'Trump is terrified' and 'addicted to conflict': Psychiatrist Justin Frank on the president's mental decompensation

Donald Trump was impeached by the House of Representatives last week. He is now the third president to be impeached, and will be the first to run for re-election after impeachment. Neither previous impeachment involved the blatant corruption of foreign policy seen in Trump's apparent plot to extort the president of Ukraine into aiding him in the 2020 election.

In the days following Trump’s impeachment new evidence of his wrongdoing has been uncovered.

On Friday, a Freedom of Information request by the Center for Public Integrity uncovered documents showing that almost immediately after Trump's July 25 shakedown conversation with Ukrainian President Volodymyr Zelensky, military aid to that country was stopped.

The Washington Post reported last Thursday that officials within the Trump administration were concerned that on matters regarding Ukraine and Russian interference in the 2016 election, the president has been following the personal dictates of Vladimir Putin. This is further evidence that Donald Trump is doing Putin’s bidding, and working to advance Russia’s interests over those of the United States.

Donald Trump may be stained by another singular “distinction” as well. Because Republican senators have already promised to ignore any and all evidence against Donald Trump — ensuring that under no circumstances will he be convicted and removed from office — Speaker Nancy Pelosi has not yet forwarded the articles of impeachment to the Senate. If the Republicans refuse to put service to the country and the Constitution over partisan loyalty, then Trump may be impeached for all time, but neither convicted nor acquitted.

At the exact moment he was being impeached, Donald Trump was giving a speech at a campaign rally in Battle Creek, Michigan. He followed his usual routine of violent threats, lies, hate-mongering and other repugnant behavior. He raged at Pelosi and the Democrats, calling them “traitors” involved in a “witch hunt” against him. He implied that his opponents, such as the late Rep. John Dingell, a Michigan Democrat, will burn in hell. Trump has recently become obsessed with toilets and human waste, and has trained his faithful to engage in a scatological call-and-response routine.

None of this should be surprising. Trump previewed his reaction to being impeached in a hate-filled and threatening letter to Pelosi last Tuesday which leading mental health professionals have described as “psychotic.”

Dr. Justin Frank is a former clinical professor of psychiatry at the George Washington University Medical Center and a physician with more than 40 years of experience in psychoanalysis. He is the author of the bestselling books "Bush on the Couch" and "Obama on the Couch." His most recent book is "Trump on the Couch: Inside the Mind of the President."

In this conversation, Frank offers a detailed analysis of Trump’s impeachment letter to Nancy Pelosi, warning that Donald Trump loves anger and conflict. The consequent danger is that impeachment will make Trump feel truly alive. Frank also explains that Trump is behaving like an injured child, a drug addict or a severely delusional person who is detached from reality and spiraling out of control.

Frank also says that Pelosi, the Democrats and the American people more generally are not the real audience for Trump’s impeachment letter. Trump is primarily speaking to his cult members and seeking to further cementing his control over them and their unquestioned loyalty.

This conversation has been edited for clarity and length.

What was your initial reaction to Trump’s impeachment letter to Pelosi?

It was a letter written by a person who is making a very clear statement to everyone that he is a victim. Without lauding too much praise on this president, in a way it is actually a brilliant letter. Trump’s letter to Pelosi is a clear example of how obsessive victims think about world because he blames everyone. Trump projects. Trump criticizes other people. Some of his projections are in fact delusional — and then he justifies how great he is with that long paragraph about all of his accomplishments, such as the economy, etc.

But Trump’s letter is laced with not just lies and self-aggrandizement, but a feeling that made me think of a little child who says, "Not fair! What you're doing is not fair! You shouldn't do this to me. It's not fair, Mommy! It's not fair, Daddy! You shouldn't do this!" That is what Trump’s letter sounded like. A little child.

Of course, what Trump is writing is crazy, but my first reaction was really about the childish aspects and his always being a victim.

Donald Trump is also very deft at what mental health professionals describe as “a change in point of view.” I've seen this in very few patients who I treat outside a hospital, because they are people who essentially distort reality. They would say things to me such as I'm the one with the problem and I'm the one who's crazy. Instead of looking inward they say things such as, “What's wrong with you, Dr. Frank?" Donald Trump juxtaposes everything in his letter. All the things that Trump accuses Pelosi of doing are basically what he is in fact doing.

Trump’s letter is also similar to what one would expect from a drug addict. Blaming others, the false victim narrative, the grandiosity.

You are correct. Trump’s letter is similar to how a drug addict’s mind works. We see this in addicts who are in recovery. When there is stress and pressure on drug addicts, they revert to their earlier state of anxiety and accusations. They act like they're cornered. As Donald Trump becomes more and more cornered, he behaves exactly the way addicts behave, which is to accuse other people. Drug addicts make themselves into victims.

Trump is doing something else that drug addicts do: They try to make other people anxious. In this case, Trump is trying to make the public, Nancy Pelosi, members of Congress and other people nervous and full of anxiety, as a way of denying it in himself. Trump is forcing anxiety out on to other people, so he does not have to feel it. Unfortunately, many people are succumbing to this by feeling the president’s outward projected anxiety.

In his letter, is Trump mocking Pelosi and impeachment? Or is he serious?

Donald Trump is serious. I think he is not aware when he is being mocking. In other words, when Trump talks about how his family has been injured by Pelosi, one thing he is not talking about is how in fact it is Trump who has put his own family in harm’s way. He's the one who put them in the public eye. Trump did this, not Nancy Pelosi.

Trump also paid a porn star to not speak about their affair. By doing that, Trump has subjected his own wife to public scrutiny. And when there is public scrutiny many secrets will be unearthed. Trump did that to his wife and family. So that's why his letter on the one hand is massively delusional, but it is also massively sincere. People who are delusional can also be sincere.

What is the clinical definition of “delusional”? How does such a state of mind present itself?

It's a distortion of reality. It is also what is termed as a "false belief” that is based on an internal fantasy life. For example, the simplest delusion that we see in this letter, and that we've seen with Trump in the last few weeks, with the Ukraine scandal, is his saying over and over again, "It was a perfect phone call." There's no such thing as perfection, first of all. Trump’s repeated insistence that he had a “perfect phone call” is a false belief. To keep saying that is both psychotic and sincere because the person who is deluded does not know they are delusional. When a person is full-blown deluded, they are possessed by their feelings, and their feelings are a fact to them.

In one of our previous conversations, you explained that Donald Trump is afraid of Nancy Pelosi. Is that dynamic present in this letter?

Fear is turned into attack in this letter. That is what is so frightening about Trump’s letter to Pelosi. I don't think he felt afraid of her consciously when he was writing this letter. It is unconscious. He has converted his fear into claims that it is she, and not him, who is destroying America. She's the one who's ruining everything and trying to undo his election. Trump has a deep unconscious fear of Nancy Pelosi.

Donald Trump is a con artist. And one of the things that con artists do is seduce people into believing them. Trump has done this with his followers. Trump fears Nancy Pelosi because he can't seduce her. He's afraid of her because she is not distractible. Pelosi reminds Trump of his father, someone he cannot trick, seduce or bully, a person who is not afraid of him.

In this letter, Trump accuses Pelosi, the Democrats and in general anyone who opposes him of being a traitor, participating in a coup against him, betraying democracy, etc. Is this an example of Trump consciously accusing others of what he knows he is guilty of? Or is this projection, and Trump really believes he is a patriot and a great president?

Again, this is about projection. Is projection something that is conscious or unconscious? It's unconscious. When you accuse a person of something that is really about yourself, you do not realize what you are doing until someone points it out. Projection is an unconscious defense.

The other aspect of Trump's behavior is that with him we are dealing with a person who is mentally decompensating. Trump has a decompensating character structure right now, and it is public and right in front of the world.

Trump is going to a rally on the same night as he is being impeached. This will allow him to re-compensate his mind. He needs other people to help him get back on track and realize what a great person he is.

But the delusional part of what is happening with Donald Trump, as shown in this letter, is that when a person is cornered and very regressed emotionally and mentally they go from projection —which is what we all do to some extent at times — to an unconscious process that includes what we call “delusional projection.”

Delusional projection is something you see in very disturbed people. I only see this behavior in hospitalized patients. Their projections are so out of touch with reality that everybody can see that they are delusional.

 Who is the real audience for the letter? It seems like it's more for Trump’s cult members than the general public.

The audience for that letter is Trump’s followers. The letter is not intended for Nancy Pelosi or the Democrats. In the letter Trump says something to Pelosi like, "No intelligent person will believe what you're saying.”

Trump is really saying that his followers are intelligent, because no intelligent person would ever believe what Pelosi is saying. By implication, no one should believe what Harvard graduates are saying or what public servants who work in the State Department or other parts of the government are saying, because no truly intelligent person should believe them. “You, my base, are intelligent.”

Of course Trump’s base of supporters are not in fact intelligent. In a way, that part of the letter is a brilliant ploy on his part to rally his followers.

What of Trump’s comments in the letter about how much he has endured, and that few people could have done everything that he has done in the fact of such attacks? 

Trump is letting his most loyal followers know how strong and powerful he is. He is trying to inspire them to stand with him and not be cowed or intimidated by these supposed slanderous lies that Pelosi is spreading about their leader.

Trump’s claims about his strength and power are also compensatory for feelings of terrible inadequacy that he has had from the earliest stages of his life. He had problems with reading. He couldn't understand what people were saying when he was in class. He was unable to control his impulses. He was very terrifying to people. Trump is always trying to let people know that he can stand on his own and that he is healthy and strong.

Impeachment is a type of public shaming. But is Donald Trump even capable of feeling shame? 

No, he is not. But Donald Trump is afraid of shame. Trump is terrified of being shamed. He's terrified of being humiliated. The terror that Trump has of being shamed should make all of us nervous.

Donald Trump’s letter to Pelosi reads like it was written by someone who is unhappy and miserable. What is it like to be Donald Trump?

Donald Trump feeds off of anger. Trump’s being angry, feeling wronged and assaulted, and living in a dangerous world gives him energy. Donald Trump is addicted to conflict. Impeachment is the most serious conflict he has ever faced. But Donald Trump is very alive right now. He's going to his rallies, writing these letters. Donald Trump is as alive a person as we can possibly imagine. Donald Trump is addicted to conflict because it gives him life.

Chauncey DeVega is a politics staff writer for Salon. His essays can also be found at Chaunceydevega.com. He also hosts a weekly podcast, The Chauncey DeVega Show. Chauncey can be followed on Twitter and Facebook.