There is significant debate as to whether the Goldwater Rule, the statute in the American Psychiatric Association’s Principles of Medical Ethics, indicating that it is unethical for psychiatrists to give an opinion about public figures they have not personally examined, and from whom they have not obtained consent, applies to the President of the US. While many mental health professionals have opinions as to the emotional stability of President Trump, they have held back from saying anything that might be construed as a diagnosis. Others have openly labeled Mr. Trump with a pathological Narcissistic Personality disorder. Both positions can be argued but I believe there is a better way to understand what is happening in the White House, one that does not require a specific diagnosis but an understanding of character development and flaws.

First, some background.

Before most people are awake Mr. Trump tweets venom virtually daily. He tweets fantasies and hatred and goes out of his way to name people who challenge him as weak and wrong. All news that he finds disagreeable he calls “Fake.” He even started his own “news” outlet housed in his Trump Tower in Manhattan. Smacks a bit of Stalin and Hitler – controlling the media.

Then there is his need to surround himself with generals. He is building a wall to protect himself using tough, hired help as his own personal mafia not his own skills for leadership. Further, his threats against his own supporters, strongly suggests a President who has little interest in rules and overwhelming interest in his own self-aggrandizement.

But, this is not all Trump has been doing. He seems to have a strong tendency, with great joy, to turn his own staff against one another.

A President who leads by creating and fomenting conflict rather than using the talents of his staff to work together suggests a personality that is in disarray but also someone who takes pleasure in seeing this happen. The President’s behaviors are not simply because he has no plan. It suggests something more insidious. I see behavior in the President that is passive – aggressive, with a desire to manipulate others to the point of explosive animosity and to take credit for some of the worst possible outcomes.

There are several ways to understand the chaos, anger, lack of direction that we are seeing these days in American leadership.

In the field of psychology, personality, or the character flaws that underlie a personality disorder, is often more broadly conceptualized.

My colleagues in the mental health field who have given the Narcissistic diagnosis to Mr. Trump are following the strict definitions for the disorder they ascribe to him. I believe a broader perspective has more appeal and provides greater insight.

When we, in the mental health care world, speak of personality disorders, we refer to specific disorders. To diagnose one requires a proper psychological evaluation. However, personality disorders are grouped in clusters that break down based on character profiles. Specific personality disorders can be placed in three distinct clusters. Cluster A tends to refer to individuals whose character traits indicate a detachment from social relationships. The traits of those in Cluster C include a sense of inadequacy and need to be cared for.

Cluster B is unique in that it includes individuals who have little regard for the rights of others, unstable interpersonal relationships, are excessive attention seekers, and have an extensive need for admiration. There are four distinct Personality disorders in Cluster C, Narcissistic Personality is but one of them. Yet, Mr. Trump has displayed characteristics for all of the four. He is not so much a Narcissistic personality as a Cluster B character type.

Changing the focus from diagnosis to character traits allow us to avoid the Goldwater rule issue but more importantly, provides a better view of the President’s temperament.

We are not interested so much in the clinical component as we are in understanding the underpinnings of a character.

Given this approach, my fear is the lack of consistent, stable leadership he displays and what that may mean when the next real crisis happens. This is not simply about his less than diplomatic greeting that he inscribed at Yad Vashem or the fact that he seemed to have given voice to the alt-right movement in the US. This is about the leadership of the free world.

Where will we be without solid, engaged, caring leadership from the US? For those with the character flaws that fit a Cluster B profile are interested only in their own self-aggrandizement, disregarding the need for stability, and with little care for the greater good – regardless of how much they claim to do so. They enjoy creating conflict as opposed to dealing with conflict. While I hope this is never the case we can very likely find ourselves in an administration that inadvertently pours more fuel on fires around the world rather than attempting to extinguish them.