I am not a psychologist, but I work somewhere there are psychiatrists. The distinction is quite important in some ways. I won't give Trump a diagnosis (I'm not qualified) but I can say he has very clear presentation that aligns with my experience of Personality Disordered patients I work with - confabulation, grandiosity, gratification issues, obsession with being slighted, and problems with relationships.

You can go about life functioning with a personality disorder - but I don't think that necessarily makes you well. There are some cases where having a personality disorder might be advantageous and Trump seems to have found one in reality TV and the turning of politics into reality TV. Its an interesting thing. That said, people with personality disorders are predictable and often easily manipulated through flattery and sycophancy. That might be a problem for the next four years. People have the measure of the man and whilst it might be fine for you to know how he behaves, it's quite another thing for other nation states to know how to hack the Trump brain.

I disagree on the centralisation issue - I think certain things can be done at the federal level but I think most of those were ignored. Biden/Harris should've spent four years trying to work out how to get money from wealthy people to poorer communities to ensure economic growth in small towns - instead they seemed to focus on large GDP and being large-scale fiscally responsible. That cost them votes, but it should've been a no-brainer.

As for abortion rights, I think it needs to be codified into law and applied at the Federal level and I think theres' support for that amongst the populace, but Roe vs Wade was bad law to base this on and was always likely to be overturned. There should now be some creative thought by the various Governors of Blue States on how best to get their neighbouring states to turn the whole thing in line with the majority. If this was somewhere in the UK, there might be a referenda - I think that would demonstrate a clear pro-choice position, but you guys don't seem to do them. :o/