Four years ago, psychiatrists and authors Dr. Robert Jay Lifton and Dr. Bandy Lee, among others, felt a duty to warn the country about dangerous possibilities stemming from a man who lacked the mental fitness to be president. With Dr. Lee as editor, they joined with other experts to publish The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Professionals Assess a President. The book went on to become an instant number one bestseller in 2017 and a second edition added ten additional chapters. The authors have also written hundreds of articles and spoken out in the news media about the continuous crisis that was the Trump presidency
As a bookend to the Trump era, one of the book’s contributors, psychotherapist Harper West, compiled excerpts from each of the essays in the original book. Even these brief selections show that at a time when few were speaking out about Trump’s pathological personality, these experts were extremely prescient in their predictions about a wide range of aspects of Trump’s behaviors, including the psychological impact on the country.
As you read these, remember the authors were writing four years ago and yet their statements sound as if they could be describing Trump’s most recent behaviors. Clearly, he did not become more “presidential.” In fact his behaviors all worsened, as was predicted. We can take heart, however, that the authors offer not only a roadmap to preventing future authoritarians, but also words of advice for moving forward past Trumpism.
Foreward: Our Witness to Malignant Normality, by Robert Jay Lifton
“[Trump] has also, in various ways, violated our American institutional requirements and threatened the viability of American democracy. Yet, because he is president and operates within the broad contours and interactions of the president, there is a tendency to view what he does as simply part of our democratic process – that is, as politically and even ethically normal. In this way, a dangerous president becomes normalized, and malignant normality comes to dominate our governing (or, one could say, our antigoverning) dynamic.” (p. xvi-xvii)
Prologue, by Judith Lewis Herman, M.D., and Bandy X. Lee, M.D., M.Div.
“A man can be both evil and mentally compromised – which is a more frightening proposition. Power not only corrupts but also magnifies existing psychopathologies, even as it creates new ones. Fostered by the flattery of underlings and the chants of crowds, a political leader’s grandiosity may morph into grotesque delusions of grandeur. Sociopathic traits may be amplified as the leader discovers that he can violate the norms of civil society and even commit crimes with impunity. And the leader who rules through fear, lies, and betrayal may become increasingly isolated and paranoid, as the loyalty of even his closest confidants must forever be suspect.” (p. 7)
Introduction: Our Duty to Warn, by Bandy X. Lee, M.D., M.Div.
“Possibly the oddest experience in my career as a psychiatrist has been to find that the only people not allowed to speak about an issue are those who know the most about it. Hence, truth is suppressed. Yet, what if that truth, furthermore, harbored dangers of such magnitude that it could be the key to future human survival?” (p. 11)
Unbridled and Extreme Present Hedonism, by Philip Zimbardo, Ph.D., and Rosemary Sword
“In Donald Trump, we have a frightening Venn diagram consisting of three circles: the first is extreme present hedonism; the second, narcissism; and the third, bullying behavior. These three circles overlap in the middle to create an impulsive, immature, incompetent person who, when in the position of ultimate power, easily slides into the role of tyrant, complete with family members sitting at his proverbial ‘ruling table.’ Like a fledgling dictator, he plants psychological seeds of treachery in sections of our populace that reinforce already negative attitudes.” (p. 44)
Pathological Narcissism and Politics, by Craig Malkin, Ph.D.
“When it comes to the question of whether or not someone who’s mentally ill can function, danger is the key – to self or others. This is where pathological narcissism and politics can indeed become a toxic, even lethal mix. When peace at home and abroad are at stake – not just the feelings of coworkers, friends, or partners – pathological narcissism unchecked could lead to World War III.” (p. 60)
I Wrote the Art of the Deal with Donald Trump: His Self-Sabotage is Rooted in his Past, by Tony Schwartz
“Trump can devolve into survival mode on a moment’s notice. Look no further than the thousands of tweets he has written attacking his personal enemies over the past year. In neurochemical terms, when he feels threatened or thwarted, Trump moves into a fight-or-flight state. His amygdala is triggered, his hypothalamic-pituitary-adrenal axis activates, and his prefontal cortex – the part of the brain that makes us capable of rationality and reflection – shuts down. He reacts rather than reflects, and damn the consequences. This is what makes his access to the nuclear codes so dangerous and frightening.” (p. 72-3)
Trump’s Trust Deficit is the Core Problem, Gail Sheehy, Ph.D.
“The narcissism and paranoia are issues, but the bigger concern is that Donald Trump trusts no one. This will be his downfall – maybe ours.” (p. 75) “Beneath the grandiose behavior of every narcissist lies the pit of fragile self-esteem. What if, deep down, the person whom Trump trusts least is himself? The humiliation of being widely exposed as a ‘loser,’ unable to bully through the actions he promised during the campaign, could drive him to prove he is, after all, a ‘killer.’ In only the first four months of his presidency, he teed up for starting a war in three places, Syria, Afghanistan, and North Korea. It is up to Congress, backed by the public, to restrain him.” (p. 81)
Sociopathy, Lance Dodes, M.D.
“Donald Trump’s speech and behavior show that he has severe sociopathic traits. The significance of this cannot be overstated. While there have surely been American presidents who could be said to be narcissistic, none have shown sociopathic qualities to the degree seen in Mr. Trump. Correspondingly, none have been so definitively and so obviously dangerous. Democracy requires respect and protection for multiple points of view, concepts that are incompatible with sociopathy. The need to be seen as superior, when coupled with lack of empathy or remorse for harming other people, are in fact the signature characteristics of tyrants, who seek the control and destruction of all who oppose them, as well as loyalty to themselves instead of to the country they lead. … Mr. Trump’s sociopathic characteristics are undeniable. They create a profound danger for America’s democracy and safety. Over time these characteristics will only become worse, either because Mr. Trump will succeed in gaining more power and more grandiosity with less grasp on reality, or because he will engender more criticism producing more paranoia, more lies, and more enraged destruction.” (p. 91-2)
Donald Trump Is: a) Bad b) Mad, c) All of the Above, by John D. Gartner, Ph.D.
“Let’s put these two moving parts together, bad and mad. Trump is a profoundly evil man exhibiting malignant narcissism. His worsening hypomania is making him increasingly more irrational, grandiose, paranoid, aggressive, irritable, and impulsive. Trump is bad, mad, and getting worse. He evinces the most destructive and dangerous collection of psychiatric symptoms possible for a leader. The worst-case scenario is now our reality.” (p. 107)
Why ‘Crazy Like a Fox’ versus ‘Crazy Like a Crazy’ Really Matters: Delusional Disorder, Admiration of Brutal Dictators, the Nuclear Codes, and Trump, by Michael J. Tansey, Ph.D.
“If, in fact, DT harbors an underlying delusional disorder, from a clinical perspective, his delusions would likely be grandiose and paranoid in nature. This would help us to answer once and for all the question of why, during the 2016 presidential campaign and beyond, DT has repeatedly and openly expressed admiration for Kim Jong-Un of North Korea, Bashar al-Assad of Syria, Iraq’s Saddam Hussein, and especially Vladimir Putin. There is considerable evidence to suggest that absolute tyranny is DT’s wet dream. The unopposed dictator is the embodiment of the ability to demand adulation on the one hand and to eradicate all perceived enemies with the simple nod of the head on the other.” (p. 115-116)
Cognitive Impairment, Dementia, and POTUS, by David M. Reiss, M.D.
“No reasonable person would want someone with compromised cognitive/intellectual functioning to serve as POTUS. However, to date, there is no process or procedure (beyond voluntary release of medical records) that provides the public with any reliable knowledge regarding whether a candidate for the office of POTUS suffers from cognitive impairment or is at high risk for cognitive degeneration.” (p. 133)
Donald J. Trump, Alleged Incapacitated Person: Mental Incapacity, the Electoral College and the Twenty-Fifth Amendment, by James A. Herb, Esq.
“Once, when I tuned in to watch a Trump rally on TV, he was reciting lyrics from a song titled, ‘The Snake,’ about a tenderhearted woman who rescues a half-frozen snake, only to be fatally bitten by it once it has revived. The snake says, ‘You knew damn well I was a snake before you took me in.’ I thought Trump was speaking about himself, and the American people were the tenderhearted woman. It turned out he was speaking about immigrants as being vicious snakes.” (p. 137-8)
Should Psychiatrists Refrain from Commenting on Trump’s Psychology? By Leonard J. Glass, M.D., M.P.H.
“Donald Trump’s presidency confronts the psychiatric profession and, much more important, our country with the challenge of dealing with an elected leader whose psychological style (marked by impulsivity, insistence on his own infallibility, vengeful retaliation, and unwarranted certainty in uncertain circumstances) is a profound impediment to sound decision making and presages the erratic and ill-considered exercise of enormous power.” (p. 158)
On Seeing What You See and Saying What You Know: A Psychiatrist’s Responsibility, by Henry J. Friedman, M.D.
“A paranoid, hypersensitive, grandiose, ill-informed leader such as Donald Trump, who has surrounded himself with a Cabinet and a set of advisers who either are unable to bring him out of his paranoid suspicions and insistences or, worse, identify with his positions, represents a multidimensional threat to our country and the world.” (p. 166)
The Issue is Dangerousness, Not Mental Illness, by James Gilligan, M.D.
“If we are silent about the numerous says in which Donald Trump has repeatedly threatened violence, incited violence, or boasted about his own violence, we are passively supporting and enabling the dangerous and naïve mistake of treating him as if he were a ‘normal’ president or a ‘normal’ political leader. He is not, and it is our duty to say so, and to say it publicly. He is unprecedentedly and abnormally dangerous.” (p. 178)
A Clinical Case for the Dangerousness of Donald J. Trump, by Diane Jhueck, L.M.H.C., D.M.H.P.
“As the ultimate representative of our nation, Donald J. Trump is normalizing previously outrageous behaviors, negatively impacting everyone from leaders of other nations to our own children. … He exhibits extreme denial of any feedback that does not affirm his self-image and psychopathic tendencies, which affords him very limited ability to learn and effectively adjust to the requirements of the office of president. Rather, he consistently displays a revenge-oriented response to any such feedback. Holding this office at once feeds his grandiosity and claws at the fragile sense of self underneath it. His patterns of behavior while in the role of president of the United States have potentially dire impact on every individual living not only in this nation but across the entire globe. … Trump is and has demonstrated himself to be a danger to others – not just one person or a few, but possibly to all others.” (p. 193)
Health, Risk, and the Duty to Protect the Community, by Howard H. Covitz, Ph.D. A.B.P.P.
“Donald Trump has displayed, frequently, all six of the characteristics that I and many other mental health professionals associate with severe character pathology. … I believe it is my ethical responsibility to work within the confines of the law to have Mr. Trump psychologically and psychiatrically examined – or in the absence of his willingness to do so, to have him removed from office.” (p. 206-7)
New Opportunities for Therapy in the Age of Trump, by William J. Doherty, Ph.D.
“The boundary between the personal and public has ruptured in the age of Trump… [B]efore Trump, we therapists who felt comfortable in the mainstream of a democratic society could assume that our therapist ‘hat’ and our citizen ‘hat’ were separate.” (p. 207) … “[T]o truly fulfill the potential of our professional role in a democracy, we have to be active outside our offices. I feel passionately that we’re healers with something important to offer our neighbors and communities. Here’s a short definition of the concept of the citizen therapist: A citizen therapist works with people in the office and the community on coping productively with public stress and becoming active agents of their personal and civic lives. Citizen-therapist work is not separate from the traditional practice of psychological and interpersonal healing – it’s integrated with it.” (p. 215)
Trauma, Time, Truth, and Trump: How a President Freezes Healing and Promotes Crisis, by Betty P. Teng, M.F.A., L.M.S.W.
“Looking through the lens of trauma treatment, it is of particular concern that we find ourselves in a perfect storm where we have, as our U.S. president, a narcissist fixed on broadcasting his own unilateral and inconsistent versions of reality in a climate driven by Internet media channels that produce information so quickly that they privilege falsehoods over truth. It is a tenet of trauma therapy to validate our patients’ truths.” (p. 229) … “Thus, it is traumatizing to have, in the White House, a president and an administration intent on confounding ‘full communication by manipulating the truth to serve their own ends.” (p. 230) “In trauma therapy, we see the corrosive long-term effects upon the human spirit when an individual’s truth and reality are denied, particularly when those individuals grapple with traumas that take away their sense of subjectivity and self-efficacy. In his constant attempts to redefine the truth against the wrongdoings he has enacted, Donald Trump behaves like an aggressive perpetrator who fundamentally has no respect for the rights and subjectivities of those in American society who disagree with him. He shows this through his insistence on overpowering and shaming individuals who will not bend to his opinion or his will. From my stance as a trauma therapist, it is heartbreaking to see the damage Donald Trump is wreaking upon American society. It is a perpetration, creating deep wounds from which, I fear, it will already take us years to heal.” (p. 231).
Trump Anxiety Disorder: The Trump Effect on the Mental Health of Half the Nation and Special Populations, by Jennifer Contarino Panning, Psy.D.
“Symptoms associated with Trump anxiety disorder include: feeling a loss of control; helplessness ruminations/worries, especially about the uncertain sociopolitical climate while Trump is in office; and a tendency toward excessive social media consumption. In fact, the polarization that this has created has caused a deep divide between families and friends of differing political beliefs. Trump’s specific personality characteristics, and his use of psychological manipulation tools such as gaslighting, lying, and blaming, are described as contributing factors to Trump anxiety disorder.” (p. 237)
In Relationship with an Abusive President, by Harper West, M.A., L.L.P.
“A fundamental problem with a Trump presidency is not merely that his poorly thought-out policies may harm us. It is that his character defects will normalize immoral Other-blaming behaviors and encourage their full expression among those who may have previously been held in check by expectations of socially acceptable behavior. If the recent uptick in racial violence is an indicator, Trump has given his followers a green light to act out. Just as the trauma of witnessing domestic violence damages children, an emotionally immature president can affect the future of our nation regarding moral behavior, cultural stability, and psychological wellness.
Other-blamers can be restrained only by prompt, calm boundary setting and enforcement of moral and social norms. Without these influences, Other-blamers grow in boldness and their presumption of power. Other-blamers will take as much ground as they can get.
We must resist, not only to contain Trump’s behaviors, but also to signal to his followers that abusive behavior is not appropriate. Unfortunately, now that millions of Other-blamers have been encouraged by Trump to misbehave, it may be impossible to get that genie back in the bottle.” (p. 256-7)
Birtherism and the Deployment of the Trumpian Mind-set, by Luba Kessler, M.D.
“It remains our challenge to right the political, civic, and interpersonal relations needed for the mutual benefit of the present and future American generations: white, black, and any Other. In order to rise to the challenge, we need the courage of truth and awareness. We need to question rationalized public policies that maintain segregation and inequality; be it at the voting booth or in judicial or police protection. We need to tune into and question habits of prejudice and bigotry. We need to probe better the stereotypes of our culture and of ourselves. Such an examination will inoculate our civic consciousness against the lies masquerading as truth. We will choose worthy leaders aware of their responsibility to represent the integrity of this nation’s essential values. Birtherism shows Donald Trump not only as unworthy but as dangerous to the nation’s central tenet: E pluribus unum. It is not negotiable.” (p. 266)
Trump’s Daddy Issues: A Toxic Mix for America, by Steve Wruble, M.D.
“As I observe President Trump’s behavior, I imagine that there is a good chance he identifies with his father’s aggressive business style and parenting, and is now employing that orientation to his role as president. In psychology, this is called identification with the aggressor. At first, it may appear counter-intuitive to identify with an aggressor who has abused his position of power to take advantage. However, our brains often use this early relationship as a template to shape our future behaviors. We are attracted to the power we witness from our powerless position. We can be hungry for the same power that we originally resented or even fought against.” (p. 273)
Trump and the American Collective Psyche, by Thomas Singer, M.D.
“[O]ne of the most disturbing thoughts about the Trump presidency is that he has taken up residence not just in the White House but in the psyches of each and every one of us. We are going to have to live with him rattling around inside us, all of us at the mercy of his impulsive and bullying whims, as he lashes out at whatever gets under his skin in the moment with uniformed, inflammatory barbs.” (p. 294)
Who Goes Trump? Tyranny as a Triumph of Narcissism, by Elizabeth Mika, M.A., L.C.P.C.
“The tyrant’s narcissism is the main attractor of his followers, who project their hopes and dreams onto him. The more grandiose his sense of his own self and his promises to his fans, the greater their attraction and the stronger their support… Through the process of identification, the tyrant’s followers absorb his omnipotence and glory and imagine themselves as powerful as he is, the winners in the game of life. This identification heals the followers’ narcissistic wounds, but also tends to shut down their reason and conscience, allowing them to engage in immoral and criminal behaviors with a sense of impunity engendered by this identification.” (p. 305)
The Loneliness of Fateful Decisions: Social Contexts and Psychological Vulnerability, by Edwin B. Fisher, Ph.D.
“Reflecting the interplay of personal and social, narcissistic concerns for self and a preoccupation with power may initially shape and limit those invited to the narcissistic leader’s social network. Sensitivity to slights and angry reactions to them may further erode it. Those left tend to be indulgent of the individual and to persist for other gains. Either way, the advice and counsel they provide are liable to be guided by their motives for persisting.” (p. 336)
He’s Got the World In His Hands and his Finger on the Trigger: The Twenty-Fifth Amendment Solution, by Nanette Gartrell, M.D., and Dee Mosbacher, M.D., Ph.D.
“All in all, Mr. Trump’s hostile, impulsive, provocative, suspicious, and erratic conduct poses a grave threat to our national security.… The Twenty-Fifth Amendment to the U.S. Constitution addresses presidential disability and succession… We (Drs. Gartrell and Mosbacher) call on Congress to act now within these provisions to create an independent, impartial panel of investigators to evaluate Mr. Trump’s fitness to fulfill the duties of the presidency. We urge Congress to pass legislation to ensure that future presidential and vice-presidential candidates are evaluated by this professional panel before the general election, and that the sitting president and vice president be assessed on an annual basis.” (p. 348)
Compiled by Harper West