On the Necessity and Perils of Declaring Trump Mentally Unfit for the Presidency

On the Necessity and Perils of Declaring Trump Mentally Unfit for the Presidency May 30, 2017

Trump inauguration

In normal times, I would stick to writing the movie reviews that appear weekly in this column.  But these are not normal times.

Never in my five decades have I felt the same existential fear for the future of our republic, not to mention the safety of our entire globe.  Never has there been such a toxic stranglehold on our executive, legislative, and judicial branches by the reactionary wing of one political party, such that America substantially functions as a one party state.  Never have I felt such peril that our country could cave to an unstable autocrat and degrade into fascism.

Writing about our president’s mental health carries professional risk for me, about which I’ll have more to say later.  I might’ve dodged that peril in good conscience if my home state of Tennessee weren’t hunkered down so unrepentantly in the heart of Trumpland.  I’ve joined the protests, and I’ve written and called my elected officials, but these actions now overwhelm me with their deadweight feeling of futility.  My two Republican senators, Lamar Alexander and Bob Corker, only rarely show signs of a backbone in the face of Trump’s blatant corruption and inhumanity.  My U.S. Representative, Phil Roe, is a malignant tumor on the body politic, an unimaginative regurgitator of Freedom Caucus propaganda.

Such dangerous times call for pulling out all the stops on any legal means to press for the peaceful removal of the diseased human occupying the Oval Office.  Not only am I utterly convinced of his immorality, corruption, ineptitude, and baseness, but I am fully persuaded that he is mentally unfit for the presidency.

As a board-certified psychiatrist, with over 20 years of professional experience, I write those words with the greatest care.  I see highly persuasive evidence that Donald Trump suffers from two conditions, either of which should exclude him from a position of leadership.

First, Trump’s statements and behavior could literally serve as a textbook example of delusional paranoia.  If you read any of the major texts on psychology or psychiatry, you will discover that a delusion is defined as a fixed false belief, from which its bearer cannot be dissuaded by rational evidence.  Trump’s tweets and statements about the alleged wiretapping by President Obama, as well as his utterances about massive voting corruption and the nonexistent crowds on Inauguration Day, clearly meet this definition.

Second, without making a definitive diagnosis from afar, a close study of its symptom checklist shows that Trump meets the criteria for Antisocial Personality Disorder (ASPD).  To make my case here, allow me to walk you through the symptoms and behaviors of this disorder, as elaborated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the gold standard for making psychiatric diagnoses in the United States.

An individual with ASPD, also known as a sociopath, will fail to conform to societal norms and flagrantly engage in unlawful behavior.  The Trump University scam, the repeated use of the White House to promote his business interests, and Trump’s encouragement of Russian hacking during the election all demonstrate this in abundance.

Sociopaths also engage in deceitfulness, evidenced by “repeated lying, use of aliases, or conning others” (to cite the DSM-5 directly).  Need I elaborate much here, about Donald Trump/John Miller/John Barron?  I can’t do any better than quote Yale historian Timothy Snyder’s On Tyranny, where he writes that Trump lies so brazenly and frequently “that it makes the correct assertions seem like unintended oversights on the path toward total fiction.”

Another DSM-5 criterion for sociopathy is impulsivity.  Exhibit #1 for this symptom would have to be the 2 AM tweets that have White House staff repeatedly scrambling for damage control and reportedly staging a Twitter intervention.  For that matter, Trump’s entire presidency seems to fly by the seat of his capacious golf slacks, with 180 degree changes of position arising weekly.

Irritability and aggressiveness are other criteria.  Evidence for these problems emerges from the White House reports of Trump’s tantrums and angry outbursts.  The President’s own caught-on-tape admission to Billy Bush of habitual sexual assault also fits the bill, as does his egging his partisans on at rallies to physically attack dissenters.

Consistent irresponsibility is another symptom of sociopathy, with the DSM-5 specifically citing a disregard of financial obligations and a deficient work ethic.  So many possibilities to choose from here!  How about Trump’s weekly Mar-a-Lago trips, his repeated shirking of payment to contractors on his properties, his exploitation of the Trump Foundation for personal gain, and his failure to follow through on his promised donation to veterans’ charities until called out by the media?

Those with ASPD also show a lack of remorse.  We have in the White House a man who never apologizes, who is surrounded by enablers who double down on his falsehoods and malice.  His sexual assault braggadocio was only “locker room talk”; he fallaciously boasts that he never settles lawsuits, implying that he’s never wrong.

Broadly speaking, individuals with personality disorders exhibit their behaviors chronically and across multiple settings (within their families, at work, and in other social settings).  Their symptoms also significantly impair their ability to function.  I think the examples offered above clearly demonstrate that Trump’s misconduct overflowingly meets these general criteria.

Other writers have suggested that Trump could also be diagnosed with Narcissistic Personality Disorder.  I won’t dispute this claim, but my strong suspicion is that many political figures on a national level suffer from this condition, and it doesn’t necessarily render them occupationally nonfunctional.

I also have a moderate degree of suspicion that Trump is in the early stages of dementia.  I’ve spent thousands of hours working with individuals with Alzheimer’s and vascular dementias, and Trump’s utterance of grossly incoherent sentences, diminished vocabulary, repetitive confabulations, and paranoia bear a strong resemblance to the symptoms I’ve observed in such patients.  Some in-depth neuropsychological testing of our president would be highly enlightening in this regard.

But to return to my main two clinical assertions, the presence of either delusional paranoia or ASPD would by themselves more than adequately disqualify a politician from holding office.  Taken together, they’re doubly toxic.  A paranoid individual cannot be trusted to discern real dangers from those only imagined.  A sociopath by definition can only be relied upon to act in their own interest, imperiling the safety and wellbeing of everyone around them.

And this is a key point here.  I cannot offer definitive diagnoses of someone I’ve never examined in person.  The key point here is Trump’s dangerousness because of his manifest psychological instability.  Whether or not he would meet the full DSM criteria for ASPD during an in-person examination, he exhibits enough of the traits of this diagnosis to make him a clear and present danger to our nation and the world at large.

The evidence in Trump’s words and behavior of the symptom construct of delusional paranoia and the diagnostic construct of ASPD show the relevance of the mental health professions at this time of immense national crisis.  In my measured opinion, these concerns – shared by many of my colleagues – should be sufficient to trigger those around Trump to order an in-depth psychiatric and medical examination of the man.  If my diagnostic fears are verified, then the time has come to trigger Article 4 of the 25th Amendment, removing Trump from the presidency on the basis of his inability to discharge the duties of his office.

Next, I must acknowledge the pitfalls in formulating my presumptive diagnoses of our president, as well as my reasons for pressing forward in spite of these risks.

Obviously, I have not examined Trump personally, which is a major limitation.  However, our president has chosen to make himself one of the most publicly exposed figures in American history, by way of his Apprentice shows, his frequent appearances on news programs, his bloviating rallies, and his Twitter feed.  He used all of this coverage to his immense advantage, for without it he would have never been elected president.

This exposure is a double-edged sword, however, as it elevates my level of confidence in Trump’s clinical diagnoses.  And these are not diagnoses that require a high level of sophistication to make.  This is nowhere near as tricky, say, as differentiating Bipolar Disorder from Borderline Personality Disorder, or discerning the etiology of an atypically presenting psychosis.  An impartial individual with a Bachelor’s of Science in Psychology could arrive at the same conclusions as I have.

Nonetheless, the lack of face-to-face interviews, plus the absence of Trump’s informed consent for assessment, place me in violation of my professional association’s “Goldwater Rule.”  This ethical principle, articulated by the American Psychiatric Association (APA), is meant to bar its members from diagnosing public officials whom we are not treating.

But, forgive the cliché, desperate times call for desperate measures.  On this matter, I have sided with the Duty to Warn movement, signing their petition and joining their organization.  And I hope you will do likewise and add your name to the 67,000 signatories.

Duty to Warn takes its name from the ethical obligation that mental health professionals bear, when we are compelled to break therapist-patient confidentiality if a patient poses an imminent risk to himself or others.

In his recklessness, Trump is a constant danger to our nation and our world.  He cannot be trusted to keep us out of impulsively initiated wars.  His sickening racism has already created a national environment where Hispanics, Muslims, Jews, and African-Americans live in heightened danger of physical harm and even death.

In the APA’s demands that its members adhere to the Goldwater Rule, steadily repeated in its publications of late, my professional organization is rigidly and irresponsibly abandoning a higher call to use our hard-earned clinical wisdom to protect America’s citizenry.

I find this cowardice to be hypocritical, since the APA simultaneously loves to tout its ethnic and religious diversity.  (In what I suspect is an anemic sop to the leadership’s conscience, our main journal has recently begun a monthly column that addresses mental health issues affecting residents of the countries affected by Trump’s Muslim travel ban.)

Such institutional cravenness is ironic as well, since the ethnic and religious minorities the APA claims to advocate for include those currently in imminent danger from our president.  And to state what ought to be obvious, adherents to Jewish culture and religion have long had a high representation within our profession, starting with the great Sigmund Freud himself.  Jews of course suffered the brunt of brutality under 20th Century fascist regimes, the style of leadership that Trump so frequently admires and strives to emulate.  So much for “never forget.”

I realize that publishing this essay puts me at risk for suffering professional consequences.  But for me, disregarding the Goldwater Rule in America in 2017 is analogous to a professional soldier disregarding an immoral order, knowing that he or she may have to answer for it.  I’m willing to surrender my APA membership if I must.  (Though I think my personal risk is relatively low:  considering the 55,000 people who have already signed the Duty to Warn petition, the APA and other professional organizations would have to invest a lot of time and money to instigate a purge against us.)

President Trump manifestly does not labor under the burden of a conscience.  I do.  My personal tranquility has already been disrupted by the weekly injustices that Trump and his warped minions inflict on our poor, our underinsured, our minorities, and our environment.  My conscience and empathy demand that I do everything I peacefully can, to aid in ending the reign of someone I deem dangerous in light of his mental instability.  I hope you are doing the same.


(Photo source:  Public domain, U.S. Federal Government)

*Note:  This article was updated on October 29, 2017

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