Monday, January 16, 2017

Healthcare, the 25th Amendment, psychotherapy

Tonight is The Bachelor, so I feel like I ought to do a blog post before that time to make up for the inanity of the reality TV post.

Trump has vowed that he will find a solution to healthcare coverage and will be ready to unveil it in just a few days. This promise is in direct contrast to what GOP leaders are saying; that they don't have formal details lined up and aren't ready to announce a new plan. My fear is that "repeal and replace" really means "repeal and don't replace and hope that the people who benefited from universal health care forget what it was like." It doesn't directly effect me, because my work covers my health insurance, but it does effect Dan, who has MS and so had trouble getting coverage prior to ACA. To be fair, he also lost insurance because his provider folded after about a year, but then he was able to sign up for another provider. It could also effect me in the long run if costs rise generally, but for now, I'm more concerned about the fact that without healthcare, Dan can't afford to get MRI's that track the progress of his diagnosis.  Or the fear that if he did get worse, he would have no way to pay hospitalization or treatment.  What could happen is that Congress modifies ACA and pretends like they fixed it; I'm fine with that too. If taking credit for Obama's plan is what needs to happen for universal healthcare to be enacted,  I'll take it.

Read an article today about how Trump could be removed from office if Congress used the 25th amendment, that's a relatively new amendment put in place during Reagan's era to allow for a president to be removed if he is deemed incompetent by a majority of those around him. Specifically, section four states that: “Whenever the Vice President and a majority [of the US cabinet] transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.” In other words, if the VP and 15 cabinet members decide Trump is unfit to serve due to mental incapacity (see: narcissist disorder), they can oust him. I wouldn't welcome a Mike Pence presidency, and though Pence is anti-gay, anti-women's rights, anti-environment, anti-social change, he's seemingly not mentally ill. I believe that Trump actually can't help the way that he behaves.

Here are some of the characteristics of narcissistic personality, as outlined by the DSM V:

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of
pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):

a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal
may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in
order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.


2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to
reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little
genuine interest in others‟ experiences and predominance of a need for personal gain

B. Pathological personality traits in the following domain:
1. Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert;  self-centeredness; firmly holding to the belief that one is
better than others; condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and
consistent across situations.
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative
for the individual‟s developmental stage or socio-cultural environment.
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct
physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head

How do you treat this disorder? Years of psychotherapy.

Here's an article from The Atlantic about what a psychologist found in looking at Trump's  behavior.

Addendum: The article is somewhat reassuring--the writer points out what could work with his approach, as well as where it might create problems. But it's not a dire, apocalyptic version of the future with this man has president.

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