ANNOUNCER: Welcome to Moyers on Democracy. Dr. Bandy Lee saw it coming – the violence foretold in Donald Trump’s election. She was ahead of the curve – way ahead. While millions of Americans were still trying to figure out if Trump was just a crude playboy and fast-talking con man – more mesmerizing than menacing – she felt a duty to warn the country about dangerous possibilities stemming from a man who lacked the mental fitness to be president. She had no background or interest in politics. For almost 20 years she had been trying to understand and prevent violence. It was her calling. After earning medical and divinity degrees while studying at Yale and Harvard, and a stint as chief resident at Massachusetts General Hospital, she joined Yale’s faculty to teach in both the school of medicine and the law school. In her clinical practice, she treated inmates in maximum security prisons. And in time she began applying psychiatric concepts to public health and safety. She’s become a sought-after adviser on violence prevention for prisons, communities, and governments in the U.S. and abroad. When Trump emerged as a political candidate, everything she had learned from her career in mental health seemed to converge. She began corresponding with kindred spirits and colleagues about how best to make their voices heard. She would become the catalyst of their collaboration, and the editor of the book they produced, titled THE DANGEROUS CASE OF DONALD TRUMP. It appeared just months after Trump’s inauguration and became an instant bestseller, dubbed by The Washington Post as “the most courageous book of the year.” But not without a price. Bandy Lee and colleagues had broken ranks to speak the truth, had stirred the hornet’s nest, and the hornets came after them in swarms. They never gave ground. Now, with the Trump regime coming to an end, marked by violence he incited, their collaboration has proven prophetic. And Bandy Lee has published another book – PROFILE OF A NATION: TRUMP’S MIND, AMERICA’S SOUL. Here to talk with her is Bill Moyers.
BILL MOYERS: Bandy Lee, thank you for joining me.
BANDY LEE: Thank you for having me.
BILL MOYERS: When Trump’s supporters formed a mob and attacked the Capitol, you must have been the least surprised person in the country.
BANDY LEE: I have been receiving a barrage of emails and phone messages and text messages, even from Congress members, speaking about how this was what I had warned against years ago.
BILL MOYERS: You and some of your professional colleagues warned us four years ago that the Trump regime would end this way. Listen to what we’ve just heard or read in the past few days. Quote, Trump is “in a very dangerous frame of mind.” Quote, Trump “is completely off kilter. He’s a danger to the country.” Quote, he’s “unfit and unhinged.” Quote, “He’s acting and thinking in an irrational way.” Quote, “Deranged, unhinged, dangerous.” His own niece, Mary Trump, herself a trained psychologist, says my uncle is unstable and needs to be removed immediately. Do you feel vindicated?
BANDY LEE: In a sense, yes. But I’m mostly worried about our country because we have let it come this far. Just like the pandemic, prevention is much easier. And catching things at the early stages prevents a great deal of harm. But now there is a great deal of danger.
BILL MOYERS: Yes, we now know that the attack on Congress itself last week was even more violent than it even appeared to be at the time.
BANDY LEE: None of it was really surprising to me. Perhaps one advantage that I have as a mental health professional is that I have seen the full range of the possibilities in human beings. And what are healthy characteristics in one’s normal personality versus what are extreme states where people can be led to for various reasons. And this has been going on in the country for some time. And so, it’s not surprising to me at the same time as somewhat sad, because all this is preventable.
BILL MOYERS: What does Trump’s behavior today suggest to you about his state of mind now, and how is it different from the last three years?
BANDY LEE: The difference is that the growing pressures and the mere period of time that he has been in power have caused his symptoms to grow worse. But the basic psychological makeup that he brought at the start of the presidency was the same, in that he lacked mental capacity for rational decision making, which was basic fitness for the office. And he shows signs of violence proneness, which is what alarmed us. He was showing verbal aggressiveness. He had boasted about sexual assaults. He incited violence at his rallies. And in the presidency, he denigrated whole populations that led to violent policies. And he taunted allied and enemy nations alike, including nuclear powers. One does not necessarily have to be physically violent as a president to cause violence. In fact, societal epidemics of violence usually start with rhetoric. And with this, he has caused hate crimes and violent behavior throughout his presidency. There have been studies showing that whenever he held a rally, hate crimes went up by 226%. And there are numerous studies like that, showing his influence.
BILL MOYERS: In The Los Angeles Times, the psychiatrist and scholar Eli Merritt asks, “Could Trump have a reality-distorting mental condition?” What do you think?
BANDY LEE: We were always worried about his loose grip on reality. He doesn’t have a primary psychotic disorder, which means the disorder itself brings detachment from reality. But under stress, a fragile mental state can slip into a psychotic spiral. And I think even recently the hour-long phone call with Georgia’s secretary of state, which a colleague and I also analyzed, we can almost pretty much assess delusions in his thinking. Which means that he’s fixed in his beliefs and is not amenable to facts or logic or reason and will usually resist and double down if you challenge them.
BILL MOYERS: Is it possible that Trump’s fixation on reversing the election drove him nuts?
BANDY LEE: It is possible and likely. It seems his psychology was going in that direction. Even before the election, I stated exactly what he would do, that he would not concede the results, call the election a fraud, and refuse to leave office. And it was quite obvious from the start that this would be a very intolerable reality for him, because–
BILL MOYERS: Losing the election, losing power, having to leave the White House, the helicopters, all of that?
BANDY LEE: The privileges that he feels entitled to, and also the accolades. He has had difficulty dealing with any kind of criticism or lack of approval, and losing an election is the ultimate rejection of him by the nation.
BILL MOYERS: From his behavior recently, do you think he really believes he’s won? Or is he lying in an effort to remain in the White House, to be a force in politics in the next four years?
BANDY LEE: Yes. He has shown difficulty coping and adapting in multiple areas. And so, he’s quite impaired, but impairment in the highest functions sometimes can actually activate the more primitive drives.
BANDY LEE: When you lack the capacity to truly take in facts and assess the real situation, then your primitive drives and wishful thinking and fantasies could take over. And in his case, his desire to be re-elected is so overwhelming so as to push out any other possibility, then it becomes a delusion.
BILL MOYERS: The Wall Street Journal recently quoted a person close to Trump who said the president is in “a dark place.” From a mental health perspective what does that term suggest to you, “a dark place”?
BANDY LEE: Well, as a health professional, I would go back to my conceptualization of a healthy state versus one that is disordered and abnormal, where one starts to need help. And it’s very important to catch it early on, because once one loses one’s mental health and starts to spiral downward, one cannot recognize that one is ill, and will tend to project what is happening within oneself onto other people. So healthy people are actually the ones who are deranged, or incorrect. And one becomes increasingly self-destructive. In the early stages there may be conflicts. There’s a healthy part that is trying to go one way, and the disordered part that’s trying to go another. And one is stuck in conflict. But when the disordered drives take over, then there’s nothing inhibiting that person into going into a very dark place of destruction, damage, and even death. That’s where suicides or homicides happen.
BILL MOYERS: So, as Congress deliberates what to do – impeachment, censure, possibly prosecution – should they consider the mental health perspective that he’s trapped in a delusion? Or just stick to the facts of observed behavior? Because whatever he was thinking at the time, the facts are clear. The president incited insurrection when he sent those protesters to the Capitol to be tough, to be strong. Is the act of the behavior sufficient? Or do you need some evidence of the delusion?
BANDY LEE: I think that consultation with mental health experts is critical, because it will be central in understanding the nature of his dangerousness, why and how he has come to incite the violence against the government of the United States as well as the very practical consideration of what will be the degree and type of dangers we will be confronting in the coming days. So, it’s for imminent safety as well as an in-depth understanding of the situation. In the vast range of overlapping mental impairments, alongside criminal mindedness, there is a very serious increase in dangers that can occur.
BILL MOYERS: You used the word dangerousness. We’re not talking about Donald Trump’s danger. We’re talking about the dangerousness he creates.
BANDY LEE: Yes. So, we distinguish between danger, which is a situation, and the dangerous individuals who embody the danger. And then we do assessments of dangerousness of individuals. Usually dangerousness is not assessed only by personal exam. If we have enough information from the situation, we can assess dangerousness, even before we do a full evaluation. In fact, we’re required to, because we have to intervene and contain the dangers. And so, in our regular practice, danger to self, danger to others, and danger to the public, those are our responsibility to contain. But of course, in this presidency, we have made an extraordinary exception, especially with the intervention of the American Psychiatric Association telling us that we do not have a responsibility to society in that regard, but rather not to voice any comment on the public figure, including dangerousness, which was a shocking turn of events for me, and the reason why I felt that I needed to speak up for the first time in my career.
BILL MOYERS: On the morning of what became the invasion of the Capitol, Donald Trump spoke in person to his followers, and told them to march to the Capitol. He went back to the White House and watched the events on television. What does that say to you about him?
BANDY LEE: Again, it was not surprising. He does not really care about his followers. He has manipulated and used their psychology to fulfill his own needs for adulation, to be seen as this powerful omnipotent figure who is godlike. But at the same time, he carries contempt for them for being duped by himself. And this is actually a common dynamic that I see in violent individuals ,usually leaders of gangs or criminal conspirators, who often treat their followers and their partners terribly, just for sacrificing for that leader, for being such sycophants. That’s really tragic for his followers, because their loyalty is true. They are ready to sacrifice their safety, their health, and their lives for their leader.
BILL MOYERS: What does that say about their own individual and collective or public mental health?
BANDY LEE: Individually, they may not be psychologically impaired. But as a collective, they are certainly acting in ways that are not psychologically healthy.
BILL MOYERS: Just like last week.
BANDY LEE: Bill, if you remember one of our earliest conversations, I told you about the concern that I had had for decades, in fact, of our collective state of mental health as a nation. Which is the reason why I have gone more in the direction of public health, because I was concerned about the public’s mental health which has allowed a large segment to become vulnerable to this type of manipulation, and, since the election of Donald Trump, I have always said that the Trump presidency is not really about Donald Trump the individual. But he was a barometer for societal mental health, that the public was vulnerable enough to be attracted to a severely impaired leader as he. That he was an expression of the national state of mind, as well as a highly pernicious aggravator of its characteristics and symptoms once he was in office.
BILL MOYERS: When I read THE DANGEROUS CASE OF DONALD TRUMP, the book you edited in 2017 soon after Donald Trump’s election, I was overwhelmed by the quality and experience of those 27 mental health professionals. People like the great psycho-historian Robert Jay Lifton, who is a towering icon of the field. Judith Herman, I think she was your mentor as well as now your friend, famous for her work on trauma and recovery. James Gilligan, whose book on violence was a groundbreaker, and another of his books, WHY SOME POLITICIANS ARE MORE DANGEROUS THAN OTHERS has been a kind of bible for me as I’ve covered politics. Tom Singer, the Jungian psychologist who has taken deep dives into politics and mythology. Gail Sheehy, whom I know, 17 books over 50 years. Her book, PASSAGES, is considered one of the 10 most influential books of our time. All in all, deeply experienced and respected mental health experts. It became a bestseller instantly. And The Washington Post called it, “The most courageous book of the year.” What was it that drew all of you together to alert all of us to the dangerousness of Donald Trump?
BANDY LEE: It was actually Judith Herman who put out a letter to Barack Obama asking for a neuropsychiatric evaluation of the president-elect at the time. And I couldn’t agree with her more. So that was the start of it. I reached out to her, very happy that she had done that. James Gilligan, I was always in touch with. Robert Jay Lifton, all these towering figures of ethics and on the right side of history during other dark times. And so, I felt another dark time descending upon us. I invited all of them to do a conference at the Yale School of Medicine, which began our speaking up in public. We decided that our duty to professionally inform and educate the public about the dangers it faced overwhelmed any other consideration, that human survival was at stake. And, therefore, we decided to speak up and to put together the book.
BILL MOYERS: Before Trump came into our lives, you had devoted your life to trying to understand and prevent violence. And you did a lot of work with inmates in maximum security prisons.
BANDY LEE: Yes. I have treated violent offenders in jails and prisons and have gotten to know and understand their psychology as well as help treat them. Usually, they’re abandoned without being considered for treatment. But yet they are treatable, in my view, if we can understand it. And they, in turn, have helped me to apply psychiatric principles to advising public health officials.
BILL MOYERS: Give me an example of something that you saw change in them psychologically.
BANDY LEE: Yes. One thing I recognized is that they are quite desperate for human recognition and, more deeply, love. I often describe violence as a life-affirming impulse gone awry. So, the life impulse is for love, which is most basic and fundamental. And when one cannot attain love, one settles for respect. And that respect may turn out to be the need of adulation from millions of people. But the next thing one turns to is respect. And if even that is unattainable, one resorts to violence. And we can see it in the president. When at least more than half the country rejected him, then his next means of salvaging his psychic survival in his mind would be through violence. And that is why violence is so attractive to him and such individuals. And he is very familiar to me, because I’ve treated about 1,000 individuals with his exact psychological structure.
BILL MOYERS: What was it about Donald Trump that caught your attention?
BANDY LEE: His interactions with the crowd in rallies. So, the way that he was manipulating their reactions, responding to them, able to tug on their heartstrings in ways that I knew a very dangerous person could, especially someone with severe impairments. Because they cannot generate self-respect, they look to external sources. And because they are so hungry for adulation, they will puff themselves up and present a grandiose image of themselves primarily for themselves. But it becomes very attractive to a large audience that is also hungering for an idealized figure who they can identify with, and who will represent them, help them, and protect them, almost like a parental figure.
BILL MOYERS: Do you know Burt Neuborne?
BANDY LEE: Yes. I’ve read some of his work.
BILL MOYERS: The founding legal director of the Brennan Center has argued many cases before the Supreme Court. I mean, he’s no rookie in all of this. And he wrote a book last year called A CITIZEN’S GUIDE TO DEFENDING TO OUR REPUBLIC. I learned from that book that Donald Trump’s first wife had revealed that he kept in a locked cabinet, beside his bed, a book translating and annotating Adolf Hitler’s speeches before World War II. It was called, quote, MY NEW ORDER, and it described the Germany he would bring about if he had the power. Neuborne wrote, “Ugly and appalling as they are, those speeches are masterpieces of demagogic manipulation.” So, my question to you is, what if Trump is some kind of sui generis? Someone superbly gifted at performing the script he has created for himself, and all of this is not madness, but brilliant manipulation. Is it possible that he studied to be a demagogue? That he decided this was his way to fulfill himself, to get what he wanted, to create the world he wanted?
BANDY LEE: Yes, I’m sure it’s his ambition, and certainly demagogues learn from one another. They’re actually magnetically attracted to one another. And so, when people often mention about how Vladimir Putin must have something on Donald Trump, I think not directly to kompromat, but I think directly to the psychological pull he must have. Because they’re all of very similar psychologies. And so even without knowing about Hitler or his history, Donald Trump would be attracted to his speeches if he were to come across them. It’s a product of their psychopathology rather than a formula. It is also a formula, but I believe that the formula or playbook comes after the psychological drive. Because if you look at such autocratic figures, Donald Trump, Vladimir Putin, Recep Erdogan, or Joseph Stalin, Mao Zedong, they all exhibit very similar features that are recognizable for us mental health professionals as a very common condition we see in patients. Except they never rise to the level of such national leadership and national influence. And so their sphere of destruction is limited. But we see the same psychological characteristics all the time. In fact, it’s projected that such dangerous personalities range anywhere from 1% to 5% of the population in the United States.
BILL MOYERS: People ask me, “What have you learned from studying Germany in the 1930s?” And it occurred to me that I learned what Donald Trump may have learned, that public opinion defines what is true and false. And I think this is something profoundly common to strongmen dictators, demagogues, that you mentioned. That they compose those speeches knowing that what they’re saying will create the reality they want.
BANDY LEE: Yes. And they can sense their audience almost as precisely as a seismograph. And they respond to it because all their power is dependent on their responding rightly to the mood of their audience. They bring out those characteristics in the audience because that is how they conceive of reality. It is not so much what the proof and the facts and the evidence say, but they’re pulled more by what is emotionally compelling to them. And so, all they need to do is communicate that and shape their audience in that direction. And the more vulnerable the population is, the more they will be carried away. In fact, it can also occur in a population at times of socioeconomic or political stress. And when a population has been affected to the degree that it has at this point with the four years of the Trump presidency that the steps toward healing include first to remove the offending agent, who is the influential figure with severe symptoms, and then actually a lot of the symptoms will dissipate.
Secondly, what you do is you regulate some of the thought control mechanisms that are already in place — disinformation being called news. We shouldn’t allow such sources to be called news, and yet they are. And the propaganda that is perpetuated, especially by the right-wing media that do use psychological techniques to draw in the public and to mislead them to wrong beliefs. It’s a system of indoctrination that started with advertising, and now it is pervasive in the media and even in politics. So that would be the second step, to regulate some of those outlets.
And the third would be to fix the socioeconomic conditions that gave rise to a poor state of collective mental health in the first place. And that socioeconomic inequality gives rise to behavioral violence as well as being a form of violence in itself. More excess deaths occur from structural violence, from the inequalities of society, be it economic, racial, or gender inequalities than all the suicides, homicides, and collective violence combined. And so, inequalities are actually deadly, in addition to being the most potent stimulants of behavioral violence.
BILL MOYERS: The inequalities at the end of this pandemic and of Donald Trump’s reign are going to be vast. That does not augur well for our democracy.
BANDY LEE: Our democracy has been eroding in tandem with the rise in inequality. We did a study of 40 countries — low, middle, and high-income countries — over several decades, looking at how their level of democracy affected violent death rates, suicides and homicides. A lot of democracies start out with a lot of violence because we don’t really measure the governmental violence that happened before. But it transfers onto individual violence for a while. And we were hoping that we would see with the democratization of multiple nations that there would be a dissipation of violent death rates. But what we saw was in fact a continuation, especially with the rise in inequality, with the adoption of unequal capitalism with democracy, it seems it cancels out the beneficial aspects of democracy that would prevent violence.
BILL MOYERS: What’s your explanation for how Trump harnessed his anger, and he has plenty of it, and the anger of millions of Americans for his own purpose?
BANDY LEE: Yes. So, people identify with him and feel that he represents them, not because he’s of a similar socioeconomic background. In fact, he would not be caught dead with some of his supporters. But because he shares their anger and a feeling that they have been robbed somehow in life, that they are victims, even as they are perpetrators, they consider themselves victims. And this is actually quite common among offenders of violence and violation of rights. It’s certainly not a healthy dynamic. In my new book, I describe how this magnetic attraction comes about in their meeting. That one mechanism is narcissistic symbiosis, as I term it, in that the developmentally wounded leader meets the wounds of those who are also developmentally wounded in the population, a lack in their upbringing that has caused arrested development, or a regression. That can happen through large segments of society when there’s socioeconomic stress. And we know that the psychological injury is greater when there is relative, not absolute, deprivation. And socioeconomic inequality is precisely that, it’s relative deprivation. So, the narcissistic leader meets with the narcissistic followers who are looking for an ideal figure who could represent them and give their entire loyalty and trust to. And the leader is hungry for followers and adulation, and would present himself as the only one who can solve all problems, as the best president ever, other than, perhaps, Abraham Lincoln—
BILL MOYERS: And the notion that I alone can fix it—
BANDY LEE: And they’re actually looking for someone who will present themselves as omnipotent and will be strong enough to take charge and solve their problems. And you can see how both Donald Trump’s and his followers’ expressions are quite childlike. Someone had described the invaders of the Capitol the other day of just how childish they were in terms of the symbolism, the kinds of painting of their faces and wearing exaggerated attire that resembles more cartoons than reality. And we often see Donald Trump do the same. He has presented himself in a picture of Rambo at one time. He showed up in a balcony like a strongman, posturing. And these are all indicative of arrested development, unfortunately.
BILL MOYERS: Did you read Mary Trump’s book this last summer? Trump’s niece who wrote just about everything you and your co-authors wrote over three years ago, about the psychological factors behind the president’s, her uncle’s, chaotic and destructive behavior. Including that the president likely suffers from a string of psychiatric disorders, including what you’ve referred to as a narcissistic and antisocial personality. How are such diagnoses made? What evidence, I mean, say a brain scan, would we need to be sure of a particular diagnosis that he’s narcissistic and has an antisocial personality?
BANDY LEE: Yes, Mary Trump came out and said she would have no difficulty saying that her uncle has these disorders. I can say that he shows characteristics of pathological narcissism and sociopathy or antisocial tendencies. And these are tendencies. She also mentions dependent personality disorder, which I thought was very insightful, because he is a follower, not a leader. He’s a follower of what his audience directs him to do to get their adulation.
BILL MOYERS: He reads well the mood of the country.
BANDY LEE: Exactly. That’s actually a symptom that’s common among strongmen because their survival depends on it.
BILL MOYERS: How do you get elected president of the United States if you have an antisocial personality disorder?
BANDY LEE: So, the adulation of crowds is something he welcomes and desires, but not an intimate relationship. You may have noticed that he has not even a single close friend. And eventually, everyone falls short of his expectations. And he goes through this cycle of idealizing people and then devaluing them and discarding them. So that’s a very typical cycle of these personalities. In addition to narcissistic symbiosis, I describe a phenomenon called shared psychosis, which used to be called folie à deux. You may be familiar with that, folie à deux, folie à trois, quatre– folie à million, so madness by the millions when it happens in a population. And it’s the phenomenon where if you have an influential figure with severe symptoms, the symptoms actually spread to healthy individuals. It’s quite a dramatic occurrence that I have had the occasion to see multiple times in the public sector, as well as the prison setting, it is quite common. And it most often happens in a family, where you have a severely ill person who has gone untreated who is a dominant person in the in the family. And it’s not the healthy people who get the sick person better. If you simply leave them alone, it’s the healthy individuals who eventually are almost bulldozed over with the symptoms, and then carry on the most bizarre delusions, and look like they have the exact same disorder that the primary individual has. But if you can distinguish who has the primary illness and separate them, usually hospitalize them, then the other family members return to normal. Now, I’ve seen this occur also in gangs and I believe that is what I am seeing with the nation.
BILL MOYERS: Is this what happens when a leader discovers that he or she can violate the norms of a civil society and get away with it?
BANDY LEE: So, in terms of his followership, they were probably drawn for many different reasons. But once they form those emotional bonds, then symptoms can be transmitted, just like an infectious disease, in fact. Perhaps even more transmittable because you don’t require physical exposure, but only require emotional bonds. And so, delusions, paranoia, and violence-proneness are especially transmittable.
BILL MOYERS: A couple of years ago a past president of the American Psychiatric Association wrote an influential op-ed in The New York Times about Trump. Quote, “it’s entirely possible that he simply has certain personal qualities that we don’t find ideal in a leader, like being a narcissistic bully who lacks basic civility and common courtesies,” end quote. Is it plausible to you that Trump’s just a sorry human being, twisted emotionally by stunted if not stupid parenting?
BANDY LEE: Yes. It could be some variation of the normal. But I think as psychiatrists, our obligation is to tell apart what is abnormal from what is normal. Because the usual tendency of the public will be to believe that it’s a variation of the normal and something that they have commonly seen, or that his narcissism is not so bad, or that he still has all the human characteristics you expect another human being to have. And that’s why I consider that New York Times op-ed to be especially egregious for a psychiatrist to say so because the popular opinion was to consider Trump more a jerk than someone who is severely—
BILL MOYERS: You’re right.
BANDY LEE: –impaired, that one needed intervention with. And it’s unfortunate that that was the only a full-page op-ed by a psychiatrist on Donald Trump that The New York Times ever published, despite some of the most renowned figures of psychiatry repeatedly making submissions upwards of about 200 op-eds over the past few years. And the Times has not accepted even one of them. And so, the public keeps complaining of how psychiatrists are unhelpful. We don’t say anything most of the time. But when we do, we say he’s just a jerk. Well, I try to tell them that this is nowhere near the consensus that we have had since the beginning. There has been a consensus since the start that he is dangerous. And whereas there has been argument as to whether we should speak about this or not, I don’t believe a conscientious competent clinician would conclude that he was not dangerous, even at the start of the presidency.
BILL MOYERS: The Times even printed an editorial saying you had no business passing this kind of judgment on a sitting president, right?
BANDY LEE: Well, one of the two most shocking events of my career, have been first the American Psychiatric Association coming out that we should not make any comment on a public figure, no matter how much national security threat the person is– which actually violates all the core principles of our medical ethics. And then The New York Times coming out and saying what the parameters of mental health expertise are. Usually the responsible expert delineates the boundaries of one’s expertise and where one is capable of speaking, and where one is not. But for a newspaper to come out and say psychiatrists should not talk about psychiatric issues was quite astonishing.
BILL MOYERS: And you were rather ostracized by the rest of the mainstream press for a while.
BANDY LEE: At first it was not the case. In fact, I was interviewing 15 hours a day, every single day. I was invited by all the major news programs. In fact, there’s no major program I was not invited by, including Fox. And I was cautious in the beginning in not wanting to blow it up all at once. We were the number one topic of national conversation within two months of publication of the book. But that was exactly when the American Psychiatric Association stepped in with The New York Times and with the editorial by the past APA president you mentioned. In other words, they put out all the guns at once, and it worked. Within two weeks all the inquiries stopped from the major media. And later on, we found out that that was when they formed informal policies not to have on mental health experts on issues of mental health.
BILL MOYERS: Well, the American Psychiatric Association was defending the “Goldwater Rule,” which grew out of Barry Goldwater’s defeat by Lyndon Johnson in 1964. After Goldwater had been nominated for president, a magazine sent out a questionnaire to 12,356 psychiatrists asking, “Do you believe Barry Goldwater is psychologically fit to serve as president?” Goldwater thought that helped to beat him and he filed suit for defamation and he won. And since then, the American Psychiatric Association, having passed the Goldwater Rule, said that no psychiatrist should publicly discuss a candidate’s, a public figure’s, mental health without a personal examination of that person. Now, I know that probably the majority of psychiatrists today no longer believe or practice the Goldwater Rule, they’re doing what you’re doing. In fact, more than a year ago, following your lead, more than 800 mental health professionals joined to petition Congress about the danger Trump represents. And more recently, 100 senior health professionals declared on video that Trump is mentally unfit and psychologically dangerous. They clearly didn’t believe the Goldwater Rule any longer is binding, or that they needed a personal diagnosis of the patient before they reached the conclusions that got you roundly opposed by not all, not all by any means, but by the–
BANDY LEE: By the establishment, yes.
BILL MOYERS: By the establishment. Right.
BANDY LEE: And that is where I strongly, in fact in the strongest possible terms, object to the American Psychiatric Association’s actions. They did not clarify that they only cover 6% of practicing mental health professionals, which are APA members. I’m not a member. I resigned 14 years ago because of its alignment with the pharmaceutical industry. I think it’s important to note that the Goldwater Rule is unlike any other ethical guideline in that it comes from, as the name suggests, a political compromise. When Barry Goldwater launched his lawsuit, it was against the magazine for defamation, not for faulty clinical care or faulty actions on the part of psychiatrists. The APA was merely embarrassed but was pressured by the American Medical Association, which was closely aligned with the Republican Party, in fact, a big lobby in Washington at the time, and supported every Republican candidate. It became so political that most physicians in the U.S. do not belong to the AMA. And so, the Goldwater Rule was a rule that even most psychiatrists didn’t know about because it was so obscure and irrelevant until this presidency. And for them to go on a public campaign silencing all mental health professionals, not just members– if the Goldwater Rule were a valid ethical guideline, they would be disciplining their members through an ethics committee. None of that has happened. Their guideline is not admissible in any licensing board, because it goes against the First Amendment. And in my view, it goes against the core principles of our medical ethics and duty. Their own preamble to the code of psychiatric ethics says we have a responsibility to patients as well as society. And so, they are telling us that we have to subordinate our responsibility to society to an etiquette, essentially, to a public figure.
BILL MOYERS: Trump still got more votes in losing this year than he got in winning in 2016. And the journalist Jon Wiener argues that you didn’t find any new evidence about Trump that wasn’t available to any discerning observer. In other words, the people could see Trump in action and can watch his behavior, listen to his speeches, and judge him for themselves. And millions voted for him. So, Wiener asks, shouldn’t we be asking, are Trump voters crazy? Isn’t that more important than asking what’s wrong with him?
BANDY LEE: In my book, I advise against considering them in isolation. They’re really an ecology of interconnected parts Donald Trump, his supporters, and the nation are all interrelated, and they all are interdependent, in that what one does influences what the others are like. And so, what do mental health professionals bring? Well, this is exactly what we bring to this same information. We bring decades of research, of studying human behavior and personality, hundreds of examples of cases in our clinical experience so that we interpret the exact same signs that other people see through an informed, educated lens.
BILL MOYERS: What does it tell us, that seven out of 10 Republicans believe Trump’s lie that the election was stolen?
BANDY LEE: I believe it’s a combination of shared psychosis. There are certainly signs of that. But it could’ve also begun with corruption, opportunism, and seeing this as a chance to take advantage of someone’s mental weakness to advance their extreme policies that would not be possible under a rational president. But they may have underestimated the degree to which pathology could be destructive. Or could be just taken up by the pathology and do not mind the destruction.
BILL MOYERS: Any threat to Trump’s power and position is a threat to themselves and that’s why they are so tolerant of his behavior?
BANDY LEE: Yes, absolutely. The psychological pull that he has is incredibly strong. It speaks to the power of the mind. And no one is immune from transmission of symptoms. We also know from the people who voted for him that even Black and other minority groups voted for him in greater numbers. There is indeed profound identification with him. Such that I do believe his followers think that his loss is their loss, and they’re fighting for their survival when they are fighting for Donald Trump’s–
BILL MOYERS: Right. And at the same time, I’ve never felt so much anxiety among people who don’t support Trump.
BANDY LEE: Absolutely. As therapists there is no clinician that I know of who has not experienced a surge in patients. Those who have been suffering from symptoms find their symptoms worsen. Those with a history of trauma, coming back retraumatized. And those without symptoms presenting for the first time. And the American Psychological Association and the American Psychiatric Association did surveys of the population that showed unprecedented stress levels and anxiety levels since the start of this presidency, not even lately. And so, yes. That is often what one experiences when one has a disordered person in charge of the nation’s entire welfare.
BILL MOYERS: Are you holding your breath the next few days as Trump’s fictional reality crashes down around him and he’s acting what has been described as the mindset of a mad monarchy? Are you worried?
BANDY LEE: I am very worried. I fear that the failure of imagination on the part of just how much harm the president could do and just how impaired he is is going to come back and bite us. We have appealed to the vice president, the speaker of the House and to all Congress members in a letter urging them once again to consider consulting with us and to work on immediate removal as well as immediate guardrails. And not to rule out an involuntary psychiatric evaluation, which would be the medical standard of care, which the president is supposed to be under. I’m glad that he is disconnected from social media and not able to communicate as closely with his followers. But not all the guardrails are in place. And this is really not the way that we manage someone of his condition. That’s one of the reasons why a foremost scholar of psychopathy described the condition that he was studying as a “mask of sanity.” That’s one of the reasons why the drafter of the 25th Amendment, John Feerick, with whom I have shared a number of conferences has said that, where psychiatric conditions are concerned, mental health experts may need to speak up first, not come last. But that the data that they provide could be critical for those who would start the process. And for him, the vice president wasn’t the person driving the process, but rather the person who came last. Otherwise, if the vice president were supposed to be in charge, it could turn into totally political process. And we know that medical conditions are scientifically based always buttressed by data and, therefore, not as easily politically misused.
BILL MOYERS: Well, for those of us who have been anxious, some honestly depressed over the circumstances our country faces, you have some very useful counsel in your new book TRUMP’S MIND, AMERICA’S SOUL, that I really highly recommend. You say what matters most critically is the spiritual resolve, resilience and resourcefulness that lie behind an action. In other words, to achieve greater outward power and we really do need citizens now to exercise their civic worth and commitment. Citizens should seemingly paradoxically first tune into themselves and meet their own needs. This involves making sure that they’re getting enough sleep, eating healthy meals, connecting with friends and family, and limiting news consumption. Recognizing and attending to their own state is an essential part of their everyday reasonable practice. Now, does the advice of this psychiatrist apply to herself?
BANDY LEE: I hope so. Yes. Yes, I have placed brakes on myself because there is an axiom in medicine. “When in an emergency, first check your own pulse.” And it applies to psychiatry as well. When there is a critical situation, you first must take care of yourself. That is how you can most effectively deal with the situation. And in this case, the healer of the nation, the persons in charge, are the people. And if we can take care of ourselves, our mental health and our spiritual balance, we can see how much power we have. And be firm in our ethical grounding as well as in the certitude of our actions.
BILL MOYERS: Joe Biden is honestly talking about healing the nation, about our need to be united again. What about the people who did enter the Capitol in awe at one point, and in terror at another? How do all of us who want the nation to heal deal with them? You say, how to engage these followers is a chief question for many people. And mental health professionals are often confronted with the question, how do we reason with a Trump supporter? Well, what’s the answer?
BANDY LEE: The answer first is to recognize what is happening. If we can identify the problem and understand it, then the solutions naturally follow. What is happening is that many Trump supporters are like victims of abuse or members in a cult who are so emotionally bonded to their leader at this point, where they don’t see the harm that is being done to them. And they are not open to evidence or reason. But will rather resist any challenges to their beliefs. And so, what you do is you don’t try to persuade them, you try to correct the circumstances that led to those beliefs.
And that, first of all, is to separate them from their leader. And secondly, to offer them emotional support, including social support; a place of belonging, a means of attaining dignity. And again, I go back to the socioeconomic conditions that led to the psychological injury that made such a person attractive in the first place. Now, you talked about the healing that the nation and Joe Biden will be attempting to do. I think we have to have the correct notion of healing. Healing does not simply mean reconciling with whatever there is. That holds true within the healthy realm, certainly. But when not all is healthy, Joe Biden and others may need to actually consult with healers who are used to dealing with these personality pathologies and these disordered situations, where in fact vigorous prosecution and accountability, setting limits, clear boundaries and standards, are actually the beginning of healing.
Without that, it’s almost impossible to heal or to create a safe situation where healing can occur. We cannot underestimate what has happened. It was an incredibly violent insurrection. It’s been described as an act of domestic terrorism. It certainly violated the People’s House, both physically ransacking it, as well as psychologically. And in the spirit of our nation, our concept of democracy have been violated. The meaning of that cannot be understated. And treason and sedition are considered one of the highest crimes against the nation. So, to let these people go without accountability, actually helps further violation in the future [and] increases the violation against those who are law abiding and those who are indeed patriotic. And so, when you are dealing with individuals who are usually violating others’ rights denigrating lives and causing essentially violence and trauma, first, you wish to create a safe environment. And setting limits, prosecuting, holding people accountable shows that there are limits.
BILL MOYERS: Dr. Bandy Lee, thank you.
BANDY LEE: Thank you so much for your support and your concern for our nation.
ANNOUNCER: Thanks for listening to Moyers on Democracy. On our website you can find out more about the attack on the Capitol. Until next time, you’ll find all this and more at Billmoyers.com.