The first week of public impeachment hearings against Donald Trump in the House of Representatives has concluded. Despite the obsessive efforts of Trump’s Republican Party minions, his personal spokespeople and the right-wing disinformation media, the facts are clear: Multiple witnesses independently report that Donald Trump abused the power of the presidency for personal gain in an effort to bribe and extort the president of Ukraine into aiding his re-election campaign.

As documented by Robert Mueller's report, the Ukraine scandal is part of a long pattern by Donald Trump and his supplicants to seek out foreign assistance to subvert American democracy, with the goal of first installing Trump in power and then keeping him there.

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During their public testimony, career State Department officials George Kent and Bill Taylor reported that military aid to Ukraine was delayed until that country’s government agreed to Trump’s demands to investigate Joe Biden and his son Hunter Biden for “crimes” which they did not commit.

Donald Trump’s selfish, self-interested, corrupt and apparently illegal plan resulted in the deaths of Ukrainian soldiers who are fighting Russian aggression against their country.

During private hearings before the House, Jennifer Williams, a special adviser to Vice President Mike Pence, and Timothy Morrison, a deputy assistant to the president, have testified that there were serious concerns about the legality of Trump’s attempts to force the Ukraine government to investigate the Bidens as a precondition for military assistance.

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Transcripts of this testimony released on Saturday show that the president and his personal emissaries were more concerned with forcing the president of Ukraine to interfere in the 2020 election than in aiding America’s ally in its struggle against Vladimir Putin’s Russia.

In perhaps the most dramatic public testimony, former U.S. ambassador to Ukraine Marie Yovanovitch testified that she was recalled from her post by Donald Trump because she would not cooperate with his efforts to extort the Ukrainian government.

In a textbook example of witness intimidation, Trump responded to Yovanovitch’s testimony via Twitter with insults and threats. He targeted other witnesses, Democrats and critics with the same bile and vitriol last week. Insulting and threatening his perceived enemies is one of the main ways Trump uses Twitter, as documented by the recent New York Times article “How Trump Reshaped the Presidency in Over 11,000 Tweets.”

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Donald Trump is not acting like late-stage Richard Nixon — yet. The latter raged and wandered about the White House in a drunken state during the climax of the Watergate impeachment scandal. But as the impeachment process moves forward, there are indications that Trump is spiraling out of control and his closest aides are apparently unable to control him.

Trump has lived almost his entire adult life without restraints on his behavior. The stress of the impeachment process, along with the growing sense that the 2020 election will be a referendum on a deeply unpopular presidency, are forcing a man who has already shown himself to be mentally unwell into a steep decline, perhaps into psychotic behavior.

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Dr. John Gartner is a psychologist, psychoanalyst and former professor at the Johns Hopkins University Medical School. Gartner is also the founder of the Duty to Warn PAC, an organization working to raise awareness about the danger to the United States and the world posed by Donald Trump. Gartner was a contributor to the 2017 bestseller "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President." Along with two other mental health professionals, he wrote the recent USA Today op-ed proclaiming that "Trump's rash Syria move looked like a 'hypomanic episode.'"

I recently spoke with Gartner about Donald Trump’s mental state and the likelihood that impeachment will force the president to act out in even more dangerous and unpredictable ways. Gartner also explains the ways that Trump’s malignant narcissism manifests itself through sadistic pleasure, which may even be sexual in nature. Gartner also considers what will happen to Trump’s followers and their “fascist fever” when Trump is eventually no longer president of the United States.

This conversation has been edited for clarity and length. You can also listen to my full conversation with Dr. John Gartner through the player embedded below.

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If Donald Trump were your patient, how would you evaluate his behavior over the last year or so? Is Donald Trump's behavior devolving, as predicted by the medical literature?

Yes, but in ways that I think are even more ominous than when we spoke almost a year ago. Trump is a malignant narcissist. Erich Fromm, the noted psychoanalyst who studied Nazi Germany — and the person who introduced the diagnosis of “narcissism” — explained that in such personalities their grandiosity, their narcissism, their paranoia, conspiracy theories, sociopathy, criminal behavior and sadism all go into overdrive when they get power. Those traits are also inflamed when a narcissist is challenged or attacked.

And there is a feedback loop as well, where because they're gaining power — which inflames their narcissism and their paranoia and their freedom to act on their criminal impulses — of course that means there will be opposition and resistance to them. Narcissists like Donald Trump then demonize and try to brutalize and invalidate anyone who does not kiss his ring. Trump has systematically eliminated every single guardrail on his power and behavior in the White House.

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There is literally nobody, not one person, who can tell him “no” right now, intervene against him. But there is another element to Trump’s dangerous behavior that we should be paying very close attention to. I believe that Donald Trump is having a hypomanic episode.

Many reporters and journalists have described Trump’s recent behavior as manic. Concerned observers highlight Trump’s tweets, which have greatly increased in number.

A hypomanic episode is not the same as a manic episode. “Manic” is only partially accurate in describing Donald Trump because when somebody is manic, they think they're Jesus Christ, which means they are psychotic and usually end up in the psychiatric hospital. But when someone's hypomanic, they become more agitated, more energized, more impulsive. They act out more aggressively with poorer judgment. A hypomanic person does not listen to anybody. They do not delay their activity. They do not accept feedback from anybody else.

This means that a hypomanic person can act quickly, impulsively and urgently, with poor judgment, in ways that will have predictably catastrophic consequences. A person with that temperament can, in moments of stress, devolve into something that is a psychiatric disorder. Essentially, everything gets accelerated for the worst. This is what we are now seeing with Donald Trump. When this will really become an even greater crisis — a crescendo in his dangerous behavior — is when Donald Trump starts making catastrophic moves internationally. He could start a war.

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Trump’s speech after the Delta Force commandos killed al-Baghdadi, the ISIS leader, was utterly unpresidential. It was crass and disturbing. He was truly in his element.

Note Trump’s lies and grandiosity. Of course, he claims that he destroyed ISIS. He has said things such as "I'm the chosen one." It is malignant narcissism and grandiosity, which has become more extreme.

It is very alarming that Trump’s dysfunctional behavior is getting worse — even by earlier standards, which were very alarming. For example, Trump made a catastrophic decision to impulsively withdraw the U.S. military from Syria which leaves the Kurds to face genocide. He literally picked up the phone, talked to the president of Turkey, and without consulting or informing even one human being in his own administration, literally at 3:00 a.m. and called the military and said, "Start withdrawing from Syria." That is a manic style of decision-making. It did start a war. There is always that narrative about a president’s leadership and the 3 a.m. phone call about a global crisis as the test of his leadership. Well, in this case Donald Trump is the crisis. He is the 3 a.m. phone call.

What do we do in a moment where it is the president of the United States who is the greatest danger to the nation and the world?

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It's not that Donald Trump is the greatest danger to the world, but that he is so much more erratic and desperate, and more driven now to act out in destructive ways to feel powerful.

Donald Trump was booed during the World Series. The same thing happened when he went to Madison Square Garden to attend a UFC event. During the baseball game Trump looked like a man about to explode in rage and tears. In such a moment, how does a malignant narcissist such as Donald Trump resolve the obvious public scorn, when he imagines himself as being universally loved?

Reality has always been fluid for Donald Trump. Erich Fromm said that malignant narcissists live on the boundary between sanity and insanity. This is a state almost akin to being in the middle between psychosis and neurosis. Because Donald Trump is such an inveterate liar and con man, the American people and the world do not know if Trump is just trying to con everybody or if he actually believes the crazy conspiracy theories that he touts, or crazy grandiose things such as the claim that he won the popular vote, or that he is cheered instead of being booed at public events.

I believe that Donald Trump may just be lying and at other times he may be delusional. It shifts back and forth. People who have this level of severe personality disorder must psychologically project everything bad outward. They can never be to blame. They're always the victim. Someone else is always to blame. They can't own up to the bad things that they're doing, so they must externalize the blame. People like Trump end up accusing other people of the very thing within themselves that they cannot tolerate or acknowledge.

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At his rallies and other events Trump often claims that the Democrats don't respect the Constitution: "They're traitors, they're treasonous. The Democrats have conducted a coup.” Does Trump actually believe that, or is that all outward projection of his own internalized guilt?

Donald Trump is incapable of feeling guilt, shame or remorse. But Trump does project externally onto others what he knows is within himself. Sometimes it's unconscious, though, so Trump is not aware that he's projecting. Donald Trump does not feel any compunction about lying. Donald Trump cannot tolerate anything negative about himself, therefore he needs to experience it as coming from the outside where he is the innocent victim.

Several weeks ago, Trump publicly said that his wife, Melania, would not be willing to take a bullet for him. Was that a moment of honesty about their relationship?

Donald Trump is a person who really is incapable of thinking of relationships as being anything but transactional. I don't believe that Trump has a single human being in the world who actually feels affection for him or likes him and where he in turn returns the favor. There's no human being that Donald Trump likes, unless they are helping Trump or doing something useful for him at a given moment. But the minute that person stops being useful, they cease to exist to Donald Trump.

If you look at malignant narcissistic leaders such as Hitler, Stalin, Mao, Saddam Hussein and others, they all act in that way. Unless you are a slavish toady, such personalities will eventually see you as an enemy. This is what we've seen with Trump’s systematic purging of people in the White House. Anyone who does not put the Great Leader above all other things — in this case, above American democracy — is purged. And that is how you get a totalitarian state.

Trump has really normalized deviance. At one of his recent rallies he even pretended to have an orgasm on stage while re-enacting a sex act. There is a deeply libidinal connection between Donald Trump and his cult members. This is an aspect of fascism which is little understood by the general public and most in the news media.

Trump experiences great pleasure from sadism. One of the four components of narcissism is sadism, getting pleasure — maybe even sexual pleasure — from degrading, humiliating and harming your enemies.

What about Trump’s threats of both explicit and implied lethal violence against the Democrats, the whistleblower and other people who dare to oppose him?

What would Trump be like if he didn't have the restraints from the remnants of the United States Constitution or the Democrats in the House of Representatives? We have to wonder how many immigrants would be in concentration camps right now. How many FBI agents and Democrats and journalists would be in jail?

Donald Trump would not mind seeing some journalists killed. I don't think Trump sees the deaths of journalists as a bad thing. In totalitarian states like Russia, journalists are killed and the opposition is jailed. The courts are used to put people in jail for “corruption” when they dare to challenge the real corruption of the state. Donald Trump would be as bad as any of the other totalitarian leaders throughout history if he had the chance and the unrestricted power.

The New York Times has analyzed approximately 11,000 of Trump’s tweets. Reading them as a mental health professional, what do Trump’s tweets reveal?

The most frequent use of Trump’s tweets is to attack people. There's almost a manic level to Trump’s rage. The other most common category was self-praise. Trump is a malignant narcissist. He's shamelessly grandiose. Trump’s paranoia is inflamed and all these behaviors and traits are getting dramatically worse because he's destabilized.

When Trump looks in the mirror, what do you think he sees?

I think that Donald Trump sees a god. I believe that Donald Trump sees someone who's the greatest president in history.

All that boasting seems to suggest he is very weak inside.

Absolutely. Donald Trump is an empty shell of a human being. That is what he is manically trying to overcome with all this grandiosity. Deep down inside, Donald Trump is a very empty and sad person. His attempt to compensate is that Donald Trump is going to beat the world to death to prove that he really is triumphant. I believe that Donald Trump’s whole life is about a battle to be dominant and to crush his enemies. That is what gets him off. It excites him. The problem with people like Donald Trump is that there is no limit to the amount of destruction they are willing to create.

Donald Trump is likely going to be impeached in the House and then acquitted by the Republican-controlled Senate. What comes next? I am deeply concerned that the impeachment process will end with Trump feeling vindicated and free to act even more like a demagogue and a tyrant.

One of the most ominous recent developments is that Trump is telling the Republican senators who will vote on his impeachment that he will give them money. The fact that other than Sen. Mitt Romney, no senior Republicans have spoken against him. Trump’s already got the fix in with the swing-state senators. Trump is ready to take his behavior to the next horrible level. Trump already realizes, "They're not going to stop me."

How will Trump’s supporters in his political cult react if he is removed from office or otherwise forced out? And how will Trump’s behavior continue to worsen?

The fever breaks when the malignant narcissistic leader is removed. After Hitler, the Germans were fine. They weren't intrinsically bad people. It was like a fever that was being led by this madman. Some people were more susceptible to it than others and then it took over the society.

I think the thing to keep our eyes on now is that the rate and the volume of Trump’s dysfunction are accelerating. We're actually entering a period where Donald Trump is like a rocket taking off. The rate and the extremism of Trump’s madness is escalating. His acting out is escalating. America and the world are in an escalating crisis right now in terms of Trump’s mental health.