News & Politics

Does Sarah Palin Have Narcissistic Personality Disorder?

No. But she’s still vindictive, dishonest, and unjustifiably self-righteous.

In his recent piece on Sarah Palin for Vanity Fair, Todd Purdum floats two psychiatric explanations for her imperious and erratic behavior: narcissistic personality disorder and postpartum depression. Purdum’s source for the first label is several people he met in Alaska. For the second, he cites aides in the McCain campaign. How seriously should we take these diagnoses? As a practicing psychiatrist, I would say, not very—but my reasons for dismissal are different for each of them.

Postpartum depression is a mood disorder that classically arises in mothers within four weeks of a delivery. Often the condition is severe. The depressed women can be delusional, holding quite terrible beliefs about themselves and the world; in the extreme case they kill their babies or themselves.

Palin’s youngest son was 5 or 6 months old in the heat of the presidential campaign. That’s not necessarily too late for PPD, even if it’s not the usual time frame. In my practice, I have seen depressions that I am content to call postpartum that, contrary to the diagnostic manual’s definition, arose months, not weeks, after a delivery. The cases involved otherwise unexplained mood disorders with a sudden onset. The patients were dramatically disabled—not at all in shape to participate in a national political campaign, even ineptly. Occasionally, I have managed to help patients recover in short order; still, the deterioration and recovery was hardly invisible to those close to the patient. To apply the depression diagnosis in Palin’s case, we would need to imagine too much at once: grave illness, prompt and vigorous treatment, and so on. The idea that this diagnosis fits Palin seems to arise from misunderstanding—from reaching for a label without ever having seen what it applies to in a real woman’s life. In effect, the unnamed aides seem simply to be saying that there was something disturbing and unexplained about Palin. Better journalism might have yielded more explanation of those apprehensions. Instead of bandying about the phrase “postpartum depression,” what we want are the details of Palin’s strange behavior.

What of the claim that Palin has narcissistic personality disorder? This diagnosis is at least plausible—but does it add, in any useful way, to the Palin discussion? As readers, we know perfectly well what the unnamed Alaskans are talking about when they slap that label on her. She is full of herself. It’s all about her. If we look at the specific criteria for the condition, we may judge that the suit fits. “Shows arrogant, haughty behaviors or attitudes.” Check. “Has a sense of entitlement” and “is interpersonally exploitative.” Check, check. (More here from Emily Yoffe in Slate about the disorder, and this “cultural moment of the narcissist.”)

Psychiatrists are not allowed to diagnose people they have not interviewed. Still, I don’t think that I’m transgressing any strictures when I say that I find Palin unlikable. She is, in my reading of her behavior, dogmatic, incurious, irascible, vindictive, dishonest, manipulative, trivial in her view of the world, and unjustifiably self-righteous. Katie Couric did the country a great service by bringing those traits to the fore in her unforgettable TV interview with Palin in September; the Pulitzer Prize committee missed an opportunity when it failed to recognize her work, easily the best piece of journalism of 2008.

But merely manifesting specific traits (“arrogant,” “exploitative,” etc.) does not qualify you for a diagnosis. You must also meet the general criteria for personality disorder. Your obnoxiousness must cause certain sorts of problems. For instance, from the American Psychiatric Association: “The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning” (my italics). If a personality style gets you a devoted husband, admiring children, a loyal circle of friends, a governorship, and a vice-presidential nomination, can we really call it a disorder?

Tags: narcissistic personality disorder, psychiatric diagnosis, Sarah Palin

Peter D. Kramer is the author of Listening to Prozac and is working on a book about psychiatric diagnosis.

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