Top psychiatrists issue urgent letter to Congress about Trump's mental instability

News photographers wait for U.S. President Donald Trump to walk out of the Oval Office to speak with reporters at the White House in Washington, D.C., U.S., April 13, 2026. REUTERS/Jonathan Ernst

Editor’s note: The following letter was sent to the bipartisan leadership of Congress on Monday, April 13, 2026 in regard to recent rhetoric and actions taken by US President Donald J. Trump.

Senator John Thune
Senate Majority Leader, US Senate

Senator Charles E. Schumer
Senate Minority Leader, US Senate

Representative Mike Johnson
Speaker of the House, USHouse of Representatives

Representative Hakeem Jeffries
House Minority Leader, US House of Representatives

Dear Senate Majority Leader Thune, Senate Minority Leader Schumer, Speaker Johnson, and House Minority Leader Jeffries:

We write to you today with a sense of urgency that we do not use lightly. The behavior and rhetoric of President Donald Trump have crossed a threshold that demands the immediate and bipartisan attention of Congress. This is not a partisan assessment. It is a judgment grounded in observable fact, consistent professional assessment, and the constitutional responsibilities that your offices carry.

President Trump exhibits what forensic mental health experts have, across dozens of independent assessments, identified as the “Dark Triad” of personality traits: narcissism, Machiavellianism, and psychopathy. Rather than constituting a clinical diagnosis, this trait-based assessment is grounded in behavioral observation and is particularly useful for assessing the level of danger an individual poses in a political leadership position. We do not offer this as a clinical verdict. We offer it as the considered judgment of a substantial body of professional opinion, based on well-researched evidence that is consistent, accumulating, and impossible to dismiss.

What makes this more than an academic matter is what predictably happens when this personality structure collides with immovable obstacles. The clinical literature is clear: individuals with Dark Triad profiles, when confronted with situations they cannot control or escape, do not recalibrate. They escalate. The psychological imperative to relieve narcissistic collapse overrides strategic calculation, concern for consequences, and ordinary self-restraint. Rage surges to domination. Impulsivity overrides caution. The urgent need to extinguish psychological pain eclipses every other consideration.

We are watching this dynamic unfold in real time.

The President’s recent public communications have been, by any normal standard of political discourse, alarming. His posts demanding that Iran “open the f------’ strait, you crazy b------” and his threat to bomb Iran “back to the stone ages,” adding that “a whole civilization will die tonight, never to be brought back again,” are not the rhetoric of calculated geopolitical pressure. They are the expressions of a man in profound psychological distress who is reaching for the most extreme retaliatory threats available to him. That these statements were addressed to an adversary in the context of an active military confrontation makes them not merely shocking but profoundly dangerous.

President Trump has now ordered a US naval blockade of Iran — an action that has sent world oil prices soaring and placed the United States in direct opposition to the international community. His ongoing actions carry the potential to trigger a global economic catastrophe, draw in regional and great powers, and ignite a wider conflict with consequences that no one can bound. These orders are being issued without adequate deliberation, without congressional authorization, and in a context in which the President’s judgment is, by every visible measure, severely compromised.

We urge three specific actions.

First, Congress must immediately retake its constitutional authority over war. The bombing of Iran and the initiation of a naval blockade — acts of war under both US and international law — cannot be authorized by presidential fiat. Article I of the Constitution vests in Congress the sole power to declare war and to regulate commerce with foreign nations. The Framers intended Congress to deliberate upon and be accountable for precisely such consequential actions. Congress must assume its constitutional authority now, before further escalation renders the question moot.

Second, congressional leadership — on a bipartisan basis — must convene urgent consultations with senior administration officials, including the Secretary of Defense, the Chairman of the Joint Chiefs, the Secretary of State, and the Director of National Intelligence. The purpose is not routine oversight. It is to create a circuit breaker capable of preventing escalation toward catastrophe, including the potential use of nuclear weapons. Those officials have their own constitutional and statutory obligations. Congress should insist on those obligations and provide a forum in which they can be exercised.

Third, Congress should formally initiate consultation with the Vice President and Cabinet regarding the President’s fitness for office under Section 4 of the Twenty-Fifth Amendment. We do not prejudge the outcome. We are not calling for the President’s immediate removal. We are calling for the process that the Constitution itself provides for this contingency: when a President’s capacity to discharge the duties of office is in question and poses a potential imminent danger to the nation. The Amendment exists because those who drafted it recognized that the question of presidential incapacity would occasionally arise, and that it required a constitutional answer rather than a political improvisation.

He is a constitutional emergency. The mechanisms for addressing such an emergency exist. They were placed in the Constitution and its amendments for moments precisely like this one.

We recognize the gravity of what we are asking. We ask it because the gravity of the situation demands it.

A President who publicly threatens to destroy a foreign civilization, who launches a bombing campaign and then imposes a naval blockade without congressional authorization, and who shows every behavioral sign of a personality in acute crisis is not merely a political problem. He is a constitutional emergency. The mechanisms for addressing such an emergency exist. They were placed in the Constitution and its amendments for moments precisely like this one.

The war with Iran will not wait. The escalation dynamics of this active military confrontation will not wait. The psychological conditions driving the President’s decisions will not improve under pressure — they will worsen.

We urge you to act without delay. The Constitution gives you the tools. Your oath of office assigns you the responsibility.

Respectfully,

James Gilligan, M.D.
Clinical Professor of Psychiatry, New York University School of Medicine
Adjunct Professor of Law, New York University School of Law
Former Faculty of Psychiatry, Harvard Medical School
Former President, International Association of Forensic Psychotherapy

Prudence L. Gourguechon, M.D.
Former President, American Psychoanalytic Association
Former Vice President, World Mental Health Coalition

Bandy X. Lee, M.D., M.Div.
President, World Mental Health Coalition
Co-Founder, Preventing Violence Now
Former Faculty of Social Medicine, Harvard Medical School
Former Faculty of Law and Psychiatry, Yale School of Medicine

James R. Merikangas, M.D.
Clinical Professor of Psychiatry and Behavioral Science, George Washington University
Research Consultant, National Institute of Mental Health
Co-Founder, American Neuropsychiatric Association
Former President, American Academy of Clinical Psychiatrists

Jeffrey D. Sachs, Ph.D.
University Professor, Columbia University

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