In December, 2003, the columnist Charles Krauthammer made a brief return to his first career, as a psychiatrist. Writing in the Washington Post, he said, “It has been 25 years since I discovered a psychiatric syndrome (for the record: ‘Secondary Mania,’ Archives of General Psychiatry, November 1978), and in the interim I haven’t been looking for new ones. But it’s time to don the white coat again. A plague is abroad in the land. Bush Derangement Syndrome: the acute onset of paranoia in otherwise normal people in reaction to the policies, the presidency—nay—the very existence of George W. Bush.”

Krauthammer, who studied psychiatry at Harvard Medical School before becoming disenchanted with the profession, wryly, if predictably, located the worst of the “epidemic” on the Upper West Side of Manhattan and in “the tonier parts of Los Angeles.” Some of the most acute sufferers, he said, included Barbra Streisand, Paul Krugman, Bill Moyers, and John Dean. The leading institutional culprit was the liberal media. “The sad news is that there is no cure,” he concluded. “But there is hope. There are many fine researchers seeking that cure. Your donation to the BDS Foundation, no matter how small, can help. Mailing address: Republican National Committee, Washington, D.C., Attention: psychiatric department. Just make sure your amount does not exceed $2,000 ($4,000 for a married couple).”

This specimen of op-ed high jinks came not long after the American invasion of Iraq. Some joke. No matter. The phrase “Bush Derangement Syndrome” stuck around for years, a deflector shield wielded by right-wing gladiators, even as the invasion proved a colossal disaster and the economy, thanks in part to the Administration’s enthusiasm for deregulation, sank into its worst slump since the Great Depression. The implication was that the real culprits of the era were not the policymakers in the White House but the critics baying their irrational ravings.

Krauthammer spent his political youth as a liberal-ish speechwriter for Walter Mondale and ended up a neocon on Fox News. Asked once about his rightward journey, he remarked, “I was young once.” But, as deep as his conservatism ran, Krauthammer, who died last year, refused to get in line with Donald Trump. (In 2016, he voted for an unnamed third-party candidate.) “I used to think Trump was an eleven-year-old, an undeveloped bully,” he wrote in the Post, in an analysis that was as much psychiatric as it was political. “I was off by about ten years. His needs are more primitive, an infantile hunger for approval, and praise, a craving that can never be satisfied. He lives in a cocoon of solipsism where the world outside himself has value—indeed exists—only insofar as it sustains and inflates him.” Trump, naturally, responded with his customary Burkean eloquence, tweeting that Krauthammer was “a dummy” and “an overrated clown.”

Since the last election, many Republican politicians and pundits have updated Krauthammer’s phrase and have used “Trump Derangement Syndrome” to describe what they see as a mass of mush-minded lefties who lose their minds at the mere mention of the President’s name. Just a few weeks ago, the publisher, author, and convicted felon Conrad Black, who, coincidentally, received a full pardon from Trump last year, trotted it out for a piece in National Review.

But it is hard to know what such defenders make of their hero after, say, these recent August days, in which Trump has, in no particular order, uttered, then repeated, an anti-Semitic slur about the “loyalty” of Jewish Democrats; expressed admiration for the “legendary” industrialist Henry Ford, who was also the publisher of “The International Jew: The World’s Foremost Problem”; retweeted praise from a conspiracy-mongering radio host who said that Trump is practically “the King of Israel” and “the second coming of God”; reneged on a promise to establish background checks for gun buyers, after checking in for moral guidance with Wayne LaPierre, of the National Rifle Association; doubled down on a trade war with China that threatens to help spark a self-imposed recession; and cancelled a trip to Denmark because the Danish leadership had rebuffed his desire to buy Greenland in a manner that Trump, a stickler for etiquette, thought was “very not nice.” In the midst of an extended, hallucinatory press session out on the White House lawn, with Marine One providing an ominous “Apocalypse Now” chopper roar to the scene, Trump gazed briefly at the sky and remarked, “I am the Chosen One.”

One might ask Lord Black of Crossharbour and other Trumpists, Who exactly is deranged here? Is there still some mystery?

Again and again, Trump’s top advisers––Daniel Coats, Gary Cohn, James Mattis, Rex Tillerson, H. R. McMaster, and John Kelly among them––have left the White House clutching their heads, their dignity and nerves in rags, realizing that they have served a President who is unreachable, beyond cure and counsel; a man of rotten character, blatant instability, and zero empathy; an empty but radically dangerous human being, who occupies the highest office in the land. “I think the guy is losing it, mentally,” Anthony Scaramucci, the six-day White House communications director, said recently, after watching another sweaty performance by the President. While Scaramucci can hardly claim Charles Krauthammer’s medical training, it becomes increasingly impossible to contradict such a diagnosis. And yet does this week seem markedly different from other soul-depleting weeks in which the President of the United States, who dismisses the transformation of the global climate as a “Chinese hoax,” lays waste to countless environmental laws and tweets racist canards that inspire the dark imaginings of mass shooters? Trump seems perilously close to some kind of final unwinding. Just today, he tweeted, “My only question is, who is our bigger enemy, [Federal Reserve Chairman] Jay Powell or Chairman Xi?”

But, as perilous and unnerving as things are, any form of political despair at such a moment remains unforgivable. Despair is a form of self-indulgence, a dodge. Trump’s derangements in policy and character should instead instill a kind of Trump Clarification Syndrome, a reckoning with what confronts us. A reckoning, as the Amazon rain forest burns, with climate change. A reckoning, as Trump threatens to revoke the barest protections for immigrant children and the guarantee of birthright citizenship, with the history and persistence of bigotry in all forms. With the structural persistence of inequality of income and opportunity. With matters of truth and falsehood. Trump’s presence in the White House is depressing, there is no doubt, but to wallow in that gloom, or even to imagine that public life will “return to normal” on its own after his departure, is insufficient, even inexcusable. Democrats, Independents, and Republicans who cannot countenance Trumpist politics ought to welcome the most urgent kind of political debate on matters of policy and on who we are as a country. Perhaps it is a form of derangement to say it, but it’s entirely possible that Donald Trump, who has been such a ruinous figure on the public scene, has at least done the country an unintended service by clarifying some of our deepest flaws and looming dangers in his uniquely lurid light.