Psychological Factors Need to Be Considered Alongside Legal Considerations in This Impeachment

On Thursday, leading psychiatrists and I, along with more than 650 other mental health professionals, submitted a “Petition to the Judiciary Committee of the U.S. House of Representatives,” to include our statement on the psychological dangers of the president. It reads: “We are speaking out at this time because … as the time of possible impeachment approaches, Donald Trump has the real potential to become ever more dangerous, a threat to the safety of our nation.” We believe we have an ethical obligation to warn of the danger that Mr. Trump poses as the impeachment process proceeds and have offered ourselves for consultation.

The World Mental Health Coalition was formed to step in where we believe our own professional associations have failed in leadership. The American Psychiatric Association’s own ethics guideline states: “Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.”

We are deeply concerned about the president’s mental instability, which continues to go unmanaged alongside his unchecked proximity to nuclear weapons and other war-making powers

We also wish to keep the affirmative obligation of the Goldwater principle, which encourages psychiatrists to educate the public when asked about a public figure, so that we may improve the community and better public health. The American Psychiatric Association’s reinterpretation of the principle to prohibit all commentary, with the start of this presidency, many believe goes too far). In medicine, safety comes first, and the World Medical Association’s Declaration of Geneva obligates us to speak up when humanitarian concerns are at stake.

My colleagues and I have been deeply concerned about the president’s mental instability, which continues to go unmanaged alongside his unchecked proximity to nuclear weapons and other war-making powers. As pressures from the impeachment proceedings mount, the dangers only heighten as the nation’s attention to this issue lessens.

Concerns Since 2017

A group of us first outlined our concerns at a conference at Yale School of Medicine in April 2017. The very next month crises began with the firing of FBI Director James Comey. We followed up with a public-service book, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. Many claim the book predicted the course of this presidency, as it has gone on to separate children from their families at a massive scale, to inspire white supremacist groups and mass shootings, and to pull out of key treaties that had allowed for international peace.

When the impeachment inquiry was announced, we submitted an urgent letter with 250 signatures to Congress, warning of the impending psychological dangers. Three days later, the president, without warning, unleashed Turkish forces on our Kurdish allies and ceded dominance of northern Syria to our enemies. Now, there is evidence of worsening of the president’s psychological state, as demonstrated in his intimidation of witnesses, his reigniting of a war of words with North Korea and his abrupt cancelation of a NATO press conference after tense exchanges with world leaders.

We are proposing that psychological factors be considered alongside the legal process because they are acutely relevant. When a powerful person, especially a leader, suffers from mental pathology, a substantial portion of the population can be affected by a phenomenon called “shared psychosis.” Common in households where an individual suffering from severe mental illness goes untreated, we observe that, rather than the sick person getting better, the healthy members of the family take on the symptoms of the afflicted individual. At large scale, individuals who are paranoid or delusional are often very effective at garnering irrational, fervent support.

Projecting His Own Undesirable Traits

Psychological defenses play a complicating role. Donald Trump recently said of the chairman of the Intelligence Committee: “I think Adam Schiff is a deranged human being. I think he grew up with a complex for lots of reasons that are obvious.” This is a recognizable defense mechanism called “projection,” or placing undesirable traits of oneself one is denying onto other, unfavorably perceived target persons. When a person’s own criminality or mental incapacity are projected this way, trying to convince the person and his followers of those traits will be met with great resistance.

Finally, impeachment is the ultimate rebuke of a president, and Donald Trump has already shown a profound inability to tolerate criticism. While we have avoided diagnosing so far, a colleague in this endeavor, Dr. John Zinner, who is a former researcher on narcissistic disorders for the National Institute of Mental Health, believes it is important to state his conclusion of “narcissistic personality disorder” to illustrate the extent of the dangers.

I support his judgment, since Donald Trump is exceptional in his transparency, offering continuous, unfiltered streams of thought through Twitter and other means, over many years, and given the availability of sworn testimonies by persons who have closely interacted with him. Further, narcissistic personality disorder falls within the spectrum of diagnoses for which a personal interview actually harms accuracy.

‘Narcissistic Rage’

Hence, as Dr. Zinner states, “What makes Donald Trump so dangerous is the brittleness of his sense of worth. Any slight or criticism is experienced as humiliation and degradation. To cope with the resultant hollow and empty feelings, he reacts with what is referred to as narcissistic rage.”

Narcissistic rage has the potential to be extremely destructive, bringing down as many people as possible amid one’s real or perceived downfall, without empathy, compassion, authentic guilt, or remorse. Incapable of caring for anyone but oneself, one lacks the capacity to avoid the harm one can cause to others. For someone who has unfettered access to the world’s greatest arsenals and the most powerful military on earth, with few who are able to constrain him, this is a potentially catastrophic situation.

For these reasons, we are petitioning Congress to take these danger signs seriously and to consult with us privately. While we are willing to testify for educational purposes for the public, we believe that the communication of our ultimate concerns should happen privately, in order to avoid provoking the president. Nevertheless, we and many others have made ourselves available for the critical need to convey important relevant information and recommendations that can help maximize our nation’s safety.

Bandy X. Lee is a forensic psychiatrist at the Yale School of Medicine, president of the World Mental Health Coalition, and editor of “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.”