Based on Donald Trump’s public behavior, some of America and the world’s leading psychologists, psychiatrists and other clinicians have concluded that the president of the United States is mentally unwell. Trump appears, in their opinion, to suffer from malignant narcissism. He is also a compulsive liar who lacks empathy for his fellow human beings and shows no remorse for his bad behavior. Most importantly, Trump’s personality defects amplify his authoritarian values, beliefs and behavior. The results of this could be catastrophic.

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This article was originally published at Salon

This week, Donald Trump met with Kim Jong Un in Singapore, the first time an American president and a North Korean leader had ever met in person. This encounter quite literally had the potential to be explosive. Trump has alternated between threatening Kim with nuclear annihilation and praising him and other totalitarian leaders for their “strength.” Moreover, in many ways Kim Jong Un is everything Trump would like to be — a despot with no restraints on his personal and political power. Kim is also free to dispense with his enemies as he sees fit. He is literally the law in his nation and leads a society where he is worshiped as a god: North Korea is the ultimate cult of personality.

For the moment, disaster has been averted. At the Singapore summit, Trump and Kim engaged in an alpha-male bromance with one another. At this point, it appears that North Korea’s leader outmaneuvered Trump and the United States. Kim left Singapore with more international prestige and seemingly extracted important concessions. Donald Trump’s ego was stroked while the security of the United States and its allies in the region was weakened. Given Trump’s impulsive behavior, cultivated ignorance and hostility towards serious experts in diplomacy, East Asia and North Korea in particular, war may merely have been postponed for a later date, one that depends on the mercurial whims of Donald Trump and Kim Jong Un.

What role does Donald Trump’s mental health play in how he governs? Is the stress of Robert Mueller’s investigation and the other scandals swirling around Trump’s White House accelerating his mental decline? Why are so many of Trump’s supporters and other members of the general public still in denial about the global and national crisis that is Trump’s assault on American democracy? Can anything be done about a president who appears unstable yet still maintains the unilateral power to order the use of nuclear weapons?

In an effort to answer these questions, I recently spoke with Dr. John Gartner, a former professor of psychiatry at the Johns Hopkins University Medical School. Gartner is also the founder of the Duty to Warn PAC, an organization working to raise awareness about the danger to the United States and the world posed by Donald Trump. Gartner was a contributor to the 2017 bestseller book “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.” Along with Steven Buser and Leonard Cruz, Gartner has edited a new collection, “Rocket Man: Nuclear Madness and the Mind of Donald Trump.”

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This conversation has been edited for clarity and length.

Donald Trump’s presidency remains a global crisis and a national disaster, yet many Americans have quickly adjusted to the situation. I don’t just mean the millions of Trump supporters who are cheering on his assault on democracy and the country’s prestige and well-being. Is this learned helplessness or cowardice? How do you explain the relative non-response to Trumpism?

Part of the reason many people do this is because it really is psychologically overwhelming. It’s just almost too frightening to consider that a madman has control of the nuclear button, and he truly doesn’t care if he destroys us all. In fact, there’s a part of Trump that would almost take glee in it. He’s impulsive, he’s erratic, he’s seeing the world in a grossly distorted way. He’s only concerned with how things impact his own thriving and survival. Trump does not care about the well-being of literally anyone but himself. It really is a kind of dystopian nightmare.

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You and I have closely followed Trump’s rise to power and tried to communicate the depth of this disaster to the public. You have written or edited several books on this moment. I am trying to get my Trump book project finished as well. Are there moments when you feel like ignorance is bliss?

I do find myself feeling like, “Dear God, why can these people not see it? And what can we do to open their eyes?” It is like a 1950s or 1960s horror movie where nobody would believe that there was actually a monster that’s about to destroy the town and there are these Cassandra-like figures trying to warn people. But the townspeople remain in denial and they are doomed.

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Trump’s political movement meets the criteria for a political cult. You are a psychiatrist. Is it possible to reach someone who is stuck in Trump’s cult? Why does he have such influence over these people?

It does meet the criteria. You’ve got the charismatic leader, and his followers subsume their identity into his group, which makes them feel larger and more powerful. Once you have that kind of blind belief and loyalty, the leader, as Donald Trump has said, could really shoot someone on Fifth Avenue and nothing would happen. The cognitive dissonance is such that the cult members will rationalize anything. For example, something like 50 percent of Republicans say that if Trump wanted to cancel the 2020 election, that would be fine with them.

He is actually the second most popular Republican president in the history of modern polling.

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Yes, that’s right. It’s really shocking and frightening. It’s shocking and frightening in a way that just makes you feel like you’re on some kind of bad acid trip.

This is what I have described as a “malignant reality.” Trump, the Republican Party, and their supporters’ sadism is a key part of it.

The sadism is very important. When I first started talking about Trump as a malignant narcissist, people could see the narcissism, the paranoia and the antisocial element. But the fourth component of malignant narcissism is sadism. You see it in everything he does, from the separating of the children at the border to how Trump tortures anyone who doesn’t give him what he wants. There’s a way in which he takes a kind of manic glee in causing harm and pain and humiliation to other people.

At this point in Trump’s presidency, are things better or worse than you initially thought, regarding his behavior and public evidence of his mental health and well-being?

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The theme of my chapter in “Rocket Man” is that Donald Trump is actually deteriorating psychologically. We’ve not seen the bottom. We’re not in a static situation. We’re actually in a dynamic situation. Now, some people look at it as, OK, he’s not crazy, he’s just an authoritarian and we’re going through a period where American democracy is being degraded. That may be true, as horrible as it is. But from a mental health point of view, Trump is getting worse in several regards.

Malignant narcissists deteriorate. When they gain power, they become more inflamed in their grandiosity and in their paranoia. They also become more unrestrained in their sadism and in their will to power. Malignant narcissists like Trump are antisocial and have a willingness to do anything to get and keep power. The noted psychologist Erich Fromm actually argued that such personalities then begin to verge on psychosis at that point, becoming so grandiose and paranoid that they really live on the boundary of psychosis and reality.

In addition to that, I think Donald Trump is deteriorating for a second completely independent reason, which is that we’re seeing clear evidence of organically based cognitive decline. If you look at the interviews that he did in the 1980s, he was actually surprisingly articulate. He still expressed what I think we would considered by many to be loathsome views, but he spoke with a high level of vocabulary that included polished sentences and complete paragraphs. If you compare that to how Trump speaks now, he almost can’t complete a thought or a sentence without meandering into something nonsensical.

Trump’s defenders would point to the alleged fact that he passed a “mental health screening” and is in great shape.

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First of all, I was part of a group that sent the letter to Dr. Ronny Jackson, asking him to give Trump the Montreal Cognitive Assessment test. What you need to understand about the test is it asks questions like, “Can you identify a camel? Can you repeat three words back, three numbers backwards?” These are things that, if you can’t do them, it means you are grossly demented. It doesn’t mean that if you can do them, you’re free of all cognitive and psychological problems, as Dr. Jackson explicitly said. Especially for people who are at high levels of intelligence, because they can fall a pretty long way before they can’t identify a camel.

The simplest explanation is that Donald Trump is experiencing substantial organic cognitive decline, but he hasn’t reached the bottom of the hill yet. He’s fallen, let’s say, 25 stories, but he’s going to continue to deteriorate. Cognitive deterioration only goes in one direction. It doesn’t stand still and it doesn’t get better. No, Trump is not ready for the nursing home. But that doesn’t mean he’s capable of managing the White House. Once you factor in nuclear weapons the possibilities are truly horrific.

As we’ve learned from history, a person can be an authoritarian and also a sociopath.

They actually help each other. Nobody with a conscience could really be a good dictator.

Trump’s spokesman Rudy Giuliani has been doing the media rounds, making threatening remarks about James Comey and Robert Mueller. This is banana-republic dictator behavior. There is also the memo where Trump’s attorneys argued that he could pardon himself and is a de facto king who is above the law. Given his personality, how does this impact Donald Trump emotionally and cognitively? Is he excited? Titillated?

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I think he does feel that way. Giuliani really is his alter ego. This is what he wanted in his spokesman and lawyer. Someone who would just make up vicious lies and just keep slashing and burning and hurling mud and threats, devaluations and false accusations and conspiracies to muddy the waters, to make Trump look like the victim. You’re right, this is not a metaphor. This is organized crime stuff. It is the same psychology where there are all kinds of open extortionist threats

Trump and Kim Jong Un just met in Singapore for their so-called summit. Kim is a totalitarian dictator who literally has the power of life and death and runs North Korea like his own playground. Trump has a history of publicly praising autocrats and other demagogues but has also threatened Kim with nuclear annihilation. What is the dynamic when two such personalities encounter each other?

This is like a new axis of evil getting together and dividing up the world. That is the kind of statesmanship which Donald Trump understands. Trump attacks our closest allies in the G7 and wants Russia included in that group. His overtures to North Korea — it’s almost like in the mob, when the Brooklyn boss and the Manhattan boss and the New Jersey boss all sit in a room and divide up the territory to try to keep the peace.

I think we have to hold out hope about what happens in the future. In a very paradoxical way, the two alpha dogs showing respect for each other’s power and coming to some kind of deal would be the best outcome. But of course, those alpha-dog mob bosses also tend to get into wars with each other, don’t they? It’s not very stable because they are psychopathic, paranoid and quick to take aggressive action to seize the initiative. When you’re dealing with personalities like Trump and Kim Jong Un anything can ultimately happen. Hitler turned on Stalin.

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As Dr. David Reiss points out in your new book, Donald Trump probably wouldn’t qualify as a police officer, never mind not being able to get a security clearance. A man who literally has access to the nuclear football could destroy the world and you wouldn’t want to trust him as a beat cop. Yet he’s the president.

Dr. David Reiss does “fitness for duty” evaluations for police departments. His approach is that when he interviews a policeman who has fired his gun, he wants to hear what the reasoning was. What was the situation? What were the alternatives? Looking back on it afterwards, would you do anything differently? When you listen to Trump, you can’t see any of these connections. You don’t understand why he’s taking a certain policy. He’s not giving a rationale that fits the action.

Trump’s behavior is either based on a faulty premise or some kind of paranoid conspiracy theory or a denial of reality. On that basis, Dr. Reiss argues that if Trump were a policeman, he would take away his gun. In the book, other contributors such as Dr. Steven Buser and former Gen. William Enyart argue that Trump would not be able to qualify for a security clearance to be a nuclear missile launch officer.

Dr. Buser argued in a New York Times op-ed that Trump’s behavior and character suggest that he is not stable. Trump is not trustworthy; he’s not of the highest character. He’s not of the highest honesty. Therefore, Trump would fail to gain the clearance that allows an airman to handle nuclear weapons. He would be disqualified. Yet this person who is not qualified to even load the bombs onto the planes is the commander in chief and has the unilateral authority for any reason at any time to launch nuclear weapons.

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Trump also has a blatant disregard for expert knowledge, which signals to a broader problem with American culture at present and especially to how American conservatives embrace anti-intellectualism. Trump bragged that he would not need to prepare for his meeting with Kim because he works on instinct. Is Trump even capable of processing the seriousness of his meeting with North Korea’s leader?

No. Trump’s grandiosity is such that he actually believes he is an expert on everything. Based on his speeches and interviews, Trump is apparently the world authority on 25 different issues. This also speaks to a bigger problem, which is the death of expertise. For authoritarians and malignant narcissists like Trump an independent source of authority, whether it’s the press, the bureaucracy or the experts, are threats to his authority. Trump leaves positions at the State Department unfilled because he doesn’t want experts telling him what to do. He knows that he knows more than everybody else. What’s really frightening is that he actually believes that he has this kind of papal infallibility.

How would you explain to Republican leaders and other right-wing elites the seriousness of Trump’s mental and personality issues and the danger he poses to America and the world?

I truly believe that the elected Republican politicians are completely lost souls. They are like the characters in a zombie movie who keep their father in the basement because they don’t really understand that he is a zombie. He’s not coming back. I really, truly think it’s that bad. There a few Republicans who are trying to sound the alarm about Trump, but the Republican Party as a whole is like organized crime at this point, and Trump is the boss. There’s absolutely no other conclusion you could draw.

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How would you respond to those people who would say that you are panic-stricken? The world hasn’t ended because of Donald Trump, and this is all misplaced concern and worry. You are possessed by what his defenders call “Trump derangement syndrome.”

It’s a little bit like that patient who falls forward nine stories. He goes, “So far, so good.” We just haven’t hit the ground and splattered yet, but we are falling.

I have long argued that Donald Trump is version 1.0 of the American fascist. American fascist 2.0 or 3.0 is going to be far worse. We’ve crossed the Rubicon at this point, and the old version of American democracy, however flawed and [in] need of improvement, is gone.

Look at the people who are winning nomination on the Republican side. Nazis are running for office as Republicans. There are candidates who take Trump as a role model and will be even more extreme than him. There have been elections where Republican candidates and officeholders who dared to criticize Trump have been punished by Republican voters. It’s almost like a refinement process. This happens in fascist societies. We saw this with Nazi Germany.

As this crisis continues with Donald Trump, his party and his voters, will we reach a crescendo at some point? Or given his personality and behavior, will it be a series of seemingly never-ending events that just keep dragging the United States farther down?

It all reminds me of the saying about how people go broke very slowly and then all at once. I think that’s what we’re heading for right now. What if there is a global crisis like a war? What if Trump refuses to step down, if he is impeached and convicted? It is a coup that is not moving slowly anymore. It is accelerating.