The hardest thing in psychiatry is to keep an open mind while sitting with a patient, who might be trying to provoke and manipulate the doctor, day after day, month after month. We want to understand troubled people, but people are complex. Psychiatric diagnoses are just reasonable guesses. Most human beings are much too mixed, much too complicated, and much too interesting to reduce to just a checklist.
Obama is the exception. Lots of people talk like narcissist s — when teenagers get grandiose, or when they start to lie to and manipulate their parents, it might be just a phase they’re going through. Lots of people preen and strut on life’s stage without losing their sense of proportion. But I think Obama just turned all his grandiose talk into irrevocable action. I don’t think we’ve had this extreme and radical a president ever before in American history. Lincoln, Wilson, and FDR took radical actions, but only at a time of huge national crises. We don’t have a national crisis today. Obama is our national crisis.