MS. DIANE REHMThanks for joining us. I'm Diane Rehm. In a break with professional protocol, some psychiatrists have offered public negative views on Donald Trump's mental fitness to be president. Others in the field say diagnosing from afar is unethical and usually inaccurate. Here to talk about arm-chair mental health assessments, their impact on the mental health profession and the presidential campaign, Amy Ellis Nutt of The Washington Post, Ron Elving of NPR News.

MS. DIANE REHMJoining us from a studio at Minnesota Public Radio, William Doherty, a psychologist at the University of Minnesota. By phone from New York City, Dr. Paul Appelbaum. He's professor of psychiatry, medicine and law at Columbia University. I do invite you to weigh in. Give us a call at 800-433-8850. Send an email to drshow@wamu.org. You can follow us on Facebook or send us a tweet. And thank you all for being with us.

MR. RON ELVINGGood morning, Diane. Good to be here.

MS. AMY ELLIS NUTTThank you.

MR. WILLIAM DOHERTYNice to be here.

REHMAmy, I'll start with you. You wrote a piece in The Washington Post this week saying, Donald Trump has sparked a new industry, which you say might be called Trumpology. What do you mean?

NUTTWell, first of all, I'll say that it's not original with The Washington Post. I believe Politico, at least several months ago, coined that term. In looking at the plethora of tweets, of remarks that seem, you know, outside the norm of political discourse, and to try and catalog them, make sense of them, categorize them, to figure out, you know, what is Trump and what does he stand for and what does he mean. And all of those things would seem on face value to be obvious in most political candidates. But not necessarily with Donald Trump.

REHMHow come? I mean, how different is he or what he says from what other candidates have said?

NUTTYou know, I should preface this by saying I'm actually not a political reporter. I'm a science writer. And so my interest in Donald Trump was obviously how other people talk about him. And certainly the thing that appeared to us over a number of months, beginning really last year, if not earlier, was the use of the word narcissism and narcissist. Which, frankly, was being used by -- mostly by other political figures.

NUTTAnd obviously as a criticism. And as that discourse sort of continued, you know, we decided well, what does that actually mean. You know, what does it mean for someone to be a narcissist? And why, in particular, I mean, many things are said about politicians all the time. Is there something distinctive about Donald Trump by which, you know, that characterization is more accurate than for anyone else?

REHMAnd what kinds of conclusions did you reach?

NUTTWell, remarkably, and I guess this would be part of our discussion here today, is that a number -- when I spoke to a number of psychologists and psychiatrists, some of them were willing to talk about it as a general phenomenon, not in particular about Donald Trump. And others were -- felt able to speak more directly. When we talk about narcissism, of course we're talking about a personality trait. A trait that at least at some time or another in most of our lives, according to psychologists, everybody, you know, shows evidence of.

NUTTYou know, we all like to think well of ourselves, for instance. Narcissistic personality disorder, of course, is something that's in the "Diagnostic and Statistical Manual of Mental Disorders" put out by The American Psychiatric Association. And really highlights people with narcissistic personality traits that lie far outside the norm. So it's, like many things in life, it's a spectrum, but it is a lens through which we can look and analyze what people say and how they think and how they behave.

NUTTAnd, as it turns out, it seemed to be, for many people, a particularly well-defined way of looking at the kinds of remarks that Donald Trump would make. That a belief in being special, this apparent need for excessive admiration, a sense of self-entitlement, and, you know, arrogance, haughtiness. Again, something that many politicians show evidence of, but I think it's the constellation of these characteristics in Donald Trump that made it particularly acute.

REHMInteresting. Dr. Paul Appelbaum, I know there are many reasons that psychiatrists don't offer diagnoses of people they have not examined. Explain to us why.

DR. PAUL APPELBAUMSure. To begin with the process of making a psychiatric diagnosis depends on more than just observing somebody's behavior or listening to their words. It requires an opportunity to probe the possible roots of those behaviors, Identifying whether there are constellations of pathological symptoms that might constitute a syndrome, whether substance abuse may be involved, whether there's a deliberate persona being projected by the individual, a way that he or she wants to portray themselves and, in fact, doesn’t represent their inner functioning accurately.

DR. PAUL APPELBAUMNone of that is discernible by watching somebody on TV or reading what they have to say in the newspaper. So the accuracy of these diagnoses at a distance is highly questionable. From there, I think, you know, the psychiatric profession in adopting rule against diagnosing people who have not been evaluated, was concerned about the negative effects of these kinds of diagnoses on the person.

REHMAnd that…

APPELBAUMI'm sorry.

REHMAnd, I'm sorry, and that was the so-called Goldwater rule instituted in 1973. Is that correct?

APPELBAUMThat's correct. After an episode in 1964, where several thousand psychiatrists responded to a survey by Fact Magazine and its publisher, Ralph Ginzburg, in which they were willing to label Barry Goldwater, the Republican candidate with an amazingly wide variety of diagnoses, from psychosis to narcissism to impaired masculinity. The concern was in part the embarrassment of what had just happened.

APPELBAUMBut much more importantly, that real people can be hurt by these mistaken diagnoses, the public can be misled by them and people who really could benefit from the attention of mental health professionals might be discouraged from seeking it by a mistaken perception that this is a profession that simply shoots from the hip and really has nothing substantive to offer.

REHMAnd, Bill Doherty, you are a psychologist. And as such, I gather, you felt the need to break that rule. Tell me why.

DOHERTYWell, I didn't feel the need to break that rule. That rule was about offering a diagnosis of somebody's -- somebody as person, somebody's pathology. The approach that I've taken and written a manifesto for a psychotherapist, that 2,200 have signed, is really an evaluation, a commentary on Trump's public behavior, public persona, public character. And explicitly avoids offering a diagnosis of that individual. We know nothing. I certainly know nothing about his personal life, him as a husband, as a father, as a friend.

DOHERTYBut we have a lot of public behavior in somebody who would be a public leader, that is evidencing behavior that is quite troubling and concerning. And I think that is fair game for behavioral scientists, for mental health professionals to comment on, as long as we don't claim more knowledge of his personal life.

REHMSo what motivated you to speak out about what's been called Trumpism?

DOHERTYLike many people that -- in the field that I know, when Donald Trump first went on the campaign trail, I laughed. I thought that he was clownish. I thought he would crash and burn. And then I grow -- I grew increasingly concerned about his popularity. And then in May I visited Eastern Europe and saw uniformed young neo-Nazi youth on the streets of a small town in Austria. And was aware that in Austria the most prominent fascist since the '30s, the '40s nearly got elected to president of Austria.

DOHERTYI subsequently visited a concentration camp and saw -- visited Freud's home and saw videos of him fleeing the Nazis. And so I -- and when I became aware of it, as I looked into it is that mental health professionals were silent during the rise of fascism in Eastern Europe. And some, in fact, collaborated. And so I decided I had a responsibility as a therapist, as a mental health professional to speak out and see if others would like to join me about a threat to the public mental health, which I think is what we're seeing…

REHMAll right.

DOHERTY…with the denigration of minorities.

REHMOkay.

DOHERTYAnd a threat to our democracy.

REHMAll right. We'll have to take a short break here. William Doherty is a psychologist at the University of Minnesota. Short break, right back.

REHMAnd welcome back. In this hour, we're looking at allegations at sort of armchair analysis of candidates and both mental, physical health that have been raised, certainly by the news media. And William Doherty, a psychologist at the University of Minnesota just talked about the fact that he and 2,200 other mental health professionals have published what's been called a manifesto against Trumpism. Amy, I want to turn back to you because I know that Sean Hannity on Fox news recently ran a segment questioning Hillary Clinton's medical fitness for office based on what?

MS. AMY NUTTWell, that was unclear. Some of it was based on I think photographs of Hillary Clinton being helped up a step. I think that she -- I'm not sure where it was, but I think she had fallen. Of course it was also a reference, I think, to her use of the word that her brain had short-circuited in her response -- some of her responses to questioning about the email server, which is interesting that someone saying of themselves my brain short-circuited, which is just kind of a way of saying I...

REHMI went blank or whatever.

NUTTExactly, that that should spark questions about her mental stability.

REHMInteresting. Turning to you, Ron Elving, don't both Clinton and Trump have reports from their doctors giving each a clean bill of health?

ELVINGYes, and we've come to expect that from candidates. They rarely have a doctor who is going to come forward and say, well, you know, I've kind of got my doubts about this person here. That would not be surprising. There have been, in just the last few days, there has been sort of a gusher of information on the Internet and in one's email box from people who are health care professionals or purport to be saying that they've observed things that trouble them about Hillary Clinton.

ELVINGAnd of course they go back oftentimes to 2012, when she did not go to a hearing on the Benghazi tragedy because she had had a fall and a concussion, and when she did subsequently appear in public, she was wearing glasses to help her focus, special glasses, which she subsequently did not need. But the raising questions of, gee, if she had a concussion then, and it was so serious back then when a lot of people were making fun of it and saying, oh, well, that's clearly a dodge to keep from going to the committee hearing, if it was so serious back then, how do we know that she's fully recovered.

ELVINGWell, we have the testimony of medical professionals that she is fully recovered, and we also have the ability to observe over the last three and a half years and judge whatever or reach whatever judgment we may reach.

REHMPaul Appelbaum, the question about the rationale for making such judgments about people from afar, is that perhaps they are public figures seen by millions, billions of people around the world who are bound to have impressions of their behavior, and among those billions of people, are those like yourself, who have great experience in diagnosing individuals? So do you see this coming out now, all these questions about both mental and physical health, sort of a normal part of assessing a candidate, or is there something unusual going on here?

APPELBAUMI think there's something unusual this year in terms of the intensity of this discussion. But actually if you look back every four years to 1864, when the Goldwater episode took place, it has been a rare campaign season when we haven't seen somebody raise questions about one or the other, or sometimes both, candidates' mental health, calling on remote diagnosticians to support their judgments. So that, unfortunately I think, has become a routine part of our campaign, at least our presidential campaign, seasons.

APPELBAUMWhat's worth noting is that although what you say about mental health professionals along with everyone else forming opinions as we watch Donald Trump, Hillary Clinton, as we watch the primary seasons, the fact is that the kinds of judgments that I form watching people on TV are probably no different than the kinds of judgment that you form. And to turn to me as a mental health professional and to ask me to deliver some sort of expert judgment, I can pretend to do that, but in reality my judgment is probably no better than yours and in some sense, for people who are more attuned to the political process, my judgment may be worse than theirs in that regard.

APPELBAUMSo the notion that we bring something special to these public observations of behavior I think is fundamentally flawed.

REHMAnd Ron Elving, of course we remember Tom Eagleton and the fact that he had to withdraw as a vice presidential candidate because he acknowledged that he had had electroshock therapy as a result of depression. He gave no symptoms whatsoever, at least outwardly, of having any psychological, psychiatric problems. So, you know, it seems we can go around and around on this.

ELVINGWell, even going back a little further than that, after the Goldwater incident in '64, we should say the Goldwater case because really it didn't have much to do with Barry Goldwater. I think it was largely driven by his ideas, which some people thought were unhinged, particularly with respect to nuclear war. But no one really seriously thought there was something wrong with Barry Goldwater. He was a pretty stable figure and came back and served in the Senate for many years, into the 1980s.

ELVINGBut Tom Eagleton's case was preceded by something a lot of people have forgotten. Mitt Romney's father, George Romney, ran for president in the run-up to 1968, and he went to Vietnam, and he came back, and he said that when he had been there, he had gotten a good brainwashing from the generals. Well, okay, maybe not the best choice of word, as indeed short-circuited probably wasn't, either. What he was saying was that he got propagandized while he was there.

ELVINGWell, brainwash was a term with a lot of meaning in the Cold War period and really kind of let people think that somehow someone had taken over your brain or wiped out your previous brain. It was a bad choice of words. And people gave him a lot of trouble for that for a long period of time. Then we had the Eagleton episode in '72. Michael Dukakis in 1988 had to get up and absolutely deny having gone to see a psychiatrist because of a wacky question asked at a Reagan press conference, to which Ronald Reagan replied, oh, I don't want to, you know, beat up on an invalid.

ELVINGWhat does Ronald Reagan know? Well, he was, himself, an hour, said, well, I was just joking, I don't have any information about Michael Dukakis, but that went out to such a degree that he had to exactly, 28 years ago this month, he had to go out and say I've never been to a psychiatrist.

REHMAll right, but on the other hand, Bill Doherty, you're talking about behaviors that we are all seeing, language that we are all hearing, which is, I gather, why 2,200 mental health professionals have joined you in this whole document that you've signed. What is it that concerns you most about Donald Trump?

DOHERTYThere -- he is projecting an image of hyper-masculinity, demeaning critics, brittle -- brittleness in the face of criticism and the strongman idea that trust me, I won't be very specific, trust me, and I will take care of all your problems. And we are seeing in our -- in our therapy offices particularly members of minority groups who are very troubled by what they're hearing and seeing. And so this strongman, brittle ego, hyper-masculinity needs to be named, called out, and I think that the public can decide how much credibility they want to give to mental health professionals talking about these things.

DOHERTYBut I think this is a much bigger issue than exactly what is the role of mental health professionals in our society. I think lots of people need to speak out, and I think therapists need to be speaking out, as well, about the unhealthy approach to interpersonal relationships we're seeing in Donald Trump and what's behind him.

REHMHow do you see that, Amy?

NUTTYou know, I think it's worth mentioning that since narcissism is sort of the catchword right now that people in the past, social scientists and behavioral psychologists, have actually looked at the narcissistic qualities of presidents. And again, you know, as Bill mentioned, you know, we're only looking at behaviors, obviously. But as recently as 2013, there was a very interesting Pew study that basically ranked, according to grandiose, narcissistic traits, the presidents in order, excluding the sitting president, Barack Obama.

NUTTAnd at the top of their list was LBJ. Teddy Roosevelt was two. FDR was in there. And what they basically found was that people with, you know, high levels of narcissistic traits tended to be the people that got the most done. So again, I think we go back to this idea of it being a spectrum and it being -- you know, what is the difference between having narcissistic personality traits and having, you know, pathological narcissism as several of the psychiatrists that I spoke with in doing a couple of my articles mentioned to me, it's very rare for someone to walk into the office and say I have a bad case of narcissism, you know, can you help me with that.

NUTTAlmost always they come in, you know, complaining of maybe difficulty in relationships or depression, and it takes a long time to get around to that, to that word because it's also a very, very loaded word, and it's -- you know, we're hurling it now as an epithet more frequently than not.

REHMBut Bill Doherty, I gather you're concerned about more than just narcissism.

DOHERTYYes, in fact I haven't used the word here in the conversation. There -- you know, in Minnesota we had a governor who was a wrestler and a celebrity named Jesse Ventura, and one of the things we learned, and this is I think true of Donald Trump's public behavior, is a brittleness in the face of criticism, which is a terrible thing in a public figure, a counterattack, and this is a kind of a leadership image that he is portraying that I think is deeply unhealthy and needs to be called out.

DOHERTYWhatever the underlying traits are, the underlying psychopathology, if he has it, we need to be talking about how we treat each other in this country and what our leaders demonstrate about how we treat each other.

REHMAmy?

NUTTFollowing up on what Bill's saying, it's interesting to note, and obviously we have such a range of things to pull from in terms of interviews and videos going back 20, 30 years with Donald Trump, but one thing he has made clear on several occasions is that he has said his greatest thrill in life is getting even. So without obviously even referring, you know, to narcissism, I think many people see that obviously as a troubling characteristic.

REHMAnd you're listening to the Diane Rehm Show. We have a number of callers waiting. I want to go first to Cleveland, Ohio. Paulette, you're on the air.

PAULETTEYes, Diane, thank you so much for taking my call.

REHMSurely.

PAULETTEI'm -- my comment is that early on in the campaign, I sensed that Donald Trump was really a master manipulator, and it seemed as though he was testing his followers to see how outrageous he could be and how -- what could he say and still have them follow him and still have them support him. And it seemed like no matter what he said, they were there with him. And that's what I find scary is that he could tell them that the moon is made of cheese, and they would believe it.

PAULETTEHe has all the characteristics of, you know, projection and deflection and everything else, and his relationship with the truth is very -- you know, he states lies as facts, and his followers believe that, too.

REHMAll right, Dr. Appelbaum.

APPELBAUMYeah, so I think Paulette's observations, and in fact Bill Doherty's observations, are the kinds of things that any attentive observer can notice. Donald Trump doesn't like to be criticized. He's brittle in that way. He lashes out against opponent or perceived enemies, there's a hyper-masculine quality. You don't need to be, and obviously Paulette's comment I think demonstrates that, a mental health professional to observe these things, and I'm not sure being a mental health professional particularly lends credence to any of those observations.

APPELBAUMI would note that bill Doherty ironically, and I've read his manifesto very carefully, doesn't cross the line into diagnosing Donald Trump. His manifesto is very much focused on what he calls Trumpism, which he characterizes as an ideology, and it's the political approach that that manifesto criticizes, and to me that's fair game. I'm fine with that.

REHMRon Elving?

ELVINGThis is I think an area where journalists need to tread softly and reluctantly not only because we have heard people impugn the mental state of presidential candidates before, probably back as far as there have been presidential campaigns or any other kind of political campaigns.

REHMCertainly Abraham Lincoln.

ELVINGOh, people have frequently used casual terms, like oh, he's nuts, or he's crazy, and remember Barry Goldwater's theme back in '64 was in your heart, you know he's right, and LBJ would say, and in your guts you know he's nuts. And that kind of casual attribute -- attributing of mental instability is so rife in our normal discourse that it's -- we have to be careful not to let it creep into our more formal discussion of this campaign.

REHMAnd here's an email from Portia. Regarding psychoanalyzing Trump from afar, one thing that makes him very different from Goldwater is our age of social media. Trump's constant indulgence in Twitter reveals a great deal of his inner thoughts. Doesn't this make him much more accessible from afar, Bill Doherty?

DOHERTYYes, absolutely, and I agree with what my colleagues on the panel have been saying, that we really have to be careful, though, about what I call weaponizing diagnoses. This is -- I think Dr. Appelbaum's caution here is well nothing. I view...

REHMAnd we've got to take another short break. I'll come back to you, Bill Doherty. After we do this break we'll take more of your calls, your questions. Stay with us.

REHMAnd welcome back. Dr. Appelbaum, I want to come to you and ask you to differentiate for us a mental disorder and a personality disorder.

APPELBAUMYeah, so I think Amy did a great job earlier in this show to lay that out. Among the broad category of dysfunctions that we call mental disorders is a group that we call personality disorders. What's different about them, as Amy was suggesting, is that they are not what most people think of as mental illnesses. They're not marked by the kind of detachment from reality that you see in schizophrenia or some of the other psychotic disorders. They are enduring patterns of behaving and interacting with other people. They usually start early in life.

APPELBAUMAnd as Amy correctly said, the populous has a spectrum of these traits. We all have some narcissism. We all have some obsessive traits. We're all hysterical to some extent. That's what makes us us. We have these unique mixes of personality characteristics. They become disorders when they cross the line into causing personal distress or societal dysfunction. If I can't work, if I can't collaborate with people, if I can't run a business or see patients or teach, then I've got a disorder. And then I may, and probably should, seek some treatment for it.

REHMAll right. Here's a message for The Diane Rehm Show. It is from John who says, your coverage of Donald Trump's alleged mental health issues is deeply irresponsible and not worthy of wide circulation. Simply put, if you don't like someone's politics, just say that then. But don't pretend to bring medicine into politics. Your yet another point missed in your abysmal coverage is the right of those with mental illness to hold office and positions of leadership. Again, this was a shameful way of dealing with a shameful politician.

ELVINGSo, I gather then John is not a fan of either Donald Trump or our coverage of Donald Trump. And all that's understood. The point he raises about how we characterize mental illness is a really large issue. We are still, as a society, in our infancy in dealing with the degree to which health problems can be mental problems, can be mental diseases. And this is a highly important point to make, that we should not act as though raising an issue of any of these kinds.

ELVINGAnd the difference between personality disorder and mental disease is an enormous difference. But we should be very careful not to suggest, in some way or another, that there is something morally or reprehensible about people who suffer from any degree of mental disease.

REHMBill Doherty, do you want to weigh in?

DOHERTYYes, I concur. This is tricky waters here, because labeling people who are suffering from personality disorders as patients do, there is intense suffering and shame. This is why, I think, we have to be very careful about using diagnosis for political reasons. And that's what I think was behind the Goldwater Rule in psychiatry. Having said that, I think that mental health professionals, psychotherapists, have to be able and willing to speak in the public domain not claiming, and I agree with Dr. Appelbaum here.

DOHERTYNot claiming scientific knowledge and expertise and we should be listened to more than anyone else. But I think we need to be weighing in and I want to repeat that the principal thing that I'm after is this Trumpism, this collection of ways to deal with public issues that Donald Trump represents that will live after him. And that's why I think a narrow focus on his personality, in some ways, misses the larger issue.

REHMAmy.

NUTTI just want to say, as a journalist, you know, Donald Trump obviously has made it clear that he craves the attention and the media. And it's one way of him speaking directly to his audience. But I want to make it clear that that's, and all the psychiatrists and the psychologists that I talk to, I never once asked them what their political party was or who they were going to vote for. And that it would be journalistic malpractice to, in some ways, not cover what Donald Trump has been saying.

NUTTThis of course, does lead us into frankly important discussions about the difference between personality traits and disorders and mental illness. And one of the more interesting things that I was told by a psychiatrist is that a lot of the suffering that's actually involved around narcissistic personality disorder is the suffering of other people. Not actually of the person, him or herself. That, in the way it affects the relationships and how you deal with other people or not deal with them. That it's the people who are close to someone with NPD that have the most difficulty and that frankly suffer the most consequences.

REHMRon Elving, you were saying during the break that it's impossible not to focus on what Donald Trump is doing each day. Today being a perfect example when he has changed his whole upper echelon of campaign officials.

ELVINGYes, now of course, the Trump campaign is saying that they've just added a couple of more people at the top and that there will be a core of four instead of the two people who were running the campaign before. That appears to pretty much everyone on the outside and clearly some of the people within the Trump organization as well to be a changing of the guard. And we now have Steve Bannon, who is the CEO of Breitbart.com, which is a well-known sort of alt-right website.

ELVINGAnd we have Kellyanne Conway, who is a longtime respected Republican pollster, who has been, in the past, associated with the Ted Cruz campaign. And we also have, apparently, a greater influence for Robert Mercer, the hedge fund manager from New York, who was also, previously, a Ted Cruz supporter. His biggest donor, I believe, or certainly one of Ted Cruz's biggest donors. We also seem to have more of his influence in the campaign. He was invited in. People wanted him to support Trump.

ELVINGAnd so, there seems to be a shift here. And the idea seems to be to unleash, perhaps the leash wasn't that apparent, but to unleash Donald Trump to be his economic populist self. To be his angry person, and not to try to pivot to some sort of more moderated Presidential tone, as the previous top dog, Paul Manafort, had been tasked with doing and had had some struggle trying to achieve. It's hard to ignore a change like that on a day like this. There isn't a lot of other news coming from the other campaigns that is nearly that vivid.

ELVINGOr nearly that consequential. And that seems to be true more days than not, perhaps five days out of seven. Something happens in the Donald Trump campaign, or he says something live and in color quite vividly that is impossible to ignore.

REHMLike what?

ELVINGWell, such as last week when he said that President Obama was the founder of ISIS and that he and Hillary Clinton had founded ISIS. This is an organization that is more than a dozen years old, goes back to the early part of the last decade when Barack Obama was a State Legislator in Illinois. I mean, these are almost non-sensical comments. Then, the next day he would say, well, can't you -- no, the next day, he said, no, I meant that literally. I meant that literally, given many opportunities to walk it back.

ELVINGAnd then the day after that, he said, don't you understand sarcasm, and later the same day, he said, but then I wasn't being that sarcastic. Now, which of those, which of those remarks should the media not pay attention to?

REHMBill Doherty.

DOHERTYWell, I'm a family therapist, and this kind of thing goes on in families. This is interpersonal communication that is highly dysfunctional. Whipping the whole country around as occurs in some very dysfunctional, interpersonal relationships. It's quite striking. I also want to mention, go back to what Paulette said, the caller, that from what I understand, and I use this cautiously here, but in the rise of Hitler in Germany, he pushed the envelope to see what people would tolerate in his anti-Semitic remarks.

DOHERTYAnd apparently, according to his story is he found acceptance, and then he kept ratcheting it up. So the kind of offensiveness that Trump does, that particularly during the primaries, met with applause, encouraged him to continue.

REHMDo you want to comment, Dr. Appelbaum?

APPELBAUMYeah, so, you know, I think, although one could characterize the behavior that Ron described as dysfunctional, what we don't know is whether it's highly choreographed. Whether there is something that just works for the Trump campaign and that seemingly erratic pattern of behavior. So, I would keep that in mind as a possibility, back off on pathologizing it and just describe what's going on and take it for what it is.

REHMAll right, to Indianapolis. Hi there, Louis. You're on the air.

LOUISHi. Thanks, Diane.

REHMSure.

LOUISI think one of your panelists describing Donald Trump as hyper masculine. Another one described him as Hitler. I think most Trump supporters see this kind of examination of him as just a fearful neutered politically correct response to an alpha male.

REHMTo an alpha male. How do you respond, Amy?

NUTTYou know, as a journalist, we're asked to interpret and report and make sense. And I think, to a large extent, the reporting about Donald Trump has been about trying to get a handle on what it means. Dr. Appelbaum was absolutely right. This is a difficult to tease out. What are we -- are we hearing what a person really is? What they really think, or is this a performance? Is it performance art? Is he the PT Barnum, you know, of politics?

NUTTAnd that's an important discussion. So, I think this may seem like it's overkill in talking about this, but our brains are geared to try and figure things out and I think Donald Trump has presented the American public with a conundrum. And, you know, what does it mean? This is someone who's very, very different from any other politician that we've had. So, in a way, it's trying to get a handle on how do we understand someone as a politician, as a person, as a human being?

REHMTo Judy in Syracuse, New York. You're on the air.

JUDYHi, I've been a mental health therapist now for over 40 years. I have a great deal of concern about Mr. Trump. And if we look at this as being showmanship, my interpretation of this is if you do not want people to see you the way you are, then don't be that way. If, as far as I'm concerned, he appears to me to be severely bipolar, and is often in a hypo-manic state. Personally, I wouldn't want that person as Commander-in-Chief. Because if he is in a hypomanic or manic state, we're in trouble.

REHMAnd you're listening to The Diane Rehm Show. What about that, Bill Doherty?

DOHERTYWell, it's a really interesting conversation about the public and private. So, I go back to this notion that, that his public persona, which as Dr. Appelbaum said, could be performance, is all we have access to. That, in itself, though, is quite troubling, because it's highly likely that this would be the public behavior that he would show as President. So whatever underlying this is that we don't have access to, I think the conversation about the public behavior and the public persona is important to have.

DOHERTYI also want to go back to this alpha male. Wow. This is the gorilla, right? And what we're seeing in Donald Trump, as this alpha male, is degrading and demeaning and appealing to fear and saying, trust me. And I'll solve your problems. That's not a male leadership or a female leadership.

REHMDr. Appelbaum.

APPELBAUMYou know, Diane, the email that you read earlier made a comment that we haven't touched on, which was to encourage people to recognize the essentially political nature of many of the comments being made about both candidates mental functioning. And I think that's important to acknowledge. That even trained mental health professionals, when they form judgments about people, those judgments are influenced by their pre-existing biases, including their political biases.

APPELBAUMAnd I would actually be quite surprised to know how many mental health professionals, who are lifelong Republicans, have been among those speaking out with concern about Trump. And how many lifelong Democrats have been expressing concern about Hillary Clinton's mental state. I think we're too easily influenced by our political judgments here.

ELVINGCertainly a valid point, no question about it. One of the things that has been noted often by people who have gotten to know Donald Trump in a more private context is they will tell you. They will say, he's nothing like that. When you meet him in a more private context, you meet him with his family, he doesn't behave the way you see him behaving as a Presidential candidate. He's kind, he's charming, he's self-effacing, he steps back and that is a remarkable observation. But the person who ghost wrote "Art of the Deal" for him has made that observation.

ELVINGMark Fisher of the Washington Post, who has just written a book about Donald Trump that's coming out very quickly. He observes that when you actually meet the man, he's remarkably gracious. And others who have met him and known him personally, socially, say he's really quite different. That is a fascinating element in all of this. Why does he behave so differently when he goes out to ask people to vote for him?

REHMAnd Bill Doherty, I guess that's something that concerns you.

DOHERTYYes, we're not voting for the friend of the year, the father of the year. We're voting for President of the United States. And so, this public behavior is worth commenting on. And also, I appreciate the observations about we all bring our political biases to this. I can tell you, I asked for a show of hands, if you will, in the -- among the 2200 therapists who signed our citizen therapist manifesto against Trumpism. I heard from a number of lifelong Republican therapists who share the concerns that we express in the manifesto.

REHMAnd finally, to you Amy. Words of wisdom for all of us?

NUTTYou know, words do matter. We've heard that before. And you know, basically all we have to go on are what we see and what we hear and what we read. We can't truly know what's in the heart of Donald Trump or frankly Hillary Clinton. And so, the discussion, while excessive at times, I think, again, is critically important, because it's the only way we have to understand what's going on and who we're going to be voting for. And the more discussion, the more we know.

REHMAmy Ellis Nutt, she is Science Writer for the Washington Post. Dr. Paul Appelbaum, Professor of Psychiatry, Medicine and Law at Columbia University. William Doherty, he's a Psychologist at the University of Minnesota. And Ron Elving, Senior Washington Editor for NPR News. Thank you all so much.

NUTTThank you.

ELVINGThank you, Diane.

DOHERTYA pleasure.

APPELBAUMThank you.

REHMAnd thanks all, for listening. I'm Diane Rehm.