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Peter Silverstone is a professor of psychiatry at the University of Alberta.

Is U.S. President Donald Trump mad, mad and bad or just bad? This question arises because of the increasing speculation about whether or not the U.S. President is mentally ill. Mental-health professionals have recently weighed in – most notably in a Feb. 14 letter to The New York Times – suggesting Mr. Trump is incapable, on psychiatric grounds, of serving as president.

I think a clear case can be made that Mr. Trump is bad, but he is definitely not mad (in the sense of having a mental illness, though he is frequently "mad" in the sense of being angry). Mental-health diagnoses are widely misunderstood, as is the difference between being bad and being mad.

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People who carry out bad things are often talked about in terms such as "they must be crazy," implying the presence of a mental-health disorder. It is true that, at times, individuals who are psychotic do bad things, but this is a tiny minority of such acts. However, when they occur they are widely reported. An example is the tragic episode involving a murder, beheading and cannibalization that occurred on a Greyhound bus in 2008.

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One of the widely misunderstood issues is that mental-health professionals will only make a diagnosis such as psychosis when someone's beliefs are not compatible with those held by others – no matter how odd or unusual they may be. This means that people who belong to small groups with unusual beliefs do not receive mental-health diagnoses. Thus, whether or not such beliefs are factually based is not the basis for a diagnosis. Even when people believe things that are clearly factually inaccurate, they are not "mad" or "crazy" in a mental-health sense. If this were not the case, then individuals who believe that Elvis Presley is still alive, that cigarettes don't cause cancer, that 9/11 was a U.S. conspiracy, that humans didn't arise through evolution or that global warming is not occurring would meet criteria for mental illness.

There have been concerns raised that mental-health professionals should not make a diagnosis from a distance, and in the United States (but not in Canada), there are specific guidelines to this effect. I am less concerned about this, as this has always felt inappropriate. If somebody shows evidence of mental-health conditions that can be diagnosed from a distance, it will usually be highly apparent (such as somebody calling to police to shoot them or running naked in the streets). Additionally, we constantly make judgments about the guilt or innocence of individuals on trial based solely on what is available in the media – without understanding all of the evidence.

Therefore, while individuals can propound many beliefs that are not compatible with facts, of which Mr. Trump is a good example, this does not make him mad. Is he bad? There are many reasons to believe that his actions, beliefs, statements, instability, lying, bullying and misogyny would make one believe that he is bad. So Mr. Trump is not mad and bad, just bad.

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In summary, it is clear that we should move on from looking for a mental-health diagnosis to explain why Mr. Trump is the person he is – and just recognize how frequently bad people occupy positions of power in many countries.

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