It is sometimes argued that the media should spend less time on President Trump's transgressive tweets in order to devote more attention to real issues such as North Korea. In fact, it is necessary to focus on Trump's tweets precisely because they shed light on the mind that is doing the deciding on North Korea. It is a distasteful exercise. But we cannot look away. We need to know the state of mind we're dealing with.

Trump's tweets reveal a leader who is compulsive, abusive and easily triggered. Trump describes all this as "modern day presidential." Lincoln had his Gettysburg Address. Franklin Roosevelt had his Four Freedoms. But modern schoolchildren will learn the Mika bloody facelift tweet.

What we are witnessing is not a new age in presidential communications. It is an ongoing, public breakdown. And the question naturally arises: Is this the result of mental dysfunction?

Most psychiatrists are (understandably) uncomfortable with diagnosis from a distance. And the particular diagnosis of narcissistic personality disorder requires significant impairment - which is a hard case to make of a figure at the pinnacle of American politics.

And yet. There are judgments that must be made about the fitness of the leaders. Citizens are under no ethical obligation to be silent when they see serious dysfunction. The challenge here is not merely the trashing of political norms. The main problem is the possibility that America has an unbalanced president during a period of high-stakes global testing. This is not a clinical diagnosis. It is a civic and political judgment, made necessary by the president's own words and acts. Trump holds a job that requires, above all else, the ability to unite and steady the nation in a time of crisis. There is no reason to believe he can play that role.

Much of the prudence and courage required to confront this problem will need to come from Republicans and conservatives. Where to start? How about refusing to downplay revolting lunacy?

It is not merely an "occasional ad hominem" for a president to employ the tremendous power of his office to target individual American citizens who oppose him. It is an abuse of power.

It is not merely "uncouth" for a president to tolerate, even to hint support for, violence against political opponents ("I'd like to punch him in the face"). It creates an atmosphere of intimidation.

It is not merely "exaggeration" for a president to issue a series of eye-stretching lies, including that his predecessor spied on him and that a popular vote victory was denied to him by widespread electoral fraud. It indicates either a deep cynicism or a tenuous connection to reality.

It is not being "coarse" for a president to engage in consistent misogyny. It is a sign of a disturbing and deep-seated dehumanization of women.

Many conservatives would respond to this critique by saying, "At least he fights!" The question is: For what? Trump evinces no strong or consistent policy views. He fights for himself - for admiration and adulation - which is the only cause his extreme narcissism allows.

Many conservatives would also respond by saying, "At least he does conservative things!" But if health care is any indication, Trump lacks conviction, knowledge and the ability to persuade. Other than that, he is Ronald Reagan incarnate.

Trump's conservative defenders are attempting something extraordinary: to politically normalize abnormal psychology. Their sycophancy enables a sickness.

What next? Applying the 25th Amendment (containing the procedure to remove an unfit president from office) is a practical impossibility, since it involves the Cabinet turning against the president. But House and Senate Republicans should be prepared to aggressively challenge unbalanced or unhinged presidential language and decisions, rather than trying to dismiss them as simply a "distraction."

And responsible officials in the executive branch - particularly at the State Department, Department of Defense, Justice Department and in the various intelligence services - may also need to provide an internal check on foolish, precipitous orders. The option here is to refuse, to defy, to resign (or be fired) and then to publicly provide the reasons.

No one really knows how to deal with this situation, which still feels more like an unnerving political novel than our political reality. Trump has led our country into unexplored territory. If this is "modern day presidential," all progress moves toward the past.

Michael Gerson's email address is michaelgerson@washpost.com.