The president attacks the mayor of San Juan after a devastating hurricane as the death toll rises. In his maiden UN speech, he threatens North Korea with “total destruction.” His tweetstorms show a narcissistic mind obsessed with cutting down critics and igniting culture wars while ignoring the responsibilities of his office. No wonder a new poll shows that a stunning 56 percent of Americans believe Donald Trump is “not fit” to serve as president.

But while much of America has begun speaking openly about the mental state of their president, the actual professionals in the field of psychiatry are prohibited from doing so because of the gag rule imposed by the American Psychiatric Association (APA).

Until now. Twenty-seven eminent psychiatrists and psychologists—including professors from Harvard, Yale, and Stanford—have rebelled against the so-called Goldwater rule in favor of what they see as their own ethical “duty to warn” the public of the perils of being led by a president who will feed his “malignant narcissism” at any cost.

Their essays are collected in a powerful new book called The Dangerous Case of Donald Trump, which hits bookstores on Oct 2. They warn that the Trump effect has created a “malignant normalcy,” a collective psychological anesthesia. It’s the kind of hush that falls before an impending hurricane or an October surprise. As comforting as this lull may feel, evidence mounts that the worst is coming.

This is not a bleached academic text. It is a kaleidoscope of vivid observations of a baffling personality. These expert observers of behavior argue that this president provides them with a vast treasure of public performances, videos, and twittered screeds on which to base their assessments of his mental state. It is not a diagnosis, but an effort to educate the public on behaviors that are well-documented as dangerous and pathological, not only by psychology but by many historical accounts of the rise of dictators.

The psychiatrists argue that objectively observable evidence of mental impairment is no different from physical infirmity, as far as meeting the intentions of the 25th amendment. They have sent their statement of alarm about President Trump’s mental stability to every senator and House member, urging they act to form an independent expert panel to evaluate the president. Simultaneously, 27 representatives, all Democrats, have co-sponsored a bill to establish a “commission on presidential capacity,” including four psychiatrists, which would give Congress the authority to declare a president “unable to discharge the powers and duties of his office.”

***

The revolt of the shrinks began last April. A normally apolitical Korean-American professor of law and psychiatry at Yale University, Dr. Bandy Lee, called a town meeting to debate the APA rule vs. the ethical duty of “activist witnessing professionals” to warn and protect America first. Yale withdrew its backing at the last minute. The expected audience shrank to fill a few scattered rows. Undeterred, Yale’s Dr. Lee joined ranks with Harvard’s Dr. Judith Herman, both women believing that the Trump presidency rises to a historic turning point in the nation’s necessary response to an evident mental health crisis in the Oval Office.

The key question, says Herman, “is whether mental health professionals are engaging in political collusion with state abuses of power, or in resistance to them.”

Lee considers the book exactly what the Goldwater rule recommends in the original contract between the APA and its members. It reads: “On occasion psychiatrists are asked for an opinion about an individual who is in light of public attention” and “may share with the public his or her expertise about psychiatric issues in general.” But a month before the Yale town hall meeting, the APA expanded its rule to decree that psychiatrists must refrain from speaking at all about a public figure’s presentation.

“This is an outrageous violation of free speech,” Lee told me, based on her consults with specialist lawyers. Howard Covitz, a psychoanalyst and another contributor to the book, told me in an email, “The Goldwater rule, as it now stands, has no limits. Hypothetically, a president could be hallucinating and running on the White House lawn buck naked, screaming ‘Bring me my nuclear codes’ and the new rule would continue to gag professionals from speaking up.”

But Lee was not about to give up. She doubled down by recruiting more than two dozen respected professionals to contribute to the book which found an eager publisher in St. Martin’s Press and an 100,000 initial print run.

***

In fairness, many reasonable people would argue that anyone who exalts him or herself to the degree of exceptionalism necessary to lead the world as president of the United States must have at least a healthy degree of narcissism.

They’re right, according to Craig Malkin, a clinical psychologist and lecturer for Harvard medical school and a contributor to the book. Healthy narcissism is a trait that all of us carry: the drive to feel special or unique. “In fact, people with a healthy dose of narcissism are happier, more optimistic and consistently confident than people at the low end of the spectrum,” he writes. Pathological [or malignant] narcissism begins “when people become so addicted to feeling special that, just like with any drug, they’ll do anything to get their ‘high,’” writes Malkin, author of Rethinking Narcissism.

“Donald Trump is the most dangerous man in the world,” writes another famous contributor to the book, Philip Zimbardo, professor emeritus at Stanford University and a scholar-author best known for his landmark prison study. The call to action for Zimbardo came when he recognized in Trump the pathological behavior he has defined as “extreme present hedonism.”

These are people who live for the moment, he told me, “mostly children, but some adult hedonists, too. They make decisions on the spur of the moment, never thinking about the consequences.” Easily bored, they constantly seek novelty and are vulnerable to addiction. This extreme present hedonism is apparent in Trump, “because he will say whatever it takes to pump up his ego and to assuage his inherent low self-esteem, without any thought for the potentially devastating future outcomes from his off-the-cuff remarks or even major decisions,” according to the scholar psychologist.

Dr. Lance Dodes, a retired assistant clinical professor of psychiatry at Harvard medical school, who makes clear why a lack of empathy is a tragic flaw in a leader. “Caring for others and trying not to harm them is a fundamental quality of not just humans, but many mammals,” he writes. Its lack opens up a moral vacuum in a person who is easily able to con others, who can lie, cheat, manipulate, and who doesn’t care whom he hurts just as long as he is gratifying himself.

Who would have guessed that the Army Field Manual identifies empathy as an essential attribute of a leader’s character? The Army repeatedly stresses the necessity that a leader” “demonstrates an understanding of another person’s point of view,” and “identifies with others’ feelings and emotions.” It’s not enough to understand how another person feels—the best dictators are adept at sensing people’s vulnerabilities and exploiting them. A democratic leader also has to care about the impact of his words and actions on others.

Other authors highlight Trump’s isolation. It is well-documented by his biographers that Donald Trump has no real friends in whom to confide, and he likes it that way. He has boasted of his lack of trust: “The world is a vicious and brutal place. Even your friends are out to get you; they want your job, your money, your wife.” This is the sound of paranoia, an excessive or irrational distrust of others. What is the consequence in a leader? A leader who does not trust his subordinates cannot inspire trust. That leaves his anxious aides and cabinet members with the tortured conflict between loyalty and leaking.

The final chapter of the book is subtitled “Tyranny as a Triumph of Narcissism.” Elizabeth Mika, a clinical psychologist who earned her degree in an Eastern European country once ruled by a dictatorial regime, made the point to me that narcissism contains within itself the seeds of its own demise. “It animates the beast while, paradoxically, eating it alive, bringing its downfall in due time,” she has written. She gave me her definition of “narcissistic collusion,” as “the interplay of grandiose hopes and expectations between the tyrant-in-the-making and his supporters.” I asked if narcissistic collusion inevitably expands as time goes on. “Yes, like a balloon we keep inflating,” she said. The darkest outcome, she predicts, is “an explosion that could destroy all within its reach.”