Until recently, the debate over our president’s mental health has focused on questions of psychological pathology: Do Donald Trump’s flamboyant narcissism, hedonism, and self-delusions add up to a malignant personality — or a malignant personality disorder?

Scores of psychiatric professionals say the latter. Some of their peers — and a large number of laymen — have insisted that the matter can only be settled by a psychiatrist who has personally, privately evaluated the president. That argument has always struck me as nuts.

There is no diagnostic blood test or brain scan for narcissistic personality disorder; there’s just a list of observable traits. A mental-health professional simply studies a patient’s modes of reasoning and patterns of behavior, and assesses whether they fit the checklist of symptoms for NPD. It’s absurd to believe that a psychiatrist who has spent a couple of hours talking to a patient in an office is qualified to make this diagnosis — but one with access to hundreds of hours of a patient’s interviews and improvisatory remarks, along with a small library’s worth of biographical information and testimonials from his closest confidants — is not. To insist otherwise is to mystify psychiatric practice; it’s to pretend that there is some shamanistic knowledge that mental-health professionals can only access once you provide them with a co-pay.

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