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Tags donald trump , mental illness issues , psychiatry incidents , psychiatry issues , Trump controversies

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Old 31st August 2017, 12:09 PM   #2601
xjx388
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Originally Posted by TheL8Elvis View Post
I don't think you can make a case for NPD of any poster based on this thread.

I think that's a ludicrous claim.
It's pretty easy to make a case for any given person having any given psychiatric diagnosis if we 1)Interpret everything they do through biased lenses, 2)Cherry pick their statements so as to fit criteria, 3)Start from the assumption that they must have some kind of diagnosis and 4)Ignore all standard medical procedure and ethics by practicing checklist medicine on people we have never met.

As a pure exercise without any serious intent whatsoever, here is the criteria for NPD:
Quote:
Grandiosity with expectations of superior treatment from others

Fixated on fantasies of power, success, intelligence, attractiveness, etc.

Self-perception of being unique, superior and associated with high-status people and institutions

Needing constant admiration from others

Sense of entitlement to special treatment and to obedience from others

Exploitative of others to achieve personal gain

Unwilling to empathize with others' feelings, wishes, or needs

Intensely envious of others and the belief that others are equally envious of them

Pompous and arrogant demeanor
Are you saying that we can't pick certain statements from posters in this thread and make them fit into this criteria? Of course we can! With permission, I could easily demonstrate it for argument's sake.
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Old 31st August 2017, 12:16 PM   #2602
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Originally Posted by blutoski View Post
Earlier, you were willing to participate in a real dollar challenge with another list member.

I'd like to offer one of my own. Regarding above, would you be willing to write your certifying body an email, asking them if you are qualified to diagnose a potential patient based on their media history and share the results with the forum?
I already posted supporting citations that basic psychiatric diagnoses were within the scope of family practice. I am certified in family practice, occupational health and infection prevention. In WA State NPs are independently licensed to practice in the areas they are certified in.

Your request is unrealistic given that is not a function of the state nursing commission (my licensing board).

I don't really care, this is a forum. It's not up to me to prove anything to anyone here though I'm pretty sure people who know me don't doubt my profession.

I will say it again, I am not the only professional who has concluded Trump has NPD. Look at the OP for Pete's sake!

If you draw a contradictory conclusion, that's your business. But you need to address all the professionals that have made public statements. Trying to make this about me is disingenuous cherry picking.
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Old 31st August 2017, 12:19 PM   #2603
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Originally Posted by xjx388 View Post
It's pretty easy to make a case for any given person having any given psychiatric diagnosis if we 1)Interpret everything they do through biased lenses, 2)Cherry pick their statements so as to fit criteria, 3)Start from the assumption that they must have some kind of diagnosis and 4)Ignore all standard medical procedure and ethics by practicing checklist medicine on people we have never met.

As a pure exercise without any serious intent whatsoever, here is the criteria for NPD:

Are you saying that we can't pick certain statements from posters in this thread and make them fit into this criteria? Of course we can! With permission, I could easily demonstrate it for argument's sake.
Another example of Dunning Kruger, you read the criteria in the DSM and imagine that without any context the criteria apply to anyone. It does not.

Trump does however, meet the NPD diagnostic criteria as many recognized professionals have attested to.
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Old 31st August 2017, 12:31 PM   #2604
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Originally Posted by blutoski View Post
I think the opposite, and I up the ante by saying that given the challenge of remote diagnosing any member of this forum with any random cluster B, we can be guaranteed to get a hit. The evaluator just needs some motivation and time to read through every post, selecting the juicy bits to present as confirmatory evidence.

This is the reason remote diagnosis is considered malpractice: there's too much filtering when the presentment is captured from curated snippets versus an interactive process.

Here's an easy one: let's start with [OCPD].

In the interest of the list education, I volunteer to go first.
Oooh, oooh - do me next!

I can almost guarantee that I'll tick a lot of OCPD boxes. Probably a pile of the others PDs too.
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Old 31st August 2017, 12:34 PM   #2605
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Originally Posted by blutoski View Post
I didn't see anything in that list that bears relation to a medical diagnosis for NPD.

He's a bold faced liar for political gain - so's every politician in history. Nothing medically debilitating about that.
Trump's lies look different to normal politicians. Most politicians don't lie about trivial things that don't matter when they are obvious lies.

Originally Posted by blutoski View Post
I also think there's a misunderstanding about NPD versus colloquial narcissism.

NPD isn't narcissism on steroids. There's no "if narcissim gets very severe it crosses a threshold and becomes NPD" - that's not how it works.

A key qualifying characteristic of any Cluster B is that the personality traits are causing the patient suffering. I just don't see it in this case. I can't picture him moaning, "If only I was less narcissistic, my life would be so much better, I wish I could change."

A real life example is one of my wife's patients. For some reason, his condition manifests as having to push ahead in lines. Recently, he made the mistake of crossing a fellow liner-upper who was a professional pub bouncer, and the patient got a sock in the stomach that led to surgery for internal bleeding. In terms of magnitude, this guy's practically harmless. But the inability to turn off the impulse to demonstrate his superiority has led to clear self harm and suffering, and combined with enough of the other criteria, he checks out for NPD.

There's NPD patients out there who've lost visitation rights to their children, beat their spouses and ended up in prison, lost an eye because they couldn't stand down and walk away when they've been insulted...

Meanwhile, this dude's a billionaire playboy president. I just don't see the suffering.
The trouble with the "harm" criterion is that Caligula and Nero probably weren't harmed by their behaviour until it ended up getting them killed.

Similarly, Jim Jones or David Koresh did quite well... until they didn't.



Trump's need to have more scoops ice cream than anyone else in the white house is pretty close to your wife's patient's need to be in the front of a queue.
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Old 31st August 2017, 12:34 PM   #2606
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Originally Posted by Skeptic Ginger View Post
I already posted supporting citations that basic psychiatric diagnoses were within the scope of family practice. I am certified in family practice, occupational health and infection prevention. In WA State NPs are independently licensed to practice in the areas they are certified in.
Once again, I will point out that 1) Personality Disorders aren't "basic psychiatric diagnoses" and 2) you are not certified to practice a psychiatric specialty, and there for are NOT licensed to practice mental health.
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Old 31st August 2017, 12:42 PM   #2607
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Originally Posted by Skeptic Ginger View Post
I already posted supporting citations that basic psychiatric diagnoses were within the scope of family practice. I am certified in family practice, occupational health and infection prevention. In WA State NPs are independently licensed to practice in the areas they are certified in.

Your request is unrealistic given that is not a function of the state nursing commission (my licensing board).

I don't really care, this is a forum. It's not up to me to prove anything to anyone here though I'm pretty sure people who know me don't doubt my profession.

I will say it again, I am not the only professional who has concluded Trump has NPD. Look at the OP for Pete's sake!

If you draw a contradictory conclusion, that's your business. But you need to address all the professionals that have made public statements. Trying to make this about me is disingenuous cherry picking.
Blutoski, me, EC . . . none of us has made this about you. You introduced your expertise so you made it about you. You are trying to "win the argument" by saying you are an expert so we should listen to you. I think you should put up or shut up, in this case. The Nursing Board of Washington is not who you should be emailing for an answer. They license you to practice within the scope of practice of the certification you have. You have said that you are an FP APRN so that means you need an answer from the certifying body that you went through: the AAPN or the ANCC most likely. The question for them is: Does an FNP have the expertise to diagnose mental health conditions in people they have never met? I don't think you'll like the answer.

But fundamentally, you are correct: this isn't about you or even what the scope of practice of an FNP should be. This is about the standards of practice and ethics of the mental health profession. The official positions are clear.
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Old 31st August 2017, 12:44 PM   #2608
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Originally Posted by jimbob View Post
Trump's lies look different to normal politicians. Most politicians don't lie about trivial things that don't matter when they are obvious lies.
Pretty vague. Sounds like diagnosis through anecdote and opinion.



Originally Posted by jimbob View Post
The trouble with the "harm" criterion is that Caligula and Nero probably weren't harmed by their behaviour until it ended up getting them killed.

Similarly, Jim Jones or David Koresh did quite well... until they didn't.
Sorry, not sure what you're saying... are we diagnosing through history books now?

Or is this meaning that OK the diagnosis has that criteria but you disagree with it? (diagnosing through personal criteria, not DSM?)
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Old 31st August 2017, 12:48 PM   #2609
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Originally Posted by Skeptic Ginger View Post
I already posted supporting citations that basic psychiatric diagnoses were within the scope of family practice.
And I think we're disputing that NPD is one of them.

Easy to clear up, we can just send an email. I'm willing to wager a coke.
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Old 31st August 2017, 12:53 PM   #2610
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Originally Posted by Emily's Cat View Post
Oooh, oooh - do me next!

I can almost guarantee that I'll tick a lot of OCPD boxes. Probably a pile of the others PDs too.
OCPD pretty much has "typical skeptic" written all over it.

"Loves to argue - can't lose an argument." Check, check, check, aaaaand check.

Yet, we're probably not pathological. Cluster B Diagnosis is just too contextual.
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Old 31st August 2017, 01:02 PM   #2611
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Originally Posted by Skeptic Ginger View Post
Another example of Dunning Kruger, you read the criteria in the DSM and imagine that without any context the criteria apply to anyone. It does not.
Why not? That is exactly what you are doing here: insisting that since you can demonstrate Trump checks all the criteria boxes he must have NPD. You add only one wrinkle: "I am a medical professional so I must be more right than you."

You are using "Dunning-Kruger" to basically call me stupid -an ad hom and misapplication of the term. I have never represented myself as anything other than a layman who is using the standards of the profession which are publicly available. I'm going to use Dunning-Kruger much more precisely: You are an FNP who thinks your license to practice medicine means you are expert in all facets of medicine. This is true illusory superiority. Your training and certification is not in psychiatry. You don't have practice experience in psychiatry. You should know enough to know how much you don't know. So tell us again how expert you are in diagnosing psychiatric conditions . . .

Quote:
Trump does however, meet the NPD diagnostic criteria as many recognized professionals have attested to.
And many, many more have either remained silent or said that they don't have enough information. The organization involved in training and representing the profession has issued a very clear refutation of your position. Sorry, but your insistence that the vast majority of the mental health profession is wrong is not very convincing.
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Old 31st August 2017, 01:42 PM   #2612
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Originally Posted by blutoski View Post
Originally Posted by jimbob View Post
Trump's lies look different to normal politicians. Most politicians don't lie about trivial things that don't matter when they are obvious lies.
Pretty vague. Sounds like diagnosis through anecdote and opinion.
True - I am an engineer not psychologist or psychiatrist. However the easiest way to predict what Trump will say is to ignore the truth, but just think what someone with no self-awareness and a massive sense of entitlement would say. "I grabbed her by the pussy" (almost certainly true). "I had the biggest crowd" (obvious lie). Telling the Economist magazine that he had just come up with the term "priming the pump" (laughably wrong)

Quote:


Originally Posted by jimbob View Post
The trouble with the "harm" criterion is that Caligula and Nero probably weren't harmed by their behaviour until it ended up getting them killed.

Similarly, Jim Jones or David Koresh did quite well... until they didn't.
Sorry, not sure what you're saying... are we diagnosing through history books now?

Or is this meaning that OK the diagnosis has that criteria but you disagree with it? (diagnosing through personal criteria, not DSM?)
Not diagnosing through history books, but I'm making the point that their behaviours eventually *did* cause them harm, but until that time, their "skewed view of the world" had caused them to behave in a certain way.

The fact that it didn't cause them problems earlier, is a problem with the definition in my view. That was what I was highlighting. Not diagnosing historical figures with a particular condition, but choosing notoriously dangerously odd historical figures who had been protected by their position.
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Old 31st August 2017, 01:53 PM   #2613
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Originally Posted by xjx388 View Post
Blutoski, me, EC . . . none of us has made this about you.
Yes you have, when you stopped including other professionals' opinions and only argued against mine as if that was the only opinion Trump has NPD..

Originally Posted by xjx388 View Post
... The question for them is: Does an FNP have the expertise to diagnose mental health conditions in people they have never met? I don't think you'll like the answer.
You may not like the answer, but it has been addressed in this thread.

Originally Posted by xjx388 View Post
But fundamentally, you are correct: this isn't about you or even what the scope of practice of an FNP should be. This is about the standards of practice and ethics of the mental health profession. The official positions are clear.
Yeah, they are. You just choose to only look at some of those positions and you ignore the positions you don't like.
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Old 31st August 2017, 01:57 PM   #2614
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Originally Posted by jimbob View Post
True - I am an engineer not psychologist or psychiatrist. However the easiest way to predict what Trump will say is to ignore the truth, but just think what someone with no self-awareness and a massive sense of entitlement would say. "I grabbed her by the pussy" (almost certainly true). "I had the biggest crowd" (obvious lie). Telling the Economist magazine that he had just come up with the term "priming the pump" (laughably wrong)
Yep. Lies like a sidewalk. I diagnose "liar," but not necessarily "NPD".



Originally Posted by jimbob View Post
Not diagnosing through history books, but I'm making the point that their behaviours eventually *did* cause them harm, but until that time, their "skewed view of the world" had caused them to behave in a certain way.

The fact that it didn't cause them problems earlier, is a problem with the definition in my view. That was what I was highlighting. Not diagnosing historical figures with a particular condition, but choosing notoriously dangerously odd historical figures who had been protected by their position.
Right, and this highlights the reason we don't diagnose through media. Your knowledge of these historical figures is filtered, you have no idea what their private thoughts or motives were, or even if they had consequences prior to their deaths, so maybe they did, right?

A good example is Nero, who is actually a case study in adolescent depression. He was a first century "emo" kid. Multiple suicide attempts, constantly writing prose about how lonely he was and how nobody liked the real him. He wasn't killed, he committed suicide.

But here's the thing... and this relates to an earlier post you had about how rich people can be depressed... the diagnostic interest is whether a person's depression is specifically caused by the narcissism. Not whether it's concurrent due to an unrelated cause.

Let's assume that Trump is failing at one of his goals. Take Obamacare Repeal, for example. Is he unable to accomplish this because of his narcissism? Or is it because it's flat out difficult? Did the Senate fail to produce a bill because there was no political route at the moment, or because they don't like Trump's attitude and spiked it to spite him? I don't see the necessary connections to say that anything I would speculate as a failure (and we're also making assumptions about what he considers a success or failure - what if his goals are to enrich his family, and all this presidenting is a pretense to loot?)
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Old 31st August 2017, 01:59 PM   #2615
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Originally Posted by blutoski View Post
And I think we're disputing that NPD is one of them.

Easy to clear up, we can just send an email. I'm willing to wager a coke.
IOW present inappropriate evidence. (I told you, that is not the nursing commission's function.)

As for disputing my scope of practice, what are you basing your assertion on? Like I said, I posted supporting evidence that recognizing/diagnosing basic psychiatric disorders was indeed within the scope of family practice. Why you think NPD is so complex is another unsupportable assertion you've made.
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Old 31st August 2017, 02:09 PM   #2616
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Originally Posted by blutoski View Post
Yep. Lies like a sidewalk. I diagnose "liar," but not necessarily "NPD".





Right, and this highlights the reason we don't diagnose through media. Your knowledge of these historical figures is filtered, you have no idea what their private thoughts or motives were, or even if they had consequences prior to their deaths, so maybe they did, right?

A good example is Nero, who is actually a case study in adolescent depression. He was a first century "emo" kid. Multiple suicide attempts, constantly writing prose about how lonely he was and how nobody liked the real him. He wasn't killed, he committed suicide.

But here's the thing... and this relates to an earlier post you had about how rich people can be depressed... the diagnostic interest is whether a person's depression is specifically caused by the narcissism. Not whether it's concurrent due to an unrelated cause.

Let's assume that Trump is failing at one of his goals. Take Obamacare Repeal, for example. Is he unable to accomplish this because of his narcissism? Or is it because it's flat out difficult? Did the Senate fail to produce a bill because there was no political route at the moment, or because they don't like Trump's attitude and spiked it to spite him? I don't see the necessary connections to say that anything I would speculate as a failure (and we're also making assumptions about what he considers a success or failure - what if his goals are to enrich his family, and all this presidenting is a pretense to loot?)
I think the last paragraph is the "Trump might be playing 4D chess" argument. I find that implausible.

My view is that Trump's behaviour is so odd that it raises warning flags, and that he should be subjected to an examination to see whether he is fit for office.

Whilst I accept that clinical psychologists would not diagnose someone without an examination, criminal psychologists have to do something pretty akin to this, based on the evidence they have available, which would be far less than the evidence we have in the case of Trump.
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Old 31st August 2017, 02:18 PM   #2617
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Originally Posted by blutoski View Post
Yep. Lies like a sidewalk. I diagnose "liar," but not necessarily "NPD".

Right, and this highlights the reason we don't diagnose through media. Your knowledge of these historical figures is filtered, you have no idea what their private thoughts or motives were, or even if they had consequences prior to their deaths, so maybe they did, right?
You don't seem to be looking at the totality of the evidence, something that has been addressed in the thread more than once.

Originally Posted by blutoski View Post
A good example is Nero, who is actually a case study in adolescent depression. He was a first century "emo" kid. Multiple suicide attempts, constantly writing prose about how lonely he was and how nobody liked the real him. He wasn't killed, he committed suicide.

But here's the thing... and this relates to an earlier post you had about how rich people can be depressed... the diagnostic interest is whether a person's depression is specifically caused by the narcissism. Not whether it's concurrent due to an unrelated cause.
Depression is not the dysfunction Trump has evidence of.

Originally Posted by blutoski View Post
Let's assume that Trump is failing at one of his goals. Take Obamacare Repeal, for example. Is he unable to accomplish this because of his narcissism? Or is it because it's flat out difficult? Did the Senate fail to produce a bill because there was no political route at the moment, or because they don't like Trump's attitude and spiked it to spite him? I don't see the necessary connections to say that anything I would speculate as a failure (and we're also making assumptions about what he considers a success or failure - what if his goals are to enrich his family, and all this presidenting is a pretense to loot?)
You're looking at the evidence all wrong.

Trump claims he has an Obama care replacement plan, says it over and over during his campaign. When the time comes to present his plan, he shifts into denial and insists that McConnell and Ryan present their plan. They don't have one either. No plan is passed. Trump now says it's the GOP that failed and despite irrefutable evidence Trump had claimed he had a plan when he didn't, it's as if he simply cannot accept that he ever said that. You can show a video to him where he said it, he still can't see it.

Now one might say this was no different from typical campaign promises and deflecting criticism. But when you look at Trump repeating this same pattern again and again you see that his behavior crosses into the pathologic side of the continuum. His denial is extremely pathologic as there is no evidence Trump can control this behavior. It's not even clear that he recognizes his behavior, I suspect he doesn't. That is the typical lack of insight people with mental illnesses often have.

Take his insistence more people were at his inauguration than were at Obama's. He didn't just insist it and claim the park department images were taken at the wrong time. He contrived a conspiracy against him by the park employees. That is paranoia associated with mental illness. Then he had images
of different angles appearing to show a fuller attendance blown up and framed. He placed them on the walls in the White House and pointed them out to reporters. He had Spicer go out and make outright false statements in the first press briefing. He brings up his crowd attendance claiming it set records months after the inauguration. That is obsessive preoccupation with that crowd size. There is little to no political gain from that big lie except to con his shrinking base into agreeing the mainstream news is fake news.

There is no evidence Trump knows he's lying about the crowd attendance, again, his pattern is consistent. Again and again he repeats lies inflating his accomplishments and popularity.

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Old 31st August 2017, 02:20 PM   #2618
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Originally Posted by jimbob View Post
<snip>
Not diagnosing through history books, but I'm making the point that their behaviours eventually *did* cause them harm, but until that time, their "skewed view of the world" had caused them to behave in a certain way.

The fact that it didn't cause them problems earlier, is a problem with the definition in my view. That was what I was highlighting. Not diagnosing historical figures with a particular condition, but choosing notoriously dangerously odd historical figures who had been protected by their position.
There's a difference between people who make bad decisions and have a bad outcome and people who have bad outcomes because of a mental illness.
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Old 31st August 2017, 02:27 PM   #2619
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Originally Posted by Skeptic Ginger View Post
You don't seem to be looking at the totality of the evidence, something that has been addressed in the thread more than once.
Yep, but neither are you. Neither did these Yale Docs. They're going by filtered curated media snippets, not "the totality of the evidence." Specifically, they're omitting personal interview results. Nobody's going by the totality of the evidence. Thus my proposal that we advocate for a proper examination.



Originally Posted by Skeptic Ginger View Post
Depression is not the dysfunction Trump has evidence of.
He doesn't seem depressed at all! Maybe no consequences, then! No consequences, no NPD.

As five minutes ago, you didn't think Nero did either, because your resources were incomplete. There was an information gap that led to an inaccurate diagnosis. That's why I unpacked your example, I thought it proved my point.
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Old 31st August 2017, 02:30 PM   #2620
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Originally Posted by Skeptic Ginger View Post
Yes you have, when you stopped including other professionals' opinions and only argued against mine as if that was the only opinion Trump has NPD..
You are the one in this thread representing the position in the OP and using your credentials to do it. But no one brought up your credentials except you.

Quote:
You may not like the answer, but it has been addressed in this thread.
No it hasn't. You cited the Washington Board of Nursing that licenses you to practice. You haven't cited anything from the credentialing body that issued your certificate. And you certainly haven't cited anything that says a FNP has the expertise to diagnose people they have never met.

Quote:
Yeah, they are. You just choose to only look at some of those positions and you ignore the positions you don't like.
No. You are dismissing the APA based only on the idea that you and a handful of other professionals disagree with them.
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Old 31st August 2017, 02:38 PM   #2621
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Originally Posted by jimbob View Post
I think the last paragraph is the "Trump might be playing 4D chess" argument. I find that implausible.

My view is that Trump's behaviour is so odd that it raises warning flags, and that he should be subjected to an examination to see whether he is fit for office.

Whilst I accept that clinical psychologists would not diagnose someone without an examination,
Then you aren't that far off from my view.
Quote:
criminal psychologists have to do something pretty akin to this, based on the evidence they have available, which would be far less than the evidence we have in the case of Trump.
But the evidence they have available includes the legal and medical history of the subject and almost always a personal interview with the subject and/or those close to the subject. Criminal profilers, who may not even know who the subject is, are not making clinical diagnoses; they are trying to glean whatever information they can based on the standards of their profession.
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Old 31st August 2017, 02:39 PM   #2622
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Originally Posted by xjx388 View Post
There's a difference between people who make bad decisions and have a bad outcome and people who have bad outcomes because of a mental illness.
Yes, but the examples I gave, their behaviour was abnormal, and it eventually caused them problems (Nero included).

The thing was that there was a threshold, mostly of time before which their same behaviour and same underlying ... worldview hadn't caused problems, although the changes were outwith them.

If I believe a magic pixie tells me what cards to pick, and I gamble and win, and then I gamble and lose everything, I was still deluded at the start, even though I actually benefited from it.

I can see why mental illness is defined as causing harm or distress to the subject, but there are sufficient situations where I would say that such a definition is missing something, which a more colloquial definition of "mad" is not.

Did the Yorkshire Ripper suffer harm or distress until he was caught?
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Old 31st August 2017, 02:41 PM   #2623
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Originally Posted by jimbob View Post
I think the last paragraph is the "Trump might be playing 4D chess" argument. I find that implausible.
Well, it's more that I think his goal is to get rich, and that he's shooting from the hip on the president stuff. I'm not proposing there's any sophisticated planning.



Originally Posted by jimbob View Post
My view is that Trump's behaviour is so odd that it raises warning flags, and that he should be subjected to an examination to see whether he is fit for office.
I totally agree. I think he's the most narcissistic person I've ever borne witness to. I think he's unstable. I think he's progressing dementia.

This doesn't make him medically diagnosable as specifically NPD, and secondly, it doesn't matter what I think medically, because I'm not qualified to diagnose.



Originally Posted by jimbob View Post
Whilst I accept that clinical psychologists would not diagnose someone without an examination, criminal psychologists have to do something pretty akin to this, based on the evidence they have available, which would be far less than the evidence we have in the case of Trump.
Not sure what that distinction is... just as an example, my wife is an emergency intake psychiatrist. Patients come from whatever funnel they come through: some walk in voluntarily, some are brought in by the police. There's no special process for forensic patients.

If a patient refuses to participate in a structured interview, that alone is something they have interacted with the psychiatrist about, and then they are observed further, usually in isolation, but sometimes with other people (family, other patients) with an eye to what may constitute their casual behavior. There is always a direct observation and several attempts at interaction by the psychiatrist to justify diagnosis. It's especially critical if the occupation is reportable.

I asked my wife about BC reportable occupations, and she will come up with a list, but not sure if the information is on the web. These occupations have something called "reporting bodies." Examples from her recent memory are airline staff, police, military, medical doctors. The reporting bodies have a list of conditions they want reported, so not all professions want the same conditions reported. (which makes sense... airline pilots are probably allowed to have a toe infection unreported, but they want to hear about clinical depression due to suicide risk)
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Old 31st August 2017, 02:44 PM   #2624
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Originally Posted by jimbob View Post
Yes, but the examples I gave, their behaviour was abnormal, and it eventually caused them problems (Nero included).

The thing was that there was a threshold, mostly of time before which their same behaviour and same underlying ... worldview hadn't caused problems, although the changes were outwith them.

If I believe a magic pixie tells me what cards to pick, and I gamble and win, and then I gamble and lose everything, I was still deluded at the start, even though I actually benefited from it.
How do we know what you believe unless you tell us? How do we know that you aren't merely making an excuse after the fact for your bad behavior? This is where a psychiatrist/ologist comes in and examines the patient using the standards of the profession. There are plenty of people who lose at gambling and they aren't all mentally ill. IOW, the bad outcomes are not necessarily indicative of an underlying mental illness.

Quote:
I can see why mental illness is defined as causing harm or distress to the subject, but there are sufficient situations where I would say that such a definition is missing something, which a more colloquial definition of "mad" is not.

Did the Yorkshire Ripper suffer harm or distress until he was caught?
I have no idea. I know he caused harm to others which might indicate an underlying mental illness. But I don't think we can say all murderers are mentally ill. They might be, but no one is in a position to say for sure or what their illness actually is until a professional examines them.
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Old 31st August 2017, 03:24 PM   #2625
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How is this a calculated political act and/or not bizarre?

Donald Trump gets a daily briefing all about how great he is

And this awkward staff meeting:

TRUMP APPOINTEES TAKE TURNS PRAISING HIM IN BIZARRE CABINET MEETING

The examples are numerous:

How Trump’s campaign staffers tried to keep him off Twitter - The trick? Making sure his media diet included a healthy dose of praise.

Not normal.
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Old 31st August 2017, 03:51 PM   #2626
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Originally Posted by jimbob View Post
Yes, but the examples I gave, their behaviour was abnormal, and it eventually caused them problems (Nero included).

The thing was that there was a threshold, mostly of time before which their same behaviour and same underlying ... worldview hadn't caused problems, although the changes were outwith them.

If I believe a magic pixie tells me what cards to pick, and I gamble and win, and then I gamble and lose everything, I was still deluded at the start, even though I actually benefited from it.

I can see why mental illness is defined as causing harm or distress to the subject, but there are sufficient situations where I would say that such a definition is missing something, which a more colloquial definition of "mad" is not.

Did the Yorkshire Ripper suffer harm or distress until he was caught?
Just to clarify... mental illness isn't 'defined' as causing harm &c. It's just that specifically in the case of NPD, it's one of several necessary but insufficient criteria, which is why I feel it can't be dismissed casually in this thread.

Regarding the pixie example, this is a good example of why a structured interview may be necessary... there is a difference between delusional versus misinformed. Consider if the gambler in question was a child (or mentally delayed adult), and she thinks a pixie guides her because her mom said. Perfectly healthy, quite normal. But you don't know until you engage directly with a few back and forth questions.
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Old 31st August 2017, 05:51 PM   #2627
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Originally Posted by Skeptic Ginger View Post
IOW present inappropriate evidence. (I told you, that is not the nursing commission's function.)

As for disputing my scope of practice, what are you basing your assertion on? Like I said, I posted supporting evidence that recognizing/diagnosing basic psychiatric disorders was indeed within the scope of family practice. Why you think NPD is so complex is another unsupportable assertion you've made.
How many cases of personality disorders have you diagnosed or treated?

Do you also consider epilepsy to be a simple condition that is within your scope as a Family Practice ARNP?
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Old 31st August 2017, 05:53 PM   #2628
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Originally Posted by Skeptic Ginger View Post
Why does someone have to be normal? That is a little bigoted.
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Old 1st September 2017, 09:50 AM   #2629
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Originally Posted by BobTheCoward View Post
Why does someone have to be normal? That is a little bigoted.
It's also why there's a lot of heat surrounding the Cluster B "personality disorders." They're at the top of the list for examples of "medical overreach."

In principle, medicine is interested in relieving suffering caused by our bodies not working the way we want. This is what makes Chicken Pox a disease, rather than a 'rite of passage,' as some antivaxxers assert.

Their claim is extreme (that the suffering is cultural - why not celebrate the pus filled blisters!), but somewhere along the continuum I think there's a good case for "Did we just hand the medical establishment a license to treat... Dickery?"

Their toe in the door is that the patient may have the same jackass personality as his neighbour, but for some reason - in his family or social group or occupation or legal region or whatever - it's not working for him.
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Old 1st September 2017, 10:00 AM   #2630
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Originally Posted by Emily's Cat View Post
How many cases of personality disorders have you diagnosed or treated?

Do you also consider epilepsy to be a simple condition that is within your scope as a Family Practice ARNP?
There was also that passage about how if the patient's occupation is at risk, it's out of scope not only for FP ARNP, but even for the psych specialists. Basically if a job is at stake, the nurses need to bow out and hand it over to an MD psych. I suspect that's part of the criteria for what excludes a condition from being 'basic'

But we really should defer to the authors; I hate wasting cycles on what I call "duelling interpretations" when there's an actual SME available.
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Old 1st September 2017, 10:09 AM   #2631
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Wow, there are still people who don't think Trump's a narcissist?

"Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."
http://www.mayoclinic.org/diseases-c...n/con-20025568

Does that sound like anyone we know? Hmmm.....
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Old 1st September 2017, 10:17 AM   #2632
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Originally Posted by Fudbucker View Post
Wow, there are still people who don't think Trump's a narcissist?



"Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."

http://www.mayoclinic.org/diseases-c...n/con-20025568



Does that sound like anyone we know? Hmmm.....

Great. More doctoring by Google...


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Old 1st September 2017, 10:19 AM   #2633
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Originally Posted by xjx388 View Post
Great. More doctoring by Google...


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If someone on the subway is wearing a tinfoil hat and talking to invisible people, are you going to think, "Now, now, I'm not a doctor.."
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Old 1st September 2017, 10:38 AM   #2634
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Pretty much. I'm certainly not going to speculate about which illness they have. I also won't vote for them if they run for President.


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Old 1st September 2017, 10:39 AM   #2635
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Originally Posted by xjx388 View Post
Great. More doctoring by Google...


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The op in this thread provides the professional opinion of several doctors that Trump has NPD. xjx388, who is not a doctor and who acquires his information by googling, has spent 40 pages arguing his position that the doctors' opinion is not valid. Someone else, who is also not a doctor, expresses an opinion that is different than xjx388's. xjx388 dismisses that opinion because the poster is not a doctor.

See where this is going....?
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Old 1st September 2017, 10:48 AM   #2636
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Originally Posted by Steve View Post
The op in this thread provides the professional opinion of several doctors that Trump has NPD. xjx388, who is not a doctor and who acquires his information by googling, has spent 40 pages arguing his position that the doctors' opinion is not valid. Someone else, who is also not a doctor, expresses an opinion that is different than xjx388's. xjx388 dismisses that opinion because the poster is not a doctor.



See where this is going....?


Please cite where I have made any diagnosis or performed any doctoring. I am discussing the ethical/social aspects of medicine's role. I have cited the ethical position of the APA as well as other doctors who have commented on the situation. I also don't want to live in a society where doctors have free reign to stigmatize their political opponents.

Your "summary" is a greater zinger, I'll give you that; too bad it doesn't reflect what the discussion is actually about.


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Old 1st September 2017, 10:51 AM   #2637
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Originally Posted by xjx388 View Post
Please cite where I have made any diagnosis or performed any doctoring. I am discussing the ethical/social aspects of medicine's role. I have cited the ethical position of the APA as well as other doctors who have commented on the situation. I also don't want to live in a society where doctors have free reign to stigmatize their political opponents.
And this is partly where I come from as well. I'm from the other side of the iron curtain. Classifying political opponents as mentally ill is a totalitarian tool. There's a prudent human rights reason the APA wants its members to resist the temptation to participate in partisan diagnostics.

Onesource link: [Political abuse of psychiatry in Russia]
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Old 1st September 2017, 10:53 AM   #2638
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Originally Posted by Fudbucker View Post
Wow, there are still people who don't think Trump's a narcissist?

"Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism."
http://www.mayoclinic.org/diseases-c...n/con-20025568

Does that sound like anyone we know? Hmmm.....
Feels like a strawperson.

I may have missed it, but I don't think anybody said Trump isn't a narcissist.

I think critics of the OP have been saying the medical diagnosis of NPD is not confirmed.
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Old 1st September 2017, 11:14 AM   #2639
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Originally Posted by Steve View Post
The op in this thread provides the professional opinion of several doctors that Trump has NPD. xjx388, who is not a doctor and who acquires his information by googling, has spent 40 pages arguing his position that the doctors' opinion is not valid. Someone else, who is also not a doctor, expresses an opinion that is different than xjx388's. xjx388 dismisses that opinion because the poster is not a doctor.

See where this is going....?
Not sure what you mean exactly. xjx388 has been saying that from what we can tell, these doctors are acting outside their scope of competence.

As skeptics, we make this type of evaluation all the time - it's part of our quackbusting mission.

I'll revisit the criteria I use for laypersons' evaluation of expert claims (from a 2nd year course in critical thinking):
  • Is the claim within an acknowledged discipline? (yes, medicine)
  • Is the claimant recognized as a member of this specialty? (yes, he's a licsensed psychiatrist)
  • Is the claim consitent with a professional consensus? (it doesn't look like it)
  • Is the claimant unduly biased / conflict of interest? (I think so)

Here's a proposed alternative structure, actually by a colleague of mine at Cap U of all places: [Assessing Expert Claims: Critical Thinking and the Appeal to Authority]

Quote:
AsaysP.
Pis in A's area of competence.
Is P's claim particular or general?

If the claim is empirical/general, then we can ask whether the nature
of A's discipline is fractured or homogeneous?
If it is homogeneous, then
Is P a well-accepted claim in A's discipline?
If yes,
Why is P well-accepted?

If the explanation is plausible and intelligible, then P can be considered
knowledge.
If no, why does A believe P?
Intrinsic plausibility of claim.
The more implausible, the more evidence necessary.
Is the justification plausible?
Are the reasons for rejection of other positions plausible?
What are A's credentials relative to the discipline?
What are A's likely biases?

Prestige of A.
If discipline is fractured, then, weigh crediting of P according to:
Nature of discipline.
Intrinsic plausibility of claim.
The more implausible, the more evidence necessary.
Plausibility of the explanation.
Reasons for rejection other positions.
aarity versus vagueness.
Reported depth of evidence.
Apparent objectivity of A.
Prestige of A.
Is the expert's claim scrutinized by her peers?
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Old 1st September 2017, 11:30 AM   #2640
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Originally Posted by blutoski View Post
It's also why there's a lot of heat surrounding the Cluster B "personality disorders." They're at the top of the list for examples of "medical overreach."
Looks like evidence you have another agenda here.

Originally Posted by blutoski View Post
In principle, medicine is interested in relieving suffering caused by our bodies not working the way we want. This is what makes Chicken Pox a disease, rather than a 'rite of passage,' as some antivaxxers assert.

Their claim is extreme (that the suffering is cultural - why not celebrate the pus filled blisters!), but somewhere along the continuum I think there's a good case for "Did we just hand the medical establishment a license to treat... Dickery?"
Analogy fail.

Originally Posted by blutoski View Post
Their toe in the door is that the patient may have the same jackass personality as his neighbour, but for some reason - in his family or social group or occupation or legal region or whatever - it's not working for him.
This POV misses the boat altogether.

Pathologic personality disorders differ from simply being eccentric or extreme in that they include components that are pathologic.

In Trump's case, he is incapable of not making everything about himself. And that's where the difference lies. His disorder controls him, that's why it is a pathology. He has a serious lack of empathy given he sees everything in terms of himself.

From Google/Wiki
Quote:
Narcissistic personality disorder (NPD) is a personality disorder in which there is a long-term pattern of abnormal behavior characterized by exaggerated feelings of self-importance, an excessive need for admiration, and a lack of understanding of others' feelings.
Pathological Narcissism: Definition & Symptoms
Quote:
In a clinical context, narcissism is significant if it is pathological, meaning that it is harmful or related to a larger problem....

a distorted sense of importance or ability. In clinical terms, they tend to have grandiose thoughts about their social value, particularly in relation to other people. For instance, a person with narcissistic personality disorder truly believes that they are more valuable and important than other people, that they deserve to be praised and admired, and that they deserve to be treated better than others. These beliefs are often accompanied by a lack of empathy for others, whom they believe to be insignificant.

Despite their many unattractive personality traits, narcissistic people are often very successful. This might be difficult to understand, but consider the level of confidence that it takes to achieve such high-ranking positions as politician and CEO. Nevertheless, narcissistic people do not tend to have many or any strong relationships, due in large part to the fact that the symptoms are usually very obvious and can be incredibly difficult to control.
Trump's relationships with his family may or may not be what it appears on the surface. That Trump wrote the response he wanted his grown son, Don Jr, to give regarding the meeting with the Russians in Trump Tower suggested a serious control issue. Trump more often than not appears more interested in how his family complements Trump rather than how highly he sees his children's accomplishments.

Beyond his family though, everyone around him is obviously aware of the need to constantly, effusively compliment Trump. If you don't think that reflects pathology, I suggest you aren't looking.

Quote:
clinical narcissism is about more than just having a big ego or being a braggart. The two main characteristics are the grandiose sense of importance and a general lack of empathy for others. This manifests in the way that they talk about themselves, but it also has a strong effect on how they treat other people.
Trump's blaming of others for his failures is another symptom of pathology. He is incapable of seeing his own role in his failures. He doesn't just blame other people, he actually gets angry with people when it is himself that is at fault.

It's constant, it's consistent, it's classic pathology.

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