Published in the Shepherdstown Observer, October, 2019

Confabulation and Conflation

Confabulation and Conflation, at the intersection of Mental Health and Gun Control 


Diagnosing mental health disorders isn’t one of those easy professions, like, for example, brain surgery or rocket science.  Enviably, those two specialties have clear and visible parameters for measuring success and failure, whereas defining “mental health” is fluid and debatable, at times dependent on functional and social norms. The diagnostic manual that defines criteria for mental disorders wasn’t even published until 1952 and is in its fifth evolution.  Historically, some “Mental” Hospitals were akin to prisons, with “padded walls” for the criminally insane or those with organic brain diseases and injuries.


Twice recently, Donald Trump has suggested that we construct more mental asylums; not to improve the quality of life that they might accomplish, but to take the place of gun control legislation.  Ironically, while he’s limiting “asylum” to deny refugees a safe haven here, he would build more “asylums” to lock people up in---when it would be easier to put locks on the guns.  Again, building walls is his only solution.


Mental institutions of the past had well-earned reputations for being inefficient and expensive.  But even if we could create long-term facilities that would reliably treat people humanely and successfully, who would be candidates for these possibly involuntary committals?  That judgment call has always been a hot issue. 


Would we confine the malignant narcissist, the pathological liar, or the compulsive philanderer who brags of his assaults? The alpha-male who thrives on concoctions of chaos and crisis? The borderline psychotic who deludes reality and gaslights an entire population?  The maniacal One-Man “Army of the Potomac” who slays Truth and Fact with the imaginary weapon of Fake News?


Legions of clinical diagnosticians have put their reputations on the line to suggest that Donald Trump fits enough criteria to be diagnosed as mentally unstable, offering their expertise in a book called “The Dangerous Case of Donald Trump.”  They insinuate that he could well fit the requirement for admittance to one of his new institutions on the basis that he is not only a danger to himself, but poses a danger to others---namely, all of us.


Quarantining, like committal, has been mandated in epidemics of communicable diseases like tuberculosis and typhoid, not only for those afflicted but for those who could infect others.  Typhoid Mary famously never came down with the disease; she carried it and passed it to over 50 fatal victims.  Likewise, even if Trump was completely balanced, his actions are responsible for creating a pandemic of insomnia, anger, decreased libido, and depression.  His effect on people has been dubbed by one psychologist as “Trump Anxiety Disorder.”


And “Patient O” of the AIDS epidemic, erroneously dubbed “Patient Zero,” gained notoriety as a prolific, promiscuous carrier; his strain of HIV was so easily, and widely, traced that it became the basis for millions of dollars spent on researching, treating and preventing HIV transmission.  Similarly, with Trump as “Patient One,” we could duplicate those efforts but with mental illness rather than AIDS.  We could invest in interventions, not just institutions, so that his viral scourge of madness would never be able to replicate again.


The benefit of therapy doesn’t start, or end, with expensive in-patient hospitals or lock-down facilities. And laypeople, especially the president, can promote emotional well-being by setting the standard for mature, fair, and respectful treatment of everyone.  That starts with understanding what Mental Health really is, and why our mentally ill, diagnosed or not, are already living behind invisible, institutional barriers to quality care.


Rather than build more walls for people, he would do well to tear some of them down.