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As a simple but important reminder: it is not normal for the president of the United States to give credence to conspiracy theories about a predecessor having someone murdered. But then, we’re becoming accustomed to the abnormal these days, as David Frum pointed out.

Many seem to have responded with a startled shrug. What do you expect? It’s just Trump letting off steam on Twitter. Reactions to actions by Trump are always filtered through the prism of the ever more widely accepted view—within his administration, within Congress, within the United States, and around the world—that the 45th president is a reckless buffoon; a conspiratorial, racist moron, whose weird comments should be disregarded by sensible people… But cosmic joke or no cosmic joke, Donald Trump is the president of the United States. You may not like it. I don’t like it…But it’s still a fact, and each succeeding outrage makes it no less a fact. Grinning and flashing a thumbs-up over an orphaned baby? Yes, still president. Tweeting that a third-tier dictator has threatened him with more missile tests unless he halts military exercises with a U.S. ally——and that he has surrendered to that blackmail? Shamefully, still president. Accusing a former U.S. president of murder? It’s incredible, it’s appalling, it’s humiliating … but, yes, he is the president all the same.

Frum ends by writing that “this presidency shames and disgraces the office every minute of every hour of every day. And even when it ends, however it ends, the shame will stain it still.” He could be optimistic in suggesting an end to Trump’s presidency and it’s resultant stain of shame. To understand why, it is helpful to learn what mental health professionals have come to know about the terms “malignant narcissism” and “malignant normality.”

Psychologist Eric Fromm first coined the term “malignant narcissism” in 1964. He had narrowly escaped Germany in the 1930s and used it to explain the psychology of murderous dictators and tyrants. Building on Fromm’s work, psychoanalyst Otto Kernberg defined malignant narcissism as a syndrome characterized by demonstrating a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and aggression. Here is how mental health professionals describe a malignant narcissist.

The malignant narcissist is grandiose, with an inflated sense of accomplishment, and an excessive need for admiration. He is boastful, hypersensitive to criticism, arrogant, and envious. He is always ready to raise hostility levels, and uses deceit and manipulation. He transgresses social norms, and lacks moral conscience. He is preoccupied with perceived disloyalty, bearing grudges, quick to blame others, and prone to conspiracy theories. He is dehumanizing to people he perceives as weak, capable of taking glee in their misfortune.

Of equal concern is the concept of “malignant normalcy,” a term coined by psychiatrist Robert Jay Lifton after studying both doctors who participated in the murderous activities of Nazi Germany and those who were involved with torture during the Bush-Cheney regime. Here is how Dr. John Gartner explains malignant normality:

Malignant normality is when a malignantly narcissistic leader takes control of society and gradually changes reality for everyone else. So their crazy internal reality becomes enacted in the lived true external reality of that society. This is how a leader can come in and change the mores of their society.

When it comes to changing the mores of a society, Lifton points out that not everyone has to be converted into a true believer.

Nazi normality took shape around a genocidal ideology, originally put forward by Hitler himself…namely, that the Nordic race had once been healthy and dominant as the only culture-creating race; that it became “infected” by destructive Jewish influence and rendered weak and ill; and that it could become healthy and strong again only by ridding it of that Jewish influence… Significantly, very few Nazi doctors believed fully in that ideological vision, the majority holding to little more than the existence of a “Jewish problem” that somehow had to be “solved.” Extreme ideologues do much to create a malignant normality, which comes to pervade most institutions, including medical ones. Then ordinary people who work in those institutions adhere to that normality, often aided by bits and pieces of the extreme ideology. The prevailing normality can be decisive because it excludes alternatives and provides strong pressures for destructive behavior.

It is interesting to note that researchers attempting to document the existence of malignant narcissism wrote that they discovered that it “was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry.” When it comes to malignant normality, the fable of the boiled frog persists, even though it is not scientifically true. Perhaps that is because it does a good job of capturing the slow erosion of norms that Lifton identified.

To the extent that mental health professionals like Lifton and Gartner have identified what is happening in America today, it is understandable why they have prioritized their “duty to warn” over prohibitions about diagnosing public figures. But the information they are using is also available to the American public. If our situation is more dire than a stain of shame that will be left on the presidency once Trump leaves office, it behooves us all to educate ourselves about topics like malignant normalcy.