From the book: The Dangerous Case of Donald Trump by Bandy Lee, MD, MDiv
A National Warning
Before Donald Trump was elected, 27 psychiatrists, psychologists and other mental health experts concluded he has narcissistic, antisocial (sociopathic) and paranoid personality disorders. They sent a warning and a request for a neuropsychiatric evaluation of Trump to the Obama White House, the Joint Chiefs of Staff, and select members of Congress, but nothing was done. Unfortunately, since his inauguration, Trump has escalated his dysfunctional behavior. It’s time for the general public to heed the expertise of these mental health specialists.
Mental health professionals have an obligation to bear witness to emotional pathology. They need to avoid uncritical acceptance of abnormality, expose it for what it is, be disciplined about what they know, while admitting what they do not know. In addition to the ethical requirement to protect patients, they have an ethical obligation to the larger society.
The “Goldwater rule” states that “it is unethical for a psychiatrist to offer a professional opinion [about a patient] unless the psychiatrist has conducted an examination and been granted proper authorization for such a statement.” However, the profession fails in its ethical duty if it remains silent when there is clear evidence of danger to society. Dangerousness can be detected without a full diagnosis, especially in an emergency or when the individual possesses lethal power, e.g., nuclear weapons. The paramount responsibility is to protect human life and well-being.
When there is no doctor-patient relationship, mental health professionals have a right to share their expert opinions. In the case of Trump, there are years of recorded evidence of his statements and actions on which to evaluate him. His impulsive, erratic, vindictive behavior is frequently displayed for all to see. In fact, it is what appeals to some of his devoted fans who think he speaks for them.
Donald Trump has always focused mainly on publicity for himself. He was a NYC business person; TV celebrity; did no serious philanthropy; has a history of cheating contractors for goods and services they supplied; created Trump University that charged $43,000 for one year, was a scam and was successfully sued; had many bankruptcies; switched political parties several times as it benefitted him; and has consistently bullied opponents. In the past, bullying was considered a culturally normal right of passage for children. It is not so now. The Presidential election of 2016 has made extreme bullying again more prevalent in schools and throughout society, including an increase in racial violence.
Trump has had three marriages, numerous dalliances, several sexual harassment lawsuits, and is openly contemptuous of women. All of this indicates narcissism and hedonism. He lives in the moment focused on his own pleasure with little concern for future consequences or past reality. Most children and those suffering arrested development are hedonists. They have little ability to anticipate and plan for the future. When in a stressful situation, they revert to emotional, impulsive reactions. Trump’s frequent Tweets are impulsive reactions, often involving lying, that lead to misunderstandings and toxic relationships. Others have to scramble to justify his irrational comments.
Based on Trump’s published comments, he is dehumanizing, lying, misogynistic, paranoid, racist, self-aggrandizing, and narcissistic. When narcissism, hedonism and bullying are present in a person with power, the result is impulsive, immature, incompetent behavior that escalates to tyranny.
Dangerousness is not synonymous with mental illness. Most mentally ill people do not commit serious violence, and most violence is committed by people who are not mentally ill. Major mental illnesses have a lower risk of harm than personality disorders. People who are potentially violent often deny, minimize or attempt to conceal facts that would identify them as dangerous. The most reliable data may come from the person’s family, friends, co-workers, police reports, criminal history, and medical history. In Trump’s case, we have public records, audio and video recordings, pubic speeches and interviews, and his numerous tweets
Grandiosity, impulsiveness and compulsions are especially toxic when combined with an authoritarian personality and contempt for the rule of law. You don’t need years of professional training and experience to recognize the dangerousness of statements such as: Why do we have nuclear weapons if we can’t use them? We need to bring back torture because it works. The US should broaden its laws so we don’t have to play by the rules. New York State should bring back the death penalty so five youth who were wrongly convicted and later exonerated could be executed. “When you’re a star, [women] let you do anything. You can do anything.” At a rally he said, “I’d like to punch him in the face, I’ll tell you.” “In the good old days, this doesn’t happen, because they used to treat them very, very rough.” “I love the old days. You know what they used to do to guys like that in a place like this? They’d be carried out on a stretcher, folks.” After several of his supporters were arrested and tried for assault and battery, he complained that they were not being violent enough. He suggested that his followers could assassinate or at least imprison Hillary Clinton if she were elected president. Only tyrannical dictators assassinate or imprison their personal political rivals.