ryan began, on his own, to research how to deal with someone who is amoral and transactional. the exercise initially was difficult. ryan liked to call himself a policy guy, but his wonkiness did not extend from the realm of social security and medicare into psychiatry. then, a wealthy new york doctor and republican donor called ryan and said, you need to understand what narcissistic personality disorder is. what, ryan asked. the doctor sent ryan a memo and an email with his thoughts on how to best deal with a person with anti-social personality disorder. he also sent along hyperlinks to dense articles in the new england journal of medicine. the memo contained material from the international statistical classification of diseases and related health problems, 10th edition, called "icd-10." ryan studied them for weeks, convinced trump had the personality disorder. ryan's main takeaway, do not