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A presidential campaign that is certifiably alarming

This U.S. presidential election campaign is riveting. Not in the way the 2008 race transfixed us, of course, as history reared its head and hope briefly lifted us all to a better place. This time, it's either our fascination with the macabre or outright alarm that prevents us from turning away.

In the past week alone, we've seen a major party presidential nominee evoke the assassination of his rival and accuse the sitting president of being an Islamic terrorist. That was just after he invited Russia to hack into his rival's e-mails and slandered the parents of a dead American soldier.

After repeatedly denying he ever said such horrible things, said nominee lashed out at the media and declared that they, not him, are the problem. They just don't get sarcasm, he said, unleashing a furious stream of Twitter attacks on his critics like an obsessed troll.

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Is Donald Trump certifiable? This is no longer a joke. The Republican candidate will soon be receiving intelligence briefings from White House and CIA officials, providing him with classified information that even President Barack Obama worries he could start blabbing about, all while distorting the facts. Scarier still, his rival's failure to inspire means President Trump is still a possibility.

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This has led concerned American psychiatrists to breach their professional code of ethics by diagnosing Mr. Trump without having examined him in person. Most invoke their patriotic duty and First Amendment rights in warning voters that Mr. Trump exhibits psychological traits that make him unfit for the Oval Office. Even the former head of the Harvard Medical School tweeted that Mr. Trump "doesn't just have" narcissistic personality disorder (NPD). "He defines it."

Properly speaking, NPD is not a mental illness. Rather, it constitutes abnormal behaviour that may or may not be indicative of deeper psychological problems. The Diagnostic Statistical Manual of Mental Disorders provides a long list of traits that need to be present before a diagnosis of NPD can be rendered. These include an exaggerated self-appraisal, an impaired ability to recognize or identify with the feelings and needs of others, superficial relationships that exist to serve one's own self-esteem, a penchant for grandiosity and attention-seeking. All of this leads to a distorted sense of reality that renders the person out of touch with the world around him.

Not the type of person you'd want anywhere near the nuclear codes.

IN HIS WORDS: A look at some of Trump's most incendiary comments

As far as we know, a picture of Mr. Trump does not yet accompany the DSM entry on NPD. But the chorus of U.S. doctors rendering armchair diagnoses of the candidate recently prompted the American Psychiatric Association to remind its members that breaking the APA's so-called Goldwater rule is "irresponsible, potentially stigmatizing, and definitely unethical."

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The rule is named after 1964 Republican nominee Barry Goldwater, who was the subject of a magazine article in July of that year in which 1,189 psychiatrists declared him to "psychologically unfit" to be president. The ensuing controversy, which may have contributed to Mr. Goldwater's trouncing at the polls, led the APA in 1973 to deem it unethical for a member to offer a professional opinion about a person's mental status "unless he or she has conducted an examination and has been granted proper authorization for such a statement."

The Canadian Psychiatric Association issued a similar ethical guideline a few years later. But that did not stop Toronto psychiatrist Vivian Rakoff from determining, in the wake of the 1995 Quebec referendum, that then-premier Lucien Bouchard exhibited what he called an "aesthetic character disorder" that made the separatist leader intense but fickle. Mr. Bouchard reacted on cue, with contained rage and contempt. It only made him more popular in Quebec.

Mr. Trump's rise has led many American psychiatrists to argue that the Goldwater rule should be scrapped, citing the limits of in-person clinical examinations. "The entire foundation of Freud's theory of the unconscious is that motivations and wellsprings of action are not directly accessible to the person in question, so that patient accounts are necessarily distorted by their psychological defenses," Jerome Kroll and Claire Pouncey wrote in a June article in The Journal of the American Academy of Psychiatry and the Law Online. "Public behaviors can be recorded by examining psychiatrists, by other health professionals, by journalists, and by casual observers. What is unique to psychiatry is the understanding of how those public behaviors may reflect psychopathology."

Mr. Trump may not be the only one with a messiah complex.

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