the DSM-IV criteria, because those are the ones he authored (he chaired the group that wrote that section), and he doesn’t accept the DSM-V version. That’s a defensible position, but it can’t just be assumed correct, and he doesn’t make the case in this letter, but instead, disingenuously asserts that he “wrote the criteria that define this disorder.”

Two, Frances claims that Trump is not impaired by the above characteristics. This is important because even the DSM-V says that in order to be diagnosed with Narcissistic Personality Disorder, one must experience impairment or distress, noting:

Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute narcissistic personality disorder.

Fair enough. But how would Frances support the contention that Trump “does not suffer from the distress and impairment required to diagnose mental disorder” (sic; one needs either distress or impairment, not both); that he “causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy”? Yes, he has reaped many rewards, including the position of president. But one can’t read more than a few tweets without perceiving a deeply distressed person, and as for impairment, I would like to know the name of one person who is a genuine friend of Donald Trump. Descriptions of people such as Tom Barrack, “one of Trump’s closest friends,” “a friend . . . for more than 30 years,” include such chilling asides as this: “Barrack noted that he has been able to maintain a candid and honest relationship with Trump over the years because he ‘was always subservient to him.'”

When your “closest friends” can only maintain the “friendship” by being subservient to you, I have to tell you, friend: you have not experienced friendship. You don’t know what friendship is. And to live without true friends is a deep and tragic functional impairment, made no less so by the sufferer’s illusion that he does have them.

So Dr. Frances’s argument fails to convince. Trump has NPD by the standards of the DSM-V, including being significantly impaired by the disorder.

Which leads to the reasonable question: can’t someone be a good president even with untreated NPD?

Nope. At least, someone who checks off every last criterion, like Trump, certainly can’t. Several examples of how his NPD renders him incompetent and/or dangerous:

• Because he is so desperate for praise, he is incapable of intelligent diplomacy. Every foreign leader is judged by how much he likes Trump. The foreign leaders, their vision unclouded by narcissism, immediately realize that this requires no more commitment than paying him an insincere compliment. This would be laughable if it were just a matter of foolish, fawning statements about Emmanuel Macron and Shinzo Abe. But his insatiable need for admiration causes him to be unwary when wariness is needed. All an adversary has to do is flatter him and he’s putty in their hands. So when Russia’s foreign minister and ambassador stroked his ego, he divulged classified information, including exposing a confidential source.
• His envy drives him to foolish, destructive policy decisions. When he isn’t trying to unravel Obama’s policies (regardless of whether they are helping the country), he is trying to win the competition that dominates his own mind. He must win. And so, goaded by Obama’s (undeserved, in my opinion) Nobel Peace Prize and by the idea dangled by right-wing commenters (ludicrously, in my opinion) that Trump could win one as well if he made a deal with North Korea, he rushed into a meeting with Kim Jong Un, made absurd claims of success there, and denied the evidence before, during and since that the summit had had a negligible effect on Kim’s policies.
• Another factor in the North Korea debacle was his inability to tolerate failure or even a normal level of success. Someone with NPD “exaggerates achievements and talents”; the slow pace of diplomacy is incompatible with his self-image. He has to be able to fix what no one else could fix, faster and more brilliantly than anyone in the past. When that proves impossible, he simply will not perceive it; he puts his fingers in his ears and runs from the room, shouting what a tremendous success he has been.
• Also notable in the Kim meeting was his lack of preparation. Someone who perceives himself as having “unlimited success, power, brilliance” doesn’t need no stinkin’ prep sessions. For the same reason, Trump has not had serious security briefings in his entire term so far. He won’t read the Presidential Daily Briefing–the short version of intelligence documents–even dumbed down and sprinkled with many mentions of his own name.
• He can’t grasp a concept as simple as “trade is not a zero-sum game” because to the narcissistic mind, everything is a zero-sum game. Economists from Adam Smith to Milton Erickson know that a trade deficit is not an unfavorable balance of trade. But Trump (aside from intellectual and cognitive difficulties, which may be significant factors as well) cannot even entertain that idea.
• For that matter, his narcissism won’t permit him to think of trade as a good thing at all (see forthcoming book Fear by Bob Woodward, which reprints a report with a margin note in Trump’s own handwriting, “TRADE IS BAD”). It follows a certain solipsistic logic: nothing outside his country should be taken seriously, unless it can be made to reflect well on him. He has long seen foreign relations the same way he sees personal ones: they are a contest of egos. Nothing about the past 20 months suggests that he has changed since the 1990 Playboy interview in which he said, “I think our country needs more ego, because it is being ripped off so badly by our so-called allies; i.e., Japan, West Germany, Saudi Arabia, South Korea, etc. They have literally outegotized this country, because they rule the greatest money machine ever assembled and it’s sitting on our backs. . . . We Americans are laughed at around the world for losing $150 billion year after year.” He’s talking about the trade deficit again; he thinks that if you sell $50 billion in products and buy $200 billion worth, you are losing $150 billion.
• Likewise, he not only exhibits no loyalty (he only demands it), but he can’t restrain his competitiveness enough to maintain a coalition even with his closest allies. He derides and undermines Congressional leaders in his own party when they are in the act of promoting legislation he wants to see passed. His own arrogance and sense that he is, and must be, special, leave no room for teamwork.
• He can’t absorb criticism or change course for fear of being seen as weak. Narcissist Personality Disorder does not permit apologies. Hence we have a president who, when he makes a mistake, “doubles down” rather than mitigating it. After getting flak for suggesting that people on “both sides” were to blame for the violence by Nazis in Charlottesville, he reluctantly gave a speech condemning Nazis and white supremacists. Immediately afterwards, rightly recognizing that people saw the speech as a reversal, he railed about it–the criticism of Nazism, not the coddling of it–calling it the “biggest f—ing mistake I’ve made.”

Whatever a president’s policy positions, be they leftist, liberal, conservative, libertarian, the person needs to be able to see through flattery, risk being seen as a failure, absorb new information, work with a team, and change course. Trump’s Narcissistic Personality Disorder is complicated by impulsiveness and cognitive deficits, but even if it were not, it would be as disqualifying an ailment as coma or severe brain damage. A person with untreated, severe NPD cannot be a competent president of the United States, period.

*Numbers 23 and 25 were the same person–good old Grover Cleveland–so we’ve had 43 presidents prior to Trump.