This is nuts. I don’t mean, nuts like, “Allowing the deficit to expand to a trillion dollars is nuts,” or "pretending personal diplomacy with Kim Jong Un works is nuts.” I mean, in the non-medical sense, he is erratic, narcissistic, unhinged, unable to control his anger, illogical and forgetful. (Remember the rally in New Hampshire at which he appeared to repeat a portion of the speech he gave at the beginning.) He has lost the ability to differentiate himself from the country and his own psychological needs from the country’s interests. To oppose him is to be an “enemy of the people.”

You say that we knew all this? I’d argue his ability to conceal these habits has considerably diminished and the period over which the rants stretch has lengthened. The craziness is swallowing the moments of lucidity, and given the real potential for a recession, his incoherence carries frightening risks.

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This is not a call for the 25th Amendment, which cannot be activated without his Cabinet and vice president, does not provide a final remedy and was not designed for these circumstances. I am calling for some truth-telling.

Let’s begin with former Trump officials, and I don’t mean Anthony Scaramucci. It is the patriotic obligation of Gary Cohn, Rex Tillerson, Jim Mattis, Daniel Coats and H.R. McMaster to speak with one voice, to make plain their concerns about the president’s fitness for office and call for a thorough psychological examination by a panel of expert psychiatrists, or if Trump refuses, for his resignation. They don’t have to worry about alarming other world leaders. They know. Believe me, they know.

All presidential candidates (Republican challengers and Democrats) should express grave concern about his mental and emotional fitness, as should members of Congress. If need be, hearings should be held to convey expert opinion about his observable behaviors.

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Democrats in the House should move as expeditiously as possible toward impeachment, based on the conduct outlined in the Mueller report, but with an eye toward the growing urgency of the problem.

Will these compel Republicans to turn on him (e.g., join the call for resignation, vote to impeach) or convince Trump to resign? In all likelihood, they won’t, but the voters deserve to know before the election (and hopefully sooner than November 2020) what is going on and the danger in retaining a mentally and emotionally unfit president. And if Trump’s conduct gets worse (as we imagine it will) and a recession or other national crises arises, everyone will be glad that the process had begun.