UPDATED WITH CLARIFICATION



"If we could construct a psychiatric Frankenstein monster, we could not create a leader more dangerously mentally ill than Donald Trump."

So says Baltimore psychotherapist John Gartner. He has added that the president of the United States is a "paranoid, psychopathic narcissist who is divorced from reality."

Dr. Gartner has been beating this drum for months, but he is not alone among his colleagues with such dire thoughts about the 45th president.

Despite a professional ethics code that forbids mental-health professionals from diagnosing people who are not their patients, a group of psychiatrists used "an open town-hall meeting" at Yale Medical School last week to sound off on Trump's fitness for office, New York magazine reports.

"I've worked with murderers and rapists, I can recognize dangerousness from a mile away," New York University psychiatry professor Dr. James Gilligan said. "You don't have to be an expert on dangerousness or spend 50 years studying it like I have in order to know how dangerous [Trump] is."

Dr. Lance Dodes, a retired Harvard University psychiatry professor who in February was the lead writer of a New York Times letter to the editor warning about Trump's mental health, also was at the town hall.

"He lies because of his sociopathic tendencies that Dr. Gartner was talking about," Dodes said. "He lies in the way anybody who scams people does. [But] there is also the kind of lie he has that in a way is more serious -- that he has a loose grip on reality. We can say that because he lies about things that aren't that important."

But what Dodes and the other psychiatrists who spoke at the Yale gathering call mental illness, others say is Trump's singular genius. The president, many longtime Trump observers point out, is above all a salesman. He just might be the greatest salesman ever.

"More than a belief in the power of positive thinking or the casual audacity of a tireless salesman, Trump has perfected a narrative style in which he doesn't merely obscure reality -- he tries to change it with pronouncements that act like blaring, garish roadside billboards," Politico's Michael Kruse wrote last week.

Trump biographer Tim O'Brien told Kruse that Trump has failed time and again in his business career, which has included multiple bankruptcies, and yet he's widely viewed as one of the most successful businessmen in the world. "He's not successful at what he claims to be successful at," O'Brien said. "He is, however, arguably the most successful self-promoter in United States business and political history. And that's a form of success."

Former U.S. Ambassador to Russia Michael McFaul suggested in a recent social-media post that Trump's pronouncements might be even more important to Trump than tangible accomplishments, whether the subject is a real-estate development or, now, leading the federal government.

Trump's been in office 3 months & hasnt even NAMED (let alone confirmed) a Dep Sec for Defense or State. That is crazy. 886 tweets though — Michael McFaul (@McFaul) April 20, 2017

That sounds about right to former Trump Organization vice president Barbara Res.

"He creates his own reality," Res told Politco. "He created the reality that he was this big, successful businessman, and now he's creating the reality that he's a big, accomplished president."

This rather prosaic explanation for Trump's untruthful statements and sometimes strange behavior is not one that the psychiatrists at the Yale meeting are willing to accept.

"Worse than just being a liar or a narcissist, in addition he is paranoid, delusional and exhibits grandiose thinking, and he proved that to the country the first day he was president," Gartner said. "If Donald Trump really believes he had the largest [inauguration] crowd size in history, that's delusional." Gartner insists that as a psychiatrist it is his duty to warn the country about Trump's mental state.

Maybe it is, but that a group of psychiatrists would go out on a diagnostic limb and make such statements about the president of the United States is still frowned upon by the psychiatric profession. Said Dr. Bandy Lee, the Yale psychiatry professor who put together the meeting at the university:

"I'm a pariah in my own department."

UPDATE 4/25/17: Dr. Lee has provided a clarification about the event: "The panel at Yale School of Medicine abided by 'the Goldwater rule.' Eminent psychiatrists were invited to speak about whether there are other ethical rules that override it, as in ordinary practice. The organizer, Dr. Bandy Lee, agrees with the Goldwater rule, although she is troubled by its recent expansion (as of March 16, 2017) and the silencing of debate. She hopes that the public and politicians will understand that mental health issues are not to be used as a weapon. Psychologist Dr. John Gartner was invited as an activist but was not on the actual panel. The organizer emphasizes that the event was independent and did not represent the views of Yale University or Yale School of Medicine."

-- Douglas Perry