Many of the America’s leading mental health professionals have concluded, based on Donald Trump’s public behavior, that he is emotionally and psychologically unwell. The veracity of these conclusions has been reinforced by what would, in other, more normal circumstances, be considered a series of stunning events.

This article first appeared in Salon.

ADVERTISEMENT

A senior official in the White House wrote an anonymous op-ed in the New York Times declaring that Trump is unfit for office and a danger to American democracy. (According to literary scholar Don Foster’s analysis for Salon, the likely author is Defense Secretary Jim Mattis.) On at least two other occasions, White House insiders reached out to Yale University psychiatrist Dr. Bandy Lee with their concerns that Donald Trump was “unraveling” and that they were “scared” by his behavior. According to a New York Times report, Deputy Attorney General Rod Rosenstein considered secretly recording Donald Trump as part of a broader plan to recruit senior administration officials and Cabinet members to invoke the 25th Amendment and remove Trump from the presidency.

Donald Trump’s lack of mental wellness continues to be on full display. Last week, in an almost 90-minute press conference Trump showed once again that he is detached from empirical reality, declaring that China respects him because of his “very, very large brain,” misrepresenting the facts and habitually lying about matters large and small. On Saturday night at a rally in West Virginia, Trump showed his authoritarian inclinations and grandiose, malignant narcissism by declaring that he and North Korea’s murderous dictator, Kim Jong-un, “fell in love” because of the “beautiful letters” they exchanged.

What are the origins of Donald Trump’s mental health issues? How does his childhood help to explain his pathological adult behavior? Is Trump capable of self-reflection and empathy? Is he in fact a sociopath? Is Trump’s infantile behavior and chronic lying unprecedented in the history of the American presidency? Why are some people so intensely attracted to Trump and what he represents — and what does his power over his supporters reveal about their collective mental health and psychological well-being?

In an effort to answer these questions I recently spoke with Dr. Justin Frank. He is a clinical professor of psychiatry at the George Washington University Medical Center and a physician with more than 40 years of experience in psychoanalysis. He is the author of the bestselling books “Bush on the Couch” and “Obama on the Couch.” His newest book is “Trump on the Couch.” Dr. Frank’s work has appeared in Time magazine and the Daily Beast and he has appeared as an expert commentator and guest on MSNBC, CNN, PBS and other outlets.

This conversation has been edited for clarity and length. A longer version can be heard on my podcast.

ADVERTISEMENT

Who is Donald Trump in his own story? That’s a great question. I actually think that there are a few things Trump believes. One is that Trump believes he’s a great person. He actually believes that he really is the best president we’ve ever had in the United States. Trump believes that everything he’s done has been great, the economy, everything. But while Trump believes these things he is also very fragile.

Whenever somebody criticizes Trump that belief gets challenged, which is why he has to reassert himself through tweets, TV shows, the rallies and other events. Unconsciously, Trump also has a compensatory fantasy of greatness. The fantasy compensates for a loss in early childhood, which was the loss of maternal attention. Trump compensated for this lack of attention from his mother by having a vision of being the greatest person who could do whatever he wanted to do.

ADVERTISEMENT

The second thing that Trump believes is that he is a victim. He really believes that people are out to get him and criticize him. He’s always had the need for an enemy or an adversary, someone he can imagine who’s out to get him. In fact, Trump gave a graduation speech at the Air Force Academy and said that he’s been more victimized than any other president in history. It’s really quite stunning. For a long time — and we are seeing this now in particular — it’s been the press. He’s been angry at the press way before he ever became president.

Does Trump really believe all these things or is he self-aware enough to know he is lying to himself?

ADVERTISEMENT

There is confusion between the word “really” and “only.” “Really” means he truly believes it. Trump may have other beliefs, but they are segmented. Trump is like a baby. They’re only in the moment and that’s a normal state for babies.

When we grow up, by the time we’re two years old, we realize that we are capable of more than one mood, memory or feeling. Trump is amazing in that he still is a segmented thinker. This is why when somebody asks Trump what he did the day before and they read the tweet to him, for example, he can’t answer the question. He actually doesn’t know what he meant. That’s how segmented his mind is.

Many mental health professionals have offered opinions on Donald Trump based on his public behavior. He is the president of the United States, one of the most watched and followed people on earth. Yet there are objections about the “Goldwater rule” and the proposition that any diagnosis would be “unfair” or “unprofessional.”

ADVERTISEMENT

When the Goldwater rule was passed [by the American Psychiatric Association] about not making diagnoses from afar, this was in 1964, before the internet. Senate hearings were not even televised. There was no social media. There were no daily interviews, no 24/7 news cycle. There’s a lot of public information. We didn’t know that much about Goldwater.

My analysis is not an armchair analysis. I’ve been researching this book for almost two years. It’s the most thorough analysis I could ever do of someone without having Donald Trump in my consulting room. If I interviewed Trump, I would have to see him a lot to get to this level because one interview would not accomplish anything.

What would you explain to the general public about Trump’s behavior? What are we actually seeing in terms of pathology?

There are certain facts which are very important. When Trump was eight his little brother was six. They were both building towers. Donald didn’t have enough building blocks, so he asked his brother for them. He then took the building blocks from his younger brother and glued them together so they could never be reused. He’d never have to give them back to his brother.

ADVERTISEMENT

That’s who Trump is. The blocks suddenly belong only to him. That’s the truth about Trump. That story is very predictive. Donald Trump won’t change. This is who he is. He is not able to change. It’s not that he won’t, he can’t. The people who are anti-Trump need to understand that they have to stop getting exasperated by him. Go ahead and move forward. The people who are moving forward are women and minorities who are running for office, people who are speaking out. Other people are not moving forward.

n my writing and interviews I have been trying to explain for more than two years that Donald Trump will not change. Yet there remains this persistent hope by some in the news media and public that Trump will “mature,” or “pivot” to being a more normal president. Why do people hold on to these delusions?

When we were children, we didn’t want to see our parents as anything other than great. We also believed in Santa Claus. Some of us even believed in the Easter Bunny. There’s all kinds of things that little children believe in. They idealize what they love. People believe in the presidency. People believe in the United States, that it is a great nation. People believe in our institutions and people. Even Anne Frank, when she was about to be murdered by the Germans, ended her book by saying people are basically good at heart.

People felt that once Trump could see the importance of what it means to be president, the awesome responsibility that goes with it, that he could change. We can say that in retrospect such a belief is very naïve. That’s based on hope, but it’s also based on a childhood confidence about the institution. It is very painful for people to reject those childish beliefs. It’s very painful to get these illusions. So many people can’t believe how Donald Trump is acting. This naiveté is deep in us.

ADVERTISEMENT

Donald Trump’s victory and presidency are a manifestation of social pathology. He and his voters and public and other Republicans are involved in a cult-like relationship. Add in the racism and nativism and authoritarian behavior and it is a knot of collective narcissism.

First of all, why are people narcissistic? What makes people collectively narcissistic? Rather than defining them, what about looking deeper in terms of what the causes of this behavior are? In most cases the causes of intense narcissism have to do with the need for survival. Moreover, the need to have a fantasy that compensates for hurts, frustrations and feeling helpless.

Trump taps into the compensatory part of narcissism. He talks to these “working class” people who supposedly have lost their jobs, who worked hard, who have been churchgoers and did “everything right” but haven’t gotten very far. They feel hurt. They feel rejected. They don’t have a part of the American dream. They’re left behind the way a five-year-old feels left behind when the parents go out to the movies. They’re injured. They feel upset. They feel like, “How could you do this to me? That’s Donald Trump. This is the narcissist injury. Trump says, “How could you do this to me? I won’t take it anymore.” He connects to people who feel victimized and hurt. That’s the collective narcissism, the narcissist injury.

There is another type of pathology at work with Trump and his followers. He is very infant-like. His supporters want to be infantilized as well. He is the “strong leader,” a type of father figure for them and the head of an authoritarian movement.

There are two dimensions. Infants feel that they can say whatever they want and do whatever they want. That’s what narcissists feel ,and there’s nobody more infant than a narcissist. “I cry and the breast comes to me.” “I get cold and I get my diaper changed.” Narcissists are very powerful in their fantasy life.

ADVERTISEMENT

It comes as a shock when they look into the mirror and realize, “Oh my God, I’m just a little baby.” There’s a real disconnect. I do think that people are aware of their infantile nature. One of the things that infants want to do when they’re older is they want somebody to make it safe and tell them what to do. People are longing for a leader who will take charge. I really think that’s what his supporters like about him. They feel that Trump will take charge. They’re infants and he’s not. The other side of this dynamic is that Donald Trump is an infant and then we, the American people, become like parents. Many people are attracted to somebody we can save and help.

What does that do to the office of the presidency?

One of the things that Trump does is to abdicate responsibility. He makes everyone else around him feel responsible for him. That makes us into the parents and Donald Trump into the infant. Donald Trump is the first president who we, the American people, have to comfort rather then being a leader, a president who comforts us. This is a shocking state of affairs. This is not why we have presidents. Trump cannot comfort us because he doesn’t know how. He can’t empathize.

Donald Trump cannot put himself in somebody else’s shoes. He is missing certain aspects of compassion. Trump doesn’t feel guilty. Trump doesn’t feel shame. When you don’t feel shame and you don’t feel guilt, it’s very hard to think. It’s very hard to assess a situation. It’s very hard to feel loss. It’s very hard to do all kinds of things.

ADVERTISEMENT

I have spoken to a number of the country’s leading mental health professionals about Donald Trump. There is a consensus that he exhibits signs of sociopathy. Do you agree with that diagnosis?

Yes. In my new book I explain how to know Trump is to know psychiatry. Donald Trump is really a sociopath, but he’s not only a sociopath. Donald Trump is really a big baby, but he’s not only a big baby. He’s a real shrewd, smart businessman, but he’s not only a shrewd, smart businessman. He’s all of those things. He’s Donald Trump.

Too many observers and apologists for Donald Trump claim that he can’t be mentally unwell and be successful in business. He couldn’t have made all that money and have emotional problems. Those conclusions are wrong and channel a very dangerous type of binary thinking.

Exactly. People want to organize their inner world. The way a child does this by dividing the world into something binary, into good and bad. Do we like him or do we hate him? Is he a good guy or a bad guy?

ADVERTISEMENT

They’re different, but children want to know who’s better. We have binary thinking bred into us. But we also have to deal with complex matters. The fact that I can love and hate the same person. I can feel ambivalent. I can have more than one feeling about the same person. That’s a very complicated developmental state. As we develop we go through all these phases. These are about developing a capacity for concern about other people, feeling guilty about having hurt somebody, feeling ambivalent. Trump is fundamentally a binary person. One of the things that is so powerful about any nation, especially ours right now, is that it’s a binary nation.

For instance, when these people are channeling, chanting “USA! We are the greatest! We are exceptional!” When Obama said, “Well, the British feel that they’re exceptional too,” Conservatives and others said, “Well, you’re going on an apology tour. You’re weak if you think that the British people are as good as we are.” Obama didn’t say that. He said the British also think they’re exceptional. Why shouldn’t they? People in this country don’t understand that fact.

In my book on Obama, I wrote that Obama was very unusual as a president. Barack Obama was what I call a “both/and president.” He could see things both ways but he became the president of an either/or nation.

We’re either good or bad. You’re with us or against us. You’re a capitalist or you’re a socialist. Trump is a very good example of that. He cannot tolerate any accomplishment of Obama’s. The reason he can’t tolerate Obama is not just because Trump is a racist and not just because he hates Obama. It’s because Trump can’t tolerate having a good and bad feeling about the same person. Trump cannot do this because if he feels anything positive about Obama, it’s going to ruin all his hate. Donald Trump needs to keep his hate intact.

ADVERTISEMENT

Hate is Donald Trump’s superpower. It is his greatest strength.

Yes, hate is Donald Trump’s strength. That’s what his people like. The problem is what they fell for is his hate. Trump does whip up hate in his rallies and his tweets. Trump does hate the press and he does call them the “enemy of the people.” He’s good at that. But what his supporters don’t see is that when he said “You’re fired” on “The Apprentice,” he was reading a script. That was Trump playing Trump, Trump the actor playing Trump the tycoon. The fact is, Trump doesn’t fire anybody directly. He just badmouths people and gets angry. He’s not nearly as strong as he appears to be.

I was at Donald Trump’s Chicago rally where his supporters started attacking people. That “riot” was part of a larger pattern where Trump encourages violence at his rallies and across American society. What is Trump’s role in encouraging such antisocial behavior?

Leaders have a superego function for society. They function in a parental way. Laws are given down by the parents, usually the father originally. In terms of the Ten Commandments and the Biblical father, those are the laws. Don’t kill anybody, don’t steal from anybody, honor your parents. Those are lessons for a five-year-old. The Ten Commandments are written for five-year-olds. They’re an effort to get children to learn about what to do and what not to do. What’s right and wrong. But sometimes you feel like killing somebody. Sometimes you feel like making an attack. We all do. Trump taps into those feelings.

He gives people permission to hate, permission to be angry, and the permission to express it. When he says, “I don’t believe in political correctness,” everybody cheers. When he says “the press is the enemy,” everybody cheers. He could say the name Hillary and everybody would say, “Lock her up!” If there’s a protest or in a rally, especially if it’s a person of color, they’re going to be destroyed by Trump. It is going to be a mob.

Barack Obama and Donald Trump are very different people with diametrically opposed leadership styles. Why are some people instinctively attracted to — or repulsed by — either Obama or Trump?

People who are instinctively attracted to Obama see a person who is able to say, “Everything doesn’t just work out. We have to think about it.” He has perspective and people are attracted to that. People are also attracted to Obama because he’s a perspicacious person.

People are attracted to a person who can think, who’s complicated, who can inspire by the fact that if you use reason and use your mind, you can move ahead. You don’t have to avoid them. To a writer, he’s the best writer that ever lived. To an economist, he’s the best economist. People have these fantasies about Obama. Because Obama is so good at what he does everybody thinks he’s probably better than he really is.

For the people who instinctively hate Obama, he makes them anxious. First of all Obama offends their racism. Obama throws their prejudices into disarray. For many white people to throw out their preconceptions about black people is too dangerous and upsetting. They really live in an either/or world.

By comparison, binary people love Donald Trump because he gives them permission to express their rage. He gives them permission to not feel guilty about every racist thought or every sexist thought. Donald Trump gives his people permission to do things they’ve been holding in check. In essence Trump is saying, “Civilization isn’t so great.”

Depending of what happens with Robert Mueller’s Russia investigation, Trump’s impeachment or even losing the 2020 presidential election, I do not think that Donald Trump leaves the White House. What are your thoughts on what happens next?

I agree with that. I don’t know what’s going to happen. I do think that the only leverage anybody could have over him is that if Mueller could hold up in his hand all of Trump’s tax returns and say, “Mr. President, your choice is to leave office now or I’m going to show these taxes to everybody.” Maybe then he’d leave. That’s the only leverage you have over him, which is that he’s not as rich as he says he is. That he cheats the government. He’s laundering money for Russia. Those three things, once that gets exposed, maybe Trump will leave rather than have that exposed. He’d rather have a nuclear war than have the truth about his taxes and wealth exposed.

Many other clinicians I have spoken to are concerned about Donald Trump starting a nuclear war. Do you believe Donald Trump would do such a thing?

That’s possible, but I also don’t agree with it entirely. Part of the reason I don’t think he would start a nuclear war is because he doesn’t want to blow up his own hotels all over the world. We are protected in a way by Trump’s international wealth.

What type of person is attracted to Donald Trump?

Donald Trump does not have any friends. People are afraid of him. Did the king have any friends? No. Did the head of the Romanov family have any friends? No. Donald Trump has never had a friend. I don’t think people are attracted to him. Some people are attracted to his energy and his ruthlessness. His voters and other supporters, for example. But personally, I can’t imagine anybody who’s attracted to him.

If someone were to stop you on the street and ask you what should be done about Donald Trump what would you say?

I would tell them the most important thing is to stop hoping and thinking of Donald Trump’s presidency and this entire situation as something which is going to end without your participation. The only way to make it end at this point is to vote. We’re not going to make the Republican Party stand up to him. Republicans enjoy getting all the things they want from him. As long as everybody’s angry at him, then the Republican Party can give tax breaks to their donors. The Republicans can get rid of regulations and privatize Social Security. They can poison the air.

People must take action. If that doesn’t happen, Donald Trump will be an eight-year president. Easily. Unless people do something.