Of course, the threat that psychologically dangerous leaders pose is not new. One need only look at the bloody 20th century to see that history has been profoundly shaped by a handful of leaders with dangerous psychological defects, whose unquenchable drive for power led them to attain positions of power. Joseph Stalin, Mao Zedong, Adolf Hitler, and Pol Pot are but a small sample. At times of social and political unrest, dangerous individuals may rise to power on the back of populist movements and hollow out democracies from within.

George Conway, attorney and husband of White House counselor Kellyanne Conway, recently said of President Trump : “Whether or not impeachment is in order, a serious inquiry needs to be made about this man’s condition of mind.” Since then, the media have been fixated on the Twitter war between Trump and Conway, rather than on the substance of Conway’s claim about the president’s mental health. On this one, Conway is right. He is probably relying on the growing number of statements by mental health professionals saying the same thing, but not being heard very clearly in the din of daily political banter. What Trump has resurfaced in an unprecedented way for the United States is the reality that a leader’s psychological defects can put a nation and the world in danger.


So why is this vital link between politics and psychological pathology not recognized more clearly? Why are we so reticent to discuss the mental health of political leaders, and to hear from experts?

Public misconceptions of dangerousness

First, the public often lacks an understanding of how dangerous psychological defects can be. Trump’s rantings and lies can seem amusing to some, or evidence of strength, or simply bargaining tactics. The public may not understand the dangers of his personality, which displays paranoia, cruelty toward others, and remorseless lying. Leaders with these pathologies characteristically scapegoat vulnerable minorities, equate cruelty with security, and excel in whipping up fear and hatred — all while the populace is not even aware that it is being manipulated.


Concerns over stigmatizing those with mental illness

An obstacle to discussing the mental health of political leaders has been the fear of stigmatizing those with mental illness. This is a valid and important concern. However, mental disorders are just as varied as physical disorders, and pointing out the dangers of leaders with patterns of lack of conscience, for example, should never stigmatize mental illness in general. Indeed, individuals with mental illness are far more likely to be victims of violence than perpetrators. It is important, nonetheless, to recognize for certain severe, antisocial traits, the dangers to the public can be profound. In such cases, protection of public health and safety must inform the discussion.

Political abuses of psychiatry and psychology

A further impediment to talking about politics and mental health is fear of the possible misuse of psychiatric categorization. This too is a valid concern. Abuse of psychiatry is rife in history. In the former Soviet Union, for example, around one-third of political prisoners were locked up in psychiatric hospitals, diagnosed with “sluggish schizophrenia,” whose symptoms included “reform delusions” and “struggle for the truth.”

We do not have to go far in time or place for such instances. Entire professional organizations have served as agents of the state, such as when the American Psychological Association provided cover for torture during the Iraq War, and more recently when the American Psychiatric Association imposed a gag rule on psychiatrists regarding any comments on Trump. Both did so under political pressure. In an open society, we believe that professionals should abide by their primary ethical duty to speak up about dangers to society, even and especially when their professional associations are complicit. Mental health professionals are not the final arbiters of power, but they should also not become agents of the state.


The fatal attraction of toxic leaders

A final, unsettling reason that we generally avoid talking about the mental health of political leaders is because pathological leaders often appeal to much of the public. By repressing their own anxiety, self-doubt, and guilt as well as presenting an outsized grandiose image of themselves, leaders with dangerous disorders strike many people as having qualities they would like to possess. They “say what they think” and “get things done,” regardless of criticisms. The potent attraction that pathological individuals hold for many of us means that, tragically, we often willingly place power in their hands.

A host of obstacles lie in the way of having an informed discussion about the mental health of political leaders, but such a conversation is clearly necessary, and indeed with Trump, urgent. From nearly all walks of life and every disciplinary perspective, the adverse impacts of the Trump’s mental impairment, such as an inability to have empathy for anyone, are stark. Panels like the one recently held in Washington, D.C., by the World Mental Health Coalition, and other multidisciplinary efforts are essential to shedding light on the ways a president’s actions have harmed and continue to harm the nation, and to find ways to minimize the damage. Society must become more informed about the malign impact that dangerous defects have, as well as learn to reduce the conditions of society that facilitate their dominance. By recognizing the importance of psychological health in our political leaders, and by not leaving an unsuspecting public vulnerable, we can take a crucial step toward our own safety and security.


Dr. Bandy X. Lee is a forensic psychiatrist and expert on violence at Yale School of Medicine. Ian Hughes is a scientist and author of “Disordered Minds: How Dangerous Personalities are Destroying Democracy.” Jeffrey D. Sachs is an economist and director of the Center for Sustainable Development at Columbia University. All are coauthors of “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.”