Yale psych prof: If Trump weren't president he would be 'contained and evaluated'

At the center of the chaotic maelstrom that is the Trump presidency is the question of Donald Trump's mental health. His public behavior (and, by most accounts, his private behavior as well) is that of a man who is a compulsive liar and malignant narcissist, is paranoid, lacks in impulse control and lives in an alternate reality of his own creation.

Donald Trump has recently declared a "national emergency" in order to further expand his power and gut American democracy and the Constitution in the service of his radically destructive right-wing agenda. But in reality it is Donald Trump who is the actual national emergency, an obvious threat to this country and the entire world.

Former acting FBI director Andrew McCabe recently revealed that officials in the Justice Department discussed invoking the 25th Amendment to remove President Trump from power. Yet it also may be true that Trump's apparent mental health problems are actually helping him to remain in power and to control his supporters.

How are mentally unwell leaders more dangerous than leaders who are "merely" criminals? How have the American people become so numb to Trump and the Republican Party's assault on American democracy and the common good? How is dangerous behavior normalized in an unhealthy society -- such as ours? How are Trump and his movement affecting negatively the mental and physical health of the American people?

In an effort to answer these questions I recently spoke with Dr. Bandy Lee. She is a psychiatrist at Yale University and a leading voices among the growing number of mental health and other medical professionals who have been trying to raise public awareness about Donald Trump's mental health. Lee was lead editor of the bestselling book "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President."

This conversation has been edited for clarity and length. You can hear the entire conversation on my podcast.

What is happening with Donald Trump is what me and my colleagues predicted several years ago. Nothing is a surprise, but of course, the urgent situation continues because no one is doing anything about it. This is what is putting so many people on edge in the United States and around the world.

How is Donald Trump's mental health central to the destruction, cruelty and chaos he engages in?

When a person's mind is pathological we know that it is going to create a lot of chaos and danger. That's precisely what Trump's pathology has done. When I or other mental health professionals say that we need to stop him, it is not stopping the person Donald Trump per se, it is actually freeing Donald Trump from the pathology that gets him, and the country, in trouble.

Have the American people become habituated to this crisis? With any other president and given the many dangerous things this man has done, he would be removed from office and there would be mass protests. Somehow Trump hangs on and he's still remarkably popular.

Allowing a mentally impaired president to remain in power is much more dangerous, as compared to having a president who is just a likely criminal. Studies have shown that delusional leaders are more effective at beguiling others and then getting them to agree with them and go along with their plans and goals than a leader who is just or merely a criminal.

That is highly counterintuitive. Why is a mentally unwell person with power more dangerous than someone who does not possess such attributes?

The common idea is that when someone is mentally impaired that they are somehow disabled. But that is not always the case. When a person is cognitively disabled it may empower some of the more primitive emotional forces to take over. Those primitive forces can be far more powerful than any rational decision-making.

From the "MAGAbomber" to the Pittsburgh synagogue mass murder to more minor acts such as the attack on a journalist at Trump's rally in Texas recently, it would seem that the American people have lost the capacity to remember. This is a state of  "organized forgetting" where one heretofore unacceptable action is forgotten very quickly because another one soon takes its place. How is this happening?

Human beings are malleable creatures. We adjust to many different kinds and levels of pathology. Why? We actually live in a pretty violent world. As such we are very adaptable. This is how a society can have immense amounts of pathology and many different kinds of atrocities can occur -- and yet the population adjusts. As a person or society falls into a more pathological state, an individual or populace starts to actually feel that things are not that wrong. Our ability to recognize that something is a problem starts to diminish, as a person or society falls ever more deeply into the pathology and collective sickness.

What is this stress doing to the American people?

Research shows that stress levels are the highest in our memory -- actually higher than any time since World War I. If you think of all the crises that have happened in that time period, we are actually in a worse state. We know that anxiety levels are 70 percent higher than two years ago. This is according to research from the American Psychological Association and American Psychiatric Association. We know that public mental health is deteriorating. This is shown by the drastically increasing murder rate and epidemics of suicides that the United States is experiencing now. Unfortunately a population becomes habituated to such things. We become more numb to the stress levels. People become jumpier and more anxious and looking for comfort.

The more the population is suffering, for example, the more vulnerable they will be to the false beliefs that Mr. Trump propagates, and be more convinced they are true. The rest of the population then becomes exhausted from having to deal with those people and catching up with Trump's lies and untruths.

The public is also less likely to be worked up about something that would have outraged them in the past. Trump's supporters are simultaneously becoming more and more entrenched. They believe Trump. Trump has conditioned his public to believe him and nothing else -- not even their own eyes and ears. Trump's supporters were already vulnerable to begin with. Their sense of individuality and becoming fully human emotionally and intellectually has not been allowed, because of some set of adverse circumstances.

This is when someone like Donald Trump has a great advantage because he can tell people what they want to think and believe. They will believe Donald Trump not because what he says rings  true to them but because they need to believe in and depend on someone. Trump's supporters need to be able to trust in someone who is bigger, stronger and more capable than they are. Here is the problem: Who would proclaim such things? Only people who are looking to manipulate and deceive. There is a pathological symbiosis between Donald Trump and his supporters.

Consider Trump's "national emergency," which is of course based on a lie. This outcome was a fait accompli. Because of Trump's malignant narcissism and his other apparent mental health issues he could not resist declaring a "national emergency." The grandeur and attention are too attractive to him and his ego to say no.

I think you are being very astute. I think at this point his pathology is so obvious to those who can see what is actually occurring in America that one does not need to have a degree in psychology to be able to tell what Donald Trump will do next.

Trump is under a lot of stress and he needs to project himself as strong and decisive. Trump wants to make full use of his executive power, and he'll continue to push the limits. Remember that he has had two years with absolutely no checks and balances. He is now used to exercising power and not having any limits placed on him. To have limits now placed on him now is extremely frustrating for him.

This is why someone with Donald Trump's mental impairments possessing so much power is  such a dangerous state of affairs for the United States and the world. Trump is going to abuse his powers even more than he has already. There will be no limit on what Trump is willing to do in terms of abusing his power as president.

Is there any internal governor that tells Donald Trump, "No, do not do this, this is a bad idea"?

That is what he is lacking. Donald Trump does not have internal boundaries or the ability to engage in limit setting. This is why with individuals such as Donald Trump the first step in treatment is to set limits and contain the person, because they're incapable of containing themselves. As much as people with such a condition are going to resist and complain, they actually feel more reassured when limits are placed on them. Why? Because of their internal feeling of chaos, having no boundaries and feeling so out of control. What has taken place so far during the whole of Trump's presidency is the opposite of what we need to do for correct treatment.

Donald Trump needs to have limits set on him, be urgently evaluated, have access to weapons taken away. Then we need to figure out the least restrictive means of containing him. The containment has to come from the outside. Giving a sick person such as Trump what they want and what they're demanding is exactly the wrong thing to do, for both the sake of the person as well as society.

You have had White House insiders reach out to you privately for advice about Donald Trump's mental health and their fears about what he might do. Now Andrew McCabe has confirmed that there have been serious conversations about invoking the 25th Amendment to the Constitution to remove Trump from office. What were you thinking when this information was made public last week?

I recently came back from a national symposium on the 25th Amendment. The original author of the 25th Amendment was there as well. There are currently some conundrums with the 25th Amendment, because the procedure was created so that it would not be invoked frivolously. But the problem with the 25th Amendment is that the most incapable presidents would not appear so obviously disabled. Cognitive impairments such as paranoia or delusion are far more dangerous than negative impairments, for example, someone who is unconscious or withdrawn. But cognitive impairments are more likely to appear as an actual political choice even as they cause more damage to the country and world.

I think there needs to be an equal dialogue between medical professionals, legal professionals and political leaders about the 25th Amendment and when it should be invoked.

If there were public hearings about Donald Trump's mental health and fitness for office, what evidence would be presented in favor of removing him?

A great amount of evidence has already been revealed. Donald Trump does not seem to be able to take in advice or important information. He has shown an inability to process that information and apply it to the world as it actually exists. Trump has not shown an ability to think about consequences before he makes rational, reality-based decisions that are not unduly influenced by impulse or his emotional needs.

These are just some of the basic requirements for having proper mental capacity and Trump has not shown them. Some of the most important aspects of mental capacity seem to be absent in him. A standardized procedure to test Trump's mental capacity and health, one that is done in person, is currently advisable. We could then quantify the level to which Donald Trump is mentally incapable. There are standardized procedures for assessing mental health which are performed every day, and in every community in this country.

Given both Trump's public behavior as well as other information about his private behavior that has now come to light, if he were a private citizen how would this situation be handled differently?

If Donald Trump were anyone other than the president of the United States, he would already be contained and evaluated. We actually have all the information to make that determination, because when a mental health professional is assessing dangerousness they do not depend upon a personal interview because such tests are unreliable. The person being assessed  is likely to hide the very things that the mental health professional is trying to find out.

The way you assess dangerousness in real life is by consulting the people who are around a person and who have had close contact with him or her. There are now plenty of reports from those who have worked in the White House and who have had contact with Donald Trump which suggest that something is wrong with him.

We also know the result of Donald Trump being president is that he has actually been dangerous. Hate crimes have escalated. Trump has also dramatically escalated the rates of violence in America. There was the Trump MAGAbomber, the lethal attack on journalists in [Annapolis, Maryland,] and the anti-Semitic attack at the synagogue. All these are traceable to either the ideas or the stances that Mr. Trump has made. Moreover, ABC News has reported that there are at least 17 court cases where the defense has actually cited Mr. Trump as the cause of the defendant acting in violent and assaultive ways. We know that Donald Trump is dangerous. Empirical data shows this. It is no longer in question.

All of the violence, including the geopolitical instability that exists right now, was very much inevitable. Those mental health professionals who have been sounding the alarm about what Trump would mean for the country and the world could have told you on day one -- or before -- of Trump's presidency that this was all going to happen. Everything that we argued and demonstrated in our book "The Dangerous Case of Donald Trump" has borne out to be true. I am telling the world right now that a lot worse is going to happen if Donald Trump is not contained.

In terms of Trump's "national emergency," how much worse are matters going to become? What would you warn the American people to be prepared for?

I think what we need to be most afraid of is the inability of so many people to see Donald Trump and what he has done and is doing as a problem anymore. We're already immensely habituated. Trump pulled out of the nuclear arms agreement with Russia and we're so busy attending to the next emergency that we have forgotten about it. A fuse has been lit for nuclear catastrophe. We as a country cannot continue to push our luck. The way Trump's psychology works is that he is very attracted to nuclear weapons and nuclear war. Trump will play all his cards and go all the way to show how strong and invincible he is. The more Trump is shamed or humiliated the more he will go in that direction. This is why this moment is so dangerous with Donald Trump.

As the Mueller investigation is drawing to a close and the Democratic Party is exercising its oversight, and he's losing his supporters, the dangers of a nuclear war or some other kind of devastating war are going to accelerate. Trump is declaring a fake national emergency in order to create more emergencies and crises. A rational person can be defeated through logic. Trump is pathological. He simply overwhelms rational people. That is how he overcomes them.

The end of the world, the end of humankind, none of that will matter with a person like Donald Trump when his sense of self is imperiled.

Is there any way to reach Donald Trump's supporters to convince them of the danger in which he has put this country and the world? Is that wasted energy? Can Trump's supporters ever be reached by appeals to reason or fact?

I think that Trump supporters are reachable. In fact, I think very few of them are totally unreachable. However the way to reach them is not with facts. It is not with the truth. It is not through showing them that they are wrong. I have actually communicated with a number of Trump supporters. They would write me at first, angry at me for what I've been saying about Donald Trump. But once you develop a personal relationship with them, a very human relationship, and they recognize that you are genuine and that you care, that is what really matters. Although I cannot really convert Trump's supporters from their beliefs, they come close to questioning their initial positions. I would say that human connection is the most powerful way to reach Trump's supporters. They are so hungry for that kind of caring and attention.

There are many social problems in America, such as income and wealth inequality. Unfortunately the country's leaders and many of its voters have been doing the opposite of what is needed to heal the society. America has been growing sicker and sicker. This is why so many of America's citizens and voters were attracted to an impaired leader like Donald Trump in the first place. The way that we heal society and prevent another Donald Trump from rising to power is to improve the many social inequalities in the United States.