"The Earth Itself is in Peril"

a comprehensive summary of The Dangerous Case of Donald Trump

Recently I was searching my Kindle to see what I might dig into next – perhaps an unfinished read or even a book I’d bought and forgotten about. Indeed! There was a book called The Dangerous Case of Donald Trump. I had no recollection of buying it, nor did I have any idea what it was about – except, of course, the obvious. Did it “call to me”? You bet it did! This was right at the time that Donald Trump was being inaugurated for the second time – January 2025 – and, yes, I was scared this time.

To be perfectly candid, when Donald Trump was first elected in 2016, I said to myself, “Okay. Maybe I was wrong. Maybe I voted for the wrong person. Let’s give him a chance.” And so I did, and so I came to know that this man should never, ever be our president again. Yes – that’s my opinion, and I own it.

On the morning of November 6, 2024, when I rushed to the TV to see the results of the previous day’s presidential race, I was simply wondering by how much Kamala Harris had finally won. Never would I have expected my fellow Americans to elect Donald Trump again after what I had experienced: his appalling first term; my own full reading and careful analysis of Project 2025, indicating (I now realize) exactly what was to come – at breakneck speed; his disrespectful, disparaging speech and behavior during his most recent campaign; the strange individuals with which he was now associating himself.

As you see, dear reader, I am being absolutely candid with you, as I always am. When summarizing a book here in the Speakeasy, I try diligently to represent the author’s own words, perspective and intentions honestly and objectively. (Yes, I know: Occasionally I gasp or write “OMG” or squeeze in my own “take”), but I really strive to share with my readers what I have found in the author’s work. And so I will again, but this time I must open with a confession: I had already come to the conclusion that Donald Trump is a huge danger, not only to our country, but to the entire world, and I never would have believed Americans would elect him again.

That said, I had absolutely no idea what I was getting into when I opened this book! Who was this author, and on what grounds was he or she (I had no idea who Bandy X. Lee was) calling Mr. Trump “dangerous”? So I did what I always recommend to others – I read the fine print: “27 psychiatrists and mental health experts assess a president.” And then, to my further amazement, I discovered this book had been published back in 2017! It was in response to his first administration, before Project 2025 had surfaced, before the disgusting 2024 campaign, before I witnessed his deeper progression into careless, raving behavior! (How had I not heard of this book? How long had it been on my Kindle? And how the heck did it get there?)

Well, that’s neither here nor there. Let’s see what the psychiatrists and mental health experts had to say, way back in 2017. I’m going to start in an unusual way, however. Before we launch into the book, I’m going to list the authors and their qualifications, so you can decide right now whether their observations and opinions might be credible to you. Spend as much or as little time on these authors as you wish. The analysis will start on the other side of this important list. (And let me just say: If you are a Trump supporter, either wholeheartedly or with waning enthusiasm, you will have my deepest respect and admiration if you will read this lengthy summary and let me know your response.)

Lee – Bandy X. Lee: Assistant Clinical Professor in Law and Psychiatry, Yale School of Medicine; cofounder of Yale’s Violence and Health Study Group; leader of a Violence Prevention Alliance project, World Health Organization; author of 100+ peer-reviewed articles.
Lifton – Robert Jay Lifton, MD: Lecturer in Psychiatry, Columbia University; Distinguished Professor Emeritus, John Jay College and Graduate Center of the City University of New York; psychohistorian of the Nazi war crimes and bombing of Hiroshima; a vocal opponent of government-sanctioned torture and nuclear weapons.
Herman – Judith Lewis Herman, MD: Professor of Psychiatry, Harvard Medical School; author of Trauma and Recovery; cofounder of the Victims of Violence Program, Dept. of Psychiatry at Cambridge Health Alliance; Distinguished Life Fellow of the American Psychiatric Association; recipient of the Lifetime Achievement Award from the International Society for Traumatic Stress Studies.
Zimbardo – Philip Zimbardo, PhD: Professor Emeritus, Stanford University; known for his landmark Stanford prison study; 500 publications, including psychology textbooks and the best seller, The Lucifer Effect; founder/president of the Heroic Imagination Project.
Sword – Rosemary Sword: co-author of Time Perspective Therapy and of The Time Cure: Overcoming PTSD and The Time Cure Therapist Guidebook and many more; with Zimbardo co-authors a column in Psychology Today; contributor to Appeal Power, a European Union online journal and to a Polish psychological journal.
Malkin – Craig Malkin, PhD: clinical psychologist; author of Rethinking Narcissism; lecturer, Harvard Medical School; often published in Time, New York Times and others; has been featured on NPR, CBS Radio, the Oprah Winfrey Network and others; president of Cambridge-based YM Psychotherapy and Consultation, Inc.
Schwartz – Tony Schwartz: co-author with Donald Trump of The Art of the Deal; co-author of The Power of Full Engagement: Managing Energy, Not Time; author of The Way We’re Working Isn’t Working; CEO/founder of The Energy Project.
Sheehy – Gail Sheehy, PhD: In her 50-year career has written 17 books, including Passages and Hillary’s Choice; one of the original contributors to New York Magazine; holds three honorary doctorates.
Dodes – Lance Dodes, M.D. – Training and Supervising Analyst Emeritus at the Boston Psychoanalytic Society and Institute; retired Asst. Clinical Professor of Psychiatry, Harvard Medical School; author of The Heart of Addiction, Breaking Addiction, and The Sober Truth; Distinguished Fellow, Amer. Academy of Addiction Psychiatry.
Gartner – John D. Gartner, PhD: clinical psychologist; former teacher, Dept. Of Psychiatry, Johns Hopkins Medical School (28 years); author of In Search of Bill Clinton: A Psychological Biography and The Hypomanic Edge: The Link Between (a Little) Craziness and (a Lot of) Success in America.
Tansey – Michael J. Tansey, PhD: Chicago-based clinical psychologist (35+ years), author and teacher; 1972 graduate of Harvard University with degree in Personality Theory; 1978 graduate of Northwestern University Feinberg School of Medicine with degree in clinical psychology.
Reiss – David M. Reiss, M.D.: private psychiatric practice in California since 1982; attended Northwestern University; interim medical director, Providence Hospital in Massachusetts; CA-licensed medical examiner.
Herb – James A. Herb, M.A., Esq.: has practiced law in Florida for 40 years; circuit court mediator certified by the Florida Supreme Court; certified arbitrator; member, National College of Probate Judges.
Glass – Leonard L. Glass, M.D., M.P.H.: psychiatrist and psychoanalyst in Newton, MA; Assoc. Prof. of Psychiatry, Harvard Medical School; senior attending psychiatrist, McLean Hospital; protested the Goldwater Rule in 2017.
Friedman – Henry J. Friedman, M.D.: associate professor of psychiatry, Harvard Medical School; member of editorial boards of Psychoanalytic Quarterly, American Journal of Psychoanalysis, and Journal of the American Psychoanalytic Association;
Gilligan – James Gilligan, M.D.: Clinical Professor of Psychiatry and Adjunct Professor of Law, New York University; author of Violence: Our Deadly Epidemic and its Causes and of Preventing Violence and of Why Some Politicians are More Dangerous than Others; has served as director of mental health services for Massachusetts prisons and prison mental hospital; past president of International Association for Forensic Psychotherapy.
Jhueck – Diane Jhueck, LMHC, DMHP: has operated a private therapy practice for several decades; previously a women’s specialist at the UN; founded the Women’s and Children’s Free Restaurant 30 years ago; founded the People’s AIDS Project; was assistant regional manager of Feeding America
Covitz – Howard H. Covitz, PhD, ABPP: has taught university-level mathematics, psychology, and biblical characterology; was a training analyst, Institute for Psychoanalytic Studies and Institute for Psychoanalytic Psychotherapy; authored Oedipal Paradigms in Collision
Doherty – William H. Doherty, PhD: professor of family and social science; director, Minnesota Couples on the Brink; director, Citizen Professional Center, U. of MN; author of Citizen Therapist Manifesto Against Trumpism; founder, Citizen Therapists for Democracy; senior fellow with Better Angels (dedicated to depolarizing America); Lifetime Achievement Award, American Family Therapy Academy.
Teng – Betty P. Teng, MFA, LMSW: trauma therapist, Office of Victims Services in a Manhattan hospital; graduate of Yale, UCLA, NYU; practices psychoanalytic training at the Institute for Contemporary Psychotherapy.
Panning – Jennifer Contarino Panning, PSY.D: licensed clinical psychologist; owns Mindful Psychology Associates in Evanston, IL; doctorate in clinical psychology degree, Chicago School of Professional Psychology; trained at Northern Illinois and Northwestern; specializes in treatment of mood disorders, eating disorders, stress, trauma and college student mental health; trained in clinical hypnosis.
West – Harper West, MA, LLP: a licensed psychotherapist, Clarkson, MI; graduate of MI State University in journalism; master’s degree in clinical psychology, MI School of Professional Psychology; developer of self-acceptance psychology, reframing emotional problems as adaptive responses to fear, trauma, shame, etc.; authored award-winning Pack Leader Psychology.
Kessler – Luba Kessler, M.D.: psychiatrist and psychoanalyst in private practice; a Russian native, educated in the Soviet Union, Poland, Italy and the US; postgraduate study in psychiatry at Hillside Hospital, Long Island, and in psychoanalysis at NYU Psychoanalytic Inst.; edits Issues in Education for the American Psychoanalyst of the American Psychoanalytic Assoc.
Wruble – Steve Wruble, M.D.: board-certified child and adult psychiatrist in private practice in Manhattan and at the Venn Center, Ridgewood, NJ; specializes in anxiety disorders, trauma, ADHD; medical school in TN, psychiatry residency at Northwestern University, child psychiatry fellowship at U. of IL Inst. For Juvenile Research.
Singer – Thomas Singer, M.D.: psychiatrist and Jungian psychoanalyst, San Francisco; has served on Social Security Hearing and Appeals Mental Impairment Disability team; studies relationships among myth, politics, and psyche; president of National ARAS, an archive of symbolic imagery.
Mika – Elizabeth Mika, MA, LCPC: assesses and counsels gifted children and adults at Gifted Resources, Northern IL; degree in clinical psychology, Adam Mickiewicz Univ., Poznan, Poland.
Fisher – Edwin B. Fisher, PhD: clinical psychologist; professor, Dept. of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill; past president of Society of Behavioral Medicine.
Gartrell – Nanette Gartrell, M.D.: psychiatrist, researcher, writer; formerly on faculties of Harvard Medical School and University of California, San Francisco; has conducted scientific investigations for 47 years; in 1980s and 1990s, principal investigator of sexual misconduct by physicians; her papers are archived at Smith College.
Mosbacher – Dee Mosbacher, M.D., PhD: psychiatrist; award-winning documentary filmmaker; formerly on faculty of University of California, San Francisco; specialized in treatment of patients with severe mental illness; was San Mateo County medical director for mental health; was senior psychiatrist at San Francisco’s Progress Foundation; work is archived at Smithsonian Institution and Smith College.
Chomsky – Noam Chomsky, PhD: Professor Emeritus at MIT; written and lectured widely on linguistics, philosophy, intellectual history, U.S. foreign policy, and more; holds numerous honorary degrees and awards.

Now that I’ve offered you an introduction to all the authors whose work is featured in The Dangerous Case of Donald Trump, I beg you – beg you – to take the time to read this entire long summary, no matter your politics, no matter your opinion about Donald Trump. The more time I’ve spent with this material, the more convinced I have become that we Americans might be at a crossroads far, far more critical than we’re allowing ourselves to believe. Please read it all and make your own assessment about that.

Let’s get into the book. And I’m going to take a different approach than I usually do. Instead of simply walking you through the chapters in chronological order, I’m going to organize critical passages into themes or categories. Why? Because I encountered much repetition in this book. This host of qualified, experienced mental health experts, apparently writing independently of each other, often testify to the very same things their peers have already said. They tend to use different examples or explanations, but their points are often the same. So, rather than ask you to plod through the book from start to finish, please allow me to group similar points together thematically for both of us.

1. Why should we even worry?

What actual risk do these experts identify as they study Donald Trump? Lifton starts us off with a reference to the Nazi death camps, warning us of “the process of adaptation to evil... a normalization of evil.” He goes on to cite “another kind of malignant normality, one brought about by President Trump and his administration...” asserting that “the most powerful man in the world is also the bearer of profound instability and untruth.”

Herman and Lee, in their Prologue, state that “It doesn’t take a psychiatrist to notice that our president is mentally compromised.” They ask, “Is he mentally compromised or simply vile? ...the two propositions are not mutually exclusive. A man can be both evil and mentally compromised... A political leader’s grandiosity may morph into grotesque delusions of grandeur... By paying attention to the president’s mental state as well as his actions, we are better informed to assess his dangerousness. Delusional levels of grandiosity, impulsivity, and the compulsions of mental impairment, when combined with an authoritarian cult of personality and contempt for rule of law, are a toxic mix.”

We’re warned that, later in the book, Tansey will explain that “outrageous lies may be explained by delusional disorder... even more frightening are Trump’s attraction to brutal tyrants and also the prospect of nuclear war,” and that Reiss will point out that our current political system “sets no intellectual or cognitive standards for being president.” Gilligan will discuss “the ethics of not diagnosing a public figure versus the duty to warn potential victims of danger,” and Jhueck will refer to the power of health professionals to “detain people against their will if they pose a danger due to likely mental illness – and Trump more than meets the requisite criteria.”

The authors of the Prologue also preview the work of Doherty, who claims that “the Trump era has ruptured the boundary between the personal and the public.” Next they introduce the work of Teng, who “traces the president’s sudden military action, his generation of crises, his shaken notions of truth and facts,” and Panning, who “describes a unique post-election anxiety syndrome that has emerged as a result of the Trump presidency.” (Once again, I must remind myself, as shaken as I am now, just a few weeks after Trump’s second inauguration: This was just as his first term was getting underway!)

The Prologue now prepares us for the work of West, who will write about Trump’s “vindictive anger, lack of accountability, dishonesty, lack of empathy, and attention-seeking...” We’ll hear from Kessler that “Trump amplifies and exacerbates a national ‘symptom’ of bigotry and division,” and Singer will explain to us the concept of “group psychology,” showing that “the joining of group self-identity with violent, hateful defenses is as much about us as about Trump.” Mika, we are told, will show us how tyrannies are “toxic triangles... necessitating that the tyrant, his supporters, and the society at large bind around narcissism, while... the characteristic oppression, dehumanization, and violence inevitably bring on downfall.”

Lee and Herman close their Prologue with this warning: “Anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency.” (As I read those words, I must remind myself: This was published early in his first term. Now he’s back.) Finally we are warned: “The main point of this book is not about Mr. Trump. It is about the larger context that has given rise to his presidency, and the greater population that he affects by virtue of his position. The ascendancy of an individual with such impairments speaks to our general state of health and well-being as a nation... We can either improve it or further impair it.”

The Trump Effect

So, our question is this: Should we be worried? Zimbardo and Sword suggest “the Trump effect,” warning that “one person can affect an entire nation.” The Trump effect, they explain, was originally seen as an uptick in bullying in schools, but it “crept beyond schools to include religious and racial bullying by adults.” They concede this situation seems bizarre, but “the Trump effect exists and is a growing phenomenon.” Citing a report by the Southern Poverty Law Center, they say that immigrant students and children of immigrants, which includes “close to one-third of pupils in American classrooms,” as well as African American students and other children of color have reason to fear. They report that “some used the name ‘Trump’ as a taunt or chant.” The results have included panic attacks and suicidal thoughts, yet “the great many people who witness such bullying do nothing.” The stress and anxiety have “threatened their health, their emotional state, and their schoolwork.”

The authors continue: “All students... are vulnerable to the stresses of the Trump Effect...[and] children are a reflection of their upbringing.” Statistics show, according to Zimbardo and Sword, that a small portion of the population has “become even more emboldened... engaging in hate crimes,” including “seventy anti-Jewish incidents and thirty-one anti-Muslim incidents” in the two weeks following the 2016 presidential election. The Trump effect, they tell us, “promote[s] the dehumanization of our fellow human beings.” They describe “a scary Venn diagram” with three converging circles: “extreme present hedonism... narcissism... and... bullying behavior.” Where they converge, we have “an impulsive, immature, incompetent person who, when in the position of ultimate power, easily slides into the role of tyrant, complete with family members sitting at his proverbial ‘ruling table.’” The result: “psychological seeds of treachery [planted] in sections of our population.”

“We have become a bipolar nation,” Zimbardo and Sword assert, “ with Donald Trump at the helm as his followers cheer him on and others try to resist him.”

Trust Deficit and the Snake Pit

Gail Sheehy identifies the “core problem” as “Trump’s trust deficit.” She says, “Donald Trump trusts no one,” and she worries [back in 2017!] “how much closer the day of reckoning has to come on charges of collusion with Russia before he needs a war to provide the ultimate distraction.” Sheehy reminds us that, in 1990, Trump boasted, “I’m a very untrusting guy.” And in 2007, he advised: “Hire the best people, and don’t trust them.” She notes that other biographers “have recorded his worldview as saturated with a sense of danger,” asserting that, “As far as we know, his father trained him to be a ‘killer,’ the only alternative to being a ‘loser.’”

Sheehy cites the characteristics Trump displays as he represents American people abroad: “His belligerent behavior and disrespect for leaders of our closest allies rips apart the comity and peace-keeping pledges built over decades. Yet, he never hesitates to congratulate despots, such as Turkey’s Erdogan, Egypt’s General Sisi, and, most lavishly of all, Russia’s Putin.” In fact, she notes, “Trump borrowed a phrase by Lenin and Stalin to brand the American media as an ‘enemy of the people.’”

Here at home, the author notes, “It is not surprising that Trump drew closest to him two legendary conspiracy theorists: Stephen Bannon and General Michael Flynn.” She quotes a former White House counselor thus: “Trump’s worldview is that we live in a snake pit where everybody is out for themselves.” She continues, “His pathological propensity to lie is not the worst of it – his monomaniacal attachment to lies is,” asking, “Is this president floating in his own alternate reality?”

Interestingly, Sheehy refers to an interview she conducted previously with one of the very authors of this book, Dr. Robert Jay Lifton. The psychiatrist/psychohistorian said of Trump at that time: “He insists that his spokesmen defend his false reality as normal. He then expects the rest of society to accept it – despite the lack of any evidence, [leading to] malignant normality – in other words, the gradual acceptance by a public inundated with toxic untruths... until they pass for normal.” Sheehy then quotes another of our authors, Dr. James F. Gilligan: “Trump is... no more normal than Hitler,” and he refers to Trump’s “massive hypersensitivity to shame or humiliation.”

David Brinkley is also quoted in the Sheehy essay: “In Trump’s world, he must win at all costs. It’s not about character or public service or looking out for your band of brothers.” Comparing Trump to Nixon, the author notes “Trump’s appetite for vengeance,” quoting Nixon biographer John Farrell: “Once wounded, these men never stop bleeding.” She characterizes the current president as “totally indifferent to the truth.”

Is Harm Imminent?

Another of our authors, Diane Jhueck, L.M.H.C., D.M.H.P., concludes her essay with these words: “The earth itself is in peril.” She opens, however, with the note that “of all thirty-seven US presidents up to 1974... nearly half of them had a diagnosable mental illness, including depression, anxiety, and bipolar disorder... Notably, however, personality disorders were not included in this study... Psychiatric illness alone in a president is not what causes grave concern...Is the president dangerous by reason of mental illness?” She says it’s important to “separate mental symptoms from things such as poor judgment or opinions and points of view that differ from one’s own.” The law says “it must be a disturbance of cognition, emotion regulation, or behavior... that is driving the patterns of dangerous behavior.” And, she adds, “the magnitude of the perceived harm must be considered... Is there actual damage being perpetrated?” Do behavior patterns “indicate that harm is imminent?”

Jhueck continues: “When an individual in high office makes decisions, some people may be hurt in some way... This remains an unfortunate effect of governing large groups of people... the very reason... that the leader of the United States be mentally and emotionally stable... For the leader of the free world, inappropriate words alone may create... devastating hardships to others.”

Referring to the MacArthur Violence Risk Assessment Study, Jhueck notes that “’Psychopathy [antisocial personality disorder]... was more strongly associated with violence than any other risk factor we studied.’” She notes that the president, “having access to the nuclear arsenal... should be of lower risk of violence than the average citizen... a mental health detention may need to be considered.”

“There is a preponderance of information in the public record regarding Donald J. Trump’s aberrant behavior,” the author notes. She says her intent is to “reach a reasoned conclusion about whether President Trump’s patterns of behavior indicate a clinically relevant ‘danger to others.’” Commenting on “harrowing” threats and suggestions of violence at his rallies, Jhueck explains that his defenders simply say “he did not mean the statement that way... what he said was a joke.” She says that “in no way discounts the dangerousness of his remark... [it] exemplifies the ‘willingness to violate others’ and the lack of empathy that characterize anti-social personality disorder.” She points out that “In modern history, no other candidate for president of the United States joked about his followers murdering his opponent.”

Jhueck says that “... the type of individuals Trump’s psychopathy leads him to look to for affirmation and support... [are] either family members or people who, in clinical jargon, ‘enable’ his illness.” His symptoms include, “impulsive blame-shifting, claims of unearned superiority, and delusional levels of grandiosity.” She mentions his “unhinged responses to court decisions,” saying they are “of grave concern... he has on more than one occasion questioned the legitimacy of the court.”

The author quotes some of her professional colleagues saying, “There are situations that put fear... into... the entire community.” They cite “increased hate-based crimes at schools... a record of 16,720 complaints... filed nationwide...a 61 percent increase over the previous year... an unprecedented spike in hate crimes... directed against African Americans, immigrants, members of the LGBTQ community, religious minorities, women and people with disabilities.” She points out that “threats and harassment... intimidate and silence.”

Next Jhueck suggests that “It is instructive to remove the variable of political ideology... and narrow our review to the perspective of Republicans only.” She notes a letter signed by 50 such individuals in August 2016, all self-identifying as “[having] served in senior national security and/or foreign policy positions in Republican Administrations, from Richard Nixon to George W. Bush.” The letter says: “We know the personal qualities required of a President... None of us will vote for Donald Trump... he would be a dangerous president... A president must be willing to listen... encourage consideration of conflicting views... acknowledge errors and learn from them... be disciplined, control emotions, and act only after reflection and careful deliberation... must maintain cordial relationships... have their respect and trust, be able and willing ‘to separate truth from falsehood.’” She says the letter writers conclude: “... he would be the most reckless President in American history.” Then she reminds us of the nuclear codes at his disposal, relating a “nightmare scenario of this unstable, impulsive, blame-shifting, and revenge-obsessed individual having mere minutes to make the kind of decision required.”

Jhueck notes that “Trump has distanced himself from possible checks and balances while enabling his own disorder: a lack of insight and confirmation seeking... He exhibits extreme denial of any feedback that does not affirm his self-image... he consistently displays a revenge-oriented response to any such feedback. Holding office at once feeds his grandiosity and claws at the fragile sense of self underneath it.” And then she closes with that awful warning: “The earth itself is in peril.”

Betty Teng summarizes the danger like this: “...his dramatic and inconsistent behavior captures all media attention [and] becomes a compulsive fixation for us all... Without adequate time to process what shocks or destabilizes us, we cannot make sense of what happened... Our president’s narcissistic, attention-hungry outrageousness for spectacle has resulted in a flood of incendiary news... Yet we gorge ourselves on such toxic infotainment... We watch because we’re worried...” Teng refers to “an epidemic of heightened anxiety... he shuts down our ability to reflect, causes us to doubt reality, and thus encourages reactivity and stress, keeping us in a difficult-to-sustain state of crisis.”

Our Trump Anxiety Disorder

Jennifer Contarino Panning, Psy.D., entitled her essay “Trump Anxiety Disorder,” but her focus is on its effect on the rest of us. She warns that “It is important to differentiate generalized anxiety disorder and Trump anxiety disorder,” and so she begins by summarizing the official definition of anxiety disorder used by mental health professionals: “excessive, uncontrollable, and often irrational worry... apprehensive expectation about events or activities.”

People with Generalized Anxiety Disorder, she says, “anticipate disaster and are overly concerned about everyday matters such as health issues, money, death, family problems, interpersonal relationship problems, or work difficulties.” They often exhibit “physical symptoms, including fatigue, fidgeting, headaches, nausea... stomach pain... diarrhea...” She says it’s actually “one of the more prevalent mood disorders in Americans.”

Symptoms associated with Trump anxiety disorder, Panning says, include “feeling a loss of control; helplessness; ruminations/worry... a tendency toward excessive social media consumption.” Then she identifies some of Trump’s “psychological manipulation tools:
gaslighting, lying and blaming.”

“Many Americans impacted by Trump anxiety disorder,” according to Panning, “have admitted to an unhealthy obsession with checking news websites... and the amount of news involving Trump... has been constant, chaotic, confusing, and often overwhelming.” (And this was back in 2016-17 – in my opinion, mild compared to 2025.) Why does Trump “gaslight” the public? The author quotes Stern, indicating he “desperately needs to be right in order to bolster his own sense of self and hold onto his own sense of power.”

Panning reports that, prior to the 2016 presidential election, she had “zero Trump supporters among [her] caseload of clients. After the election... most clients struggled with similar feelings of shock, sadness, worry, panic, uncertainty for the future, and anger.” Focusing on one specific patient as an example, she says, “Our work was to help ground her in what she could and could not control... Many times the role of the therapist involves helping clients feel more hopeful and confident in their lives. This task proved to be quite difficult, as we therapists were left with similar feelings of helplessness.”

The Doomsday Clock

Finally, what does a 97-year-old revered (leftist) American professor and intellectual have to say about the danger? Noam Chomsky (not a mental health expert) was invited to write the epilogue for this book; I will share some of his insights here. Chomsky asserts that “much of the support for Trump is coming from mostly white, working-class people who have been cast by the wayside during the neoliberal period.” He says their own “elected officials barely reflect their interests and concerns.” Therefore “contempt for institutions, especially Congress, has just skyrocketed.” Chomsky mentions the issue of great wealth having gone into very few hands.

He cites two “huge dangers... nuclear war... and... environmental catastrophe,” noting that “Trump wants to virtually eliminate the Environmental Protection Agency... cut back regulations, and race toward the precipice as quickly as possible.” He also mentions military “confrontations that could be extremely hazardous.” In fact, Chomsky asks, “How close are we to termination of the species?” He warns, when the Doomsday Clock “hits midnight, we are finished.”

Chomsky explains that, when the nuclear age began in 1947, we were “seven minutes to midnight. It has been moving back ever since.” In the early 1950s, with hydrogen bombs and intercontinental ballistic missiles being developed by both the US and Russia, “it came to two minutes to midnight.” In 2014, though, analysts noted that the beginning of the nuclear age “coincided with the beginning of a new geological epoch, the so-called Anthropocene... So we are in these two eras in which the possibility of human survival is very much at stake.” A few years ago, Chomsky says, we were at “three minutes to midnight.” One week into Trump’s first term, he asserts, we were at two-and-a-half minutes to midnight.

Eventually, Chomsky says, the white working class will see that “promises are built on sand.” To maintain his popularity, he explains, Trump will “find some means of rallying the support and changing the discourse.” He now suggests the Trump administration might try “scapegoating,” a strategy explained in detail by another author later in this summary. The two authors agree that the blame for all “ills” will be cast on vulnerable people: immigrants “terrorists,” Muslims, elitists. Chomsky even warns of the possibility of a “staged or alleged terrorist act, which can change the country instantly.”

2. How did this “danger” develop?

Let’s now take a look at the essay by another author who has no training in mental health, but brings to the table a most unique perspective on Donald Trump: Tony Schwartz, Trump’s co-author for The Art of the Deal. Perhaps, before we explore the development of danger to the nation, we should understand (if possible), how “a dangerous president” even got that way. Schwartz claims Trump’s “self-sabotage is rooted in his past.” He says, after spending nearly a year in close contact with Trump, that “none of what he has said or done over the past four months as president comes as a surprise.” He claims it’s all “entirely predictable.”

“Trump’s sense of self-worth,” Schwartz asserts, “is forever at risk. When he feels aggrieved, he reacts impulsively and defensively, constructing a self-justifying story that doesn’t depend on facts and always directs the blame to others.” When I first met him in 1985, Schwartz explains, he “had lived nearly all his life in survival mode... His father, Fred, was relentlessly demanding, difficult, and driven... His older brother, Fred, Jr., who became an alcoholic and died at age 42, was overwhelmed by his father.”

He goes on: “To survive... Trump felt compelled to go to war with the world... You either dominated or you submitted.” Schwartz calls it a “narrow, defensive outlook,” explaining that “Trump grew up fighting for his life and taking no prisoners... [he] treated every encounter as a contest he had to win,” confessing that “Many of the deals in The Art of the Deal were massive failures... but Trump had me describe each of them as a huge success.” He recalls how Trump bragged about being an “assertive, aggressive kid [who] had once punched a music teacher in the eye.” What is clear, Schwartz says, “is that he has spent his life seeking to dominate others.”

“I never sensed from Trump any guilt or contrition about anything he’d done,” Tony Schwartz reports. “He didn’t value – nor even necessarily recognize... empathy, generosity, reflectiveness, the capacity to delay gratification, or, above all, a conscience... The life he lived was all transactional, all the time.” He continues: “Facts are whatever Trump deems them to be... When he is challenged, he instinctively doubles down... exaggerating the number of floors at Trump Tower or... telling me that his casinos were performing well when they were actually going bankrupt... His aim is never accuracy; it’s domination.”

“The Trump I got to know,” Schwartz reports, lacked any “deep ideological beliefs... [or] feeling about anything but his immediate self-interest. He derives his sense of significance from conquests and accomplishments... Trump has more opportunities now to feel significant and accomplished than almost any other human being on the planet... Trump also now has a far bigger and more public stage on which to feel unworthy.”

Schwartz says that, from the moment he met him in Trump Tower in 1985, “the image I had of Trump was that of a black hole... a hurt, incredibly vulnerable little boy who just wanted to be loved. What Trump craves most deeply is the adulation... Trump’s need for unquestioning praise and flattery also helps to explain his hostility to democracy and to a free press – both of which thrive on open dissent... He reacts rather than reflects, and damn the consequences. This is what makes his access to the nuclear codes so dangerous and frightening... The more he feels at the mercy of forces he cannot control... the more resentful, desperate, and impulsive he becomes.”

Trump’s co-author reports that, in the hundreds of meetings and phone calls he observed over that year, “I can never remember anyone disagreeing with him about anything.”

Identifying with the Aggressor

Author Steve Wruble, M.D., digs into the fundamental problem that created “a toxic mix for America”: Trump’s Daddy Issues. He begins this way: “As a psychiatrist, I am interested in why people are the way they are...I’d like to take a short drive through Donald Trump’s life to show you some things that help make sense of what we’re witnessing... how Trump’s relationship with his father, Fred Trump, may have impacted his development.”

As Donald watched the demise of his older brother due to alcoholism (because, Wruble says, Fred Trump’s “intensity was too much for Freddie, Jr.”), Donald “stepped up and became his father’s protégé in his building empire... Donald appeared to be attracted to... the challenge of being more successful than his father.” His childhood friends, the doctor says, saw Donald’s “often palpable need to please and impress the patriarch... Donald said he learned his father’s values, and his killer sense of competition.”

Dr. Wruble asserts that “there is a good chance he identifies with his father’s aggressive business style and parenting, and is now employing that orientation to his role as president. In psychology, this is called identification with the aggressor... our brains often use this early relationship as a template to shape our future behavior. We are attracted to the power we witness from our powerless position... Individuals with such a history often exhibit insecurities that can lead to all kinds of compensatory behaviors... fear usually still exists unconsciously and can be uncovered at times of stress.”

Trump appears to compensate for his insecurity, Wruble explains, “by trying to be seen as powerful and special with the hope that he will indeed feel powerful and special.” The author explains that “early events that stimulate our fight-or-flight response have long-lasting effects... Trump will most likely change his way of being only if reality throws him a large enough curveball to which he is unable to respond using the signature defensive measures he has grown accustomed to... He is either limited in understanding the impact of his behavior or insensitive to it.”

Wruble concludes: “Trump’s base of support saw in him the strength to be powerful in ways they didn’t see in themselves and/or in past leadership. What they may not be aware of is that President Trump appears to question his own ability to deliver what they are seeking. Evidence of this can be seen in his use of lying, distortion, marginalization, and the firing of those he fears are disloyal... What most concerns me is whether we Americans can tread water long enough to come together and avoid being pulled under.” (As I read these words in early 2025, I cannot help but see that we are no longer treading water; now we face a tsunami of irrational, thoughtless, and terrifying behavior – in my opinion.)

And the danger to America?

Doctor Lifton, psychiatrist, refers to Trump’s “creation of his own reality and his inability to manage the inevitable crises that face an American president.” He goes on to explain that, because Trump is president, “there is a tendency to view what he does as simply part of our democratic process.” In this way, “a dangerous president becomes normalized, and malignant normality comes to dominate our governing.”

Lee and Herman explain in their Prologue that “our nation is now living in... a paradigm that splits along partisan lines, and the quick conclusion will be that the speakers or contributors of this volume ‘must be Democrats’ if they are casting a negative light on a Republican president. However, there are other paradigms... health versus disease... The leader of the Free World has proven himself unfit for duty by his extreme ties to the present moment, without much thought for the consequences of his actions or for the future.”

The two mention the work of Malkin: “Narcissism happens on a scale, and... pathological levels in a leader can spiral into psychosis and imperil the safety of his country through paranoia, impaired judgment, volatile decision making, and behavior called gaslighting.” Then they refer to Tony Schwartz, quoted above. Schwartz says that, during that year he worked with Trump, he “could have predicted his presidency of black hole-level low self-worth, fact-free self-justification, and a compulsion to go to war with the world.”

The Prologue also alerts us to words published by another of our authors, Dodes, who “shows that someone who cons others, lies, cheats, and manipulates to get what he wants... may be... severely impaired, as sociopaths lack a central human characteristic, empathy.” They also preview Gartner, who “emphasizes the complexity of Trump’s presentation, in that he shows signs of being ‘bad’ as well as ‘mad,’ but also with a hypomanic temperament that generates whirlwinds of activity and a constant need for stimulation.”

Betty P. Teng, M.F.A., L.M.S.W., writes about “how a president freezes healing and promotes crisis.” She opens with a reference to a colleague who says that reactions to the Trump presidency have been far worse than reactions to the 9/11 terrorist attacks on the World Trade Center. Why? “Trump was elected by those among us, and his aggression feels incessant and never ending.” Teng asks, “How could a nonviolent event such as the peaceful election of a president generate a trauma response?” She reasons, “One could not equate Trump’s win with an actual physical attack or a natural catastrophe. Or could one? The American Psychological Association defines trauma as ‘an emotional response to a terrible event...’”

Now, Teng calls herself a “trauma therapist,” and she sees parallels between the response to Trump and PTSD! She cites “the incessant barrage of aggressive words and daily reports of the erratic conduct of a powerful, narcissistic, and attention-seeking world leader.” Applying “PTSD” as “Post-Trump Stress Disorder,” Teng notes that some have wondered whether it’s “real, or just another example of how ‘snowflake liberals,’ goaded on by a ‘hysterical’ left-leaning media, overinflate their suffering.” She concludes that, “Donald Trump, a wholly unqualified president who neglects history, highlights division, and makes impulsive decisions, would foment unrest in us all.” She calls him “a destabilizing force that stirs some of us to the point where we experience him as a psycho-socio-political tornado.”

3. Addressing Post-Trump Stress Disorder

Teng asks: “Is Donald Trump causing a trauma epidemic?” She points to “two key components of trauma (time and truth)” hoping to show “how we can minimize Trump’s effect on us.” Teng says “we can prevent ourselves from becoming overwhelmed and immobilized by anger or anxiety.” She quotes Jade E. Davis, a cultural studies professor: “trauma can exist only in the post-tense,” because, she says, it must be “after survivors have been able to find words to describe the horrific event... Communicating fully is the opposite of being traumatized.” But, she says, that “takes skill, care, and time... traumatic experiences silence the speech centers of the brain... rendering us literally speechless.”

The author explains that, “without language, there is only mindless action and reaction, a cycle driven by fear, panic, and dissociation.” And, she says, “This is the state that President Trump keeps us in... flooding media outlets, both old and new, with myriad vindictive tweets, defensive press conferences, and sudden firings... if Trump were not president... his ravings would simply be those of an arrogant, unmindful, loudmouthed reality TV celebrity who compulsively seeks attention.” So, why can’t we break away? Teng refers to important “aspects of our current technological climate which... keep the American public fixated on his toxic behavior and stuck in a state of chaotic, meaningless crisis. Our ever-increasing use of the Internet demands that we process new information...” Moving on to social media, Teng mentions Descartes’s “I think, therefore I am,” suggesting our truth now is “I post, therefore I am.”

“Seeking... satisfaction via the Internet is like trying to quench thirst by sipping water from a fire hose,” Teng warns. “The onslaught of information disallows us from taking the time to truly consider any of it.” This is what causes us to believe “dangerous and unchecked falsehoods,” noting “the alarming political consequences of our collective inability to think or verify the truth.” And so she asks: “Can Democracy survive the Internet?” She says it does uniquely privilege messages that appeal to outrage and grab attention, adding that “Democracy depends on both the ability and the will of voters to base their political judgments on facts.”

In the section of her essay entitled “Trauma and Truth,” Teng notes that “we have, as our U.S. President, a narcissist fixed on broadcasting his own unilateral and inconsistent versions of reality” through “channels that produce information so quickly that they privilege falsehoods over truth.” She goes on to say that “it is traumatizing to have... a president... intent on confounding ‘full communication’ by manipulating the truth to serve their own ends,” claiming that “Trump... aims to subvert our relation to reality in general.” Whether we accept or reject this strange reality Trump and his followers are trying to impose on us, Teng says, it remains “an ever-present source of the specific confusion and anxiety that Trumpism evokes”

“When a world leader... insists on there being ‘alternative facts’ derived from a reality only he knows, this is alarming and destabilizing for us all,” according to Teng. It “puts the definition of truth and reality into the hands of those with the most social, political, and/or economic power. Donald Trump,” she says, behaves like an aggressive perpetrator who fundamentally has no respect for the rights and subjectivities of those in American society who disagree with him.” He shames “individuals who will not bend to his opinion... creating deep wounds from which, I fear, it will already take us years to heal.” (And, again, to keep us grounded: This was written at the start of the first Trump administration.)

Recognizing our own Pathology

Thomas Singer, M.D., entitled his essay Trump and the American Collective Psyche. He explains, “my focus is less on individual psychopathology than on the interface between Trump and the American collective psyche... Trump mirrors, even amplifies, our collective attention deficit disorder, our sociopathy, and our narcissism... this is less about diagnosing a public figure than about recognizing our own pathology.” He points out that “The more vulgar, bullying, impulsive, and self-congratulatory Trump’s behavior and rhetoric, the more some people worship him.”

The author notes a direct link between Trump’s narcissism and “the collective psyche of those Americans who... feel that he understands and speaks to them... the group psyche...contributes enormously to and fuels political processes.” These energies, he says, “are activated at times of heightened threats to the core identity of the group.”

Now Singer cites a 2009 piece by Christopher Hedges: “Reality is complicated. Reality is boring. We are incapable or unwilling to handle its confusion.” Hedges refers to “our collective inability to sort out illusion from reality... our cult of celebrity... intoxication with celebrity.” In this celebrity culture, Hedges explains, “no one has any worth beyond his or her appearance, usefulness, or ability to succeed. [We seek] wealth, sexual conquest, and fame... We can do anything... to make money, to be happy, and to become famous.”

Singer then claims that “Trump’s narcissism and attacks on political correctness dovetail with deep needs in a significant portion of the American population to enhance their dwindling sense of place in America... a perfect compensatory mirror for the narcissistic needs and injuries of those who support him... to protect against further injury...[with] hope of a cure for the wound.”

Expanding on “a wound to the American Group Self,” Singer identifies “those who have not participated in our nation’s prosperity...others who are... aware that our system of government and our way of life are threatened...” He notes the “nervousness about our essential well-being... those who feel alienated and angered by the current leaders of all branches of government...”

The author says he postulates amplification of these threats by “an even deeper, less conscious threat that I call extinction anxiety... both in the personal and group psyche... fear of the loss of supremacy by white Americans... loss of America’s place in the world... destruction of the environment and the world itself.” For example, he cites “climate change deniers... denying the very real possibility of the planet’s destruction... defending themselves against the fear of extinction.” Trump denies it is real and, Singer says, appoints “a well-known climate change denier as head of the EPA.” (This, in 2016-17, by a psychiatrist who could not have imagined Trump’s 2025 cabinet picks!)

“Denial,” Singer explains, “whether at the individual or group level, is the most primitive defense the mind employs to protect itself from psychic pain.” He goes on to quote Joseph Epstein in 2016, describing “the United States on the descent, hostage to progressivist ideas that... foster a state of perpetual protest and agitation, anger and tumult.” Epstein says Americans “are ready to turn, in their near hopelessness, to a man of Donald Trump’s patently low quality.”

Singer recalls our country’s past “capacity to transcend loss, failure...a positive vision of ourselves that has been fundamentally solid at the core for a long time... that Self-image is subject to inflation, arrogance, and a morphing into hubris, in which we believe in our own exceptionalism and are blind to our causing grave injury to peoples at home and abroad... Trump’s personal inflation, arrogance, and hubris represent [an] antidote...to... self-doubt about our ability to navigate a highly uncertain future.”

Riding the Wave of Resentment

The author notes that “many feel cut off from what they believe to be their inherited, natural birthright as American citizens... a narcissistic injury at the group level... Trump has somehow intuited that injury.” And how does Trump embrace “the shadow of political correctness”? Singer refers to Trump’s 2016 “attack on political correctness... when he urged... his crowd to get rid of protestors... Mexicans and Muslims... He sensed that political correctness could be the trigger word... He rode a huge wave of pent-up resentment, racism, and hatred... Skillful politicians can trigger cultural or group complexes by a collective word association process... Trump is at his best when he is at his most awful... politically incorrect.”

“A group caught up in a cultural complex has highly selective memory,” Singer says. “No matter what Trump does or how many lies he tells, his base remains steadfast.” Trump can exploit “a group that previously saw itself as having a solid place in American society... [and now] finds itself marginalized... [seeing] immigrants... stealing the American dream from them... What a relief... to hear a politician speak their unspoken resentments and express their rage... facts simply become irrelevant.”

(Now, as the author comments on Trump’s cabinet picks of 2017, I gasp, having just witnessed Trump’s cabinet picks of 2025.) But, back then, Singer wrote: “Trump’s cabinet appointments strongly suggest that... the job of each new Cabinet leader is to reverse or dismantle the very reason for which his or her department exists.” He goes on to discuss the “archetypal defenses of the Group Self,” writing that “the most primitive psychological forces come alive for the purpose of defending the group and its collective spirit or Self... when it is threatened, the defenses mobilized to protect it are ferocious and impersonal.” (I can’t help but think of January 6, 2021, at the U. S. Capitol!)

“What makes Trump’s narcissism so dangerous,” the author explains, “is that it plays to the unholy marriage of Self and the aggressive, hateful, and violent elements in the collective psyche... [giving] permission for shadowy thoughts, feelings, and actions on behalf of the Self. This underlying group dynamic explains the comparison of Trump to Hitler... [who] mobilized the most shadowy forces in modern history in the so-called service of that Self-image... there is great danger of violence, tyranny, and absolutism – especially with an authoritarian leader and a citizenry responsive to authoritarianism.”

And what is the “cure” for that “wounded Self of America”? The author notes “Trump’s implicit promise of providing a cure for the wound... This is where his narcissism is most prominent and most dangerous.” Singer offers “the unconscious equation... By identifying with how great I am, you can rekindle your wounded American dream and make yourself and America great again... I am the incarnation of the Self that the country aspires to.” And so Trump identifies himself with the Self of America, encouraging disillusioned Americans to “place their trust in him as a mirror of their own potential.” In fact, in his own The Art of the Deal, Trump says, “People want to believe that something is the biggest and the greatest and the most spectacular. I call it truthful hyperbole.” Singer says Trump is suggesting that “You, too, can be like me: aggressive, successful, big, powerful.”

Ultimately, the psychiatrist points out, “the Trump phenomenon is less about Trump than about us... He has taken up residence not just in the White House but in the psyches of each and every one of us.” The author refers to Trump’s “capacity to dwell in and stink up our collective inner space,” saying “Trump has grabbed the American psyche by the ‘pussy.’”

4. We didn’t see this coming?!

Zimbardo and Sword, in their essay called “Unbridled and Extreme Present Hedonism... Unfit for Duty” take us back to the summer of 2015: “We didn’t take him seriously... He had no political experience, and he failed to show any real interest in philanthropy, much less in helping the American people... His products were made outside the United States... he didn’t pay those small businesses that supplied him... Trump University... was a scam... Students... won their lawsuits, and Trump U got dumped... [He] was a businessman interested primarily in personal gain, sometimes using unscrupulous methods... Trump had flip-flopped, switching political parties.”

The authors say that, over the next few months, they “became increasingly concerned... he would appeal to people who were unaware of the dangers of narcissism in extremis, or of the offensive behaviors that can accompany it.”

5. The professionals respond

Lifton explains that psychological professionals “need to combine our sense of outrage with a disciplined use of our professional knowledge and expertise.” He asserts that he and his colleagues need to use “our knowledge and technical skills to expose such normality, to bear witness to its malignance—to become witnessing professionals.” Lifton urges the combination of scholarship and activism, saying “I believe that some such approach is what we require now, in the Trump era.” We must “be disciplined about what we believe we know, while refraining from holding forth on what we do not know... bring our experience and knowledge to bear on what threatens us and what might renew us.”

In their Prologue, Lee and Herman explain that, “Soon after the presidential election of 2016, alarmed by the apparent mental instability of the president-elect, we both separately circulated letters among some of our professional colleagues, expressing our concern. Most of them declined to sign.” They warned about being “targeted,” demonstrating how “a climate of fear can induce people to censor themselves.” But, they explain, “if professional endorsement serves as important cover for human rights abuses, then professional condemnation must also carry weight.”

The Safety of the Public is Paramount

Lee and Herman continue: “No doubt, the physician’s responsibility is first and foremost to the patient, but it extends as well to society.” Then we are introduced to the “Goldwater Rule,” which will be referenced by several authors. It “highlights the boundaries of practice, helps to preserve professional integrity, and protects public figures from defamation.” But, they add, “even this respectable rule must be balanced against the other rules and principles of professional practice,” explaining that “the safety of the public [must] be paramount.” They assert that “the public trust is also violated if the profession fails in its duty to alert the public when a person who holds the power of life and death over us all shows signs of clear, dangerous mental impairment.”

The Prologue continues: “Only in an emergency should a physician breach the trust of confidentiality and intervene without consent, and only in an emergency should a physician breach the Goldwater rule. We believe that such an emergency now exists... If... we perceive that state power is being abused by an executive who seems to be mentally unstable, then we may certainly speak out... as professionals who are privy to special information and have a responsibility to educate the public.”

Zimbardo and Sword decline to actually “diagnose,” but they cite Trump’s “condescension, gross exaggeration (lying), bullying, jealousy, fragile self-esteem, lack of compassion, and viewing the world through an ‘us-vs.-them’ lens.” They recall “having observed the schoolyard bully tactics... and his absurdly boastful presentation during interviews.” They report that, in January 2016, they published an outline in Psychology Today about “bullies and the hostile social environments they create,” and they reflect that, as Trump’s campaign gained momentum, they increased their “efforts to make people aware of the potential dangers he posed for our democracy,” publishing a column in March 2016 “about the narcissistic personality.” The authors say they were “hoping it would be easy for readers to come to their own conclusions that Trump fit every example.”

What Zimbardo and Sword did not mention, they now explain, were Trump’s “romantic dalliances... sexual harassment lawsuits... or his three marriages.” They say each of these behaviors, on its own, is not exceptional, but that anyone could see that “these behaviors, coupled with his ever-shifting political party affiliations... indicated that this person’s main focus was self-interest... incongruent with one important character trait” we Americans expect in our president: “stability.”

Invoking the “Tarasoff doctrine” based on Tarasoff v. Regents of the University of California (1976), these two authors state that “it is the responsibility of mental health professionals to warn the citizens... of the potentially devastating effects of such an extreme present-hedonistic world leader... When an individual is psychologically unbalanced, everything can teeter and fall apart if change does not occur.” Zimbardo and Sword charge that “We believe that Donald Trump is the most dangerous man in the world... We are gravely concerned about Trump’s abrupt, capricious 180-degree shifts... displays of instability... [with] the potential [for] causing catastrophe.” They claim that Trump is “chumming for war.”

Clinical psychologist John D. Gartner closes his essay with this warning: “History will not be kind to a profession that aided the rise of an American Hitler through its silence.”

In an essay entitled “Health, Risk, and the Duty to Protect the Community,” Howard H. Covitz, Ph.D., A.B.P.P., like his co-authors, first cites the tension between the Goldwater rule (protecting a public figure from defamation) and “the duty to warn those who may be at risk of serious harm from the very same public figure... In the psychological and social science,” Covitz says, “theoretical neatness is a luxury... theories... are intertwined with the views of a healthy polity, with the need to protect the community, and with a vision of the good life.”

When the Leader is Unhealthy

Covitz warns of the dangers of “cultural bias... assumptions and values” in such an undertaking as this, and then he offers a three-part definition of “the healthy person”:

Has “the capacity to recognize his own wishes and impulses...”
Can “determine whether... actions... are likely to cause avoidable damage to himself or others...”
Has “the agency necessary to act upon those impulses without intrusive anger, anxiety, depression, guilt, prohibition, or shame”

Then the author moves to the other “subgroup of humanity,” describing “those who fail to accept others as subjects in their own right... the personality-disordered subgroup”:

“generally incapable of understanding and responding in an emotionally empathic way to how another feels... others... remain objects to them, like pieces on a chessboard to be moved about in order to win the game.”
“black-and-white thinking splits the world into friend or foe...”
“... these people react more quickly, and with less skepticism about the correctness of their actions.”
They “have not yet developed respect for others’ thinking, relationships, or efforts... [they] put little value in the accomplishments of others... they tend not to recognize the necessity for maintaining extant organizations, government structures, conventional practices and laws.” (I pause again and catch my breath, thinking how prescient all of this was in 2016/17 as I watch, in 2025, Elon Musk dismantle our federal government to the glee of the again-elected Donald Trump.) “They may appear civilized but are not safely socialized.”
As a result, “thinking is focused but lacks nuance... a monomania of sorts... ‘my will be done’ syndrome...”
“Display limited capacity to distinguish the real world from the wished for or imagined... [with a] willingness to distort the truth.”

Covitz offers two “fables,” which I will leave to your own reading, but he concludes them with this statement: “the damage... was done, the lies were believed by tens of millions of Trump’s followers, violent rhetoric at his meetings produced real harm, and Mr. Trump has irresponsibly alienated (so far) five of our closest trading partners.” (Again, back in 2016-17, that was the status – well before his 2025 tariffs on Canada and Mexico, his threats to seize Greenland and the Panama Canal...) Concluding his essay, Covitz writes: “Donald Trump has displayed, frequently, all six of the characteristics that I and many other mental health professionals associate with severe character pathology... When the outcome is possibly devastating, even if the probability that it will occur is relatively small, the clinician and perhaps every citizen is duty-bound to warn.”

Trump “displays all the signs of a seriously personality-disordered person and has repeatedly spoken of using violence,” Covitz writes. The outcome, if he is indeed as ill as some sizable portion of the mental health professional community suspects, could well be potentially devastating to a significant percentage of humanity.” He suggests we should “have Mr. Trump psychologically and psychiatrically examined – or, in the absence of his willingness to do so, to have him removed from office.” Finally he closes with a warning we’ve heard from his colleagues: “a possibly unfit-to-serve president who is in the possession of the U.S. nuclear codes.”

A Scorpion King?

In his essay on “mental incapacity, the electoral college, and the Twenty-fifth Amendment,” attorney James A. Herb relates his efforts to gain an official determination of Donald Trump’s “alleged incapacity,” beginning before the 2016 election. He says he compiled a “list of 200 items that I believed reflected his mental disability to discharge the duties of the president.” Why? “I was concerned that we might end up with a scorpion king in the White House, someone who was unable to control a dangerous part of his nature.” He filed it about a month before the election, citing actions and statements supporting a “histrionic personality disorder... [and] a diagnosis of narcissistic personality disorder.” The result: “The day before the election, the court dismissed my incapacity proceeding.”

After the election, Herb asked the court to reconsider its decision; that did not happen. Herb continued to record his observations: “In those first ten days, Trump espoused at least two delusional beliefs... the size of the crowd at his inauguration... [and] that Secretary Clinton had won the popular vote... only because between three million and five million illegal votes had been cast.” Herb goes on to note “various executive orders that demonstrated his mental inability to comprehend... what is and is not legal... what he can and cannot do without ...funding approval from congress... and what is and is not in the best interest of our country’s security.”

He goes on to list Trump actions and decisions that suggested inability to govern well and possibly mental inability. For example, the author says his petition asserted that a president must have the capacity to:

Separate fact from fiction
Think through an issue or matter before speaking or acting
Be able and willing to learn about issues
Apply coherent decision making to fact
Communicate coherently
Be consistent in making statements
Comprehend likely results of statements or actions
Differentiate between acceptable an horrendous decisions
Understand, protect, and defend the US Constitution
Refrain from committing high crimes and misdemeanors
Make and keep agreements
Learn about and conduct foreign policy
Deal with people reasonably and effectively
Not be delusional
Understand basic principles of democracy (e.g. not claiming an election is “rigged” before it has occurred)
Be stable in thought and speech

Ultimately, the attorney asserted that “the statements of Trump support a determination that he suffers from narcissistic personality disorder.” He cited the characteristics that would “make him mentally incapable of continuing as president”:

“a grandiose sense of self-importance”
Preoccupation “with fantasies of unlimited success, power, or brilliance”
“believes he is special and unique”
“requires excessive admiration”
“has a sense of entitlement”
“takes advantage of others to achieve his own ends”
“lacks empathy”
“shows arrogant, haughty behaviors or attitudes”

Herb termed the mental problem “histrionic personality disorder,” based on behaviors that have included:

“inappropriate sexually seductive or provocative behavior”
“shallow expressions of emotions”
“speech that is excessively impressionistic and lacking in detail”
“theatricality and exaggerated expression of emotion”
“easily influenced by others or circumstances”

And so he refers to the Twenty-Fifth Amendment and outlines for the reader the way it has been used three times in our history to transfer power from a president who is unable to discharge the duties of that office. He reports: “On February 21, 2017, the court dismissed my second petition.” He filed an appellate brief on May 1, 2017, seeking an ultimate determination of whether Trump “is mentally incapacitated to serve as president.” It seems the matter was never resolved.

Should Professionals Speak Out?

Leonard Glass, M.D., M.P.H., titled his essay, “Should Psychiatrists Refrain from Commenting on Trump’s Psychology?” His opening lines: “You might think the answer is obvious, but it isn’t.” He explains that, “recently, the American Psychiatric Association’s Ethics Committee expanded its interpretation of the Goldwater rule to prohibit any comment by psychiatrists on a public figure that included reference to their professional status.” Then Dr. Glass goes on to say that the answer to his opening question is, “less obviously, ‘yes.’” He points out that, in the case of the president, “there is no patient,” going on to say, “Our duty to warn is an expression of our concerns as citizens possessed of a particular expertise; not as clinicians,” explaining that “one of the explicit ethical principles guiding physicians is to make ‘relevant information available to... the general public’... Thus it is precisely the role of trained professionals to offer expert perspectives to the public at large.”

Citing newsreels and “videotaped evidence of his behavioral reactions,” Glass says “there is an impressive quantity of Donald Trump’s emotional responses and spoken ideation for us to draw on.” He adds that “it’s a matter of opinion,” but then offers an explanation on “why I choose to speak out: These are frightening times. The current occupant of the White House is widely perceived as erratic and vindictive... those very elements of his character may well have endeared him to his base. He... repudiates ‘political correctness.’ That convinces some that he is authentic, saying things that they’ve felt but have feared to say out loud... [he is] easily moved to anger and heedless retaliation... appealing to people who feel powerless and oppressed.”

Dr. Glass says he can understand that. “It would be comforting to believe I had a forceful advocate who possessed the authority and motivation to fix what worries me.” And so he moves on to a discussion of “the essentially dangerous nature of Donald Trump as Commander in Chief.” He describes “a pattern of impulsivitythat leads to vengeful attacks on those who challenge him. He doesn’t seem to pause to consider the validity of facts and perspectives that are unfamiliar or displeasing to him. He presents himself as ‘knowing more’... having ‘great’ plans... [a] combination of overconfidence and rash reactions... constantly extols his abilities and feels driven to diminish and ridicule others...”

Such behavior, Glass explains, “often arises from profound insecurity, the very opposite of the supreme confidence that is being projected... he has, in fact, no demonstrated competence, but it soothes such a person’s inner doubts.” This impulsivity and “profound inability to acknowledge what one doesn’t know all augur profound psychological interference with the rational and considered exercise of power... This is a recognizable personality style that predictably impedes reliable judgment and a sound, considered response to crises.”

Then Glass asks, “Is Donald Trump mentally ill?” He concludes: “We don’t know and can’t tell if Mr. Trump knows that what he is saying is demonstrably untrue. What we do know is that he can’t be relied upon to recognize having been wrong... An elected leader whose psychological style (marked by impulsivity, insistence on his own infallibility, vengeful retaliation, and unwarranted certainty in

The Dangers of Paranoia

Dr. Henry Friedman calls his section of the book “On Seeing What you See and Saying What you Know – a psychiatrist’s responsibility.” It’s impossible not to see the problem, Friedman says, explaining, “Because of the constant exposure to Donald Trump on TV news and his open expression of his thinking in rapidly expressed tweets and a multitude of other extemporaneous, unscripted remarks, a trained observer cannot avoid noting the style of his thinking and his reaction to the existence of frustrating realities that challenge his version of events.”

Friedman continues: “Paranoid thinking, when persistent, is indicative of a paranoid character structure... an individual...will...find exaggerated danger and malevolent intent in others and in the situations he encounters... totalitarian leaders of the twentieth century have all manifested paranoid thinking.” He says they were “always acting to increase their power by suppressing freedom of the press and media, jailing or killing the political opposition, and militarizing their political power.” He notes, however, that “When attention is called to the resemblance between Hitler and Trump, it tends to elicit a veritable storm of objection.” Friedman concedes that “the restraints operating in our country have prevented Trump from moving as swiftly as Hitler did... attributed to the balance of powers and... democratic traditions.”

“Trump, like Hitler, began with his insistence on identifying the United States as in decline,” Friedman writes. Trump claimed Obama “had left our country in a mess, an ‘American carnage.’ This, despite the actual spectacular record of President Obama in saving the economy after the crash of 2008... For Hitler, the Jews represented an existential threat; for Trump, it is illegal immigrants and Mexicans in particular. Also... insisting on the nefarious intent of a large group... is typical of paranoid characters who need an enemy against whom to focus group hate.”

“Many critics of Trump... have focused on his so-called narcissism... minimizing the significance of his paranoid beliefs.” Some say he is just “feeding his base. In doing so, they are suggesting that he himself knows better... Yet, this overlooks and minimizes the more ominous probability: that he actually is paranoid and that there is an overlap of his personal hatreds and those of his followers... The very fact of a black man in the White House appeared to generate a degree of hatred and resistance... Trump used the racism of the white working class to engage their [the Republican Party] enthusiastic support... He depended upon his populist appeal to his followers’ discontent and disdain for the establishment... This reckless relationship to reality on Trump’s part...[is] a reliably occurring part of his character.”

Friedman now asks rhetorically, “Am I making a diagnosis of President Trump? Well, yes and now... There is one thing that I am refusing to do: to deny what I am hearing and seeing coming from Trump himself on the TV news and in the printed reliable press...His attack on the press, accusing real reporting of facts as being ‘fake news,’ is an attenuated version of the more extreme takeover of the media that is usual in totalitarian governments.”

The author continues: “A paranoid, hypersensitive, grandiose, ill-informed leader such as Donald Trump, who has surrounded himself with a cabinet and a set of advisers who either are unable to bring him out of his paranoid suspicions and insistences or, worse, identify with this positions, represents a multidimensional threat to our country and the world... Trump’s need to destroy everything that Obama achieved derives from the paranoid character’s hatred of goodness in others whose achievements he cannot attain, understand, or tolerate.”

However, Friedman concludes: “Judged by the criteria of classical psychoanalysis, no analysis of candidate or President Trump is possible... it is possible to think psychoanalytically about him only from a distance... to see him as a fit subject for descriptive reflection rather than treatment of any kind; we need to believe what we see in all that he reveals to us... these revelations cannot be normalized; nor will they change... His critics often treat him as if he were... merely acting like a child... suggesting that... he can still grow up... Such an approach... grossly underestimates the importance of Trump’s adult paranoid character with its belief in an apocalyptic vision of a weak, diminished Unites States that only he can save.”

“Ultimately,” Friedman writes, “the response to the Trump administration will have to come from the electorate.” (And, of course, 5 years later, we know exactly what that electorate did: Elected him again!) “Perhaps the observations of this psychiatrist-psychoanalyst... will help clarify why the threat of President Trump exceeds the issue of his policies, and resides instead in his core paranoid personality.” He says we should “be prepared to witness many more situations in which Trump feels betrayed and turns on those who have previously served him... and react with retaliatory anger – Hitler and Stalin, by murdering their newly minted enemies; and Trump by firing them. (Again, I must pause to reflect on the thousands of federal employees Trump has just fired at the start of his second term as president.)

Psychiatric knowledge, Friedman asserts, “is the only way to ensure the preservation and viability of our democracy and our national security.”

Troublesome Patterns of Behavior

Edwin B. Fisher, Ph.D., in his essay entitled “The Loneliness of Fateful Decisions,” devotes a great deal of space to a fascinating analysis of the1962 Cuban Missile Crisis, which I well remember, personally. His conclusion is that President John F. Kennedy acted and reacted with just the right self-control, patience, empathy and humility to avoid a catastrophe. I am not going to relate that analysis here; I certainly encourage you to read it on your own. However, from that analysis Fisher moves to contrast Donald Trump with a leader of Kennedy’s ilk. I will share his analysis of Trump, as that is the topic of the day.

Fisher first warns that one should not jump to conclusions about a leader without firsthand knowledge or an examination. He notes that his fellow authors have suggested “narcissism, psychopathic deviance, and attention deficit/hyperactivity disorder.” He concedes that “several diagnoses may be pertinent. What is important is... rather, understanding the behavior patterns that raise concerns about mental status and that affect policy decisions and public welfare.”

“In the case of President Trump,” Fisher explains, “acute threat, cognitive control, affiliation/attachment, social communication, perception/understanding of both self and others, arousal, and biological rhythms are all functions that may be pertinent to a number of the concerns that have been raised about his behavior.” The point, he explains, is “how they interact to lead to troublesome patterns of behavior that... have substantial societal implications... [that is] the basis for sounding the alarm.”

“The criteria for identifying psychopathology might be applied to judging the fitness of the president to exercise his power,” Fisher suggests. “What is striking,” he says, “is the persistence of some of his behavior in spite of strong disconfirmation... he seems not to notice the harmfulness of his behavior... He also appears to deny or ignore the aggressiveness of his behavior... These patterns persist despite... broad attention and even though they may place President Trump in jeopardy of criminal charges or impeachment.” (Prescient, back in early 2017, right?)

Fisher actually moves now to a discussion of “the criminal law for judging innocence by virtue of insanity... What is determinative,” he says, “is the inability to follow the law and understand how it applies to one’s own behavior... President Trump would suggest an inability on his part to recognize how his behavior is at odds with applicable laws... the Constitution, and important precedents.” He quotes James Gilligan as noted at the Yale conference: “It’s not whether [President Trump] is mentally ill or not. It’s whether he’s dangerous or not.” The author concedes that “the observation of experts in mental health and psychopathology suggest real liabilities in President Trump’s behavior. The question remains, however: does it matter?” Here Fisher quotes George Will in the Washington Post in May 2017, citing Trump’s “untrained mind bereft of information and married to stratospheric self-confidence.”

Now Fisher returns to a contrast between President Kennedy during the Cuban Missile Crisis and the newly minted President Trump. He notes that “personal characteristics may limit the nature and variety of the advice he receives.” Kennedy, according to his brother’s memoir, “would often ‘enlarge the meetings to include other options... [he] wanted people who raised questions, criticized... who represented an intelligent point of view regardless of their rank or viewpoint.’” Fisher then reminds us that, “central to narcissism is the self-referential defense.” He quotes Eugene Robinson, who said Trump “conflates power with virtue.”

Fisher cautions that one might limit his social network by “sensitivity to slights and angry reaction to them... Those left tend to be indulgent of the individual and to persist for other gains... [They] are also likely to be constrained... The more the individual selects those who flatter him and avoid confrontation... the narrower and more homogenous his network becomes, further flattering the individual, but eventually becoming a thin precipice.” He warns that “shrinking the network to the most loyal... [by] those who seek blind loyalty and flattery...leads to a preoccupation with the credit and praise received.”

So, how does Fisher assess the current president: “We are currently led by a man broadly flawed in his own person and supported by a truncated set of advisers.”(If only this author could see the “advisers” Trump has in 2025!) But he continues: “The impulsive, ill-considered, narcissistic, reckless, and apparently intentional lies, threats, and bravado not only damage the country but may leave the president even more isolated.”

Now Fisher turns to an interesting comparison of Kennedy and Trump on a personal basis, noting that “Both of their fathers were highly successful in business...Both were born to privilege... went to ‘the best schools’... were ‘womanizers’... but also apparently cared much for their families.” Therefore, the author says, we should focus on the actual behavior in question, noting that “wisdom from the fields of psychology and medicine can illuminate our understanding of these problems.”

A number of the mental health experts contributing to this volume identified specific mental illnesses they felt President Trump seemed to exhibit. Now we’ll take a look at some of those “diagnoses.”

A. Is it Extreme Present Hedonism?

Ultimately Zimbardo and Sword suggest the specific personality type Trump embodies: “an unbridled, or extreme, present hedonist,” who “live[s] in the present moment” and “will say whatever it takes to pump up his ego and to assuage his inherent low self-esteem.” They continue: “His time perspectives are totally unbalanced,” and “Trump qualifies as among the most extreme present hedonists we have ever witnessed... Donald Trump ... is therefore ‘unfit for duty.’”

They elaborate on the meaning of “TPT,” Time Perspective Theory, explaining that TPT “can cause us to be unsteady, unbalanced, or temporarily biased... [It] shades the way we think, and negatively impacts our daily decision making.” One might become “stuck in a past negative experience... or, if you are an extreme presenthedonist... living in the moment and not thinking about the future consequences of today’s actions.”

The authors discuss “present hedonism and arrested emotional development,” noting that “most children and teenagers are present hedonists.” They say that “we can only make a best guess as to whether Donald Trump suffers from arrested emotional development... [possibly related to] his extreme present hedonism.” They assure us that extensive print and video media examples expose “his bullying behavior, his immature remarks about sex, and his childlike need for constant attention.”

We are told, “An extreme present hedonist will say or do anything at any time for purposes of self-aggrandizement and to shield himself from previous (usually negatively perceived) activities, with no thought of the future or the effect of his actions.” Because the condition is usually coupled with some paranoia, they explain “extreme present hedonism is the most unpredictable and perilous time perspective... impulsive thought leads to impulsive action... If the person is in a position of power, then others scramble either to deny or to find ways to back up the original impulsive action.” Trump’s “stream of tweets or verbal remarks... spur others to try to fulfill, or deny, his thoughtless action.” They cite his tweet alleging that President Obama was tapping his phones, which “caused members of his staff to scramble to find evidence to make the false and slanderous claim ‘real.’”

Zimbardo and Sword go on to explain that extreme present hedonists often have the “unwitting... propensity to dehumanize others in order to feel superior.” They assert that, in regard to Trump specifically: “a rich trove of recorded examples gives us a strong picture of the inner workings of his unbalanced psyche.” They describe Trump’s behavior thus: “saying or tweeting whatever pops into his mind, making things up, repeating fake news, or simply lying.” The reader is now offered specific quotes by Trump (which I will leave to your own reading of the book) that illustrate his dehumanization of others, lying, misogyny, paranoia, racism and self-aggrandizement.

B. Maybe it’s Narcissism and Bullying

Zimbardo and Sword explain that Trump exhibits “two generally known personality traits that, when combined with extreme present hedonism, amplify our concerns: narcissism and bullying behavior.” His famous claim that “I alone can fix it” at the Republican National Convention is a perfect example of his narcissistic personality. People so afflicted, they explain, “think very highly of themselves while simultaneously thinking very lowly of all those whom they consider their inferiors, which is mostly everybody.” Narcissists are, we are told, “emotional, dramatic, and can lack compassion and empathy.”

Now we are introduced to specific symptoms of narcissistic personality disorder:

Believing you are better than others
Fantasizing about power, success, and attractiveness
Exaggerating your achievements or talents
Expecting constant praise and admiration
Believing that you’re special and acting accordingly
Failing to recognize other people’s emotions and feelings
Expecting others to go along with your ideas and plans
Taking advantage of others
Expressing disdain for those whom you feel to be inferior
Being jealous of others
Believing that others are jealous of you
Having trouble keeping healthy relationships
Setting unrealistic goals
Being easily hurt and rejected
Having a fragile self-esteem
Appearing tough-minded or unemotional

Whew! And there’s more from these two authors. “The narcissist,” they say, “looks down on others from his lofty pedestal... frequently appears to be a conceited, pompous braggart who dominates conversations and has a sense of entitlement... He becomes Mr. Petulant in action... What lies underneath... is often very low self-esteem.” A narcissist, they say, “can spot one of his kind a mile away and will either put down or generally avoid that other mindless competing narcissist.”

And then they introduce us to the “Bully Personality,” defining “bullying” as “systematically and chronically inflicting physical hurt and/or psychological distress.” The bully “overreacts... seeking revenge. Bullying behavior is often learned at home from family members,” and it is “caused by stress in the bully’s life. Bullies have often been abused or are driven by their insecurities. They... want to control and manipulate others to feel superior... Their targets are those whom they consider weaker... or different.” These actions “are intentional... usually on a repeated basis.”

Now we are introduced to the types of bullying: physical; verbal (“to gain power and control”); prejudicial (often targeting those who are “different,” sometimes leading to “hate crimes”); relational aggression, also called emotional bullying – “sneaky, insidious... social manipulation”; cyberbullying; sexual bullying, including “crude comments.” The authors say that “Trump over the years... has displayed every one of these bullying types,” behavior that was considered “unacceptable up until the 2016 presidential election.”

A Lesson in Narcissism

And now, back to narcissism. Craig Malkin writes about the “lethal mix” of pathological narcissism and politics, opening with a long story about former President Richard Nixon and the discovery of a secret slush fund late in his first campaign. He relates Nixon’s embarrassing, humiliating televised exposure of every one of his and Pat’s financial accounts, ending with a story of his little cocker spaniel named Checkers. It endeared him to the American people, and he enjoyed years of success until the Watergate scandal. Malkin says, “Strangely, this profanity-prone, paranoid tyrant both was – and wasn’t – the man people thought they knew.”

Concluding the Nixon story, Malkin says it is both fascinating and terrifying, because it “tells us a great deal about the relationship between personality and politics.” Nixon apparently displayed “a combination of intense ambition, authority, grandiosity, arrogance, entitlement, subterfuge, and self-importance that appears to have been common in the Oval Office throughout history. Nixon was a narcissist.”

Malkin explains: “narcissism, in fact, is best understood as a trait that occurs, to varying degrees, in all of us.” What he terms “healthy narcissism” is only slightly unrealistic: “Think of it as ‘rose-colored glasses for the self’—the glasses are strong enough to tint the world, but not so opaque they blind us to reality.” And it comes with benefits! Such people, Malkin says, “are happier, more optimistic, and more consistently self-confident.” While narcissism comes in many forms, he says, the extroverted kind is the most familiar to us. “Presidents seem to be especially likely to rank high in extroverted narcissism.” He refers to Deluga’s personality inventory of every former US commander in chief, which found that “almost all presidents scored high enough to be considered ‘narcissists.’”

He goes on with the Deluga study: “as the presidents’ narcissism scores increased, so did their likelihood of facing impeachment proceedings, ‘abusing positions of power, tolerating unethical behavior in subordinates, stealing, bending or breaking rules, cheating on taxes, and having extramarital affairs.’” Malkin explains, “Donald Trump’s brand of narcissism is clearly the obvious, loud kind... [and it] demonstrates many of the worst qualities we see in a narcissist. He brags... He boasts... And he freely insults people.”

Referring specifically to Trump’s earlier obsession with TV ratings, Malkin concedes that “perhaps the most startling display of Trump’s numbers obsession... was the size of his inauguration crowd.” Conceding that such a preoccupation is “laughably Freudian,” the author asks, “When does the double-edged sword of narcissism – Trump’s or any other president’s – turn dangerous?” The answer, he says, is, in part, “whether or not their narcissism is high enough to count as an illness.”

The addiction to feeling special, Malkin explains, becomes pathological when “they’ll do anything to get their ‘high,’ including lie, steal, cheat, betray, and even hurt those closest to them.” People with pathological narcissism, he says, “have a strong need... to be treated as if they’re special... life is a constant competition... At the heart of pathological narcissism, or NPD, is... Triple E: Entitlement... Exploitation... Empathy-impairment, neglecting and ignoring the needs and feelings of others.”

We are told that “narcissists demonstrate: aggression when their ego is threatened, infidelity, vindictiveness, extreme envy, boasting, name-dropping, denial of any problems or wrongdoing — even workplace sabotage. As people become more addicted to feeling special, they grow ever more dangerous... pathological narcissism often blends with psychopathy, a pattern of remorseless lies and manipulation...without feeling any guilt, shame or sadness.” Psychopathy, Malkin says, is a complete absence of empathy.

“When NPD and psychopathy combine, they form a pattern of behavior called malignant narcissism.” Then people “see other people as pawns in their game of kill or be killed, whether metaphorically or literally.” Here Malkin mentions Hitler, Kim Jong-un, and Vladimir Putin. But, he says, “not all malignant narcissists are as overtly dangerous” as those men, “especially in democracies like the US” where it’s still presumably illegal to kill people because they disagree with you. But, he says, we need to “look at subtler indicators... [and] examine whether or not they can perform their jobs.”

Asking whether mentally ill leaders are functional or impaired, the author refers to Steve Jobs, a “high functioning NPD... still able to be incredibly productive.” He says the most important assessment is the danger of mental illness: functional impairments – Can they “manage their intense feelings, such as anger or sadness or fear, without becoming a danger?” He concedes that “equating mental illness with incapacity merely stigmatizes the mentally ill... danger is the key – to self or others... pathological narcissism unchecked could lead to World War III.”

Referring again to Nixon, Malkin explains, “When they can’t let go of their need to be admired or recognized, they have to bend or invent a reality in which they remain special... It’s just not always obvious until it’s too late.” He says that “people with NPD bend the truth to fit their story of who they are.”

Such characteristics “constitute dangerous functional impairments for a leader... [the] equivalent of leaping from a building, believing you can fly. And they’re all part of a psychotic spiral that afflicts pathological narcissists confronted with the troubling truth that they’re not as special as they think they are.” This “psychotic spiral,” we are told, includes increasing paranoia, which leads to “insecure attachment” ( total lack of trust in others), impaired judgment, volatile decision making, and gaslighting.

Malkin describes the pathological narcissist who is in the psychotic spiral as follows: “They divide the world into good and bad, friend and enemy, in simple black-and-white terms... [they] project, imagining the danger they feel inside themselves (anxiety, panic, confusion, doubts) is coming from outside... Their insecurity [makes them] attack their enemies in order to feel safe... Pathological narcissists... lose touch with crucial information, brute facts, and harsh realities... The precariousness of the world or careful assessments of the dangers of a military assault don’t matter at this point...”

After offering another example from Nixon, the author returns to our current subject: “Trump reportedly boasted to the Russian ambassador about the impressiveness of his intelligence assessment, spilling secrets Israel shared (without their permission.)” The psychotic spiral, Malkin explains, leads to “reactivity and ill-conceived plans... Reality, circumstance, and facts cease to matter... what a leader says...may shift based on what feels best, not what’s best for the country... People with NPD [are] determined to convince others that they’re the ‘crazy’ ones who can’t see reality for what it is... they can’t bear to acknowledge their sanity is slipping away.”

(Whew! Reminder: We are reading an analysis by mental health experts of the mental status of our current US president, the man who holds the nuclear codes.) Malkin closes with this rhetorical question: “Why should we, as nations, allow them to pull us into the abyss with them?” (Why, indeed?!)

Sheehy, in her essay about trust (and lack thereof), explains, “Beneath the grandiose behavior of every narcissist lies the pit of fragile self-esteem. What if, deep down the person whom Trump trusts least is himself? The humiliation of being widely exposed as a ‘loser,’ unable to bully through the actions he promised during the campaign, could drive him to prove he is, after all, a ‘killer.’”

C. How about Sociopathy?

Lance Dodes, M.D., open his essay with this interesting question: “Crazy like a fox or just crazy?” as he launches his own explanation of the current president’s strange and worrisome behavior. Dodes asks whether a man who has behaved as Trump has been doing is “just being clever: crazy like a fox. Or are these actions a sign of something much more serious? Could they be expressions of significant mental derangement? The answer to that question,” he says, “is emphatically, ‘Yes.’”

Dodes explains that mammals (such as humans) naturally care for others; normal people (and wolves and elephants) protect one another, which, he says, “has major survival value for any species.” He then defines empathy which, he says, is “a characteristic of all people... Unless they are sociopaths.” Failure of normal empathy is central to sociopathy, he tells us, a condition described as “an absence of guilt, intentional manipulation, and controlling or even sadistically harming others for personal power or gratification.” He ranks it “among the most severe mental disturbances.”

Still, he says, sociopaths are able to achieve high status, even seen as superior, prompting the question: “How crazy can someone be who is so successful?” He notes that some people accept election to the presidency as proof that Mr. Trump could not have serious mental problems. He acknowledges that sociopaths generally choose one of two life paths. Some end in failure due to criminality, sometimes simple inability to “threaten their way back to positions of power. But those who are good at manipulation,” he continues, “can bully their way to the top.” They are “successful sociopaths.”

“As their power increases,” Dodes explains, “their ability to disguise their mental disturbance may also increase,” with others doing their dirty work. “They are still severely emotionally ill,” he says, and then he goes on to explain the term “sociopathy.” He says it’s “a major aspect of the term ‘malignant narcissism,” synonymous with “antisocial personality disorder.” He claims it’s about “a disturbance in an individual’s entire emotional makeup” – a “personality disorder.”

Concerning the subject of our interest, Dodes says we have to know “whether he has the observable, definitive traits that indicate the condition.” They include: “a pervasive pattern of disregard for and violation of the rights of others,” including some of these: failure to conform to lawful social norms; deceitfulness (repeated lying); impulsivity; irritability and aggressiveness; reckless disregard for safety; consistent irresponsibility; lack of remorse; disorderly conduct.” Other terms for essential sociopathic traits include “sadistic, unempathetic, cruel, devaluing, immoral, primitive, callous, predatory, bullying, dehumanizing.”

Dodes explains that sociopaths “fly into rages and claim that the upsetting reality isn’t real. They make up an alternative reality” which, when told to others, “is basically a lie.” He says this type of crazy “shows up when they are stressed by criticism or disappointment.” They “employ specific abnormal emotional mechanisms,” he says, primary among them being “projective identification,” whereby they believe the thoughts and feelings in their minds are also in the minds of others. “Commonly, these are aggressive and dangerous feelings, which are managed by being projected to others,” what he calls “the most serious version of paranoia.” He says it is about “seeing others... as entirely dangerous people... who have to be attacked or destroyed... the danger from such people is enormous.”

The author explains, however, that “loyalty is highly prized by sociopaths because it serves their personal ends, but there is no real relationship... Sociopathy always means lack of empathy,” but, Dodes says, some severe sociopaths have “a certain, frightening type of empathy. It is the empathy of the predator... They are closely attuned to their victim’s emotional state.” This reflects “perceptive acumen” that makes such a person “a genius at manipulation.” He summarizes the condition thus: “Life is devoted to endless destruction in the service of an endless quest for power and admiration, unmitigated by basic empathy or guilt.”

Now, just as I’m thinking, “Are we still talking about Donald Trump?” I see the subheading for the next section: “Donald Trump.” So now we’ll see how Dr. Dodes applies this all to the president. He says, “We are in an excellent position to know his behaviors – his speech and actions... the basis for making an assessment of his dangerousness.” He says we will now consider whether Trump suffers from antisocial personality disorder(APD) or malignant narcissism, or both. He intends to “consider these in turn.”

Dodes begins with “lack of empathy for others; lack of remorse; lying and cheating,” noting that Trump is remembered for mocking the handicapped reporter, was “unconcerned for the safety of protestors... sexually assaulting women... threatening physical harm... verbally attacking a family... degrading people... cheating people... creating the now forced-to-disband Trump University, targeting and terrifying minority groups...” He says they “all provide overwhelming evidence of profound sociopathic traits.”

Next is “loss of reality.” Dodes cites “Mr. Trump’s insistence on the truth of matters proven to be untrue (‘alternative facts’).” He has “falsely claimed that President Obama is not an American... that his own loss in the vote total... was caused by illegal aliens, that he had the largest inauguration crowd in history.” And then Dodes provides examples of “rage reactions and impulsivity”: The press, he says, has reported “multiple occasions” of Trump’s “rages... leading to sudden decisions and actions. He fired and... threatened... launched more than 50 missiles within 72 hours... violated diplomatic norms, creating international tensions...” He is cited for “antagonizing Germany, France, Greece... [and] issuing illegal executive orders.”

The conclusion? “Donald Trump’s speech and behavior show that he has severe sociopathic traits... While there have surely been presidents who could be said to be narcissistic, none have shown sociopathic qualities to the degree seen in Mr. Trump... none have been so definitely dangerous.” The author refers to “the signature characteristics of tyrants,” and says “The paranoia of severe sociopathy creates a profound risk of war.” Such a leader, Dodes claims, will display “rage reactions and impulsive action,” and that he will undermine “journalists’ ability to inform.” He asserts, “Mr. Trump’s sociopathic characteristics are undeniable” and “will only become worse as Trump gains more power and grandiosity.”

D. Maybe it is Malignant Narcissism

John Gartner, Ph.D., seems to agree with his two peers who mention “malignant narcissism” as the Trump ailment, although he begins his essay saying of Trump, “There are a lot of things wrong with him – and together, they are a scary witch’s brew.” He goes on to ask: “To what extent is Trump just a really bad person and to what extent is he really crazy?” He quotes psychoanalyst Steven Reisner in Slate: “It is time to call it out for what it is: evil,” noting this would make Trump “crazy like a fox... [with] a diabolical plan to manipulate the public’s worst instincts for fun, power and profit.” But he goes on: “I will argue that Trump can be both evil and crazy.”

For the definition of malignant narcissism, Gartner hails back to Ethan Fromm in 1964, who called the condition “the quintessence of evil,” noting that Fromm, a refugee from Nazi Germany, actually developed the diagnosis to describe Hitler. Fromm said malignant narcissism was “the root of the most vicious destructiveness and inhumanity.” Then Gartner turns to his former teacher, Otto Kernberg, who says this syndrome has four components:

Narcissistic personality disorder, expressed in grandiosity, self-confidence, and assurance that they know what the world needs. Pollock wrote in 1978 that such individuals shows “characteristic demonstrations of joyful cruelty and sadism.”
Antisocial behavior
Paranoid traits
Sadism

Now Gartner applies each of the four components to Donald Trump. As a narcissist, “Trump finds himself to be uniquely superior, to believe that he knows more than everyone about everything... Trump brags about being the world’s greatest expert in twenty different subject areas.”

As for antisocial personality disorder, Gartner says “antisocials lie, exploit, and violate the rights of others, and they have neither remorse nor empathy... Politifact estimated that 76 percent of Trump’s statements were false or mostly false... and Politico estimated that Trump told a lie every three minutes and fifteen seconds.” He calls Trump University “a straight up fraud,” and mentions Trump’s “pattern of serial sexual assault.” Trump is “allergic to apology,” the author asserts, saying even the notorious Roy Cohn “said that when it came to his feelings for his fellow human beings, Trump ‘pisses ice water.’”

Next Gartner ascribes “paranoia” to Trump, first describing radio talk show host Alex Jones as “the king of conspiracies.” The author notes that, “according to Trump, Jones is one of the few media personalities he trusts.” He also cites Right Wing Watch, saying that, before the 2016 election, the group had “accumulated a list of fifty-eight conspiracies that Trump had proclaimed or implied were true.”

“When you combine these three ingredients, narcissism, antisocial traits, and paranoia,” Gartner explains, “you get a leader who feels omnipotent, omniscient, and entitled to total power.” And then he adds in the final component: sadism. He says Trump “punches down,” demeans and humiliates people, adding, “In fact, a substantial portion of the thirty-four thousand tweets he has sent since he joined Twitter can be described as cyber-bullying.” He adds, “A malignant narcissist is a human monster... Success emboldens malignant narcissists to become even more grandiose, reckless and aggressive,” claiming Trump “has become more shrill, combative, and openly racist.”

Gartner explains that “The thing that distinguishes the malignant narcissistic leader from a run-of-the-mill psychotic patient is his power to coerce and seduce others to share his grandiose and persecutory delusions.” Then he again quotes Fromm: “Caesar... has forced everyone to agree he is god, the powerful and wisest of men.” And Gartner asks, “Does Trump actually believe the crazy things he says?” The author refers to Trump’s allegation that Obama was not born in the US, adding “Other false statements of his seem more blatantly crazy, precisely because they offer him no discernible strategic advantage.”

Now Gartner states that Trump “definitely has the hypomanic temperament,” which is “genetically based.” He explains that hypomaniacs “are whirlwinds of activity... restless, impatient and easily bored... and tend to dominate conversations. They are driven, ambitious... supremely confident of success... impulsive... risk takers... all of their appetites are heightened.” He says Trump reports that “I usually sleep only four hours a night” and “he claims to work seven days a week and, in a typical eighteen-hour day, to make ‘over a hundred phone calls’ and have ‘at least a dozen meetings.’” Like most hypomaniacs, Gartner explains, “Trump is easily distracted. We could add attention deficit disorder... Trump trusts his own ideas and judgment over those of anyone and everyone else.”

Gartner says that hypomaniacs, when they experience success with one of their “wildly ambitious goals,” experience a full-blown hypomanic episode, a diagnosable disorder. “Confirmed in their grandiosity, they drink their own Kool Aid and feel even more invincible and brilliant. They pursue... more ambitious goals, without listening to dissent... Once Trump was asked whom he went to for advice. With a straight face, he said, ‘Myself.’” As grandiosity increases, the author says, there comes “a corresponding increase in paranoia over the fools and rivals who might nay-say...[and] impede his progress.”

The author quotes Politico writer Michael Kruse, who wrote in his article 1988: The Year Trump Lost His Mind, “His response to his surging celebrity was a series of manic, ill-advised ventures. He cheated on his wife... He was acquisitive to the point of recklessness... He glitzed up his gaudy yacht... used hundreds of millions of dollars of borrowed money to pay high prices for a hotel and an airline... The Trump Taj Mahal (casino) led quickly to the first of his four corporate bankruptcy filings.” The article continues: “He went on a buying binge, and made impulsive, ill-advised investments... Trump could be the poster child for the dictum that when it comes to hypomaniacs, nothing fails like success.” Kruse refers to Trump’s lifelong effort to turn his name into a brand, his brand into money and all of it into power.”

Gartner continues, “While he is president, the consequences could be on a scale so vast it’s difficult even to contemplate. Let’s put these two moving parts together, bad and mad. Trump is a profoundly evil man exhibiting malignant narcissism. His worsening hypomania is making him increasingly more irrational, grandiose, paranoid, aggressive, irritable, and impulsive... The election of Donald Trump is a true emergency, and... the consequences most likely will be catastrophic.” (Again, reminding myself: This was early in the firstterm!)

Elizabeth Mika, M.A., L.C.P.C., writes about “tyranny as a triumph of narcissism,” warning that “tyrannies... encroach upon our world in a steady creep more often than overcome it in a violent takeover.” She identifies the three “wobbly legs” of the three-legged stool: the tyrant, his supporters, and the society at large “that provides a ripe ground for the collusion between them.” And, she says, “the force binding all three is narcissism.” She warns that the tyrant’s boots finally show up at our doorstep, a process that has “repeated itself countless times in history.”

With a focus on the tyranny that results from narcissism, Mika introduces “tyranny’s components and their interactions.” First, she says, she’ll identify the most salient common features of tyrants, reminding us that “not all dictators are tyrants. Tyrants are dictators gone bad... [He] may start as a seemingly benevolent dictator but turn into a tyrant.” Tyrants are, she says, “predominantly men with a specific character defect, narcissistic psychopathy (a.k.a. malignant narcissism).” We see this in “a severely impaired or absent conscience and an insatiable drive for power and adulation.” The attraction between him and his followers is seen as “charisma.”

Mika refers to Burkle’s 2015 “seminal paper” on the subject: “narcissism augments and intensifies the pathological features of a psychopathic character structure, making those endowed with it especially dangerous... because of their ability to use manipulative charm and a pretense of human ideas... [for] primitive goals.” She goes on to characterize such “leaders” as “impulsive, sensation-seeking, and incapable of experiencing empathy or guilt...it [is] easy for him to use and abuse [others]... without compunction.” This trait “serves him well in the pursuit of power, money, and adulation... He can easily lie, cheat, manipulate, destroy, and kill if he wants to – or, when powerful enough, order others to do it for him.” Many such narcissistic tyrants, Mika says, had “a history of childhood abuse.”

“The exact causes of this character defect are a matter of speculation,” we are told, but the result is “a narrow and inflexible character structure, with intelligence subsumed under primitive drives (for power, sex, and adulation).” Quoting Dabrowski, the author says such a psychopath “is not capable of empathy, and so he strives to gain control over others... He is usually deaf and blind to the problems of others... A psychopath thinks that laws are to be broken and that they do not apply to him. He uses any circumstances to secure his position, money, and fortune, regardless of the consequences for others, without any consideration for ethical norms.”

Mika continues: “Narcissistic psychopaths turned tyrants possess the right combination of manipulativeness, self-control, and intelligence to convince others to support them long enough to put their grandiose ideas to work on a large scale.” They appear to have charisma, “the ability to deliver public speeches that inspire others to follow them... This ‘charisma’ is simply their ability to tell others what they want to hear.” Once they gain power, she says, they will “unleash their sadism under the cloak of perverted ideals.” She offers several examples from Hitler’s crushing of Poland, explaining that such a tyrant “must obtain a position of ultimate power within his own nation first.”

And what about those supporters of the tyrant, mentioned as one of the 3 legs of the stool of tyranny? Mika explains that the main ingredient, “narcissism, somehow remains invisible to both participants and observers... The more grandiose his sense of his own self and his promises to his fans, the greater their attraction and the stronger their support... [they] imagine themselves as powerful as he is.” The interplay between them, the author explains, is “narcissistic collusion: a meshing of mutually compatible narcissistic needs. The people see in him their long-awaited savior.”

Now Mika reminds us that Erich Fromm in 1980 “stressed the elements of submission to and identification with the strongman,” noting that Fromm said, “submission to the powerful leader... is in depth an act of symbiosis and identification.” Next she refers to Michael Kimmel’s concept of “aggrieved entitlement,” explaining that “elevated expectations, resentments and desire for revenge on specific targets and/or society in general” are the components of that aggrieved entitlement. It works like this, she says: “The tyrant makes many good-sounding – but also openly unrealistic, bordering on delusional – promises... and usually has no intention or ability to fulfill most of them.” (I can’t help but think of Trump’s 2025 threats to make Canada the fifty-first state, take over Greenland, and seize the Panama Canal.) Mika says the tyrant uses his supporters “only as props in his domination- and adulation-oriented schemes.”

The tyrant’s need for revenge drives the collusion, the author says. He “is always chosen to perform this psychically restorative function: to avenge the humiliations (narcissistic wounds) of his followers and punish those who inflicted them.” Scapegoating now enters, and it is the “Others” who become the target of both the tyrant and his followers. “The Others always represent the split-off, devalued, and repressed parts of the narcissistic individual’s own psyche,” Mika explains. Those repressed parts are projected onto Others, “which allows us to focus on and enlarge insignificant differences between ourselves and the Others... and justify our contempt and aggression toward them.”

She explains that, the greater the level of woundedness felt by the supporters, the more grandiose a leader is required. “While his grandiosity appears grotesque to non-narcissistic people who do not share his agenda, to his followers he represents all their denied and thwarted greatness.” The natural consequence of this scapegoating, Mika says, “is dehumanization of the Others, which then justifies all kinds of atrocities perpetrated on them... indicative of a narcissistic rage that fuels it... That rage, along with dreams of glory” makes the bond between the tyrant and his followers “impervious to reality.”

“Once we dehumanize the Others and imbue them with a murderous motivation directed at us, we can easily rationalize any act of violence we perpetrate upon them as self-defense,” she says. Mika now refers to the tyrant’s supporters and sycophants, noting that “their role becomes more important with time... As his paranoia, grandiosity, and impulsivity grow, his aides, family members, and surrogates... scramble to preserve an image of his ‘normalcy’ and greatness.”

How Narcissistic Tyrants Arise

And what of the society as a whole? Mika explains, “Tyrants do not arise in a vacuum... It takes years of cultivation of a special condition in a society... oppressive economic and social inequality ignored by the elites... a breakdown of social norms... disregard for the humanity of a large portion of the population...” She says that pre-tyrannical societies “exhibit signs of a narcissistic pathology writ large... the inevitable split into the grandiose and devalued parts... [an] unspoken split between grandiose blameless I/Us and the devalued, inferior Others.” In such society, the author says, grows “ruthless competition, jealousy, and aggression... directed externally toward other nations... a society redirecting its narcissistic rage onto external objects.” She continues: “None of these processes is openly acknowledged or even noticed.” She notes that Fritz Stern “has said that ‘German moderates and German elites underestimated Hitler... they did not think that his hatred and mendacity could be taken seriously.’ Hitler was seen by many as a bombastic but harmless buffoon.” (Have I thought of Donald Trump that way?! Have you?)

“Narcissism of the elites makes them as well blind to the encroaching tyranny. It is a... myth that only the dispossessed and uninformed would support a tyrant... It is... one’s narcissism... that cuts across socioeconomic strata.” Here Mika refers to Dorothy Thompson’s 1941 essay, “Who Goes Nazi?” saying that she “identifies those threads of frustrated grandiosity, resentments, and hatreds in the well-heeled individuals’ characters that make them fall for tyrannical ideologies and movements.”

The famous German physicist Weizsacker confessed that, although “he had never believed in Nazi ideology, he had been tempted by the movement, which seemed to him then like ‘the outpouring of the Holy Spirit.’” Mika warns us that we forget, we distort historical and psychological facts when time has passed. “We tend to imagine tyrants as instantly recognizable evil beings and tyrannies as something exotic enough never to happen to us. But... power-hungry narcissistic psychopaths do not look different from normal people... if they stand out, it is for socially approved reasons: their resolve, charisma, decisiveness, and ability to inspire others... Each and every one of them promises to bring back law and order, create better economic conditions for the people, restore the nation’s glory.” (Egad! Lower the price of eggs?! Make Mexico pay tariffs?!)

And such promises, she warns, “are always tied together with the thread of scapegoating Others... pitting people against one another.” She says of the tyrant: “Once he and his sycophantic cabal assume power, they deepen and widen the disorder, dismantling and changing the society’s norms, institutions and laws...”(Like firing thousands of federal workers? Closing down complete federal agencies?) She goes on: “We can see the tyrant’s own pathology influencing every area of a society’s functioning, from politics through culture and social mores to science and technology.” (Like making oneself the president of the Kennedy Center for the Performing Arts?)

The warnings continue: “As freedom of speech, the press, and assembly disappears and the tyrant’s destructive ‘reforms’ take hold... an ethos of the New Man... is forced upon the populace... Hero worship and utmost loyalty become parts of the... prescribed behavior, reinforced by new laws and norms... Our human propensity to submit to inhumane rules established by pathological authority cannot be overestimated... An approving nod... can easily absolve us of responsibility in our minds and override any scruples imposed by our conscience... many so-called normal people shut down their conscience... psychology and psychiatry, like other branches of social science, are coopted to serve the regime. What’s considered normal... is in fact pathological... Our narcissistic blindness makes it impossible for us to believe that it could happen here.”

E. Delusional Disorder? Could Be

Michael J. Tansey, Ph.D., notes that delusional disorder is an “exceedingly rare disease,” and he says he is “intending not to diagnose but to educate the general public.” He points out that “Those with delusional disorder scoff at the notion that there is a problem.” He refers to it as “a stealth disorder... exceptionally beguiling because such individuals seem perfectly normal, logical, high functioning, and even charming so long as the delusion itself is not challenged.” He says it is a form of psychosis “in which there is profound loss of contact with external reality.” But it is “neither bizarre nor readily apparent to the outside observer.” Then he explains that delusions are beliefs that...

Exist despite indisputable, factual evidence to the contrary
Are held with absolute certainty
Are not of the bizarre variety (“I am being poisoned by the CIA”) but similar to ordinary figures of speech, such as “I alone am the chosen one, invincible, extraordinary...”
Are held by people who tend to be extremely thin-skinned and humorless
Are central to the person’s existence

Tansey says delusional disorder is “chronic, even lifelong, and tends to worsen in adulthood, middle age, and beyond.” It gives the person “a heightened sense of self-reference (‘It’s always all about me’)... making trivial events, whether positive or negative, hard to let go of and move past.” The author now refers to an address about the CIA by Donald Trump in 2017, in which “DT declared he was ‘a thousand percent behind’ the CIA” and referred to the media, who have made it “sound like I had a feud with the intelligence community” as “some of the most dishonest people on the planet.” Tansey notes that anyone could instantly find all the derogatory DT tweets about the CIA, asking, “Why would he merely lie despite knowing that each and every person in attendance knew there was not an iota of truth to the claim?”

The answer to that question, we are told, is that Donald Trump “literally believes every word he says.” He would pass a lie detector test! “He takes it as a given that the world around him will conform to his own warped view of events.” A minute later, Trump mentioned his recent inaugural address, noting that it had begun to rain. He pointed a finger to the sky and declared, “God looked down and said, ‘We’re not going to let it rain on your speech.’ He then insisted that the rain stopped immediately and it became ‘really sunny’ before it ‘poured right after I left.’” Tansey points out that anyone hearing that report could have immediately verified by video that the drizzle never stopped, it never became sunny, and it never poured. “Did he believe every word?” If yes, the author says, this, like his claim about the size of his inaugural crowd, “would be compelling evidence of underlying delusional disorder leaking through the veneer of normality... [or] grandiose delusional detachment from reality.”

We’re probably all familiar with other delusional claims by Trump that Tansey cites: he knows more than all the generals; he has the best temperament of anyone ever to be president; the Central Park Five are guilty despite the fact that the actual rapist confessed; he saw on TV thousands of Muslims celebrating the collapse of the World Trade Center; he was the very best high school baseball pro prospect in New York City; he won the presidency by the greatest electoral landslide since Reagan (“when, in fact, he trailed five of the previous seven electoral totals”); the three million popular votes by which he lost were all cast by fraudulent voters. We shake our heads when we hear these things, but Tansey is suggesting they might be evidence of delusional disorder.

Next Tansey discusses Trump’s admiration of brutal dictators, noting, “There is considerable evidence to suggest that absolute tyranny is DT’s wet dream... the ability to demand adulation... to eradicate all perceived enemies with the simple nod of the head...” He reminds us of the well-known dictators that Trump often mentions reverently: Kim Jong-un, who executed his uncle and seven of his aides – and all their children and grandchildren – by firing squad, “requiring millions to watch”; Bashar al-Assad, whose suppression of his countrymen resulted in “hundreds of thousands of deaths of civilian men, women, and children, many by gassing”; Saddam Hussein, “perhaps the most monstrous tyrant of the last several decades,” who gassed citizens and buried some alive; Vladimir Putin, earning this comment from Tansey: “DT states clearly that his radiant view of Putin required only that he be flattered by him.” Putin arranges to have dissenting journalists shot and dissidents poisoned. And what did the tyrant say of Trump? “Putin called him ‘bright’ (not a ‘genius,’ as DT has bragged ever since).”

The author reminds us of the type of language Trump used in his first campaign, such as “fighting for peaceful regime-change,” and his suggestion that “maybe ‘the Second Amendment people’ might be able to stop Hillary.” Tansey reminds us that Trump also said “that he would love to ‘hit and hit and hit [his critics from the DNC] until their heads spin and they’ll never recover.’” He “insisted that he will ‘bomb the shit out of ISIS’” and he “expressed genuine bewilderment about why we build nuclear weapons if we don’t use them.”

“Once elected,” Tansey says, many argued that Trump “would moderate his words and actions in a so-called ‘soft pivot.’ When a person is character-disordered or worse—especially one who always blames others, never apologizes or displays accountability, and who never for an instant believes there is anything wrong with himself—the only possibility for change is for him to become worse, not better.” He then reminds us of the firing of James Comey while brazenly admitting it was because of his ongoing investigation of the 2016 Trump campaign and its alleged collusion with Russia, noting that, the very next day, Trump welcomed Russian leaders into the oval office. “His thirst for adulation is rivaled only by his obsession for vengeance,” Tansey writes. Asked about Putin and the Russians, Trump said, “As long as they’re nice to me, I’ll be nice to them.”

“Like the despots he idolizes,” the author says, “DT intends to rule, not lead.” He says the 2016 presidential election was “about apocalypse, not politics.” He asserts that, while “DT's particular version of personality disorder is vital to understand, none is more compelling or terrifying than his control of the nuclear codes.” He again mentions “the now-plausible prospect of all-out nuclear war,” reminding us of “the titanic difference between a president who is merely ‘crazy like a fox’ (shrewd, calculating...) versus ... ‘crazy like crazy’ (possessing well-hidden, core grandiose and paranoid delusions... disconnected from factual reality).”

Tansey continues with evidence of “DT’s ‘crazy like crazy’ delusional disorder,” including early morning tweets about the alleged wiretapping of Trump Tower phones, comparing it to Watergate and McCarthyism with “complete lack of evidence.” As he concludes, the author explains again that “’Crazy like a fox’ defines a person whose apparent external irrationality masks underlying rational thinking. ‘Crazy like crazy’ characterizes a person whose apparent external rationality masks underlying irrational thinking.” They’re opposites! (And here, again, I find myself holding my breath, remembering that it is now 2025, and this man has just been inaugurated as president again, issuing 100+ executive orders in only days, firing strategically important federal workers, turning loose an unelected billionaire immigrant to seize control of federal finances, ordering the shut-down of key federal offices, and wreaking havoc such as the country has possibly never seen.)

F. Perhaps he’s an “other-blamer”

An essay entitled “In a Relationship with an Abusive President” by Harper West, M.A., L.L.P. opens with a discussion of a woman named “Amelia” who is in an emotionally abusive relationship with “Justin.” He is “harshly critical” of her, and “he accuses her of making up ‘fake’ stories.” Amelia tells her therapist that “the most minor disagreements seem to escalate into major arguments,” reporting that Justin can never apologize or admit fault. He refuses even to apologize when he’s caught in a lie, and “she is always the one to compromise.”

West says, “This couple is an analogy for the current relationship between America and a psychologically unstable, emotionally abusive president... [they] share common personality traits because they share common human drives, emotions and reactions.” West says she will now rename narcissists: “to simplify... I will call these other types of people Other-blamers.” The cause of their behavior, West explains, “is low self-worth [leading to] poor shame tolerance.” This, in turn, causes “vindictive anger, lack of insight and accountability, dishonesty, impulsivity, entitlement, paranoia, lack of remorse and empathy, self-importance, and attention-seeking. Trump is an extreme example.”

Other-blamers “often adopt an aggressive, dominating persona to achieve emotional self-protection,” West explains. They rarely agree to therapy “because of their aversion to the shaming experience of self-awareness and accountability... This sets up relationships with submissive people who will not challenge, correct, or blame them.” She continues: “Trump’s incoherent gibberish may be a sign of his fearful, reactive emotional state; he cannot calm his brain enough even to form a complete sentence.”

West offers evidence of this disorder from Trump’s past: “Trump’s first wife, Ivana, accused him of raping her in sworn deposition testimony... This alleged violence fits with the personality of someone fearful of rejection and living with elevated anxiety... This pattern of escalating instability is concerning when considering Trump... He may be overwhelmed by fear, which will further limit his cognitive and prosocial capabilities... [He] may become increasingly volatile and unpredictable.” (Now, from my 2025 perspective, I wonder if that’s what a fearful American public is witnessing.) “Fear-driven behaviors and a lack of insight are exactly the opposite of what we should expect of a safe, dependable partner or a leader.”

“With shame and fear as the primary emotions driving Other-blamers,” West writes, “lack of accountability becomes their most obvious and destructive character flaw... They do not hold themselves accountable... do not believe they must play by the same societal or relational norms as others... Trump’s refusal to release his tax returns or comply with ethics regulations is clear evidence of this thought process... The Other-blamer routinely blames the victim,” she says, and “Trump appears to be completely lacking in accountability... He can barely make one statement without a deflection... Trump’s tendency to ridicule facts or the opinions of others is another way of avoiding dealing with a situation honestly... Other-blamers are highly resistant to change.”

West writes, “Healthy relationships require awareness of one’s faults; care for one’s impact on others; and an ability to handle mistakes, defeats, and criticism with equanimity.” She then moves on to “lack of pro-social emotions,” explaining that sociopaths and narcissists are often noted for their lack of remorse, guilt, or empathy.” As for Trump, “He cares far more about sheltering his fragile psyche than doing what is right for the country,” referring to his “well-documented bigotry, greed, name-calling, intimidation, and vindictiveness... His goal,” she says, “is merely to lash out so he can feel better about himself... He is unconcerned about the long-term effect on the country. He is too busy being right at any cost.”

Referring to Trump’s “America First” slogans, West says “He has no real understanding of the selfless giving in true patriotism. Trump got five deferments during the Vietnam War, yet he has repeatedly verbally attacked war heroes. His policies emphasize cruelty toward the less fortunate and an abdication of caring stewardship of the earth’s resources... Trump is in it only for himself.”

Then West introduces the characteristic of “depersonalizing the victim,” saying, “Trump, for decades, has made demeaning comments about women’s looks and has bragged on videotape about sexually assaulting women. During the campaign, he mocked a disabled reporter... His extreme depersonalization of others will worsen as his entitlement increases with the power of his position... We have a president who may have lost the ability to care about the human lives he is charged with protecting.”

“Entitlement” is the next feature of Other-blamers that the author explores. She explains, “Trump seems to believe he is above reproach, once stating that he could shoot someone on Fifth Avenue and not lose any voters... Name-calling with comments of ‘loser’ and ‘lock her up’ were a staple of his campaign... He cannot even pretend to be good-natured, despite all his popularity, wealth, and power.” Next West discusses “deception” in Other-blamers, saying they “lie to exaggerate achievements in an attempt to seek approval, deflect blame, and avoid accountability... They lie to themselves constantly... He will impulsively betray us to achieve his aims... [possibly leading to] major international implications.”

Finally the author offers other characteristics of Other-blamers:

Placing high value on personal loyalty, surrounding themselves with “yes men.”
An “us-versus-them” mentality
Misusing power: “Trump boldly repeats lies so that the truth has little opportunity to flourish.”
Promoting an image of success: “Trump’s gold-plated lifestyle... protecting his delicate ego”

And how does all this affect our psychological health, West asks. She says “his character defects will normalize immoral Other-blaming behavior... [giving] a green light to act out... We must resist,” she explains, and also “signal to his followers that abusive behavior is not appropriate... This narcissistic president is doing what all narcissists do: sucking the air out of the room.” She refers to his “toxic effect... through increased anxiety and the diversion of attention from other issues.” West concludes: “The country will have less ability to focus on solutions to complex problems until we get rid of the Other-blamer in chief we are in relationship with.”

G. And then, maybe it’s none of the above

Dr. James Gilligan, M.D., says “the issue is dangerousness, not mental illness.” He explains, “Psychiatrists... have two diametrically opposite professional obligations.” First, they “have an obligation to remain silent about their evaluation of anyone if that person has not given them permission to speak... second...they have an obligation to speak out and inform others if they believe that a person may be dangerous.” [He refers now to the Goldwater Rule of 1973 and the Tarasoff decision of 1976, both mentioned above.] “The second of those two rulings trumps the first... We have a positive obligation to warn the public.”

Reflecting on Hitler’s rise to power and the work of the German Psychiatric Association of the 1930s, Gilligan calls the association “a passive enabler of the worst atrocities... as were most German clergymen, professors, lawyers, judges, physicians, journalists, and other professionals and intellectuals who could have, but did not, speak out.” Now he gets to his main point: “The issue... is not whether Trump is mentally ill. It is whether he is dangerous... The association between violence and mental illness is very tenuous at best.” Dangerous individuals often do not require an interview, he says. “Such individuals often (though not always) deny, minimize, or attempt to conceal the very facts that identify them as being dangerous.”

The author says you don’t need 50 years’ experience assessing violent criminals to “recognize the dangerousness of a president who:

“Asks what the point of having thermonuclear weapons is if we cannot use them”
“Urges our government to use torture or worse against our prisoners of war.”
“Urged... the death penalty [for five African American youths] even years after it had been proven beyond a reasonable doubt to have been committed by someone else [fourteen years after DNA evidence and a detailed confession had proved that a serial rapist had actually committed the crime].”
“Boasts about his ability to get away with sexually assaulting women because of his celebrity and power.”
“Urges his followers at political rallies to punch protesters in the face and beat them up...He even complained that his supporters were not violent enough... ‘Part of the problem... is because nobody wants to hurt each other anymore.’”
“Suggests that his followers could always assassinate...Hillary Clinton... or... throw her in prison.” [followed by his reference to “Second Amendment people]
“Believes he can always get away with whatever violence he does commit.”

Gilligan refers to the “endless stream of threats of violence, boasts of violence, and incitements to violence,” adding, “he speaks the language of dictatorship.” The author makes an interesting point: “Trump did not confess that he personally assaulted women himself; he boasted that he had... the power his celebrity had given him to force women to submit to his violation of their dignity and autonomy.” Then he reminds us that Trump “encouraged his followers to ‘punch protestors in the face,’ and ‘beat them up so badly that they’ll have to be taken out on a stretcher.”

The author calls Donald Trump “by far the most dangerous of any president in our lifetimes,” charging that “we are being either incompetent, irresponsible, or both... That is why it is so important and so appropriate... to warn the potential victims, in the interests of public health, when we recognize and identify signs and symptoms that indicate someone is dangerous to the public health.” He notes that, having been blessed by democracy for more than two centuries, “it is long enough to have made most of us complacent, and perhaps over-confident, with respect to the stability of our democracy.”

He says behavioral scientists who have studied violence “owe it to the public to share what we have learned before we experience the epidemic of violence that would be unleashed by the collapse or undermining of the rule of law...checks and balances, the freedom of the press...” Gilligan finally lands on “dictatorship,” saying all the dangers listed above “have been characteristic of Donald Trump’s public statement throughout his electoral campaign and presidency.”

“Let us not make the same mistake,” Gilligan pleads again, “that the German Psychiatric Association did in the 1930s.” He warns of an “unnecessary taboo... against regarding politics and politicians as appropriate and legitimate subjects for discussion, inquiry, and conclusions... likely to be accused of being ‘partisan’ rather than ‘professional’... I would argue that the opposite is true.” We are urged to “practice ‘evidence-based medicine,’” the author says, be we should “learn to practice ‘evidence-based politics.’” The author warns, “If we are silent...we are passively supporting and enabling the dangerous and naïve mistake of treating him as if he were a ‘normal’ president... He is not.”

“Trump’s dangerousness is so obvious,” Gilligan warns, that our role is to “heed the warnings Trump himself has already given us... Trump is now the most powerful head of state in the world, and one of the most impulsive, arrogant, ignorant, disorganized, chaotic, nihilistic, self-contradictory, self-important, and self-serving... He could kill more people in a few seconds than any dictator in past history... We will not be able to say that he did not warn us – loudly, clearly, and repeatedly.”

Tamarack Communication

Tamarack Communication

Speakeasy Blog

Tamarack Communication

1. Why should we even worry?

The Trump Effect

Trust Deficit and the Snake Pit

Is Harm Imminent?

Our Trump Anxiety Disorder

The Doomsday Clock

2. How did this “danger” develop?

Identifying with the Aggressor

And the danger to America?

3. Addressing Post-Trump Stress Disorder

Recognizing our own Pathology

Riding the Wave of Resentment

4. We didn’t see this coming?!

5. The professionals respond

The Safety of the Public is Paramount

When the Leader is Unhealthy

A Scorpion King?

Should Professionals Speak Out?

The Dangers of Paranoia

Troublesome Patterns of Behavior

A. Is it Extreme Present Hedonism?

B. Maybe it’s Narcissism and Bullying

C. How about Sociopathy?

D. Maybe it is Malignant Narcissism

How Narcissistic Tyrants Arise

E. Delusional Disorder? Could Be

F. Perhaps he’s an “other-blamer”

G. And then, maybe it’s none of the above

Tamarack Communication

Speakeasy Blog Get it right, but have some fun!

Get Updates from Us!

Tamarack Communication

Tamarack Communication

Speakeasy Blog

Tamarack Communication

1. Why should we even worry?

The Trump Effect

Trust Deficit and the Snake Pit

Is Harm Imminent?

Our Trump Anxiety Disorder

The Doomsday Clock

2. How did this “danger” develop?

Identifying with the Aggressor

And the danger to America?

3. Addressing Post-Trump Stress Disorder

Recognizing our own Pathology

Riding the Wave of Resentment

4. We didn’t see this coming?!

5. The professionals respond

The Safety of the Public is Paramount

When the Leader is Unhealthy

A Scorpion King?

Should Professionals Speak Out?

The Dangers of Paranoia

Troublesome Patterns of Behavior

A. Is it Extreme Present Hedonism?

B. Maybe it’s Narcissism and Bullying

C. How about Sociopathy?

D. Maybe it is Malignant Narcissism

How Narcissistic Tyrants Arise

E. Delusional Disorder? Could Be

F. Perhaps he’s an “other-blamer”

G. And then, maybe it’s none of the above

Tamarack Communication

Speakeasy Blog Get it right, but have some fun!

Get Updates from Us!​

Get Updates from Us!