Yale Psychiatrist Recommends Managing the Increasingly Erratic, Dangerous President

If Donald Trump were not president, he would have been held and evaluated long ago. Mental health professionals have deemed this a “no brainer” since early 2017. Dangerousness is more about the situation than the person, and we ask questions such as whether the environment, including others, can constrain the person and whether one has access to weapons.

The concerns expressed at an ethics conference at Yale and in the public-service book, The Dangerous Case of Donald Trump, unfolded over the past two years with exactitude: incitements to violence, cruel policies against children that lay the groundwork for future violence, and the fostering of a culture of violence both domestically and abroad.

With the impeachment hearings, Trump’s behavior has grown even more erratic … his psychological structure makes him especially prone to violent revenge in the face of humiliation.

With the announcement of an impeachment inquiry, we warned of our entering “a very dangerous state” and the need to handle the situation adeptly from a psychological point of view. We wrote an urgent letter to Congress members gathering 250 signatures. Three days later, without informing his advisors, the president unleashed Turkish forces on our allies and handed over advantage to our enemies. These are predictable and therefore preventable events.

Disconnected from Reality

With the impeachment hearings, the president’s behavior has grown even more erratic with frantic tweeting, rallies that are increasingly disconnected from reality, and a very disturbing letter to House Speaker Nancy Pelosi. Because of his apparent cowardice and his predatory keenness in sensing the public’s desire for peace, it may be difficult to picture him as a violent man, but his psychological structure makes him especially prone to violent revenge in the face of humiliation.

Warning against danger and alerting about the need for an evaluation, to protect public health, is not diagnosing, and hence keeping with ethical guidelines, and thousands of mental health professionals agree. We recently submitted a petition signed by more than 800 mental health professionals for the House Judiciary Committee to consider psychological aspects. But in case Congress continues to find it difficult to consult with us, I outline a few recommendations here.

Sociopathic Behavior

When an individual is dangerous with signs of sociopathic pathology, containment is the first step of correct management. Postponing accountability and allowing the president to swell in his sense of power, before proceeding with impeachment, creates one of the most dangerous periods in his presidency. Impeachment finally begins containment, but it should only be the first step.

The House speaker has done well to call out an invalid Senate trial and to delay until it is fair. In psychological terms, it is a technique called “limit setting.” When there are no other means of logistically limiting harmful actions, statements and deeds need to call out inappropriate behavior in ways that are commensurate with overall facts. Investigations should be ongoing, and the reasons for bringing only two articles of impeachment laid out: a colluding Senate rather than a lack of high crimes. While the president is likely to grow more dangerous whether he is acquitted or not (through grandiose belief in impunity or vengeful rage reaction), psychological limit setting is more effective than political strategy alone, since politics require grounding in reality to work.

Removal from His Position

When “shared psychosis” (contagion of delusions or other symptoms onto individuals who are not impaired) occurs, removal of the mentally compromised individual from close contact permits dramatic improvement. In clinical situations, the affected individuals return to normal sometimes within days. If Donald Trump’s direct exposure to audiences through Twitter, his rallies, or his recent public letter cannot be curtailed, it needs to be properly inoculated (I demonstrate a method by analytically “translating” his letter). Most effective, of course, would be removal from his position of influence.

Similarly for war-making powers, psychological containment is paramount if actual limitation of his access were impossible. South Korean President Moon Jae-in is said to have assembled a panel of mental health experts before he intervened between Donald Trump and North Korean Leader Kim Jong-un, dramatically reversing a spiraling course of verbal sparring into a dialogue for an extended period. Our own CIA employs psychiatrists to perform psychological profiles on foreign leaders. It would likewise be helpful to understand with greater nuance our own leader, especially when our safety depends on correct interpretation and management.

I and hundreds of mental health professionals are available and eager to assist with any or all these efforts. When it comes to public safety, our interests as health professionals and the interests of politicians in charge of protecting the nation coincide.

Dr. Bandy X. Lee is a forensic psychiatrist at the Yale School of Medicine, president of the World Mental Health Coalition, and editor of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President