A president who displayed behavior suggesting the presence of two or more severe personality disorders in, for example, the “Cluster-B” family, could be judged incapable to lead. The Cluster B personality disorders are all marked by impulsive, dramatic and unpredictable behavior. They are typically longstanding patterns resistant to change, even with treatment, and create significant impairment in the way a person thinks, functions and behaves. Additionally, medical studies demonstrate that both genetic risk factors and environmental variables contribute to the development of these personality disorders.
Consider, for example, that a president exhibiting Cluster B behaviors associated with anti-social personality disorder and narcissistic personality disorder would likely struggle to keep calm and think clearly in high-pressure situations. Anti-social symptoms include a disregard for the rights of others, a tendency to break the law, lack of remorse, frequent lying, failure to honor financial obligations, interpersonal exploitation, risk-taking and revenge-seeking in response to perceived slights. Hallmark narcissistic symptoms include an exaggerated self-importance, sensitivity to criticism, lack of empathy, a need for admiration and attention, entitlement and exploitation with a need for personal gain. Together, these symptoms could severely undermine a president’s ability to lead.
Granted, there are self-destructive traits in any individual. But we know for a fact that severe Cluster B behaviors in a leader do pose significant dangers. They might, for example, take drastic measures to avoid humiliation. Extreme examples of this dynamic include cult leaders like David Koresh and Jim Jones, who chose mass suicide over allowing themselves to be arrested in front of their supporters.
The tipping point
Recognizing unfitness in a president does not necessarily mean waiting for a physical sign or even a catastrophic event. Personality disorders present predictable patterns that are well documented in the medical literature. In fact, we can often find the most accurate and honest account of a public figure’s Cluster B symptoms through public records.
Public documentation is important because a president with severe Cluster B traits would likely be inclined to lie about medical conditions. People struggling with anti-social personality issues are usually chronic liars and resistant to seeking treatment. Those with narcissistic conditions are inclined to exaggerate their good health, in spite of evidence to the contrary.
Unlike psychiatrists, clinical psychologists are not bound by the now-infamous Goldwater Rule, which prohibits members of the American Psychiatry Association from diagnosing public figures without a personal assessment. The American Psychological Association’s code of ethics however, strongly discourages psychologists from diagnosing public figures they have not personally examined, and warns that those who do make remarks about public officials to take precautions, making sure their words are aligned with their expertise and the psychological literature, and that they clarify that they have no relationship with the person in question.