Bandy X. Lee

Psychiatrist details the evidence of Trump's mental health crisis and says he must be ousted now

Since March 2020, our body of mental health experts, the World Mental Health Coalition, has urgently recommended that Donald Trump be removed from the presidency, whether via the 25th Amendment, impeachment, resignation, or an involuntary psychiatric hold. Following his incitement of violent insurrection where five people were killed and a massacre of lawmakers was attempted, we have issued a call for his removal from the presidency for medical reasons.

While a second impeachment is a step in the right direction, without actual conviction and removal, the public remains vulnerable. As president, Donald Trump officially controls access to weapons capable of destroying civilization.

As independent mental health professionals with detailed knowledge of the president's condition, we have urged a reopening of the possibility of Section 4 of the 25th Amendment, or any other means of removal of presidential powers, including a psychiatric evaluation for immediate safety measures.

There is abounding evidence of Donald Trump's severe mental impairments, and the following can serve as medical data of a dangerous mindset that is important for consideration, be it for the 25th Amendment, the senate trial, or informed, critical behavioral management in the coming days.

Previously, we analyzed his lengthy phone call with Georgia's secretary of state, Brad Raffensperger. Similarly, his speech at the "Save America" rally before the Capitol offers shocking proof of his dangerous mindset. In the speech, Donald Trump shows signs of delusions, paranoia, grandiosity, pathological narcissism, and other serious symptoms.

Delusions are fixed false beliefs that are not amenable to facts or reason, and when rigid, can evoke a violent response to challenges. For example, no amount of proof, failed lawsuits, and ratification of election results would change Donald Trump's mind about the election being stolen: "All of us here today do not want to see our election victory stolen by emboldened radical left Democrats, which is what they're doing…. We will never give up. We will never concede." Delusions, or beliefs their purveyor is truly convinced of, are more effective than strategic lies in spreading across populations through emotional bonds.

His grandiosity entitles him "to try and give our Republicans, the weak ones … the kind of pride and boldness that they need to take back our country….. So let's walk down Pennsylvania Avenue." As president, he does not have to give explicit orders to orchestrate his followers in an attack: "You have to show strength, and you have to be strong," while enumerating his targets, suffices.

Donald Trump also gives ultimatums: "Our country has had enough. We will not take it anymore…. we will stop the steal." Only a reality that comports with his disordered, wishful thinking is possible to him, regardless of evidence, and he specifies his target: "The States got defrauded…. All Vice President Pence has to do is send it back to the States to recertify, and we become president, and you are the happiest people." In response, his followers went as far as to mount a noose and gallows.

He displays delusions of grandeur, stating that his and his followers' mission is "to save our democracy." Only he should be in the position of president, and if his audience fails, they will see the nation's destruction: "We want to get this right, because we're going to have somebody in there that should not be in there and our country will be destroyed."

Donald Trump claims they "built the greatest political movement in the history of our country…. There's never been a movement like that." He instructs his followers not to lose it: "Don't let them talk, 'Okay, well we promise,' I've had a lot of people, 'Sir, you're at 96% for four years.' I said, 'I'm not interested right now. I'm interested in right there.'"

Donald Trump's paranoia, or perceiving threat where it does not exist, is another risk factor for violence. Donald Trump repeatedly imposes his paranoid world view whereby they are the ones under "siege", in order to promote himself as the only one who can save them: "We've done things like nobody's ever thought possible. And that's part of the reason that many people don't like us, because we've done too much, but we've done it quickly…. And now we're out here fighting."

Perpetrators of abuse commonly cut their victims off from other sources of information, which Donald Trump does by demonizing legitimate media, which he calls, "fake news": "It's all part of the suppression effort…. The American people do not believe the corrupt fake news anymore, [or] the people who want to deceive you and demoralize you and control you, big tech, media."

Donald Trump has a history of recklessness, impulsivity, lack of empathy, a loose grip on reality, and intolerance of challenges to his fragile sense of self. His defeat as president of the United States has plunged him into a violent, psychotic spiral, and he is now fighting for his psychic survival. This has now escalated to inciting his followers to commit acts of violence against elected officials and the general public.

The mental health emergency that Donald Trump poses to the nation has been the defining characteristic of this presidency. We must not make the mistake again of overlooking psychological factors. Donald Trump continues to be a danger to himself and others, and correct management in the coming days and weeks will be critical to containing his ability to mount further violent upheavals, as well as to keeping our nation safe.

Bandy X. Lee, MD, MDiv, is president of the World Mental Health Coalition (worldmhc.org). She can be followed at her web site (bandylee.com) or on Twitter (@BandyXLee1).

Mental health experts say hour-long 'irrational, unstable' Trump call is better than a psychiatric examination

Donald Trump's behavior is imminently dangerous to the health and safety of all Americans and to democracy. Despite losing the 2020 election, he has been fighting relentlessly to stay in power.

He has called for a protest in DC on Wednesday (Jan. 6), promising it will be "wild", to which the misogynist and violent "Proud Boys" responded. His conspiracy-mongering has enlisted 140 Republican representatives to plot to overturn the election by getting Congress to contest the validity of votes that are unfavorable to him, while Sen.Ted Cruz (R-Texas) has recruited at least 11 other senators to delay election ratification by 10 days, opening room for further disruption and upheaval.

Meanwhile, there have been warnings that Trump could invoke the Insurrection Act at any sign of discord in the streets, or begin a war with Iran to interrupt the inauguration.

On Sunday, the Washington Post released a recording of Trump's hour-long call to Brad Raffensperger, Georgia's secretary of state overseeing elections, first to berate, bully, and beg him into changing the vote totals, and then to threaten him when he refused. The full recording reveals the president to be highly irrational and unstable, confirming better than any interview our previous assessment of lack of capacity for rational decision-making, but above all showing the president to be highly symptomatic and dangerous. Here are some of our alarming findings.

A person who cannot tolerate certain realities may use various conscious and unconscious methods of minimizing those disturbing feelings by trying to change reality in their minds. At the extreme end of this continuum, emotionally fragile persons can rely on delusions, or false beliefs that are rigidly fixed in order to support a vitally-needed belief, such as in their superior value. Not only are these beliefs unamenable to facts and evidence, but they may bring a need to control what other people believe and say in order to ensure that the unbearable reality does not upset them. Here are some examples:

    • "I think it's pretty clear that we won. We won very substantially in Georgia."
    • "We have many, many times the number of votes necessary to win the state. And we won the state, and we won it very substantially and easily."
    • "They say it's not possible to have lost Georgia. It's just not possible to have lost Georgia, It's not possible. When I heard it was close, I said there's no way."
    • "We won this election by hundreds of thousands of votes. There's no way I lost Georgia. There's no way. We won by hundreds of thousands of votes…. I won the state by hundreds of thousands of votes."
    • "Your numbers aren't right. They're really wrong, and they're really wrong, Brad…. Look, ultimately, I win, okay? Because you guys are so wrong."

The presence of delusions does not negate criminal intent. Donald Trump appears rather to rely on and maintain them interpersonally, by using denial, dismissal, contempt, ridicule, domination, invalidation, belittling, ignoring, and psychological annihilation to advance his agendas and to control others. His inability to hear anything that threatens his ability to feel good about himself pressures others to comply, and his actual conviction makes his false beliefs more persuasive. Psychic annihilation of others implies that others believe what he believes, and may: tell others what they know or do not know; or entirely discredit and bulldoze over the perceptions of other people as if to implant his reality inside their minds.

    • "They dropped a lot of votes in there late at night. You know that, Brad."
    • "But in Fulton, where they dumped ballots, you will find that you have many that aren't even signed, and you have many that are forgeries. Okay, you know that. You know that. You have no doubt about that."

Donald Trump's emotional vulnerability relentlessly drives him to force external reality to conform to his internal reality—in this case, that he won the state of Georgia and also the election. The need to assert this belief is evident in the phone call to Georgia Secretary of State Brad Raffensperger in several ways: Donald Trump dominates the hour-long conversation, repeatedly asserting on Raffensperger his fixed false belief that he won the election. He tries to annihilate the other person's independent perceptions by assuming a kind of ownership over them. He projects his feelings onto him and fails to differentiate between himself and "the state." Failure of differentiation manifests in ascribing to others one's own thoughts, feelings, or motives, failing to recognize the difference between what he feels and what others feel, conflating his feelings and the needs of "the state," or "the people." This facilitates narcissistic entitlement, which Donald Trump also displays, assuming that he should be able to get whatever he wants if he simply lets it be known and applies the right kind of pressure.

    • "So there were many infractions, and the bottom line is, many, many times the 11,779 margin that they said we lost by—we had vast, I mean the state is in turmoil over this."
    • "We have won this election in Georgia based on all of this. And there's nothing wrong with saying that, Brad. You know, I mean, having the correct—the people of Georgia are angry."
    • "And I hate to imagine what's going to happen on Monday or Tuesday, but it's very scary to people. You know, when the ballots flow in and out of nowhere. It's very scary to people."
    • "I think we should come to a resolution of this before the election. Otherwise, you're going to have people just not voting. They don't want to vote. They hate the state, they hate the governor, and they hate the secretary of state."

Donald Trump also refuses to acknowledge the legitimacy of any statement of fact that threatens his false beliefs. On the one hand, he must dominate in order not to have to hear information that in any way disconfirms the reality he needs to believe. On the other hand, any spreading of hearsay, childlike conclusions, fantasies, cajoling, or attempts to humiliate, intimidate, and threaten are acceptable.

Trump: … why did they put the votes in three times? You know, they put 'em in three times.

Raffensperger: Mr. President, they did not put that. We did an audit of that, we proved conclusively that they were not scanned three times.

Trump: (Changing the subject) Where was everybody else at that late time in the morning?

#

Raffensperger: Mr. President, we'll send you the link from WSB.

Trump: I don't care about the link. I don't need it.

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Trump: Dominion [Voting Systems] is really moving fast to get rid of their, uh, machinery. Do you know anything about that? Because that's illegal, right?

Ryan Germany (lawyer for Raffensperger, on the phone call): No, Dominion has not moved any machinery out of Fulton County.

Trump: But have they moved the inner parts of the machines and replaced them with other parts?

Ryan Germany: No.

Trump: Are you sure, Ryan?

Ryan Germany: I'm sure. I'm sure, Mr. President.

Trump: Have they been shredding ballots?

Ryan Germany: They have not been shredding any ballots.

Trump: It doesn't pass the smell test because we hear they're shredding thousands and thousands of ballots…. I'm just telling you, Ryan. They're shredding ballots.

#

Raffensperger: Mr. President, the problem you have with social media, they—people can say anything.

Trump: Oh, this isn't social media. This is Trump media…. Social media is Big Tech. Big Tech is on your side, you know. I don't even know why you have a side because you should want to have an accurate election.

Raffensperger: We believe that we do have an accurate election.

Trump: No, no, you don't. No, no, you don't. You don't have. Not even close.

#

Trump: We won Georgia easily. We won it by hundreds of thousands of votes.

Ryan Germany: Well, that's not the case, sir. There are things that under law we are not allowed to give out.

Trump: Well, you have to. Well, under law, you're not allowed to give faulty election results, okay? And that's what you've done. This is a faulty election result…. The real truth is, I won by 400,000 votes. At least. That's the real truth.

Incapacity to discharge the duties of office does not equal incapacity to stand trial or exemption from criminal responsibility. Rather, the presence of mental impairment may contribute to how dangerous a person is, and in the context of unfettered authority to launch nuclear weapons at any time for any reason, this is a serious issue.

We as a nation need to ask ourselves: Does it matter if the President of the United States is delusional? Do we care if the poor functioning of a president's mind adversely affects the ability of the people who keep our democratic institutions to function ethically, morally, and in keeping with the Constitution? Should we be concerned about the influence the mental condition of those in power has on the population, and how their decisions affect us?

And what are our limits? How long do we look away from a person who, in every other situation, would be deemed a danger to himself, others, and the public and be evaluated under an involuntary mental health hold—just because he is president? How far do we subordinate our safety, the nation's survival, and the wellbeing of all society to the privilege of one person?

Featured image: CBS News

Madeline Taylor, Ph.D., is a member of the World Mental Health Coalition (worldmhc.org) and a licensed marriage and family therapist residing in Los Angeles. She has a petition for the public, approved by Dr. Lee.

Fascism expert: Donald Trump has turned destructive and vindictive -- like all dictators

I have often dubbed “fascism" mental pathology in politics, and as a fascism scholar and author of the new book, Strongmen: Mussolini to the Present, Prof. Ruth Ben-Ghiat is as psychologically-minded as historians come. The way mental health professionals have brought the context of our experience with patients to understanding the turbulent presidency of Donald Trump, she has brought the context of historical figures. I interviewed her at our recent town hall.

Dr. Ruth Ben-Ghiat is a professor of History and Italian Studies at New York University; a frequent commentator on CNN; an expert on fascism, authoritarian leaders, propaganda, and threats to democracy around the world. She is also a World Mental Health Coalition Board member who has helped guide members in applying our mental health knowledge to the political domain as well as within the currents of history, to achieve our mission of bettering societal mental health.

Lee: Your work and ideas have always impressed me for their psychological sensitivity, and here again you get straight to what many historians or political scientists miss, which are the commonalities, patterns, and personality consistencies across different leaders. How have you come to such psychological awareness in your work?

Ben-Ghiat: I grew up in Pacific Palisades, Calif., which is an idyllic seaside town. It might seem a strange place to start thinking about fascism and pathologies, but it was a place where many anti-Nazis, Thomas Mann and others, came to settle. So I was always aware of this pain of exile, and perhaps being a child of immigrants and the closest family member an eleven-hour plane ride away, perhaps I was interested in what kinds of regimes force people to flee their country. So I started investigating individuals, Otto Klemperer or Schoenberg, who had had to resettle. Then my first book out of my dissertation was on Italian fascist culture, but it was really a study in intellectual and cultural collaboration, how did the regime pressure people, intimidate people to work with them.

There have been studies showing that many Americans ... would like to have the big, strong, statuesque male figure to tell them what to do.

You were among the first to predict that Donald Trump would rule as an authoritarian once he gained power. What were some early red flags for you, and what do his traits say about how dangerous he will likely be in these last 60 days of his presidency? In other words, how does he resemble or differ from authoritarian cult leaders?

In terms of the first question, I was already writing for CNN on war, and so I had that platform—and my second book was just published in 2015, a study of fascist film propaganda. From a slightly different angle, I was thinking about how people are led to believe a fictional reality and the destruction that it causes. So I turned this global lens onto my own country, and when I did that, coupled with my training in fascism, the figure of Donald Trump was very clear to me.

His demonizing the press was a big sign. Because Trump and Berlusconi and Putin have secrets and they are criminals, they have to start demonizing the press very early so that when secrets come out, his followers would already think of the press as partisan hacks. And then the final component was the violence. In the 21st century, we have fewer people with squadrons like the fascists a hundred years ago, and more people like Duterte in the Philippines who says he warned Filipinos not to vote for him, because if he won he said it would be bloody. So here is Donald Trump who comes in and in January 2016 says, “I could shoot someone and not lose any followers." This is very unusual in a context of democracy.

Donald Trump, as he loses power, is about to head toward serious financial and legal problems once he leaves the presidency. What has attracted his followers, despite his pathology, criminality, and incompetence? Astonishingly, he received more votes in 2020 than in 2016. How do we explain the many Americans who continue to follow him and parrot him?

There have been studies showing that many Americans are more authoritarian in their leanings, and they would like to have the big, strong, statuesque male figure to tell them what to do, but that is not the whole story. I have many case studies. It was very illuminating to look back over a hundred years of this and see the patterns. When he acted in this rule-breaking way, because he started inciting violence or because he posed as the truth-teller who was not believed and ostracized by the mainstream media, and only he could tell the truth. So this kind of personality who has a victim cult, who is kept down by the forces that be, who is attractive because he breaks the rules, this over and over has appealed to people. Sadly, this is how they come on the scene, and they end up kind of energizing and legitimizing existing anti-democratic and extremist tendencies. They coalesce and channel all these malcontents and extremists and people who felt the system was broken.

As you have well pointed out, dangerous leaders must maintain themselves in office at all cost. He is currently plunging the nation into tragedy and chaos because of his refusal to concede or to share intelligence and vaccination plans with the incoming administration. What might be our recourse, if any?

I had to turn my book in in the summer and had to write it for either outcome of the election, but his psychology lines up 100% with the other rulers—everyone. The outcome is very different, of course. He is not in a military junta, he is not in a fascist, one-party state. Authoritarianism works differently today, but all of the style of governance they set up makes it more difficult for them to conceptualize leaving. For example, they all create what I call inner sanctums, where you have flatterers and sycophants and family members. They shield the leader from hearing things they just do not want to hear, and then you also have this chaos because he is always trying to find more and more flatterers. Right now, there have been a lot of hiring and firing and moving people right now because he is upping the loyalty quotient, because stealing the election is the biggest game of all. This is also part of the destruction—like Gaddafi would never surrender, so he was willing to drag his country into a civil war. Pinochet in Chile had over a year before he had to leave office, and he spent that year doing as many destructive things as possible to sabotage the new democracy, from stacking the Supreme Court to passing edicts that protected his people and made it harder to find out to prosecute their crimes. So one way or the other, they are always highly destructive to the last and vindictive.

When criminals get into power ... the culture is going to reflect that, and people feel legitimated to threaten and intimidate.

I remember your sharing with me how you were strictly an academic before, and you felt a special civic duty to write and speak publicly since this administration. What in particular called you, and what has the experience been like?

It is just something I felt I had to do. I was in a very privileged position. I am tenured and a full professor. Because plenty of people do not like what you write, and they try and get you fired, they write to your provost, they write to your chair. I think everyone has to do something, but this was what I could do, and I had all this training and a platform with CNN. I would hear from people who had themselves fled dictatorships to come and settle in America, and they said, “I am so glad you are writing, because no one else is getting this." So this feedback from the public really spurred me on and told me that it was helping people. You get a lot of hate mail, you get threats, and I had to move my office to a more secure location in 2017. For a little while I had a guard, but it is just part of living through a culture where the model, the tone is being set by a brutal criminal. When criminals get into power and have been associated with organized crime, the culture is going to reflect that, and people feel legitimated to threaten and intimidate. But I have also been exposed to a whole community of people working to protect our democracy, and that has been absolutely wonderful.

A tribute to Dr. Jerrold M. Post

In Memoriam

A sad day descended for many on November 22, 2020, when we lost a beloved, pioneering psychiatrist, Dr. Jerrold Post, as one of the latest casualties to Covid-19.

Dr. Post was a renowned CIA profiler. I first met him in 2007, when he came to speak at Yale and excited me with the concept of applying psychiatry to help with international relations and, in my mind, world peace.

He, like I, received his M.D. from Yale, completed his post-graduate training at Harvard Medical School, and did a fellowship with the National Institute of Mental Health. He then went on a highly unusual trajectory. He spent 21 years at the CIA to become a pioneer of political psychology and founder of the Center for the Analysis of Personality and Political Behavior. He led an interdisciplinary unit composed of clinical and research psychiatrists, social psychologists, sociologists, anthropologists, and political scientists who looked at foreign leaders in their cultural and political context. They then probed the pathologies and personalities of some of the world's most dangerous minds to gauge to what degree they might play out personal conflicts on an international stage.

He played the lead role in developing "the Camp David profiles" of Menachem Begin and Anwar Sadat for President Jimmy Carter in 1978. Using these assessments, the president was able to ready himself for a groundbreaking summit, for which Carter gratefully acknowledged him on multiple occasions. Dr. Post also profiled Slobodan Milosevic, Kim Jong-Il, Osama bin Laden, and Saddam Hussein.

After he left the CIA, he became director of the Political Psychology Program at George Washington University and continued consulting for the Departments of Defense and Homeland Security. He received the Intelligence Medal of Merit in 1979, the Studies in Intelligence Award in 1980, the Nevitt Sanford Award for Distinguished Professional Contributions to Political Psychology in 2002, and at his 50th graduation anniversary, the Distinguished Alumni Service Award by the Association of Yale Alumni in Medicine.

I only got to know Dr. Post closely but intensely in his last years, and these were years that commanded great bravery, innovation, and integrity in the face of dangerous power. We learned from the 2020 election that no factor was trivial in removing the dangers, and Dr. Post's contribution was considerable.

He called me out of the blue in 2017, after I had held a conference at Yale School of Medicine on whether or not we should speak up about Donald Trump. He, too, was very disturbed about the president's dangerous psychology. His generous concern moved me since, in this country, while the CIA may have done profiles regularly for decades, the same is not permitted for the public (the American Psychiatric Association also made clear with the Trump administration that our own leaders are off-limits, no matter the dangers they pose).

Dr. Post was not the only one among a dozen or so well-positioned psychiatrists including chairs of psychiatry departments to contact me after the conference. But he was the only one to risk his stature to take action and to make a difference. Dr. Post and I became friends, he contributed to the second edition of The Dangerous Case of Donald Trump, and he titled his own book, Dangerous Charisma, to match it. He helped me to organize a major multidisciplinary conference at the National Press Club in 2019, bringing together thirteen leading experts from the fields of psychiatry, law, history, political science, economics, social psychology, journalism, nuclear science, and climate science, who spoke of how the president was unfit from each of their perspectives.

As a member of the former Carter commission on presidential capacity for the 25th Amendment, he gave advice on how to form an independent, peer-reviewed panel to perform fitness tests, which we used to conduct one on Donald Trump, only to discover that he failed every criterion of capacity. Dr. Post helped lead a petition to Congress just three weeks before the Qassim Soleimani assassination, predicting such dangers. He emphasized the need to focus not just on the psychology of the leader but on that of the followers, bringing his prodigious mind to helping us understand the wounds that bind leader and follower "like lock and key." Ultimately, he is my inspiration for writingProfile of a Nation: Trump's Mind, America's Soul.

In brief, Dr. Post was a hero and a gift to humanity, speaking up when it was difficult to do so as a former government official. He has inspired countless psychiatrists like myself and has set the standards for what a responsible professional is to do in a time of crisis. We will never forget his humility and generosity in helping to bring attention to the dangerous psychology of a leader. He was there when his country needed him, and we will miss him.

Experts: There's still time — and reason — to invoke the 25th Amendment

"What is the 25th Amendment for, if not designed for this exact reason?" is a question we have perpetually received regarding the current president. We finally sought to answer it at our Nov. 14 online town hall.

Indeed, since the announcement of election results, Donald Trump has refused to concede, has withheld critical information for the transition team, has fired and replaced top officials responsible for the nation's security, and has contemplated a catastrophic war with Iran. On top of this, he continues to ignore a surging pandemic that is now infecting almost 200,000 and killing 2000 Americans per day and collapsing medical systems he has refused to support.

Every hour of every day that he delays and disrupts a peaceful transfer of power, he is obstructing the critical preparations that are necessary for proper vaccine distribution and is risking a massive loss of lives. Could we have imagined, even a few months ago, keeping in charge a person who would kill a quarter-million Americans, and be poised to kill a half-million very soon? We already dubbed him "killer-in-chief," but the phrase almost fails to do justice to fully describe the magnitude of destruction he is inflicting on the nation and the world medically, politically, and mentally.

Since Donald Trump's election, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone exhibiting dangerous mental impairments.

Yet this is exactly what was predicted. Since Donald Trump's election, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone exhibiting dangerous mental impairments. We held an ethics conference with the most highly respected psychiatrists and then published The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. The latter became an unprecedented bestseller of its kind, and we donated all proceeds from the book to remove conflicts of interest. Unfolding events over the past four years merely played out the multi-dimensional dangers we warned against, with almost impeccable precision.

While it is not our place to opine on whether or not the 25th Amendment should be invoked—this goes beyond our expertise—we as mental health professionals can and should say if a president must be removed for public health and safety reasons, whatever the means. Indeed, thousands of mental health professionals followed suit since the start of this presidency, and more than 800 petitioned Congress about the dangers. Now, 100 senior mental health professionals have gone on video record to declare the current president too psychologically dangerous and mentally unfit to be in the presidency or candidacy for reelection. We recently published more than 300 pages of our letters, petitions, and conference transcripts in an attempt to alert the authorities. We also reconvened top experts in the fields of law, history, political science, economics, journalism, social psychology, climate science, and nuclear science at an emergency interdisciplinary conference. This followed a meeting with the same speakers at the National Press Club in early 2019, to discuss the critical situation of a president's unfitness in our dangerous world, with the full three hours broadcast on C-SPAN. Finally, the continued lack of intervention brought on our town hall on the 25th Amendment.

According to legal scholars, this is the expected approach. Dr. Lee has had exchanges with the author of the 25th Amendment, Attorney and professor John Feerick, at a 50th-Anniversary conference on the Amendment and at student workshops at Fordham University Law School. He discussed that the intention of the Amendment was that "the data would drive the process, and medical professionals are a source of data." Professor John Rogan, his close collaborator on the 25th Amendment, clarified on another occasion: "physicians have a supererogatory obligation to share specialized knowledge. This is especially important when discussing psychiatric conditions, which may be hard to apprehend." The vice president, instead of being the driver of the process, would agree when "leaned upon" by the cabinet or the "other body" that Congress appoints to supplant the cabinet, compelled by the data.

We are in just such a situation where the president's dangerousness yields overwhelming data. These data are consistent with the hundreds of years of scientific evidence and many thousands of hours of clinical experience we collectively brought to our warnings about the current president, in accordance with our "responsibility to society," as outlined in the first paragraph of the preamble of our ethics code. A peer-reviewed panel of independent experts has already performed a standardized assessment of mental capacity, when the right information became available, in which the president failed every criterion. This means he would be unfit for any job, let alone president. Our evaluation fully predicted that he would disastrously mismanage a pandemic, as our blow-by-blow account documents.

A question that came up at our town hall was: "What is wrong with our Constitution?" Why would it fail to protect the nation at the most basic level? Representative and constitutional scholar Jamie Raskin's (D-Md.) lecture (recorded at a previous gathering) to us on the 25th Amendment in 2019 gives an answer: we must make use of the provisions that are available. His lecture is current again with his recent reintroduction of legislation for a commission to oversee presidential capacity, of which physicians and psychiatrists would comprise half. Attorney and professor Richard Painter, former chief White House ethics counsel for the Bush/Cheney Administration and former chair of Citizens for Responsibility and Ethics in Washington (CREW) confirms that the 25th Amendment needs to be used, with an "other body" to replace the cabinet a critical component.

Their legal assertions align with our therapeutic ones. Politicians must do their part, as must mental health professionals. Political bodies should consult with mental health experts, the purpose for which we even set up an independent expert panel, and mental health professionals should continue to inform the public of the dangers, until political bodies can succeed in removing them. The public is a stakeholder, not to mention the president's employer, now at the receiving end of unacceptable levels of abuse and potential, imminent victimization; mental health professionals do not have the luxury merely to stand by. The Declaration of Geneva clarifies that we must prevent harm and injustice, especially when they are arising from a destructive government—and, if not now, when?

James R. Merikangas, M.D., is a forensic neuropsychiatrist, co-founder of the American Neuropsychiatric Association, and former president of the American Academy of Clinical Psychiatrists. His and Dr. Lee's activities can be followed at worldmhc.org.

A psychologist explains how Trump's own words reveal the traits that make him unfit for office

This continues the series, "The Dangerous Case of Donald Trump Revisited: Mental Health Experts on the Devastating Mishandling of a Pandemic." Whereas we could not have predicted a pandemic three-and-a-half years ago, the authors of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President anticipated how the president would respond, should there be a crisis. We tried to warn the public of the very consequences that are unfolding today: abuse of power, incompetence, loss of lives and livelihoods of many Americans, and increasing violence.

Philip Zimbardo, Ph.D., professor emeritus at Stanford University, is a scholar, educator, and researcher. Zimbardo is perhaps best known for his landmark Stanford prison study. Among his more than five hundred publications are the best seller The Lucifer Effect and such notable psychology textbooks as Psychology: Core Concepts, 8th edition, and Psychology and Life, now in its 20th edition. He is founder and president of the Heroic Imagination Project (heroicimagination.org), a worldwide nonprofit teaching people of all ages how to take wise and effective action in challenging situations. He continues to research the effects of time perspectives and time perspective therapy.

Lee: Your lifetime work in social psychology and more recently on time perception have guided me and others for a long time, but especially since the beginning of our publicly speaking up. What are your current observations on Donald Trump?

Zimbardo: Our president has two new distinctions: first the analog of the worst prison guards of the Stanford prison experiment; and secondly, he is the most extreme present hedonist in the universe. Two quotes that exemplify part of my presentation that will follow are, first, Trump's desire for dominance over everyone can be fully realized as his new role as the mean prison guard who rules over all citizens as his imaginary prisoners. And secondly, as an extreme present hedonist, Trump makes important national and international decisions, as we just heard from the previous speaker, without ever thinking about the future consequences. He also becomes addicted to any activity that is novel and readily accessible, notably Trump's Twitter mania.

How have you come to these conclusions?

First, Trump as domineering prison guard. I often analogize between Donald Trump and the worst prison guard in my Stanford prison experiment. That student, who by chance was assigned to play a prison guard, soon internalized that role in the extreme. He reported later that he felt as if he were a puppeteer, and the prisoners, who were other students, were his puppets. That he could make them do anything by pulling their strings. This total dehumanization of others is like a dictatorial mindset that characterizes much of Trump's treatment of everyone, starting with his personal staff, his appointed team, extending to women, American minorities, immigrants, climate scientists, victims of extreme natural disasters, and all political opponents. Power is Trump's aphrodisiac. And then I want to add another of his mindless addictions. Virtually everything he has done publicly since becoming president of the United States is part of his addiction.

Secondly, Trump's previous manifestation of sexual addiction pales in comparison to his recent Twitter over-the-top addiction. In the past three years he has made almost 22,000 "tweets." His "tweets" have been regularly increasing: 6.5 daily in 2017, eight daily in 2018, almost ten daily in 2019, and, so far, more than 34 daily in 2020! As he becomes more manic, his Twitter explosion has been as high as 200 "tweets" on one day and night in June 2020. Some are totally incoherent as if he were publicly revealing he is mentally unraveling. Many of these "tweets" reflect his egocentric megalomania and extreme grandiosity, as Trump is praising himself as brilliant: "I'm a stable genius." Even more self-aggrandizing assertions such as being able to achieve anything he wants to that no other American president in all of history has ever been able to do, and that he deserves the Nobel Peace Prize.

You have described since the beginning what people find to be the most compelling characteristic about him: his present hedonism. Would you explain what that is?

As an extreme present hedonist, Trump lives in the moment without any concern for the validity or prior foundation of any of his assertions. Since becoming president, Donald Trump has made over 20,000 lies, more for misleading claims, many of them repeated hundreds of times, and have been rising exponentially over the years. These conclusions are based on decades of scientific research on the psychology of time perspective. I developed a scale called "the Zimbardo Time Perspective Inventory," and we studied people around the world, and to be a present hedonist means you live in the moment, you seek novelty, you live only for enjoyment, you never think about the future, you never link what you are doing now to its future consequences. My inventory is the most reliable and valid measure of individual differences in time perspective, and many researchers and businesspeople around the world are using it.

Is there anything else you would like to add?

He is also an extreme narcissist. Everything is about I, he, and me. We saw this in the first debate where he was uncontainable. They could not hold him down, he was oozing all over the place! In the second debate where they had a mute, he was contained, but two interesting things. The moderator asked Joe Biden and Donald Trump: "Imagine you are elected as president in the next election, what would your acceptance speech be to the nation?" And Biden said, this means you have to imagine, something that is going to happen next month, and Biden accepted that and simply said, "My fellow Americans, as your president, I will do the following three things." When it was Trump's turn—this is his most fervent desire, to be the president—he could not do that. He could not project himself into that future, and he kept complaining about what he had been talking about earlier, that people do not appreciate what he has done, he is under-appreciated. So, that is one instance.

Recently, he has been going around the nation. He actually loves being up on the stage. He loves these things. Recently, he was going on and on about how washing machines and showers waste water. But not just mentioning it, taking five to ten minutes to this audience, what this was, he was following up on Biden's sense at that, he is not interested in conservations. He is not interested that we have to do to conserve our resources, given the climate change. His inability to project what is needed by America to go from where we are to where we should be, and also what it means to be a present hedonist is, you seek novelty. You are bored by sameness. And he has virtually said this: "The problem with COVID-19 is it keeps coming on, it is on and on. It is boring." Waving his hand, he said: "Let us get past it, let us get by it, let us get on." So, these are the traits that make him totally unfit to be a president, make him unfit to be anything, and continues to be a danger. One thing that can happen is, we vote him out of office.

Read previous interviews with Dr. Robert Jay Lifton, Dr. Judith Herman, Dr. James Gilligan, and Drs. Dee Mosbacher and Nanette Gartrell.

Follow Dr. Lee at bandylee.com.

Experts: 'Rageful' Trump's 'inability to distinguish fact from fiction' make him 'unsuitable to be in command of the nuclear arsenal'

We continue the series, "The Dangerous Case of Donald Trump Revisited: Mental Health Experts on the Devastating Mishandling of a Pandemic." Whereas we could not have predicted a pandemic three-and-a-half years ago, the authors of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President anticipated how the president would respond, should there be a crisis. We tried to warn the public of the very consequences that are unfolding today: abuse of power, incompetence, loss of lives and livelihoods of many Americans, and an existential threat to human civilization itself.

Drs. Nanette Gartrell and Dee Mosbacher were among the first to open a national conversation about this problem, joining Dr. Judith Herman in writing a letter to then-President Barack Obama about the then-president-elect's need for a thorough neuropsychiatric evaluation. The actions they took to make the letter known are how the authors of The Dangerous Case came together, and how thousands of mental health professionals would follow from around the world.

Briefly, Dr. Gartrell is a psychiatrist, researcher, and writer who was formerly on the faculties of Harvard Medical School and the University of California, San Francisco. Her half-century of groundbreaking scientific investigations have contributed greatly to our understanding of sexual minority parent families, and have brought her numerous awards, including a recent Alexandra Symonds Award for her outstanding contributions to the advancement of women.

Dr. Mosbacher is a psychiatrist and Academy Award–nominated documentary filmmaker who was formerly on the faculty of the University of California, San Francisco. As a public-sector psychiatrist, she served as San Mateo County's medical director for mental health and as senior psychiatrist at San Francisco's Progress Foundation. Her films are also contained within the Smithsonian National Museum of American History collection.

Together, they authored the essay, "He's Got the World in His Hands and His Finger on the Trigger" for The Dangerous Case of Donald Trump, outlining how a medical advisory body for the 25th Amendment should form.

Lee: The 25th Amendment to the U.S. Constitution addresses presidential disability and succession, and your recommendations, almost four years ago, for a body to be set up in its context seem remarkably prescient now. The president's recent erratic behavior seems to have driven even Speaker Nancy Pelosi into introducing new legislation. She stated that the legislation would create a "Commission on Presidential Capacity to Discharge the Powers and Duties of Office" that includes outside experts tasked with evaluating his mental and physical health. Would you remind us of the recommendations you yourselves gave?

Gartrell: Under Section 4 of the 25th Amendment to the U.S. Constitution, Congress may constitute an independent, nonpartisan panel of mental health and medical experts to evaluate Donald Trump's capability to fulfill the responsibilities of the presidency. We have recommended that the panel should consist of three neuropsychiatrists (one clinical, one academic, and one military), one clinical psychologist, one neurologist, and two internists. Our model states that the panel should be based on medical criteria, and appointed by an agency such as the nonpartisan, nongovernmental National Academy of Medicine nominating panelists, who may serve six-year terms.

Mosbacher: We stated that Congress should enact legislation to authorize this panel to perform comprehensive mental health and medical evaluations of the president and vice president on an annual basis. Also, the legislation should require the panel to evaluate all future presidential and vice-presidential candidates, and should be empowered to conduct emergency evaluations should there be an acute change in the mental or physical health of the president or vice president.

This is without doubt one of the greatest needs of our time. Yet it appears that the proposed commission will not form before 2024, and it may even die in the process if there is no presidential signature to allow it to become law. This seems a lesson not to wait until matters become very dire. What are your thoughts now?

Mosbacher: Speaker Pelosi stated that the legislation applies to future presidents, but Donald Trump's behavior reminds us of the importance of the president's mental fitness in a nuclear age. We call on our elected officials to heed the warnings of thousands of mental health professionals who have requested an independent, impartial neuropsychiatric evaluation of Donald Trump. The world as we know it could still cease to exist with a 3:00 a.m. nuclear tweet.

Gartrell: Throughout U.S. history, presidents have suffered from serious psychiatric or medical conditions, most of which were unknown to the public. For example, Presidents Pierce and Lincoln had symptoms of depression. Nixon and Johnson, paranoia. Reagan, dementia. And President Wilson experienced a massive stroke that resulted in severely impaired cognitive functioning. Although military personnel who are responsible for relaying nuclear orders must undergo rigorous mental health and medical evaluations that assess psychological, financial, and medical fitness for duty, there is no such requirement for the Commander in Chief.

With Dr. Herman, you—a team of three brave women—became the inspiration for our book, The Dangerous Case of Donald Trump, when you came forth with the first substantial public warning, which was pioneering for our profession. Would you describe what you did to get there?

Gartrell: Over the course of the U.S. 2016 presidential campaign, it became increasingly apparent that Donald Trump's inability or unwillingness to distinguish fact from fiction, wanton disregard for the rule of law, intolerance of perspectives different from his own, rageful responses to criticism, lack of impulse control, and sweeping condemnations of entire populations rendered him temperamentally unsuitable to be in command of the nuclear arsenal. When he became the president-elect, we, as psychiatrists, had grave concerns about his mental stability and fitness for office. In November 2016, we received a call from our psychiatrist friend and colleague Dr. Judith Herman, who shared our concerns about Mr. Trump's grandiose, belligerent, and unpredictable behavior. She proposed that we send a private letter to President Obama outlining our observations, and recommending an impartial psychiatric evaluation of the president-elect.

We agreed that such an assessment was warranted as a matter of national security. Dr. Herman offered to draft the letter. At the end of November, the letter was sent to President Obama, stating that Mr. Trump's "widely reported symptoms of mental instability—including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish fantasy from reality—lead us to question his fitness for the immense responsibilities of the office." We also strongly recommended that the president-elect receive a "full medical and neuropsychiatric evaluation by an impartial team of investigators." We heard nothing from the White House.

Mosbacher: In December 2016, a journalist contacted us, and we decided that we were willing to take the step of sharing our letter, in the interest of placing our recommendation in the public discourse. This led to the letter being published in the Huffington Post and going viral. We declined all requests for further comment, since most journalists wanted us to specify psychiatric diagnoses for the president-elect, even though we had not personally evaluated him. Instead, Gloria Steinem posted the article on her Facebook page, and contacted Dr. Herman to brainstorm about who in the government could implement our recommendation. Robin Morgan suggested that we convey our letter to Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, and reminded us of the series of events that transpired during the final days of the Nixon administration. Because President Nixon was drinking heavily and threatening war, the secretary of defense, James Schlesinger, instructed the military not to act on orders from the White House to deploy nuclear weapons unless authorized by Schlesinger or the secretary of state, Henry Kissinger.

In January 2017, we sent our letter to Chairman Dunford, with the subject line: "An urgent matter of national security." A week later, Dr. Gartrell met a woman who worked in government intelligence. Dr. Gartrell inquired if she would be willing to convey our recommendation to other professionals at the agency. The woman agreed to distribute our letter among key individuals who shared our views about Mr. Trump's mental instability. As Inauguration Day grew closer, Dr. Gartrell, Dr. Mosbacher, Dr. Herman, Gloria Steinem, and Robin Morgan decided to send our letter to members of Congress whom we know personally or to whom we had access. We also agreed to publicize our recommendation whenever there was an opportunity. Our message was that, all in all, Mr. Trump's hostile, impulsive, provocative, suspicious, and erratic conduct poses a grave threat to our national security.

If they had listened to you, we may not be where we are today, the most dangerous point of this presidency. It is frightening to observe his potential for apocalyptic self-destructiveness, as his fragile ego is injured, and he is filled with rage at the prospect of people falling away from him and his power diminishing. Do you have any thoughts on how our profession can help the public meet this moment?

Gartrell: One of the greatest travesties with regard to the mental health emergency that has descended upon our nation is the stifling of expert voices. Mental health professionals can alert to the need for all future presidential and vice-presidential candidates to have fitness-for-duty evaluations before they take office, just as military personnel do.

Mosbacher: When a historic movement of mental health professionals had garnered the attention of the public so as to become the number one topic of national conversation, the American Psychiatric Association extinguished the discussion rather than supported it. When independent professionals and journalists are silenced, it is usually a first sign of tyranny. We must still speak the truth to protect people everywhere.

Read previous interviews with Dr. Robert Jay Lifton, Dr. Judith Herman, and Dr. James Gilligan.

Follow Dr. Lee at bandylee.com.

Violence studies expert: The essence of Trump's dangerousness is the effect he has on his followers

This continues the series, "The Dangerous Case of Donald Trump Revisited: Mental Health Experts on the Devastating Mishandling of a Pandemic." Whereas we could not have predicted a pandemic three-and-a-half years ago, the authors of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President anticipated how the president would respond, should there be a crisis. We tried to warn the public of the very consequences that are unfolding today: abuse of power, incompetence, loss of lives and livelihoods of many Americans, and increasing violence.

James Gilligan, M.D., is an adjunct professor of law at New York University. He is a renowned violence studies expert and author of the influential Violence: Our Deadly Epidemic and Its Causes, as well as Preventing Violence and Why Some Politicians are More Dangerous than Others. He has served as director of mental health services for the Massachusetts prisons and prison mental hospital, president of the International Association for Forensic Psychotherapy, and as a consultant to President Clinton, Tony Blair, Kofi Annan, the World Court, the World Health Organization, and the World Economic Forum.

Lee: Your work with dangerous individuals and on violence prevention has guided us, since the 2017 conference at Yale, with the responsibility we have as professionals to alert and educate about danger, and that it was not about diagnosis, or mental illness. You often emphasize how mental illness does not make a person any more dangerous than the general population, that these are two separate issues. Could you expand on how to think about this?

Gilligan: If somebody starts shooting from an upper floor of a hotel, as happened some time ago in Las Vegas, you know that the guy is dangerous. The first question you ask yourself is not: "Gee, I wonder what his diagnosis is?" That question is simply not relevant. You know he is dangerous, and he needs to be stopped. So you look for the authorities who can stop him.

Something similar is relevant here with respect to Donald Trump. The main issue is not: "Is the president mentally ill?" but "Is he dangerous?" and "Who are the authorities who can bring him under control?" The only authorities who can bring him under control, at the moment, given the irresponsibility of the Republican Senators, seem to be the voters on November 3.

Regardless of what is going on inside his mind, the danger is not the likelihood that he is going to go out on Fifth Avenue and shoot somebody himself, as he mentioned as one example of what he could do without losing any voters. Political leaders do not generally commit acts of violence themselves. I don't know if Hitler ever killed anybody in his lifetime, himself, but whether he did or not, it was his effect on his followers that was the real danger. The same was true with Stalin and every major dictator; it is the followers who commit the bulk of the murders.

Is this also how Donald Trump is dangerous?

Yes. He has repeatedly incited his followers to commit acts of violence. I list seven of them in my chapter in The Dangerous Case of Donald Trump. I will just mention one of them here. He has urged his followers at political rallies to commit violence against people protesting peacefully against him. "You know what they used to do to guys like that when they were in a place like this? They'd be carried out in a stretcher, folks…. knock the crap out of them, will you? Seriously, just knock the hell out of them. I will pay for the legal fees, I promise you." He even complained that his followers were not being violent enough yet, even after they had assaulted protesters severely enough to be arrested and prosecuted for assault and battery. And then when another Trump supporter deliberately ran his truck into a group of pedestrians and killed a woman and severely injured several others, Trump, instead of condemning this, said: "Well, there were good and bad people on both sides," implying a moral equivalency between murder by his followers and non-violent demonstrations by those opposing him.

This danger derives ultimately, of course, from what is happening inside Trump's mind, but I am not going to speculate about what is going on there, as I have never examined him myself. But I do know what he has said publicly, and I will pay attention to that. Of course one could infer some psychiatric conclusions from his endless flood of tweets and public statements, but I don't think that is really what is most relevant here. I think the essence of his dangerousness is the effect he has on his followers, just as the main reason other demagogues were so dangerous and violent was because they could influence others to commit their violence for them. And that has been true throughout history. That is why I regard this as a public health problem. I am not interested in being Trump's individual psychiatrist, nor do I need to be in order to recognize how dangerous he is.

What is the difference between clinical psychiatry and public health, or preventive psychiatry?

In clinical psychiatry, we diagnose individuals, and we come up with a treatment plan, and we work with them as individuals. But public health deals with epidemics of violence, and with the incidence and rates of violence, and I think that is what we need to do here. I could spend hours describing individuals who committed acts of serious violence and attributed that to the influence of Donald Trump, which is important and relevant, but people could complain that is kind of cherry-picking this person or that. So I would rather emphasize statistical studies, such as one that pointed out that the incidence of hate crimes increased abruptly to a statistically significant degree in cities that had just had a Trump rally two or three days before, compared with comparable cities in the same state that had not had a Trump rally.

How far can epidemics of violence spread?

This happens on a worldwide basis. The mass murderer who killed people in the two synagogues in New Zealand, in order to show how thoroughly he identified with Trump, made the same complaint about Trump that Trump made about his followers: his complaint was that Trump wasn't violent enough yet. So he was showing how you could be even more violent than even Trump had called for. So what I'm saying is that the example and rhetoric of a political leader are very powerful, and can influence people to engage in violence at a level that is really dangerous to our communities and our society.

The other reason Trump is so dangerous is because even if he were the same person, with the same psychopathology but a private individual, he wouldn't be remotely as dangerous as he is now. But as president of the United States, he has his finger on the triggers of a thousand thermonuclear weapons, and as commander-in-chief he could order them to be deployed. That is the kind of thing that makes him more dangerous to this country and the whole world than any past dictator has ever been.

Renowned Harvard trauma expert: There's a 'very real threat of a racist, misogynist and deadly dystopia' if Trump wins in November

This continues the series, “The Dangerous Case of Donald Trump Revisited: Mental Health Experts on the Devastating Mishandling of a Pandemic.”  Whereas we could not have predicted a pandemic three-and-a-half years ago, the authors of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President anticipated how the president would respond, should there be a crisis.  We tried to warn the public of the very consequences that are unfolding today: abuse of power, incompetence, and loss of lives and livelihoods of many Americans.

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