Bandy X. Lee

Psychiatrist says Trump's 'glaring psychological problems' were misinterpreted and led us to disaster

Dr. Bandy X. Lee was interviewed by Prof. Johanna Fernández, author of The Young Lords: A Radical History (UNC Press, 2020), a history of the Puerto Rican counterpart of the Black Panther Party. She is the editor of Writing on the Wall: Selected Prison Writings of Mumia Abu-Jamal (City Lights, 2015) and with Abu-Jamal a special issue of the journal Socialism and Democracy, titled The Roots of Mass Incarceration in the US: Locking Up Black Dissidents and Punishing the Poor(Routledge, 2014). She teaches 20th Century U.S. history and the history of social movements at Baruch College (CUNY) and hosts "A New Day" on WBAI. She interviewed Dr. Lee, forensic psychiatrist and author of Profile of a Nation, for her "Race, Class, and Revolution" class at MayDay Space in New York. This is a two-part series. The first part of the interview series can be read here.

Where does politics begin and psychiatry end in assessing social problems?

As you know, we just experienced hundreds of thousands of unnecessary deaths, the near-loss of our democracy, and traumatization of a nation as a result of a president's mental unfitness, and so we cannot say the two areas are always separate. If the psychological dangers and unfitness were addressed earlier on, as would have been routine for any other job, we may have avoided these predictable consequences. Mental health issues do not stop at the political realm, and a high political office does not make one immune from mental problems.

At the same time, just as political matters should not be labeled as psychiatric, psychiatric issues should not be labeled as political. Politicians are supposed to consult with experts in areas that exceed their ability to handle—and not pretend that it is politics as usual—just as mental health experts should not comment on areas outside their expertise. Mislabeling can lead to catastrophes, as we have seen under Donald Trump, when glaring psychological problems were interpreted as political strategy or "3-D chess."

We associate Nazism or Stalinism with certain countries, while portraying Adolf Hitler, Idi Amin, or Pol Pot as such exceptional "monsters" that they would never be replicated on our soil, when the psychological characteristics they display are quite common—and it was handing them power that was exceptional. If we fail to understand the personality types that relentlessly seek but cannot handle power, which transforms them into grotesque megalomaniacs who run their countries to the ground, we will forever be vulnerable to them. We need to engage those who are best poised to detect these signs early, before they entrench themselves in the political structure, and that would be mental health experts.

Didn't Barack Obama deploy more structural violence against immigrants than all previous American presidents? Why not focus on this? Isn't talk about sociopathy a distraction from the real problems?

Absolutely, we need to consider the larger context—but the two are interlinked. When present, we need to point out elements of pathology in the culture that push individuals into violence, even when they may not have initially been inclined. George W. Bush might be another example of someone who was not a dangerous personality, but he was used for dangerous purposes. When I was asked to comment on the Iraq War at the World Economic Forum, I focused not on him but on our nation as suffering from a "narcissistic personality disorder" writ large. I called out Donald Trump because he is a dangerous personality, but he was simultaneously also the personification and instrument of a dangerous culture. People have asked me to comment on Joe Biden, but I have not, since he exhibits no concerning signs of relevance to doing his job, although whether he can refrain from the pressures of our violent military-industrial complex remains to be seen.

How is it helpful to discuss disorder, whether in an individual or in a society? Disorder by definition leads to destruction, no matter the stated intentions, whereas healthy, rational, and well-informed choices are always life-affirming, occasional human errors or accidents notwithstanding. Disorders can be more pernicious than criminality alone, since simple criminality at least benefits the self. It is when criminal-mindedness combines with pathology that all manner of atrocities become possible, for even the actor who is supposedly "benefiting" will eventually destroy oneself.

Prevention is critical, since, once pathology spreads, the ability to recognize that something is wrong is gone, too. This is where mental health professionals have an important role, for we have an independent duty to warn authorities and the public, as part of our responsibility to society, if the relevant people are not recognizing the dangers. One of the reasons why the American Psychiatric Association's silencing of mental health experts under the Trump administration was so alarming was because it stripped the public of its one defense against victimization—and this was after it looked the other way throughout Barack Obama's presidency when psychiatrists were constantly diagnosing him incorrectly with "narcissistic personality disorder" on Fox News. It also said nothing about those who incorrectly diagnosed Trump—as long as the diagnosis was favorable. It only aggressively shut down conscientious mental health professionals who were not unethically diagnosing but responsibly alerting about the dangers, since we were inconvenient to a dangerous government.

Recently there have been individuals who have been very destructive in social movement organizations locally. Some believe these individuals are on the NPD spectrum. How should we address these problems in social movements?

There is an epidemic of narcissistic and sociopathic personalities in our culture, even more disproportionately in leadership positions. This is a ubiquitous problem that is compromising organizational goals, hurting associates, and harming society. While psychological issues are understandably a difficult topic in the social movement world, where we often believe we ought to focus on social and economic problems and not make "ad hominem attacks," we must recognize this is a real problem. We need to be informed, recognize red flags, and set boundaries for our daily protection.

Why is it so difficult to address these issues in our organizations internally?

First, the most dangerous personalities disguise themselves so well that an early scholar called the condition a "mask of sanity." Even if you recognized them, they are intimidating, and so you end up coddling and protecting them, rather than exposing or holding them accountable, especially if you wish to avoid their cruelty, wrath, and vindictiveness. We need systematic provisions against them, both in government as well as in private organizations.

What is the value of psychiatry, despite its politics?

Politics, media companies, and corporations are making use of psychological knowledge more than ever to control people's behavior for profit. Citizens would do well to educate themselves, and mental health professionals to share their knowledge with the public, not just to serve the wealth and power that hire them. The CIA, the FBI, and the courts all make use of psychiatrist evaluations, most of the time without personal interviews, and the public should not be deprived of psychiatric assessments, especially when a nation's own president is posing a danger—which is arguably even greater than that of a foreign leader.

Follow Dr. Lee at bandylee.com.

Psychiatrist explains how the American Psychiatric Association functioned as 'as an agent of the state' under Trump

Dr. Bandy X. Lee was interviewed by Prof. Johanna Fernández, author of The Young Lords: A Radical History (UNC Press, 2020), a history of the Puerto Rican counterpart of the Black Panther Party. She is the editor of Writing on the Wall: Selected Prison Writings of Mumia Abu-Jamal(City Lights, 2015) and with Abu-Jamal a special issue of the journal Socialism and Democracy, titled The Roots of Mass Incarceration in the US: Locking Up Black Dissidents and Punishing the Poor (Routledge, 2014). She teaches 20th Century U.S. history and the history of social movements at Baruch College (CUNY) and hosts "A New Day" on WBAI. She interviewed Dr. Lee, forensic psychiatrist and author of Profile of a Nation, for her "Race, Class, and Revolution" class at MayDay Space in New York. This is the first of a two-part series.

Describe the politics of psychiatry and its tendency to criminalize the mentally ill, especially people of color.

Thank you for having me, as this is a difficult but necessary conversation to have. I believe psychiatric and psychological knowledge has become essential. I have begun to dub this "the psychological age," versus "the atomic age." The greatest threat to our survival as a species is no longer just technology, but our ability to refrain from our own collective suicidal tendency—be it through nuclear weapons, climate destruction, or the escalating inequalities, which I call structural violence.

The chief means of oppression has also become psychological, rather than through imprisonment, torture, or secret police. Hijacking and depriving people of their own minds through propaganda, indoctrination, and psychological manipulation has become more expedient than brute force.

Psychiatry, certainly, can be misused, especially if the people are uneducated about it. We would not automatically say that a surgeon, because one wields a knife, is harming people, but we must hold the professions to their standards and not allow them to abuse the trust given to them in order to, say, serve a destructive government.

What is the value of psychology in assessing public figures? Doesn't all this talk about malignant disorders strengthen the carceral apparatus and its use against the people at the bottom of society?

Psychology is of value when it is relevant. We have seen how, when mental health was pushed aside as the only field where experts cannot speak about the area of their expertise—which should be an alarming sign in itself—political pundits routinely underestimated the dangers and normalized the pathology of the Trump presidency, because they could not understand it.

Donald Trump was the first president for whom a historic number of psychiatrists, psychologists, and other mental health professionals came forth with their concerns about his dangerousness and unfitness. Since a president cannot do his job without basic psychological fitness, no matter what he claims, this was serious. So when the American Psychiatric Association shut us down and blocked us from all the major media, we said that it was acting as an agent of the state—as the psychiatric establishment had done under Nazi Germany or the Soviet Union. When a field abandons its norms and standards to become a tool of a destructive government, that is dangerous. We would not have been shut down if the information we had were not useful, and indeed we predicted the destructive course of the Trump presidency accurately, both in degree and timeline—only the public had no access to our analysis.

Psychiatric issues are real, just as physical impairments are real, and it is the culture's lack of investment in psychiatry that has criminalized the mentally ill—driving them from hospitals into jails and prisons. "Deinstitutionalization" actually resulted in a cruel and inhumane "transinstitutionalization."

What are personality disorders and sociopathy?

Personality disorders are pervasive, developmental, and ego-syntonic—which means it bothers others more than the self—impairments that cause a person to engage in destructive or maladaptive behavior. I deem sociopathy to be a societal disorder, since the causes arise from society, community, and family to manifest in an individual. We are seldom successful in curing individuals with sociopathy, but we can prevent and eliminate a great deal of it by fixing the conditions of society.

How was this manifested in the Trump presidency, and why should we care?

Those who do not deal with mental pathology day in and day out, as mental health professionals do, are less likely to detect it. Whereas sociopathy in an individual will look more functional than, say, a psychotic individual who wears a tinfoil hat and runs around naked, it is more dangerous. Things that we take for granted in a healthy person, such as empathy, caring for human life, and not deliberately wishing to torment others, are absent. We should care because a U.S. president is supposed to work for us and to keep us safe—not be driven to harm us and to do as much damage as possible. As the president's employers, the people have a right to know if the person they hired has the capacity to do the job.

Why are people reticent to even talk about sociopathy and personality disorders?

Our culture is not very psychologically-minded, and broaching the subject can be very difficult. It feels like a personal attack or an insult, if not detracting from the major, structural changes that need to take place. Some worry about stigma for those who have a "real" mental illness, such as major depression or schizophrenia. Others believe that mentioning mental disorders opens the door to oppressing ethnic or gender minorities, women, and those who are neurodiverse.

But we need to talk about it so we can protect ourselves. In a poor state of collective mental health, a society may be especially attracted, rather than repelled, by mentally-impaired leaders. Mental pathology, unlike a rational drive, brings with it powerful emotions that are not amenable to facts, logic, or even self-preservation. We have seen how, when pathology spreads into a "malignant normality," widespread human rights abuses become possible, populations are traumatized, and groups engage in cult-like behavior. We need a more systematized way of preventing this kind of victimization.

We reduce stigma through education and correct understanding, not through silence. This is where it is helpful to hear from mental health experts, for when we speak about disorders, it is not an insult but a reference to something specific that is endangering society either through direct threats or through a cultural influence that emboldens the breaking of norms, spreads delusions, or creates waves of violence. Mental health experts can separate the disorder from the individual (indeed, treating the disorder frees the individual to be oneself), understand that not all mental disease is alike (just like physical disease), and distinguish between mental illness (not always impairing in all ways) and mental unfitness (incapacity to do a specific job).

Finally, knowledge is power. Health professionals are required to share their knowledge for the benefit of society, and consulting with them does not take away a citizens' ability to choose but empowers them to make informed decisions. We need to demystify mental health and to understand how it can be important to a society's health, especially when it concerns public figures who hold a lot of power.

Follow Dr. Lee at bandylee.com.

I warned of Trump's psychological danger — and Americans suffered for the failure to stop him

In the recent escalation of anti-Asian violence, there are important immediate causes and then more enduring societal ones.

In March 2020, I wrote in Raw Story: "The greatest risk factor of disease and death is not being considered, and that is Donald Trump. If he continues in this presidency, he is on course for having three main effects: First, he will make a deadly pandemic much worse. Second, he will stoke divisions between 'believers' and 'unbelievers' in his alternative reality. And third, he will vastly augment suffering, which he will … direct into widespread violence … by calling the novel coronavirus 'Chinese virus,' simultaneously deflecting blame and creating new targets for attack."

As his presidency continued full-term, without repudiation or any reckoning for the violence he has incited, Asian-Americans have become victimized. Mental health professionals have since the beginning warned of his psychological dangerousness, among which is his tendency to project his own unacceptable actions onto others, as he did when he scapegoated Asians through derogatory phrases such as, "Chinese virus" and "Kung flu."

Just as his dehumanization of immigrants and desperate migrants led to unprecedented hate crimes and mass shootings, we have seen a more than an 800 percent increase of reported verbal and physical assaults over the course of a year, which is most certainly a gross underestimate. Furthermore, the recent mass murder at the Georgia spas made clear that Asians, particularly women and elders, are not safe.

Meanwhile, we now know that Donald Trump was responsible for at least 40 percent of the now 560,000 Covid-19 deaths, according to a Lancet report; that up to 97 percent of the deaths were unnecessary, according to a Columbia University report; and that all deaths beyond a hundred thousand "could have been mitigated," according to the former White House coronavirus response coordinator. This immense suffering has been displaced onto Asian-Americans as scapegoats, through the former president's unique, pathological ability to read his followers and to re-channel blame for his own failures onto others.

The Trump presidency was a public health emergency from the start, and violence is a societal and cultural disorder, more than an individual one. Individual circumstances may vary, but of greater significance is the cultural shift that pushes vulnerable individuals into violence where previously they may not have been. The January 6 insurrection, the mass killing of Asian-Americans, and the reign of white supremacist terrorism and intimidation are all interrelated and exacerbated as the result of a former president being so "successful" in avoiding accountability for his actions.

After two impeachment acquittals—which he and his followers interpret as exonerations—and no other prosecutions yet in sight, he is well-positioned to continue to inspire responses that make the pandemic worse, to embolden those who subscribe to his version of reality where he never fails and is never responsible, and to redirect the suffering of the populace against his targets of choice. We need vigorous delegitimizing of his actions and influence, to curtail a violent culture that will give rise to epidemics of violence, including anti-Asian violence.

Societally, we need to recognize that the deadliest violence occurs through societal structures, not through individual actions. Structural violence, be it economic inequality, sexism, or racism, is responsible for more than 10 times all the suicides, homicides, and deaths from civil strife or wars combined—that is, all deaths from behavioral violence, year after year. Structural violence such as racism is also the most potent stimulant of behavioral violence, giving rise to epidemics of hate crimes, murders, and acts of terrorism.

We must call out these cultural forces that threaten safety and our collective thriving. We must hold leaders responsible for their destructive rhetoric, and oppose legislation that disadvantages minority groups, such as voting restrictions, which is essentially the usurpation of the people's voice.

Asian-Americans have been self-silencing and silenced, alternately valorized or feared and othered. They have, in general, tried to fit in with the dominant culture in order to secure safety and survival, but this is a false sense of security through compliance and collusion.

Striving for true unity in diversity, not by conformity but by emphasizing our common humanity, equality amid differences, and justice for all will benefit all of society. African-Americans have a long history of such struggles, meeting oppression and hate with nonviolent strength, humanity, and compassion. We need to emphasize how much we have to learn from and are interdependent with all non-dominant groups and join forces. African-American struggles are also Asian struggles. Native American struggles are also Asian struggles. Latinx-American struggles are also Asian struggles. And so on.

In order to heal from the societal sickness that starts in the mainstream white American culture but spreads through the externalization and projection of its problems, and the generation of inter-generational trauma for non-whites, we need first to name our wounds and affirm our diverse identities. By embracing and drawing upon our cultural roots of who we are, and by cultivating a sharing of our uniqueness and commonality in working through the suffering we feel in our lives, we can help all of us, including the dominant class, to heal.

The World Mental Health Coalition, which is dedicated to promoting societal mental health, has recently launched a Project for National Healing with a series of Truth and Reconciliation Town Halls. Its inaugural town hall was held on March 13, 2021, with the theme: "Racism, White Supremacy, and Societal Mental Health." We need concrete steps to call out the societal problems that the four years of Donald Trump's presidency have represented, magnified, and spread. At the same time, we are called to share the gifts of our unique backgrounds as Blacks, Latinx, Native Americans, and Asians, as part of the life-affirming restoration that must occur.

How to heal from the public health emergency that was the Trump presidency

The recent mass killing of mostly Asians at three Atlanta-area Asian massage parlors is widely seen as a culmination of escalating racism against Asian-Americans. In March 2020, when Donald Trump started calling the novel coronavirus "Chinese virus" and "Kung flu" to deflect blame from himself and to create alternative targets for his followers' rage, mental health professionals warned that he would become the greatest risk factor of injury and mortality. With the now 550,000 Covid-19 deaths, at least 40% of which were directly attributable to Donald Trump's mismanagement as per a recent Lancet article, and up to 97% of which were unnecessary according to a Columbia University study, the ensuing suffering has been displaced onto China, the Chinese, and anyone who looks Chinese.

Just as four years of Donald Trump's dehumanization of immigrants and desperate migrants led to unprecedented hate crimes and mass shootings, and his portrayal of mostly peaceful Black Lives Matter protests as violent descended on them the full federal forces and police brutality, his rhetoric has now placed Asian-Americans in peril.

The Trump presidency was a public health emergency that exacerbated the nation's problems on multiple levels, and healing must follow a full accounting of its implications. The World Mental Health Coalition, which step-by-step predicted the disastrous mismanagement of the Covid-19 pandemic, accurately anticipated a violent insurrection such as what happened on January 6, 2021, and appropriately warned of a mental health pandemic in the absence of a referendum on the Trump presidency, is now launching a Project for National Healing with a series of Truth and Reconciliation Town Halls that will bring together leading intellectuals, mental health professionals, and other speakers of truth. Themes we will cover include racism, dangerous leadership, cultism, economic inequality, and imperialism. We will, together with interviews of prominent players and ordinary citizens, analyze what exactly happened over the last four years, where we are now, and how we can heal as a nation.

While the Democratic Party has announced a 9/11-type commission on the narrow focus of what happened around the January 6, 2021, insurrection, we believe that the politicians, the Congress, and the mainstream media are ill-equipped to provide a serious, credible, unconflicted, and professional analysis. The political parties and the country as a whole have become far too polarized and partisan without common method or agreed-upon reality. Additionally, they are unable to stand up to the attacks are bound to come to a major public effort. Hence, there is both a vacuum and a need that the World Mental Health Coalition (WMHC) can fill. Our work has always emphasized strict adherence to professional standards, scientific evidence, and independence from any political or financial obligations. We have additionally demonstrated an ability to withstand intense political pressures that would silence expert voices.

To this end, the WMHC has inaugurated its Truth and Reconciliation Town Hall series on March 13, 2021, with the theme: "Racism, White Supremacy, and Societal Mental Health." A video recording of the event is now available. We presented racism as a non-scientific, non-factual belief that is rooted in the pathological need to assert superiority over others in order to fight a deep-seated sense of inferiority. It shields its adherents from prosecution while subjecting Blacks, Latinx, Native Americans, and Asians to various forms of violence and intergenerational trauma, stimulating societal self-annihilation, as we have seen under Donald Trump's presidency. Kevin Washington, Ph.D., and Bandy Lee, M.D., M.Div., Board members of the World Mental Health Coalition, served as co-chairs.

  • The session opened with Cornel West, Ph.D., soon-to-be Dietrich Bonhoeffer chair at Union Theological Seminary and former professor of the practice of public philosophy at Harvard University. He drew attention to the fact that Blacks have been chronically hated for 400 years and yet keep dishing out love and producing love warriors. Instead of getting caught up in the weight and the impossibility of overcoming, Black and African people, who keep producing freedom fighters, are not calling for terrorizing others, or the Black version of the Ku Klux Klan, but liberty for everybody.
  • Wade Nobles, Ph.D., professor emeritus at San Francisco State University and co-founder of the Association of Black Psychologists, proposed as a first concept the attempted "epistemicide" of African thought, or the attempt to kill the ability even to know what it means to be African and human. Hence, Africans walk in the world fumbling, stumbling, trying to be, seeking respect and recognition from, and then ending up looking at who their oppressors really are. The assault on the capital, the very place this whole country holds to be sacred, illustrates the human savagery that is white supremacy.
  • Gregory Carr, Ph.D., associate professor of Africana studies and chair of the Department of Afro-American Studies at Howard University, noted that we need to understand what it means for a society to be mentally unwell, which has a great deal to do with the political and economic structures. Settler violence has been from the first people who came here with an intent to dispossess others of their humanity, which we are still responding to. Moving forward together may mean creating the space to be able to contribute our distinct perspectives without collapsing them.
  • Cristalis Capielo Rosario, Ph.D., assistant professor in counseling and counseling psychology at Arizona State University and former officer of the National Latinx Psychological Association, recounted the Puerto Rican experience. An internalized notion that their experiences, histories, and knowledge are inferior, underdeveloped, or do not exist at all allows political exclusion, economic exploitation, cultural control, and social fragmentation to take hold, much as in Latin America.
  • Alicia Mousseau, Ph.D., clinical psychologist and first out LGBTQ vice president of the Oglala Sioux Tribe, highlighted that there are over 560 federally recognized tribes in the United States, and therefore she could not speak on behalf of all of them, but true American history includes the indigenous people of the nation. Going from being the majority to now one to two percent of the population is a historical trauma, but they pass on who they are in their communities through the elders.

The path to healing may be arduous and long, exposing many uncomfortable truths, but it is a course we must confront, and we hope you will join us.

Mental health expert explains why Trump must be convicted

The Trump presidency may be over, but Donald Trump's dangers continue. This is because we have yet to contain the number one emergency, which is the spread of mental pathology.

Without addressing this mental health pandemic, even the Biden administration's admirable efforts to contain the viral pandemic may meet with obstacles. Similarly, without conviction and prosecution, which is the first step to containing this mental health pandemic, hopes for "reconciliation" and "unity" may also be for naught.

Mental health professionals knew from the start that Donald Trump had the psychological makeup to become very dangerous with presidential powers. Following our 2017 assessment, I and thousands of my colleagues at the World Mental Health Coalition issued more than 300 pages of letters, petitions, and statements asserting that Donald Trump's dangers would spread and erupt. In March 2020, we issued a "Prescription for Survival," stating that the president's removal through the 25th Amendment, impeachment, or resignation—or at least removal of influence—was essential to avoiding widespread unnecessary deaths.

Trump uses words and directly incites violence. Research on violence shows that rhetoric can be more efficient than specific orders or direct assaults in causing epidemics of violence.

A failure to contain led to a most dramatic demonstration of dangers on Jan. 6, but it was long in coming. Over the summer of 2020, I wrote a new public-service book, Profile of a Nation, to warn that, "he is truly someone who would do anything,… no matter how destructive, to stay in power." Indeed, the near-massacre of lawmakers he caused at the Capitol, save for a few heroes, proves how close he came to causing the kind of chaos that may have permitted him to remain.

Donald Trump's campaign to rig an election that he lost through endless lies, abuses and verbal attacks eventually led to his fomenting deadly violence and near-loss of our democracy. As we did with the Mueller report, his recent phone call with Georgia's secretary of state, and his "Save America" rally speech, mental health professionals can explain how Donald Trump uses words and directly incites violence. Research on violence shows that rhetoric can be more efficient than specific orders or direct assaults in causing epidemics of violence.

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The World Mental Health Coalition, of which Dr. Lee is president, will be holding a special online national town hall, "The Imperative to Convict Trump," on Sunday, Feb. 7, at 2 p.m. EST.

Speakers include: Laurence Tribe, constitutional scholar, Harvard Law School; Norman Eisen, former special counsel for Trump's first impeachment and trial; Richard Painter, former chief White House counsel for George W. Bush; Rep. Gerry Connolly (D-Va.), member, House Oversight Committee, and chairman, House Subcommittee on Government Operations; Claire Finkelstein, criminal lawyer, University of Pennsylvania; Ruth Ben-Ghiat, historian, New York University; Bandy Lee, moderator and president, World Mental Health Coalition

Tickets are $5 for students and low-income individuals, $25 general.

For more information, please go here, and for a video statement, see here.

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The ideal course would have been swift impeachment and conviction. Impeachment happening a week after the actual incident was already a poor precedent, prompting us to write to the speaker of the House: we would not allow a serial killer to be on the loose with bombs, ammunition, and assault rifles for days—and yet we permitted a serial mass killer, by the order of hundreds of thousands, for weeks with access to nuclear weapons capable of destroying all civilization. We urged clear and speedy actions, given that each day of delay had an adverse effect on the population's demoralization and trauma without justice, and on Trump enablers' opportunities to subvert the momentum for impeachment.

Impeachment Backfire

As we know from past experience, tepid impeachment proceedings could even backfire and boost Donald Trump's standing. As we have repeatedly emphasized, once with over 800 mental health professional signatories, even the most impeccable political calculations, without consideration of psychological factors in his case, would likely also fail politically.

Given a recalcitrant Senate, psychological influences are especially critical. Some of this might have been mobilized to advantage had impeachment occurred the day after violent insurrection and sedition, and conviction as soon as the following day, with amplification of public outcry if the Senate refused.

Since this did not happen, the next best course would be to have a complete trial with as much evidence and testimonies as possible, including those of Capitol police officers who were injured during the incident, to maximize pressure on the Senate to convict.

More High Crimes

Additional articles of impeachment would also be helpful, including his role in the soon-to-be half-million Americans who perished from the pandemic; the economic misery while he and his cronies profited; the human rights abuses as he kidnapped and placed children in concentration camps; and the aid and comfort he gave to neo-Nazi and white supremacist terrorist groups throughout his presidency, to compose an "encyclopedia of articles" more commensurate with reality that we recommended since the first impeachment.

Unless conviction promptly removes former presidential privileges and sets restrictions on future campaigns for political office, Donald Trump will likely use the acquittal to claim that he is innocent of all charges. He will claim that the second impeachment was another "hoax" intended to victimize him, using it to discredit all subsequent indictments and prosecutions.

Back on the Stump

He will resume holding rallies, continually pushing the narrative that he was the real victor in 2020, threatening further social and political divisions. He will blame the poor state of the country he created on the Biden administration, just as easily as he claimed credit for the long-term benefits that the Obama administration's policies generated, as he aims to return to power as the savior who will "make America great again." As long as positive reinforcement through a lack of accountability persists, he will not stop.

A failure to convict will, furthermore, have a devastating effect on the public's mental health. The country is already traumatized from four years of normalizing, legitimizing, and even glorifying deadly criminality, abusive behavior, and severe pathology. Members of Congress who experienced normal emotional distress as happens after a life-threatening event will not be able to have closure, as will the American people after the violation and desecration of their seat of government.

Unhealthy Bonds

A failure to convict will continue to entrap those who support him, whose unhealthy emotional bonds prevent them from seeing the damage that is being done to their personhood, livelihood, health, and even lives. It is a disservice to collude with their psychological defenses against the pain of disappointment, further entrenching them in potential future trauma upon learning the truth.

Clear boundaries need to be set that a leader should not abuse, let alone kill, the people he has sworn to serve.

The first step to healing a massive mental health pandemic is to convict, set limits, return to reality, and restore the standards of lawfulness, order, and safety. We should not continue to permit a dangerously unfit person who held high office to spread unmitigated violence, trauma, and mental pathology. Mental health professionals who routinely manage dangerous personalities have vital knowledge to contribute to society and should be consulted.

Mental health experts: Given Trump's psychopathology, last week's coup attempt was wholly predictable

Of course, the media environment was set up for the likes of Trump. America is filled with racism, sexism, and hatred, and with mass media outlets like Rupert Murdoch's Fox News that have no responsibility to the truth. The Fairness Doctrine, which used to protect us, was repealed decades ago by the Federal Communications Commission under Ronald Reagan, and in place of fairness jumped right-wing extremism. Social media platforms, including Twitter, Facebook, and Parler, also played a major role.

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Yet Trump posed a special challenge. Into the brew of hatred and racism came a mentally disordered individual with a knack for self-promotion. Trump was not merely conniving, and that's the point. He suffers from severe impairments, including characteristics of sociopathy, pathological narcissism, and sadism. A mentally disordered leader in a country filled with inequalities and a mass media environment promoting extremism led to a terrifying situation.

Mental health professionals started to warn Americans about Trump during the 2016 presidential campaign, but they were shut down by none other than a professional organization of their own, the American Psychiatric Association. The APA was unique among mental health associations to adopt the so-called Goldwater Rule, which resulted from Barry Goldwater's 1964 presidential campaign, when some psychiatrists questioned Goldwater's mental health fitness for office. After that, the APA decreed that it was unethical for mental health professionals to diagnose public figures without a personal examination and without consent.

With the arrival of the Trump administration, however, the APA expanded the Goldwater rule dramatically. Originally, the rule applied to diagnoses. Now, according to the APA, any offer of professional comment regarding the mental health of a public figure was deemed to be unethical. When some mental health professionals started to warn specifically about Trump, the APA pushed back hard, invoking the Goldwater Rule. There were reports that the APA may have acted to protect its federal funding. Whatever was the actual motivation, the APA revisions under the Trump administration troubled many mental health professionals.

Several psychiatrists convened at Yale School of Medicine in early 2017 and published the proceedings in a book, "The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President," which raised the topic of Trump's mental unfitness in public discussion.

The mental health experts correctly predicted that the dangers of Trump's presidency were greater than the public and the politicians suspected, that the dangers would grow over time, and that they would possibly become uncontainable. Of course, these experts did not predict the coronavirus pandemic, but they recognized right away that the US death toll from COVID-19 — now at nearly 390,000 — would depend more on the president's mental state than on characteristics of the virus. Well before the 2020 election, they warned that Trump would refuse to concede, declare the results a fraud, and refuse to leave office. They warned that the post-election transition would be the most dangerous days of this presidency. Though they were correct in these predications, many political leaders continued to treat Trump as a normal, albeit highly manipulative and unprincipled politician, not as dangerously disordered.

Trump's coup attempt last week was predictable from the perspective of Trump's psychopathology. Convicting him in the upcoming Senate impeachment trial is also important to keep Trump from running for office again. Yet we must draw further lessons.

We must find formal ways to incorporate psychological insights into political discourse. This would involve, among other measures, correcting the Goldwater Rule, adjusting the 25th Amendment to ensure that it can be applied to dangerous psychological disorders, and taking steps to reduce the powers of the presidency so that the nation is not vulnerable to the whims of one mentally unbalanced individual.

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.

#

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.

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