Let me reiterate that Allen Frances is in no way “the guy who invented the diagnostic criteria for NPD.” He lead a team that synthesized decades of research into the diagnostic criteria for NPD.

Allen Frances is a brilliant physician, and he’s also only one man airing an opinion about whether or not he believes Donald Trump meets the DSM-IV criterion of experiencing clinically-significant distress across multiple areas of functioning. People should absolutely consider Allen Frances’ opinion, but just because he’s Allen Francis doesn’t make it automatically right.

For example, what happens when someone denies up and down ever having any problems despite blatant evidence to the contrary? Or does having so much money that you never experience social or occupational consequences exempt one from having a personality disorder?

Donald Trump has left a wake of destroyed social and occupational relationships everywhere he has gone his entire life. He has faced continual legal ramifications for his actions for decades, but has always been in such a position of power as to avoid real consequences. Donald Trump, who, Allen Francis notes, “demonstrates in pure form every single symptom described in the DSM for Narcissistic Personality Disorder,” clearly experiences clinically significant distress related to NPD mitigated by wealth and power.

I respect Allen Frances’ work and his opinion. I respect his perspective that psychiatric diagnoses should not be thrown around as political weapons and his distress that they are being used as such. I disagree in this instance, where Allen Francis himself describes Donald Trump as demonstrating in pure form every single symptom, that this is not relevant to discuss, because it literally affects the course of this country and the well-being of people I love. Donald Trump has clinically-diagnosable Narcissistic Personality Disorder. That needs to be part of the conversation when considering whether we should put him back in the White House.