Gail Sheehy is the author of 17 books, including a biography of Hillary Clinton, Hillary’s Choice, and a current memoir, DARING: My Passages.

What is Donald Trump doing to Americans’ mental health? It came up in the debate Sunday night, when Hillary Clinton pointed to a “Trump effect,” an uptick in bullying and distress that teachers are noticing in classrooms as their students are exposed to a candidate who regularly attacks his opponents in bombastic, even threatening terms. The new revelation of Trump’s crude boasts in 2005 about being able to kiss and grope women and “move on” a married woman “like a bitch” gave new fuel to the charge that his candidacy might be normalizing aggressive, disparaging talk and behavior.

This all might be another political attack, just stacked up on top of the familiar charges that Trump is a danger to national security, an impulsive and erratic personality, and indifferent to the Constitution. But thousands of therapists are worried that it’s something more—and they’ve been saying so for months.


Over the summer, some 3,000 therapists signed a self-described manifesto declaring Trump’s proclivity for scapegoating, intolerance and blatant sexism a “threat to the well-being of the people we care for” and urging others in the profession to speak out against him. Written and circulated online by University of Minnesota psychologist William J. Doherty, the manifesto enumerated a variety of effects therapists report seeing in their patients: that Trump’s combative and chaotic campaign has stoked feelings of anxiety, fear, shame and helplessness, especially in women, gay people, minority groups and nonwhite immigrants, who feel not just alienated but personally targeted by the candidate’s message.

The manifesto also made a subtler point: that all the attention heaped on Trump is actually making it harder for therapists to do their jobs. Trump’s campaign is legitimizing, even celebrating, a set of personal behaviors that psychotherapists work to reverse every day in their offices: “The tendency to blame ‘others’ in our lives for our personal fears and insecurities, and then battle these ‘others,’ instead of taking the healthier, more difficult path, of self-awareness and self-responsibility,” as Doherty wrote. Trump also “normalizes a kind of hyper-masculinity that is antithetical to the healthy relationships that psychotherapy helps people achieve.” Not to mention that his comments in the 2005 tape, Doherty says, are consistent with the behavior of a “sexual predator.”

To some, the therapists’ campaign might sound a little touchy-feely, a worried cry from a group whose job is to be sensitive. But their effort is also an attempt to understand something bigger about what's happening to the country. There’s good reason to believe that demagogic, authoritarian leadership has a profound effect on citizens’ mental health—yet we know very little about what that effect is, Doherty says, because such repressive regimes tend to punish those who would dare to publicize findings of psychological damage. Doherty sees this moment in American politics as an important test case.

In fact, it was a recent trip to Austria, where a neo--fascist is leading in the presidential election, that inspired Doherty’s interest in Trump. He first thought to study what psychiatrists had done in 1930s Austria and Germany—some had collaborated with the Nazis, others remained silent—and then turned his attention to the present-day United States. Doherty sees in Trump echoes of the cults of personality wielded by strongmen throughout history—and amplified by Trump’s use of social media for self-propagandizing: appeals to fear and anger, blaming people seen as “other,” humiliating opponents, fomenting distrust of the media and the political system, projecting an image of exaggerated masculinity, and ridiculing women while claiming to idealize them. For that reason, Doherty sees Trump as a threat not just to the American people but to the democratic tradition, which he believes fosters the kind of openness that is essential to the work that therapists do.

Last month, to put some research heft behind his concerns, Doherty commissioned a national poll of 1,000 voting-age Americans and found that 43 percent of the respondents—not limited to people in therapy—reported experiencing emotional distress related to Trump and his campaign. Twenty-eight percent reported experiencing emotional distress related to Hillary Clinton’s campaign. Ninety percent of those feeling emotional distress say it’s worse compared with any previous election. But Trump has drawn the bulk of Doherty’s attention, both because of the GOP nominee’s overt aggression and because his name comes up more often in therapy sessions, Doherty says.

Trump’s bombastic approach, of course, has been intoxicating and persuasive to a significant portion of the electorate. He has a kind of roguish charm, and plenty of downtrodden Americans feel energized by his message that the country needs to be made “great” and “safe” again. And certainly, not all therapists attribute their clients’ anxiety to Trump or the election. In the conservative bastion of Newport Beach, California, for instance, psychologist Michelle Matusoff, a Republican whose practice focuses on children, teens and parenting, told me she was aware of the pervasive discussion on social media about misogyny, xenophobia and racism in the presidential election. She’s not a fan of Trump (especially after the release of the 2005 tape). But she criticizes him gingerly—“He doesn’t censor himself well,” she recently told me, meaning he says what he really believes but he doesn’t disguise it in coded language—and she calls analyses like Doherty’s letter “subjective.” “There’s a lot of disapproving and eye-rolling among my colleagues [about Trump], but we don’t notice a significant mental health impact on our clients,” she says.

But Doherty is deadly serious about trying to make psychotherapists across the country aware of the psychological threat of what he calls “Trumpism,” and to equip them to counter it in their practice. In his online manifesto, he urged American psychotherapists to become “citizen therapists” by actively discussing Trump with their clients and communities. I spoke to seven of those therapists, who described the effects of Trumpism they are seeing in their clients—from fear of being ostracized or stripped of legal protections they now enjoy, to suffering the terror of a childhood trauma reawakened by a candidate whose father trained him to think of himself as a “killer” and a “king.” They also spoke about how Trump—with his evident lack of self-reflection and frequent scapegoating—is making it harder for them to do their jobs.

Although it’s fair to assume that most of Doherty’s therapists skew liberal, not all of them do. Carrie Hanson-Bradley, a therapist in Lincoln, Nebraska, says she has voted for Republican presidential candidates her whole life. These days, she says, when her clients report increased anxiety and insecurity, they often point not just to personal troubles but to things they hear about in the news, including the Islamic State and the presidential election. Most of those clients, white males who skew low- to middle-income, don’t want to talk specifically about whom they’re voting for. But they do express concern about “not having a candidate that represents them and their problems,” explains Hanson-Bradley, who says she will not be voting for Trump. “It’s really hard when your conservative values lean one way, and the candidate”—Trump—“doesn’t represent that.”

Some therapists say their clients are pinning their worries much more squarely on Trump himself. Fran Davis, a Boston psychologist with 30 years of experience, told me that the day after Trump’s stunning primary victory on Super Tuesday, six of her seven regular clients said they felt acute anxiety just imagining that Trump could be president. Parents talked about their distress over eruptions of hateful talk and taunting in schoolyards. A legal immigrant parent reported her child asking, “Do we have to get out of the country?” Others had uglier worries. One of Davis’ patients, David Heimann, told me in an interview that Trump’s racist threats against Mexicans and Muslims triggered for him fears of persecution reminiscent of his family’s experience in the Holocaust.

Women have been a repeated target of Trump’s, particularly of late, with his crude hot mic comments, his revived body-shaming attacks against former Miss Universe Alicia Machado and his not-so-veiled threats on Hillary Clinton’s life—suggesting that Second Amendment supporters could take up arms against her, or that Clinton’s bodyguards should disarm to “see what happens to her.” Those comments have touched a nerve in many women, sometimes even more alarmingly among those dealing with the post-traumatic effects of physical or sexual abuse by husbands, boyfriends or fathers. Michelle Shauf, who works in the male-dominated high-tech and financial sectors in Atlanta, grew up with an abusive father and has recently sought therapeutic counseling. Shauf told me it depresses her to see Clinton’s experience and qualifications wielded as negatives to keep her from taking on a job held only by men. Plus, Shauf, who has a 9-year-old daughter, fears that Trump’s shaming of women for being “fat” or “flat-chested” can be primal injuries to adolescent girls’ self-esteem.

Trump’s suggestions that he could roll back civil rights gains for gay people—by appointing Supreme Court justices who would overturn same-sex marriage, for instance, and backing North Carolina’s controversial bathroom law (HB2)—are similarly triggering fears in some LGBT therapy patients. Susan Blank, Shauf’s therapist in Atlanta, told me about one gay male client who was married in Vermont when same-sex marriage was first legalized there and moved back to Atlanta when Georgia recognized it. He told Blank it was similar to the movie Jaws: “Just when I thought it was safe to go back in the water, Trump was nominated.” Margaret Howard, a licensed clinical social worker in St. Louis, said one of her lesbian clients was unnerved while traveling for work through what she described as “Trumpish areas” of the South with her same-sex partner. To register in a hotel, they hid their relationship and pretended to be roommates. “Having to go back in the closet has come as a real shock to my younger clients,” Howard told me. “They are used to acceptance.”

Patrick Dougherty, a trauma therapist in the Twin Cities who is a longtime colleague of Doherty’s (no relation), has found that even his mostly white heterosexual male patients—Trump’s demographic sweet spot—are experiencing anger and fear as a result of Trump’s campaign. Partly it’s that many of the men Dougherty treats grew up in dysfunctional families—a violent or alcoholic parent, or one who was depressed or negligent. Trump’s aggressiveness is triggering for them personal childhood traumas, says Dougherty, himself a Marine veteran of the Vietnam War. For others, Trump is contributing to a sense of “collective trauma,” a blow that tears at the basic tissue of social life. The videotaped police killing of Philando Castile in Minneapolis this summer and the recent stabbing at a mall in St. Cloud already have parts of Minnesota on edge; Trump’s antagonism toward minorities and others is only making matters worse, Dougherty says: “Even here in the upper Midwest, our sense of community is disappearing.” One client told Dougherty: “I work with Muslims—what’s going to happen to those people?” The client added, “I’m afraid some white motherfucker is gonna go down to the West Bank”—a part of Minneapolis that has a large population of Somali, mostly Muslim immigrants—“and shoot people up.”

Therapists, of course, must tread lightly when it comes to discussing politics, and for some particularly vulnerable patients, the fear that Trump incites can be attractive. Mary Kelleher, a marriage and family therapist in Seattle and another signatory of Doherty’s manifesto, experienced panic attacks herself just thinking about how her patients—most of whom are legal immigrants of Latin American, African or Caribbean descent—might respond to Trump’s branding of immigrants as a danger. But she was shocked to hear some of her immigrant clients say they were drawn to Trump. On reflection, she concluded, “His strongman persona represents safety to them, even if his policies could be personally destructive.” Still, Kelleher is careful not to engage in a political argument with her patients. “Their traumatization could go back decades, and that’s where I would focus,” rather than going directly to the subject of Trump, she explains. “Their alignment with Trump is a symptom of their trauma.”

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Trump’s emergence in therapy sessions presents a powerful conflict for some therapists between their professional norms—which include not imposing their political beliefs on their clients—and what some describe as a strong, even historic sense of moral obligation to keep this candidate out of the White House. Kirsten Lind Seal, a therapist who teaches ethics at Saint Mary’s University of Minnesota and signed Doherty’s manifesto, assured me, “I am not going to diagnose Trump from afar, but I have an ethical obligation to make my voice heard [outside of the consulting room] about how bigotry, xenophobia, racist and sexist speech is ripping apart the fabric of our social and political life.”

That’s where Doherty sees his work coming in. The thousands of signatories to his open letter have become an online community that shares ideas about how to counter “Trumpism.” And in August, he invited 14 of his most committed followers to brainstorm steps they can recommend to therapists in the trenches. They discussed ideas like easing into a conversation by first asking what the Trump campaign means to the client, if the client doesn’t bring up Trump on his or her own. If the answer suggests acute anxiety, then the therapist can suggest action steps, like disengaging with non-stop TV coverage of the campaign and engaging instead with friends and community. Doherty’s working group also discussed how patients who feel threatened by Trump can take action as citizens rather than feeling helpless—for instance, by registering new voters—rather than turning to passive coping mechanisms, like having another glass (or bottle) of wine.

The Marine veteran therapist Dougherty, for one, is experimenting with raising the question of political stress more directly among his regular clients. “I wrote a letter about the prevalence of hate speech in the campaign, about terrorism and mass shootings, and left it in my waiting room. I closed by saying, ‘If these things are troubling you, I want to invite you to bring it into your therapy session.’” Out of 30 patients, 20 raised those concerns, and Dougherty is working to help address them.

It isn’t enough to defeat Trump the candidate, some signers of Doherty’s manifesto say, and that’s not really the point. They believe they have to fight Trumpism—the emotional pain they say he has already caused. “There is a real and present danger for a national mental health crisis,” Doherty says. “And regardless of the outcome of the election, it will continue to need our attention.”