Trump’s mental impairment is the real public health problem: Yale psychiatrist

Trump’s mental impairment is the real public health problem: Yale psychiatrist
Photo by Shealah Craighead

The moment we feared has come: in a real emergency, the president’s inability to stay with reality and to resist the need to conform the world to what is in his head will now result in a tangible loss of lives. People are asking: Is the president capable of functioning in a crisis? Why is the messaging more important than the actual job of protecting the country and responding to a health crisis? Why does he care more about looking or acting like a president than actually performing the job of president? In all these questions, there is an implicit assumption of mental capacity.

Almost three years ago, my colleagues and I embarked on publicly warning against the dangers of the president’s mental impairments because of our concerns for public health.  As mental health experts, we found it important to inform that, when a president is mentally incapacitated, it becomes a matter of public health, with potential life-and-death consequences for whole populations.

This is what it means to lack the mental capacity for a job, and why it is critical for leadership positions of great power to possess it.

Our warnings went unheeded, and we were actively silenced, most notably by the federally-funded American Psychiatric Association, which eliminated our public health duty with this administration to favor protecting a public figure.  Media organizations followed suit with formal and informal policies not to air mental health experts who would speak about the president’s mental health.  While the public continued to ask, “Where are the mental health professionals?” our best efforts did not get proper information to the public in time.

Preoccupied with Tweeting

We are now seeing the direct results.  As coronavirus has spread across 53 countries, federal health officials are starkly warning that the new coronavirus will almost certainly spread in the United States.  But the president has been preoccupied with tweeting: “Low Ratings Fake News MSDNC (Comcast) & @CNN are doing everything possible to make the Caronavirus [sic] look as bad as possible, including panicking markets if possible.”  Meanwhile, he states, “their incompetent Do Nothing Democrat comrades are all talk, no action.  USA in great shape!”  His need to push down intolerable realities and to project his shortcomings on his opponents induce him to hold steadfast to opposite beliefs, and his actions subsequently are the opposite of what is needed.

This is what we continue to see.  His administration had gutted the Centers for Disease Control and Prevention (CDC), the National Security Council, and the Department of Homeland Security of global epidemic response capabilities.  And now, rather than confront the crisis, the White House is focused on tightening control over coronavirus messaging by government health officials and scientists, requiring them to pass their communications through Vice President Mike Pence, a known science denier.  Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci received instructions from the White House not to say anything without clearance.  This is in line with the Trump administration’s “shadow war” on science and the disbanding of scientific committees.

‘War on Reality’

We know this pattern.  We saw how, over three years without containment, his sense of unlimited power and impunity ballooned.  Impeachment, rather than bringing him to remorse, led him on a vengeful spree following acquittal.  Recently, he declared himself the law of the land, and, when information he did not wish to hear surfaced, he rather replaced the person in charge of intelligence than addressed a situation of national security.  More generally, agencies with important functions are depleted while resources are funneled to projects that are driven more by fantasy than reality.

We know what will happen as the crisis deepens.  His “war on reality” will only intensify as he steps up efforts to conform things to his invested world view.  There are no good tests and no vaccine, and continual revelations of incompetence will only worsen the response to coronavirus.  This is what it means to lack the mental capacity for a job, and why it is critical for leadership positions of great power to possess it.  The minimal requirements for mental capacity are the ability to take in information and advice, to process that information, and to think about consequences so that one can make rational, sound, non-impulsive, and reality-based decisions.  Mental health experts have been warning since the very beginning that this lack is a serious matter, and that mental health, not just political expediency, needs to be taken into consideration.

Denial and Secrecy

We know the dangers of a purely political approach from a direct, parallel example: China, under another autocratically-leaning ruler, dealt with coronavirus with denial and secrecy, which many say helped the virus to gain a tenacious hold.  One of its early whistleblowers, Dr. Li Wenliang, was reprimanded and compelled to denounce his warning as unfounded, illegal behavior; he died a little more than a month later of the disease.  Short-sighted policies focused on appearance and coverup came to damage not only a nation’s economy and international standing but the world’s stability.

America is now at a crossroads.  Stock markets plunged further after Donald Trump claimed that the market fall in previous days was because of the Democratic debates, which happened later: the world recognizes the danger we are in under a man so incapacitated.  Deception, disdain for science and medicine, threatening the Federal Reserve, blaming “the fake news media,” calling the crisis Democrats’ “new hoax,” and changing the subject will not work.  This is often a hard-learned lesson in mental health: repression of reality does not make it go away, but rather prepares it for an explosive return.

Trump’s Mental Illness

Our question is now, therefore: Will we stem our spread of cognitive distortions, false beliefs, and other mental symptoms, before it is too late?  Will we attend to the problem of mental health in the highest position of power, even if inconvenient, for survival?  Will we admit the need for expertise—or the best-established knowledge we have available—and accept that this is not a partisan matter?

We cannot expect mental capacity from a person who lacks it, and that he is hypnotic, seductive and manipulative of the population in ways that spread his symptoms—in itself a sign of pathology—does not make the situation better.  Will we let go of our cherished beliefs, especially beliefs we wish to hold about a leader—to save our own lives?  A group of mental health experts drafted a “Declaration of the Freedom of Mind” to help our fellow citizens through, with the hope that we will claim our right to mental health and our entitlement to correct information and action, before any epidemic claims us.

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