In 2008, when I was a writer for the blog Feministe, commenters began requesting warnings at the top of posts discussing distressing topics, most commonly sexual assault. Violence is, unfortunately and inevitably, central to feminist writing. Rape, domestic violence, racist violence, misogyny—these events indelibly shape women’s lives, whether we experience them directly or adjust our behavior in fear of them.

Back then, I was convinced that such warnings were sometimes necessary to convey the seriousness of the topics at hand (the term deeply problematic appears a mortifying number of times under my byline). Even so, I chafed at the demands to add ever more trigger warnings, especially when the headline already made clear what the post was about. But warnings were becoming the norm in online feminist spaces, and four words at the top of a post—“Trigger Warning: Sexual Assault”—seemed like an easy accommodation to make for the sake of our community’s well-being. We thought we were making the world just a little bit better. It didn’t occur to me until much later that we might have been part of the problem.

The warnings quickly multiplied. When I wrote that a piece of conservative legislation was “so awful it made me want to throw up,” one commenter asked for an eating-disorder trigger warning. When I posted a link to a funny BuzzFeed photo compilation, a commenter said it needed a trigger warning because the pictures of cats attacking dogs looked like domestic violence. Sometimes I rolled my eyes; sometimes I responded, telling people to get a grip. Still, I told myself that the general principle—warn people before presenting material that might upset them—was a good one.

Trigger warnings migrated from feminist websites and blogs to college campuses and progressive groups. Often, they seemed more about emphasizing the upsetting nature of certain topics than about accommodating people who had experienced traumatic events. By 2013, they had become so pervasive—and so controversial—that Slate declared it “The Year of the Trigger Warning.”

The issue only got more complicated from there. Around 2016, Richard Friedman, who ran the student mental-health program at Cornell for 22 years, started seeing the number of people seeking help each year increase by 10 or 15 percent. “Not just that,” he told me, “but the way young people were talking about upsetting events changed.” He described “this sense of being harmed by things that were unfamiliar and uncomfortable. The language that was being used seemed inflated relative to the actual harm that could be done. I mean, I was surprised—people were very upset about things that we would never have thought would be dangerous.” Some students, for instance, complained about lecturers who’d made comments they disliked, or teachers whose beliefs contradicted their personal values.

[Read: The real problem with trigger warnings]

To a certain degree, Friedman said, this represented a positive change. Mental illness was becoming less stigmatized than ever before, and seeking care was more common. But Friedman worried that students also saw themselves as fragile, and seemed to believe that coming into contact with offensive or challenging information was psychologically detrimental. In asking for more robust warnings about potentially upsetting classroom material, the students seemed to be saying: This could hurt us, and this institution owes us protection from distress.

Trigger warnings were only one part of a larger shift. Complaints quickly entered the wider culture, and were applied to “toxic” workplaces and “problematic” colleagues; students decried the “potential trauma” caused by ideas and objected to the presence of some speakers and works of art.

My own doubts about all of this came, ironically, from reporting on trauma. I’ve interviewed women around the world about the worst things human beings do to one another. I started to notice a concerning dissonance between what researchers understand about trauma and resilience, and the ways in which the concepts were being wielded in progressive institutions. And I began to question my own role in all of it.

Feminist writers were trying to make our little corner of the internet a gentler place, while also giving appropriate recognition to appallingly common female experiences that had been pushed into the shadows. To some extent, those efforts worked. But as the mental health of adolescent girls and college students crumbles, and as activist organizations, including feminist ones, find themselves repeatedly embroiled in internecine debates over power and language, a question nags: In giving greater weight to claims of individual hurt and victimization, have we inadvertently raised a generation that has fewer tools to manage hardship and transform adversity into agency?

Since my days as a feminist blogger, mental health among teenagers has plummeted. From 2007 to 2019, the suicide rate for children ages 10 to 14 tripled; for girls in that age group, it nearly quadrupled. A 2021 CDC report found that 57 percent of female high-school students reported “persistent feelings of sadness or hopelessness,” up from 36 percent in 2011. Though the pandemic undoubtedly contributed to a crash in adolescent mental health, the downturn began well before COVID hit.

Teenage girls report troublingly high rates of sexual violence and bullying, as well as concern for their own physical safety at school. But it’s not clear that their material circumstances have taken a plunge steep enough to explain their mental-health decline. The CDC study suggests that, over the past decade, bullying among high schoolers has actually decreased in certain respects. Today’s teenagers are also less likely to drink or use illicit drugs than they were 10 years ago. And even before pandemic-relief funds slashed the child-poverty rate, the percentage of children living in poverty fell precipitously after 2012. American public high schoolers are more likely to graduate than at any other time in our country’s history, and girls are significantly more likely to graduate than boys.

[Jonathan Haidt: The dangerous experiment on teen girls]

So what has changed for the worse for teenage girls since roughly 2010? The forces behind their deteriorating mental health are opaque and complex, but one big shift has been a decline in the time teenagers spend with their friends in person, dipping by 11 hours a week—a decline that began before the pandemic, but was badly exacerbated by it. Since 2014, the proportion of teens with smartphones has risen by 22 percent, and the proportion who say they use the internet “almost constantly” has doubled. Part of the issue may be a social-media ecosystem that lets teens live within a bubble of like-minded peers and tends to privilege the loudest, most aggrieved voices; this kind of insularity can encourage teenagers to understand distressing experiences as traumatizing. “I think it’s easier for them to artificially curate environments that are comfortable,” Shaili Jain, a physician and PTSD specialist, told me. “And I think that is backfiring. Because then when they’re in a situation where they’re not comfortable, it feels really alarming to them.”

Applying the language of trauma to an event changes the way we process it. That may be a good thing, allowing a person to face a moment that truly cleaved their life into a before and an after, and to seek help and begin healing. Or it may amplify feelings of helplessness and hopelessness, elevating those feelings above a sense of competence and control.

“We have this saying in the mental-health world: ‘Perception is reality,’ ” Jain said. “So if someone is adamant that they felt something was traumatizing, that is their reality, and there’s probably going to be mental-health consequences of that.”

Martin Seligman, the director of the Positive Psychology Center at the University of Pennsylvania, has spent the past 50 years researching resilience. One study he co-authored looked at the U.S. Army, to see if there was a way to predict PTSD. Unsurprisingly, he and his fellow researchers found a link to the severity of the combat to which soldiers were exposed. But the preexisting disposition that soldiers brought to their battlefield experiences also mattered. “If you’re a catastrophizer, in the worst 10 or 20 percent, you’re more than three times as likely to come down with PTSD if you face severe combat,” Seligman told me. “And this is true at every level of severity of combat—the percentage goes down, but it’s still about twice as high, even with mild combat or no obvious combat.”

In other words, a person’s sense of themselves as either capable of persevering through hardship or unable to manage it can be self-fulfilling. “To the extent we overcome and cope with the adversities and traumas in our life, we develop more mastery, more resilience, more ability to fend off bad events in the future,” Seligman told me. “But conversely, to the extent that we have an ideology or a belief that when traumatic events occur, we are the helpless victims of them—that feeds on itself.”

Seligman also found that some soldiers who experienced severe trauma could not only survive, but actually turn their suffering into a source of strength. “About as many people who showed PTSD showed something called post-traumatic growth, which means they have an awful time during the event, but a year later they’re stronger physically and psychologically than they were to begin with,” he said. But that empowering message has yet to take hold in society.

So what would be a more productive way to approach adversity? Friedman, the former Cornell mental-health coordinator, compares building resilience to physical exercise. “It’s like any form of strength training,” he told me. “People have no hesitation about going to the gym and suffering, you know, muscle pain in the service of being stronger and looking a way that they want to look. And they wake up the next day and they say, ‘Oh my God, that’s so painful. I’m so achy.’ That’s not traumatic. And yet when you bring that to the emotional world, it’s suddenly very adverse.”

The problem is that this idea—that to develop resilience, we must tough out hard situations—places a heavier burden on some people than others. Friedman pointed out that people who grew up under constant stress, perhaps owing to abuse, poverty, or food insecurity, may find that this stress is “erosive” to their ability to use those resilience muscles. The exercise metaphor rankled Michael Ungar, the director of the Resilience Research Centre at Dalhousie University, in Halifax, Canada. “Chronic exposure to a stressor like racism, misogyny, being constantly stigmatized or excluded, ableism—all of those factors do wear us down; they make us more susceptible to feelings that will be very overwhelming,” he told me. There are, after all, only so many times a person can convince themselves that they can persevere when it feels like everyone around them is telling them the opposite.

Tyffani Monford Dent, a clinical psychologist and an author whose work focuses on sexual violence and racial trauma, calls this “the resiliency trap.” Black women in particular, she told me, have long been praised for their toughness and perseverance, but individual resiliency can’t solve structural problems. From Dent’s perspective, young people aren’t rejecting the concept of inner strength; they are rejecting the demand that they navigate systemic injustice with individual grit alone. When they talk about harm and trauma, they aren’t exhibiting weakness; they’re saying, Yes, I am vulnerable, and that’s human. These days, patients are being more “transparent about what they need to feel comfortable, to feel safe, to feel valued in this world,” she said. “Is that a bad thing?”

Most of the experts I spoke with were careful to distinguish between an individual student asking a professor for a specific accommodation to help them manage a past trauma, and a cultural inclination to avoid challenging or upsetting situations entirely. Thriving requires working through discomfort and hardship. But creating the conditions where that kind of resilience is possible is as much a collective responsibility as an individual one.

If we want to replace our culture of trauma with a culture of resilience, we’ll have to relearn how to support one another—something we’ve lost as our society has moved toward viewing “wellness” as an individual pursuit, a state of mind accessed via self-work. Retreating inward, and tying our identities to all of the ways in which we’ve been hurt, may actually make our inner worlds harder places to inhabit.

“If everything is traumatic and we have no capacity to cope with these moments, what does that say about our capacity to cope when something more extreme happens?” Ungar said. “Resilience is partly about putting in place the resources for the next stressor.” Those resources have to be both internal and external. Social change is necessary if we want to improve well-being, but social change becomes possible only if our movements are made up of people who believe that the adversities they have faced are surmountable, that injustice does not have to be permanent, that the world can change for the better, and that they have the ability to make that change.

To help people build resilience, we need to provide material aid to meet basic needs. We need to repair broken community ties so fewer among us feel like they’re struggling alone. And we need to encourage the cultivation of a sense of purpose beyond the self. We also know what stands in the way of resilience: avoiding difficult ideas and imperfect people, catastrophizing, isolating ourselves inside our own heads.

In my interviews with women who have experienced sexual violence, I try not to put the traumatic event at the center of our conversations. My aim instead is to learn as much as I can about them as people—their families, their work, their interests, what makes them happy, and where they feel the most themselves. And I always end our conversations by asking them to reflect on how far they’ve come, and what they are proudest of.

That last question often elicits a powerful response. I started asking it because I hoped to let the women I met feel seen in full, beyond the worst things that had happened to them.

This article appears in the September 2023 print edition with the headline “The Resilience Gap.”

In 1973, the American Psychiatric Association established the so-called Goldwater Rule as a response to the many mental-health professionals who had ventured glib and florid diagnoses of Senator Barry Goldwater during his 1964 presidential campaign. “I believe Goldwater has the same pathological makeup as Hitler, Castro, Stalin, and other known schizophrenic leaders” was a representative comment; many other psychiatrists and psychologists deemed him schizophrenic, a “megalomaniac,” and “chronically psychotic.” In the four decades between its enshrining and the 2016 election, the Goldwater Rule—which prohibits psychiatrists from issuing diagnoses of public figures they haven’t seen as patients—was mostly honored.

But from the earliest moments of Donald Trump’s campaign, his behavior, falling far outside the boundaries of conventional candidate comportment, raised the question of whether he could be adequately assessed in purely political terms. Where did politics end and psychology—or psychopathology—begin? Thus the Trump years have inevitably given rise to the routine flouting of the Goldwater Rule, most notably in a collection of writings assembled by the former Yale psychiatrist Bandy Lee, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. (Lee subsequently got fired from Yale for publicly arguing that Alan Dershowitz was suffering from a “shared psychosis” with Trump.)

Now, with Trump the Republican 2024 front-runner—his accumulating indictments notwithstanding—the psychiatrist Peter D. Kramer seems to have successfully engineered an end run around the Goldwater Rule: In his interesting and challenging new novel, Death of the Great Man, Kramer takes on some of the relevant psychological issues of the Trump era via fiction.

Kramer, the longtime Brown University medical-school professor who became internationally famous 30 years ago for writing the best-selling Listening to Prozac, helped transform how we think about psychopharmacology and the self. In this novel, he confronts his protagonist, an idealistic psychiatrist named Henry Farber who shares much of Kramer’s biography, with the question of how and whether to provide psychotherapy to an American president who shares much of Trump’s biography.

Kramer is at pains to emphasize that he doesn’t intend a one-to-one correlation between his fictional president, who is referred to only as the “Great Man,” and the real-life Trump. Yet in his general behavior (he’s an erratic and autocratic populist who has shredded democratic norms) and many details (he has an attractive, younger European wife, and has refused to accept defeat in his reelection campaign, which took place amid the depredations of a global pandemic), the Great Man is unmistakably Trumpian.

The Great Man is also—we learn in the novel’s third sentence—dead, almost certainly murdered; his body was discovered on the couch in Farber’s consulting room in Providence, Rhode Island. The novel flashes back (how did the president come to be in Farber’s office?) and forward (who killed the Great Man? Will Farber get fingered for it?), but it is not a classic whodunit, because Kramer heavily seasons the mystery with stylistic elements drawn from literary fiction and political satire, which allows for both comedy and commentary. For instance, Kramer depicts the Great Man’s wife, Náomi, who on the surface seems much like Melania Trump, as a literary intellectual and former dramaturge with liberal leanings and an interest in existential philosophy. So nauseated is Náomi by the moral (and literal) stench of her husband that she routinely retches when he’s nearby. She also turns out to have been the secret instigator of the effort to recruit a therapist for the Great Man. She may also be his murderer.

I interviewed Kramer on Zoom earlier this summer. Our conversation has been edited for length and clarity.

Scott Stossel: What inspired this novel?

Peter D. Kramer: This was an epiphany. It was December of 2016, and Trump had just been elected. I was in New York, consulting on clinical cases at Cornell medical school. One of my editors had a short amount of time for me at the end of the day, and so I went to Union Square, near my publisher’s offices, a little early. It was rainy, so I went into the Barnes & Noble to look for books for my grandsons. I was on the escalator and the book just came to me: I thought I should write a novel that relates to Trump. The framework came to me almost whole. I went into a little corner in the children’s books section and started writing notes on my phone.

And then I went in and presented my idea to the editor, and he said: “Absolutely not.” And I thought, well, this is what I have to write, and I sat down to write it anyway.

[Read: Evaluating Trump’s psyche in public]

Stossel: What was the editor’s objection?  Fear of political blowback or just “this isn’t gonna sell”?

Kramer: I knew from the start that this book was going to begin with a toxic populist U.S. president dead on a psychiatrist’s couch—and of course if Trump had died at some point in between the writing of the book and its publication, that wouldn’t have been amusing.

This editor had another reasonable objection, which is that assassination for regime change is an illiberal expedient. It’s not amusing. You can’t kill off presidents—it’s just morally not the right thing. But in the novel, this isn’t murder for regime change; every character around him has a reason to want the Great Man dead. And these reasons are really only incidentally political. He’s just so horrible to everyone, and so many people have their own motives for killing him.

Stossel: How close did you mean to make the Great Man to Trump? Did you start with the public Trump we all see on TV and try to imagine his inner life?

Kramer: The thinking began with Trump, but of course characters take on their own lives for the writer. I am not an expert on politics or history, so I focused on what Trump would look like to a psychotherapist. That meant I had to create what I didn’t know about, which is this intimate person: How does he treat his wife? How does he treat people around him? How would he do in therapy? And I was running into this other constraint, which is that psychiatrists are not supposed to diagnose public figures from a distance. I didn’t want to violate the Goldwater Rule by saying, “Oh, this is fiction” and then depicting Trump exactly. I wanted, instead, to play with the question of what psychiatrists would do if they could really get close to a Trump figure.

Stossel: The reader’s mind inevitably goes to Trump because the Great Man behaves in very Trumplike ways and has a very Trumplike biography.

Kramer: My model was the dictator fiction that’s common in Latin America. In The Autumn of the Patriarch, Gabriel García Márquez takes a particular dictator, Gustavo Pinilla of Colombia, and adds elements of General Franco of Spain and Juan Vicente Gómez of Venezuela, and creates this outrageous version of a dictator. Márquez has him basically governing the country from the grave. So that gave me, I thought, license to create a comic character who was outrageous in certain ways. Whether he’s more outrageous than Trump, I can’t say. But he’s outrageous in his own way, and specifically Trumplike in five or six other ways.

Stossel: Let’s talk about the Goldwater Rule. Don’t mental-health professionals have a “duty to warn” when somebody poses a danger to themselves or others? And what if that danger posed is not to an individual but to the entire American population, which is clearly how some of the experts in the Lee book see Trump?

Kramer: The real function of the Goldwater Rule is to protect psychiatry from itself—from all these doctors expressing their political views through making diagnoses without a careful respect for the clinical facts. I remember an era when—this is way back—people would say, “Well, if your patient has not expressed anxiety about the atom bomb, the patient is in denial.” And I thought, My patients will express whatever they express, and the introduction of uniform political views into psychiatry is a disaster. I’ve had patients who were very much on the front lines of the anti-abortion movement, and I am very much on the other side. But you are out to treat the patient who’s in front of you—you’re not out to impose your views or ask them to see things differently than they do.

You just need to deal with patients as you find them—even with patients who are racist and prejudiced and anti-Semitic or whatever. To create some kind of internal rule in psychotherapy that integrates political views is a disaster.

Stossel: Let’s say you have a patient referred to you with depression, and he quickly evinces extreme racist and misogynistic views, and election denialism. What would that encounter in the consulting room look like?

Kramer: This is very much one of the topics of the book. One of the worries regarding Henry Farber is that he will go and treat the Great Man, and that will just give the Great Man some ease, and make him better able to do the terrible things he does. Farber has great faith in his therapeutic method, so the setup is this: He’s known—as I am—for writing a book early in his career that was a best seller, and he’s also known as a sleep doctor. Later in life he’s specialized in the treatment of paranoid men. And he’s brought in to treat the Great Man’s insomnia, but secretly there’s some hope on the part of the people who bring him in that he will treat the personality problems as well. And I think Farber is comfortable with what seems like a corrupt assignment, because he just believes in his therapeutic method, which is that if he sits empathetically beside his patient—metaphorically speaking—and looks out at the world as his patient does, and gets the patient to feel what he feels and be aware of his feelings, good things will happen, that there will be some general liberation, and that will be useful both for his sleep problems and his disordered personality. But he’s not trying to nudge the person in any direction; he’s trying to get the person to free himself of whatever it is that constrains his feeling and thinking.

Farber’s extreme commitment to this approach is comic. When the Great Man throws him into a jail cell at one point, Farber thinks, How can I utilize this thing that my patient has done? The patient will indirectly notice how I behave in the jail cell, and maybe I can do that in a way that’s therapeutic; I’ll prepare for our next encounter by reviewing similar cases. I don’t know that I am self-abnegating in that way. But I do retain an idealistic faith in the therapeutic method that if you put people in touch with themselves—that’s your job, and your job isn’t to guide the direction of progress.

Stossel: Let’s say, as implausible as this is, Ivanka calls you up and says, “My father is suffering from grave depression after his brush with COVID mortality”—would you do as Farber does and take Trump on as a patient?

Kramer: I would take the case in a minute. I think Farber cross-examines this stuff: Is he taking the case because this will demonstrate that he’s a virtuoso of empathy, or out of his own self-aggrandizement because this is such a challenging case? I do think I would be tempted by the level of effort that would be required. I like taking on cases that I thought were difficult for me because they were unlikeable patients. (Anyone who’s my patient: That wasn’t you!) I do think the book is my attempt to imagine what the level of effort would be like. Farber keeps looking for the element of full humanity in his patient. When he perceives this little spark of it, he’s so encouraged by it; he thinks there’s something here he can work with. I think that would be a challenge with someone like Trump: sort of waiting him out until you see that little hint of something that’s not propaganda and self-praise but something that has a little texture and dimensionality to it. I mean, I was really trying to imagine what that would look like for Trump.

Stossel: And what would that look like?

Kramer: I think it could be exposure of vulnerability. Could just be genuine emotion. There are easy emotions like anger, which is sort of the lowest-level emotion; patients who can’t access much else can often access rage. But there are other moments where I imagine under all the grievance there could be some genuine pain or sadness, and you’re curious about that.

Stossel: Imagine Trump meeting with a child psychiatrist when he was a younger person. Do you think this would help him process whatever the trauma of growing up with his father was?

Kramer: I think it’s at least possible to think that this grudge against the world, the constant sense of having been wronged, could have been diminished. That’s what psychiatry that examines early-childhood injuries is out to do—free people from being in the thrall of their resentment for the rest of their lives.

Stossel: Allen Frances, the former head of the American Psychiatric Association who presided over the composition of the DSM-4, has written that Trump’s presidency and aberrant behavior are more symptoms of culture that’s gone mad than of any psychiatric illness. And Jeffrey Lieberman, a psychiatrist at Columbia, has written that Trump doesn’t have any DSM illness—he’s just “a jerk.” Do you think there are links between various personality types and certain political ideologies or behaviors?

Kramer: I know Jeff and Allen a little bit, and I don’t agree with the argument “Well, this is just evil, and diagnosis has nothing to do with it.” Diagnosis aside, I think what we saw was four years of a certain kind of personality on display. And it was almost impossible to be a political analyst without wondering about certain of his actions; there wasn’t enough logic in the behavior to explain it only in political terms. In the book, I write about “arbitocracy.” This isn’t really authoritarianism, because it’s not consistent enough, or organized well enough—not that authoritarian regimes generally are either—but this seemed to be even more arbitrary and herky-jerky. So, yes, I think personality is relevant in talking about the politics of Trump.

Stossel: I know you don’t want to diagnose Trump. But having sat, as Henry Farber, in therapy sessions with the imaginary Great Man, what would you diagnose Great Man with? If he’s gonna file an insurance claim, that requires your giving him a DSM diagnosis, right?

[Read: Trump is not well]

Kramer: Right. I’m with Farber, who says that the men in his paranoid-men’s group do not meet a strict by-the-book definition of paranoia; they’re people who have this same kind of hypervigilant posture in the world. And he says of the Great Man, “Yes, he would qualify as one of my patients.” So it’s sort of a loose paranoia for the Great Man.

Stossel: Is paranoia a DSM disorder?

Kramer: It’s a delusional disorder, which is in the DSM. And of course I diagnosed patients in my practice for the purpose of deciding which medicine to use, and for insurance claims. I think diagnosis is very helpful. But personality disorders—that is, borderline personality, sociopathy, or paranoia, the kinds of diagnoses that were debated with regard to Trump—were never something where I’ve found the particulars that useful. Patients don’t necessarily stick with one personality-disorder diagnosis—they can have one and a year later have another, or the diagnosis can even disappear, and they end up with just depression or drug abuse or something, and don’t have the personality disorder. It’s not a very stable diagnosis.

Stossel: Are personality disorders susceptible to treatment by medication? If you were treating Trump—or, if you prefer, if Farber is treating the Great Man—is there a drug regimen that could ease their distress or make them less inclined to wreak pain and havoc on everyone around them?

Kramer: Well, the experience of treating personality disorder with medication has not been terrific. There certainly was a lot of use of SSRIs in treating borderline personality disorder, with some success and a lot of failure. I think the results were similar for lithium. In Listening to Prozac, I talk a lot about rejection sensitivity, a category that isn’t written about a lot anymore. And people had this diagnosis of rejection sensitive dysphoria, which sometimes did well on antidepressants. It turned out that really what was going on was that their vulnerability to social insult was so great that they looked very erratic, and on medication they could be less erratic and less in pain.

But as a therapist looking at the relationship between Henry Farber and the Great Man, I wasn’t tempted for Farber to reach for the prescription pad. I did not want to introduce medication to the book.

Stossel: You can’t medicate a politician into making better policy.

Kramer: Yeah. I mean, I think if you got up close to one of these political figures and saw that he had ADHD, maybe a stimulant would be calming in a paradoxical way. Or if the person really is manic, maybe lithium would be helpful. You can imagine some diagnosis that can’t be made from a distance but here up close you might see something that was not as evident in these speeches and debates. Medication could possibly help with those.