'He's a maniac': Psychiatrist catalogs the red flags in Trump's behavior

U.S. President Donald Trump reacts as he welcomes Israeli Prime Minister Benjamin Netanyahu (not pictured) at the White House in Washington, D.C., U.S., September 29, 2025.

Back in May, a group of 36 health professionals wrote an open letter to Congress warning that President Donald Trump is in a state of cognitive decline. Even though the medical and political communities were willing to call out President Joe Biden's apparent decline during the 2024 election, Trump has received an inexplicable and inexcusable pass for his own obvious infirmities. Individuals are willing to sound the alarm, of course, but nothing has occurred on a systematic level to alert the American people to the fact that their president is psychologically unwell.

Below is AlterNet's exclusive interview with psychiatrist Dr. Henry Abraham, formerly of Tufts University, who said that Trump is literally a "maniac" because he displays manic traits like posting on social media late into the night. He also broke down Trump's tendency to ramble, his grandiosity and his obsession with his predecessor, President Barack Obama.

This interview has been lightly edited for clarity, context and length.

Proof that Trump is in decline.

ROZSA: Can you describe, as a clinician, the symptoms you've observed of Trump experiencing seeming decline?

ABRAHAM: Oh, sure. There's a bunch off the top of my head. I'm sure I can do it.

Let me start off: The real question here is, what is baseline and what is decline? Those kinds of questions, of course, are very difficult to pin down. But having observed him for a long time, and also talking to people who have also observed him professionally in the same room with him, which I've done, I can come up with a certain number — 10 or 11 — psychiatric symptoms that are, for me, red flags. And you don't have to be a rocket scientist to recognize a red flag.

I like to use the metaphor here of a man in a supermarket. He's getting in line in a supermarket, and he has a basket full of food, and he smashes it into the woman in front of him, because she has more food than he does and it's going to take a long time and he's in a rush — and what's she doing buying so much food, and get out of the way, and she's a terrible person, and I'm really in a rush and I'm far more important than she is. And he pushes it, and he really shoves her with the shopping cart. Now, if you saw that, you would say — well, you'd probably call the police, because it's really a bizarre kind of thing. But that's the whole point. It's a bizarre kind of thing. It's crazy. It's a red flag.

Now, those kinds of red flags are obvious to you because you're in the supermarket and people usually don't behave that way. And to a clinician, it's obviously a red flag. In fact, we can begin to think about various psychiatric disorders which might explain that behavior. And that's the interesting challenge here, because we really can't make a diagnosis without looking at all the facts and, of course, having the patient in some form cooperate with the examination. So we can't come away with a diagnosis, but we can come away with, "Geez, this is a symptom which is a red flag to us, and we should pursue it and we should note it and we should not forget about it."

And that's the situation that nearly all of us in the medical profession are in with respect to Donald Trump. We see red flags, we know what causes those red flags, but we don't know the specific proximate cause of the red flag. So that's the preamble.

The red flags that really jump out at me — there are a bunch. First and foremost is he falls asleep at really inopportune times. He seems to be doing it virtually every day. And yet he's up all night in a very disordered frame of mind. So how do you explain those kinds of things? Well, there are any number of explanations. We don't really have good explanations, but we do know they're red flags.

No one stays up half the night tweeting 50 or 75 or 150 times and has a normal mental status examination. If a patient comes in to me and says, "Oh, I've been up all night and I've tweeted a hundred times," I would say, "Oh, okay, that's a red flag. That's a manic behavior." There are many causes of manic behavior, and nearly all of them are treatable with proper treatment. But also manic behavior is invariably self-defeating and in many situations absolutely dangerous. So that's the first red flag: This guy is up all night, he's manic, and he's out of gas during the day and he falls asleep.

And what is the explanation for that? Well, there are a number of explanations. He could be hyped up on stimulant drugs at night. He might have a sleep disorder which prevents him from sleeping when he's pacing the halls with his laptop and says, "Oh, I can't stop thinking about Letitia James."

But actually that merges into another red flag. It's not simply that he can't sleep, or that he's awake or supercharged by some medical explanation like stimulant drugs or coffee or too much Diet Coke — I mean, any number of explanations here. But he's pathologically hyped up and manic. In fact, the noun for this is maniac. He's a maniac at night, but he's not a maniac during the day, generally. So it's a nocturnal form of mania which remains to be explained.

Let's move on, because a lot of this stuff is at night. Another red flag is his inability to control his rage. And this is pretty dangerous stuff. If he's alone at night and he's in one of these rageful states — well, he has sole access to nuclear weapons. He could, on his own, launch a nuclear attack against whatever enemy he chooses, and he has a few, but Iran comes to mind, since he's started a war with Iran. That's a very dangerous thing. In fact, that's probably the most dangerous. That probably goes at the top of my list of abnormalities of mental function which threaten literally hundreds of millions of people.

That was just number one.

ROZSA: That's number one?

ABRAHAM: That's number one. So mania, plus rage, plus access to nuclear weapons is not a healthy combination.

Other aspects that worry me, besides those worries, are that periodically he seems to be disoriented. He doesn't know where to walk. He needs to be literally led by the arm by world leaders, who have to treat him like the demented grandfather that he probably is. I mean, dementia per se has many different causes. You can say, "Oh, he has Alzheimer's disease" — probably not; at least he doesn't have a flagrant, advanced and undeniable Alzheimer's disease. If we saw his MRI, we'd say, "Oh, well, he has cortical atrophy," or he has various other radiologic evidence that he has developing dementia with organic features that actually are visible. That would be confirmatory. But we don't have that.

We also don't have the actual results of his mental state screens, the so-called MoCA examinations — the Montreal Cognitive Assessment test. It's a test which is administered in 10 minutes, and anyone can be trained to give it, and it doesn't require great expertise to give or to add up the score. It takes some skill to understand what you're looking at. Ordinarily, the MoCA is a test that we give just once — this person is coming in, how are things going? We don't do serial MoCAs, usually. If we have a need to follow someone's mental status, we don't necessarily just use a MoCA, any more than if someone came in and took their temperature and we said, "Oh, you have a fever" — we're not going to take the temperature every day. We're going to find out what the cause of the fever is.

If we're doing it on a regular basis, like once a year, well, that's a routine physical exam. If we're doing it every three months, we're looking for fever. And the same thing is true with the MoCA. If we're repeating the MoCA frequently — which we've done, I think, now four times since he's been in public office — we're obviously tracking a number. And that number could be mild cognitive impairment. It could be a significant cognitive impairment in someone who has a dementia, which is my greatest worry here.

And you can have a guy who puts a proposal together for a press conference, or reads a teleprompter and delivers a speech. But then, in the middle or at the end of his reading of the teleprompter, he has an aside or a discursive kind of discussion, and he's talking about things that just literally don't track with what he's supposed to be talking about. He's off in outer space. Or he's not in outer space, he's just in the wrong space. He's talking about Tesla, or electric vehicles, and then he's talking about electric boats, and he's talking about falling in the water, and he's talking about being attacked by sharks or maybe he'll die from electrocution — which would he prefer? And what was the topic again?

This is another red flag, and this is called tangentiality. He's tangential. He's not always tangential, but he's tangential enough to say he's tangential. He has a symptom. It's a red flag. Someone is tangential and comes into the office and exhibits that, you write it down. You don't ignore it. And you see it fits with other aspects of mental illness.

And so there he is in a press conference, and he's annoyed by someone who's questioning him, and he says, "Quiet, piggy." Now, that's really interesting. I mean, besides being offensive — we all know it's offensive — to a clinician, it's interesting, because this is someone who is in the middle of a professional kind of exchange, and he has his feelings about it, and that's fair. But he can't stop himself from the thought that pops into his head. He can't control it. In fact, he can't inhibit — the inhibitory circuits that we all walk around with, so we don't walk around telling fat people "Quiet, piggy," they're broken down.

He has another red flag here, and that red flag is disinhibition. He can't hold himself back from what he thinks is either mirthful or hurtful, or in some way it expresses a deep-seated emotion which he doesn't understand is not a socially acceptable way to engage people. It's not that he necessarily has to be like some spook from the State Department who never says anything ever until they retire. We're not talking about that. We're talking about ordinary conversation, where he loses control of an emotion that he's having.

The other day, when he was in the Oval Office — it was a home game — he was receiving the astronauts from the Artemis expedition. They were standing there, and the head of NASA was there; he was proud of his guys. And Trump was not, as far as I could tell, using a teleprompter. He was being cordial, and he was in a good mood. They're his guys. And they'd just come back from the moon, and it was a feather in everyone's cap. He was very proud. He was very pleased with what was going on. And he was doing a good job. He was being Mr. President, and he was being congratulatory, and he even was a little patronizing to one of the members of the press, when he admitted he hadn't read a certain document — which he certainly did. And I certainly knew about it, because it was a terribly important decision by the Supreme Court which had come down. And: "I don't know about it; maybe you can explain it to me." That was a little patronizing, but okay, big deal.

So he goes through the press conference and he's doing a great job. And then all of a sudden, he starts talking about the ears of the head of NASA. He says, "Oh yes, look at those ears, they're really big ears, you know?" He does have big ears, that's true. But who says such a thing? He can't keep himself from that loss of control. He can't do what other people do in ordinary circumstances.And so that's a red flag. That's disinhibition. He can't control his impulses. Pretty soon we can put it together: He's tangential, he has rage attacks, he can't control his emotions, and he has his finger on the button. These things begin to snowball in a way that's quite worrisome.

Other red flags:

ABRAHAM: One of his other red flags is that he is grandiose. Now, he's always been grandiose. And so one of the questions that I asked my friend who has been following him for some time as a journalist, a member of the White House press corps — I asked this person, who will remain anonymous: "I'm going to give you a dozen or so symptoms, and I'd like you to go through them all and tell me if any of them are the same or have gotten better or have gotten worse in the last year." And the report that I got from the person who sees him every day is that half of them have definitely gotten worse, and they're the ones that I am most interested in tracking.

One of them that has gotten particularly worse is grandiosity. He always had a grandiose side to him. He always exaggerated his sexual prowess, or talked about how intelligent he was, and he's always the smartest person in the room, and all this kind of stuff — which has very interesting psychological roots to it, which we speculate about. But regardless of the speculation — set speculation aside and see what's in front of us. And what's in front of us is the guy who dresses himself up like the Pope.

He can say, "Well, I'm just joking." I don't think so, because in another image of himself that he put on Truth Social, he was healing the sick, like Christ. And a third, which is my favorite of this whole bunch that he's put out, is Donald Trump shaking hands with God. Now, if I were to make this up, you'd say, "Well, this crazy idea — he couldn't sell this idea as a piece of fiction to my agent." That would not be a sellable concept. But it's real. He actually did this. He shook hands with God. He photographed himself shaking hands with God, and he posted it to his millions of followers.

Well, okay, what does this say? One of my colleagues, a Catholic, saw the image of him as Pope, and he was incensed by it, of course. He said, "This is blasphemous." He's not a psychiatrist, by the way. And I said to myself: blasphemy, yes, but psychopathology, yes, squared. This is more than blasphemy. This is a meaningful clinical presentation of a symptom, a red flag that we need to pay attention to. And so my friend in the press corps said to me, "The grandiosity has definitely gotten worse in the last year."

Okay, let's go back to the drawing board. Your question was, are there signs that this person is mentally deteriorating? Well, we know that the grandiosity is a pathological symptom, and now we have a report by someone who sees him every day that yes, it's gotten worse. So we tick that box in terms of progressive mental illness, and then we try to fit it in as a piece of the puzzle with other pieces of the puzzle. So he's disinhibited, he has rage, he's sometimes disoriented, so he has trouble getting around.

There are other pieces of the story. One of them is that sometimes he just doesn't make sense. It's not like he's following a tangent and going off in outer space; he's just speaking incoherently. He seems to be trying to make a point, but the points come in fragments, and you say, "Oh, this is a guy who's not able to speak logically." That's a red flag. So we put that down on the list of things, and his illogicality has been increasing as well.

So we have disinhibition, we have poor logic, we have tangential speech, we have disorientation. Now, let's talk about the 2020 election. If someone comes in and complains of a belief that they have, that they've had for a while, that doesn't change — it's fixed — and, most importantly, it's false, it's disproven by overwhelming and contradictory evidence, you have to say, at the very least, this is a fixed idea, as we say in the trade. But more likely than not, it's a delusion. And so if he truly believes that he won the 2020 election, despite overwhelming contradictory evidence, he's deluded. This may be dementia, but it can also be consistent with psychosis. So this is a big, big red flag.

Now, you could argue that, well, maybe this is an enduring political lie, the kinds of lies that most of the world's dictators and despots have told in order to build their base of power. And it's a possibility; it's consistent. But there's no evidence that he comes off the podium and says, on a hot mic, or to one of his staffers and someone else overhears, "Well, I really put one over there. I know I lost the 2020 vote." No, he doesn't say that at all.

If we take him at his word and he believes he won the election, he's deluded, and that's not a good sign. And there are many other things that he says: COVID will be gone in a week. If you just treated it with sunlight, that'll be the best treatment. There are other kinds of things which he seems to believe, but they don't necessarily rise to the occasion of anything that has the delusional power that the belief about that 2020 election does.

So his grip on reality either is stock in trade, or he's putting one over on everyone, or he's putting one over on himself, and that's the scariest possible explanation.

So what else about this guy is interesting to me? His memory is not good. He doesn't hang on to words and language the way he used to. There are people who have studied his language 40 years ago. His command of the language has become less competent over time. There was a very nice clip of speech of his, several decades old, where he could insert a dependent clause in the middle of a paragraph that he was speaking and then come back to the independent clause in a really expeditious way. He doesn't do that anymore. If he comes up with a dependent clause, he's lost. And this is not a good sign. It also is a benchmark of a deterioration in cognitive function.

Let me say that there are any number of medical explanations for the signs and symptoms of his deterioration. We don't know what they are. They could be as benign as simple aging, or they could be as serious as untreated neurosyphilis. We don't know the answer to those questions because of a lack of transparency by his caregivers. And I think that is a huge problem for the governance of the country.

Trump is intimidated by Obama.

ROZSA: When I interviewed Governor Chris Christie in 2019, he told me about Trump, "Every negotiation can't be a test of manhood. Every negotiation can't be a beat-down." Do you have a sense of why Trump treats every negotiation like a test of manhood and like a beat-down?

ABRAHAM: Well, actually, I have a slightly different take on that. I believe that much of what he's been doing as president is tearing down the legacy of Barack Obama. And I think the heart of that is because Trump is many things, but one of the things is he's a racist. And I think he has such a terrible problem with low self-esteem. He's always been the dumbest kid in the class. He's been told he's been dumb his whole life. And he's been told he's been a jerk his whole life. So what do you do when you're confronted with that kind of self-concept? Well, one very primitive way is to turn it upside down and say, "I'm not the dumbest person, because I'm the smartest. I know more about COVID than anyone. I know more about nuclear weapons than anyone. I'm a perfectly stable genius." What he's really saying is he feels the complete opposite. And we see the complete opposite, and that seems to be the problem.

But the thing with Obama — I really believe that that's the case. I think in his heart of hearts, he says, "I can't let a Black man actually do better in his job than I'm doing. And so anything that he's accomplished, I'm going to destroy one way or another." And he has been doing that, literally.

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