Dr. Allen Frances, former chair of the department of psychiatry and behavioral sciences at the School of Medicine, has said that calling President Donald Trump mentally ill is incorrect and unfair to those with mental illnesses. Frances is the author of the recently published book, Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump, which discusses how the rise of Trump exemplifies America’s “deeper societal disease.” The Chronicle spoke to Frances about his political activism and the dangers of psychiatric over-diagnosing. This interview has been edited for length and clarity. 

The Chronicle: What do you think is psychiatry’s role in politics?

Allen Frances: One of the things I've learned through painful experience is that if anything in the diagnostic system can be misused, it will be misused. So, I've been very much against mixing psychiatric diagnoses with the politics of dealing with Donald Trump. There's no evidence that his behavior is a reflection of mental illness. And we should draw a bright line between bad behavior and mental illness. There are some few people with mental illness who do bad things, but it's a very small exception. Most people with mental illness are decent, nice people. Trump is neither, and his bad behavior shouldn't be misguided as mental illness. It's an impotent gesture to try and discredit him by saying he's mentally ill. We should use him as an opportunity to understand ourselves and correct the problems in our country that allowed him to become President.

TC: You talk a lot about America's "societal disease" in your book. Could you specify exactly what you mean by that?

AF: Unfortunately, there's a combination of human nature, political corruption and propaganda that has convinced many of the people in the country to support politicians that are very polarizing and be absolutely dead-wrong on the existential threats that are most likely to destroy us.

Global warming is the most prominent example. The Earth is heating up, the climate's becoming more extreme. And [with] racismthe difference in genetic constitution among the people of the world is miniscule. We are one of the most homogenous species on Earth, and the idea that racial differences should result in tribal warfare, hate and division is a simple propaganda trick. It has nothing to do with biology.

TC: How can America cure itself of this "disease"?

AF: The solution to these problems comes from the fact that for the most part our people are much less divided than our politicians—surveys and polls show that there's pretty widespread consensus on most common-sense solutions. [My] book suggests a contract with "We the People" that has the sensible element of America taking back the country from the political propagandists who've been able to drive our country almost over the cliff to the radical right.

Today, I did about 10 radio interviews, and three of them were with conservative stations. I think it's important that I not just preach to the choir. It's important to capture those Trump voters who possibly have an open mind. I don't expect to change minds with a book, but I think it could possibly open minds. The point here is that Trump's support includes some people who absolutely will follow Trump over the cliff. However, I think about half of his support is soft and once people catch on to the horrors that he's doing not only to the country, but also to them personally, he will be losing lots of his support. Hopefully, the public learns, as I did, that you can't sit back and be passive. You have to be part of the solution, or else you're part of the problem. 

TC: What spurred you to become politically active and to pursue this line of research?

AF: The reason I became politically active at this late date was shame for my past passivity and grave concern for my children and grandchildren, because I don't want to bequeath a world to them that is degraded.

TC:  You've argued that psychiatry's expansion has caused a lot of diagnostic inflation. Why do you think this is occurring?

AF: We have had a steady increase in using the metaphor of mental illness to mislabel normality and bad behavior. The terrible paradox is that we over-treat people who don't need it and we neglect the seriously ill who desperately do. Studies suggest that 25 percent of the population is mentally ill. That's a grave over-exaggeration based on the limits of epidemiological work in psychiatry that show only around five percent of the population has a severe mental illness. 

My previous book was called "Saving Normal," and the premise of that book was that there was an expansion of mental illness at the expense of normal. It was very much the fault of [pharmaceuticals], which began a disease-mongering campaign pitching diagnostic ills in order to sell pills, and trying to convince everyone that mental illness is always chemical and that every problem has a pill solution. It was partly the fault of insurance companies that didn't allow doctors to spend time with patients, which is why 80 percent of psychiatric medicines are given out by general practitioners. 

AF: I'm strongly in support of psychiatric diagnosis, but not when it expands into areas where it does more harm than good. That includes diagnosing normal people with mental illness and giving them pills they don't need, mislabeling people who are just bad people as mentally ill, and stigmatizing the mentally ill in the process.