Donald Trump held the American people hostage for 35 days in a vain attempt to extort billions of dollars from Congress for his pointless wall along the U.S.-Mexico border. This is the longest shutdown of the federal government in our nation's history. Estimates suggest that Trump's stunt cost the U.S. economy at least $6 billion.

That huge sum of money is an abstraction. Donald Trump and the Republican Party's political hostage-taking hurt the approximately one million people who are directly employed by the federal government. Millions of other Americans were harmed both directly and indirectly by this disruption in the government and its impact on the economy and other services.

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The personal is again the political. Federal workers were not paid. Many of them, such as janitors, security guards and other contract employees, will receive no compensation for their lost wages. Federal workers and their families in some cases were forced to choose between medicine and food; others may have been evicted or be at risk of foreclosure; those who already lead a precarious existence were forced over the ledge by Donald Trump into a financial abyss from which they may never recover.

In total this is part of a decades-long pattern in which the policies of the Republican Party and their leaders cause pain and harm to the American people. This is an empirical fact and reality.

How do the Republicans stay in power when their policies are actually dangerous to the United States and its citizens? How healthy is American society if it produces leaders who actually do not serve the common good? Does Donald Trump represent a broader cruelty and selfishness on the American right? What does Trump's hostage taking and his desire to hurt millions of people reveal about his mental health and psyche?

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In an effort to answer these questions I recently spoke with Dr. James Gilligan, a clinical professor of psychiatry at New York University and author of the book "Why Some Politicians Are More Dangerous Than Others." Gilligan is also a contributing writer for the 2017 bestseller "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President."

This conversation has been edited for clarity and length. Three years into Trump's presidency, how well is American society doing?

Once Trump got elected, I expected the worst. And frankly, I think that’s what we’re getting. He’s constrained to some extent by the fact that the United States still does have a more or less intact democracy and legal system. Trump is trying to tear it down as much he can. But there is no question that Donald Trump is a would-be dictator who would take advantage of any opportunity to trash the notion of “rule by law.”

Trump's presidency is the result of the following. America is a sick society with aspects of collective sociopathy. America's leadership class is also anti-social and pathological. Is this a correct diagnosis?

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America has, by far, the highest imprisonment rate in the world ‑- even higher than what we call “police states” such as Iran, China or Egypt. The United States is the only Western democracy that still has the death penalty and still employs long-term solitary confinement for prisoners. This is a form of torture.

If imprisoning everybody and punishing them more severely than other countries really worked in preventing violence, we would have the most nonviolent society in the world. However, the United States has incomparably the highest murder rate of any economically developed country.

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Our punitive policies are not in the least diminishing our rate of violence. If they are having any effect on it, it is only to increase it.

When I speak of the United States as a sick society, I use public health as a framework. The famous physician Rudolf Virchow made a great observation: “Medicine is a social science, and politics is simply medicine on a larger scale." By that criterion, the U.S. is the sickest of the societies that have achieved industrialization and technological progress and other so-called indicators of being "advanced."

What type of leaders does that type of society elevate?

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What we have seen in American politics and society is action and reaction from the left and the right. When Democrats get elected to the presidency, rates of suicide and homicide go down. This is the government’s own data. It’s not my data. When Republicans get elected, rates of suicide and homicide go up. Roosevelt and the Democrats were in power basically from 1932 to 1968. During those years the rates of suicide and homicide reached the lowest levels of the century.

Then, in 1968, Nixon came in and for the following quarter of a century we had mostly Republican rule. The United States then sunk into an epidemic of homicide and suicide. The rates of suicide and homicide went down again under Bill Clinton.

George W. Bush comes in and the rates of suicide and homicide started increasing a bit. Then Barack Obama is elected and he is undoing the recession that Bush Jr. had created. In sum, Republicans increase unemployment and inequality. And of course Trump is now president, and he represents a white backlash against Obama with the predictable subsequent negative effects on the country's health.

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Even with that pendulum there are going to be leaders who are going to be more moral, responsible and interested in the common good than others. Obama certainly exemplifies those values more than Trump and other Republicans and conservatives.

Right-wing leaders are people who operate by a moral value system based on shame. For them and their public the worst evil in the world is to be shamed or humiliated, meaning to be insulted or regarded as an inferior. For right-wing leaders and their supporters the most important thing in the world is to be strong, not weak. There is a will to power there, and a capacity for not feeling guilty about hurting people. For right-wing types the only concern is to benefit themselves, so they are egocentric or narcissistic -- to use the psychoanalytic jargon.

One of the things Trump said before he came to power was, “People used to laugh at me, but they don’t laugh so much anymore.” His concern was not being ridiculed or shamed. Once he got power, he didn’t have to worry about that so much. But I think Trump is now realizing that his power as president is limited and he is having those worries again. Donald Trump then transferred his own personal feelings of insecurity onto the country as a whole.

Another example: Trump has said things like, “The other countries are laughing at America, the other countries don’t respect America. I’m stopping them from laughing at us and forcing them to respect us.” Again, Donald Trump is really just transferring his own personal feelings of vulnerability to shame and humiliation onto the country as a whole.

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He speaks to the fears and insecurities of voters in this country who now think that they are going to lose some degree of security and middle-class status to this imaginary horde of immigrants from Mexico and elsewhere.

What are the values of Democrats and other liberal and progressive leaders?

Nobody’s perfect, but relatively speaking, the left-wing leaders have been more influenced by what I call a guilt ethic, meaning a value system where the worst evil is to be guilty of harming somebody and the goal is to create and achieve a state of innocence by trying to help people. Ultimately, the liberals and progressives -- the left-wing -- are really trying to create a society in which everybody’s dignity can be respected.

Here is a policy example. How do we fit Donald Trump and the Republican Party's obsessive and desperate efforts to take food stamps and other types of assistance away from needy and vulnerable people within your framework?

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In my opinion, Trump has a narcissistic personality disorder. Trump also appears to have a sociopathic or antisocial personality disorder as well as a paranoid personality disorder. Those are conditions common to people who are shame-dominated. They want to make sure no one can disrespect them or laugh at them and so forth.

People like this feel ashamed when they realize that they really want someone to take care of them. Autonomy, independence, self-reliance, take care of yourself and don’t depend on anybody else -- those are their internal rules and mantras. Consequently, they will shame other people they see as being dependent. Shame-dominated people do not want to be like other people who are “dependent” on welfare or unemployment insurance, or any other system of support or aid.

What this group fails to recognize is that in fact no human being is either totally dependent or independent. We’re a mixture of both. We are interdependent. We all need each other. There’s no such thing as a human being who can survive without depending on others for a lot of things. On the other hand, we also give things to other people and they depend on us in return. Human beings are interdependent and that is an insight and fact that people on the right wing of politics, or who have personality disorders like Donald Trump, have lost sight of.

Note that what we call “welfare” in America is when money is given to people who don’t have much. But the fact is there are all kinds of corporate welfare in America. It is little discussed and there is little shame about it from the recipients.

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The Republican war on the poor is Dickensian, a contemporary version of social Darwinism.

It is almost feudal or like something from the 18th century in Europe. That is what is continuing now with the opposition to what we label as "welfare," and shaming those who need it instead of recognizing they’re just like us. Everybody needs help from other people.

If somebody’s at the bottom of the social and economic status system, that’s a problem of the status system itself. It’s not a problem made by those who are on the bottom of the social hierarchy.

Your book "Why Some Politicians are More Dangerous Than Others" does a comprehensive job of marshaling the empirical data to show that the Republican Party is a threat to the American people and does them great harm. But let us imagine that a Republican or other conservative reads your book and rebuts that: “I’m a good person! How dare you make these conclusions? This is so absurd. Republicans and conservatives are not bad people!”

Everybody is well-meaning. “The path to hell is paved with good intentions.” In the United States there is an error of reasoning where the world is divided into the superior and the inferior as opposed to the idea that all men are created equal.

There are political leaders in the United States and elsewhere, specifically Republicans and conservatives, who hurt their own voters in order to gain more power. We call this "sadopopulism" or "political sadism." How does this work cognitively and emotionally?

Such leaders and people have a moral value system which they may or may not have thought out consciously. This value system is real, and conservatives and other right-wing authoritarians feel justified in hurting other people as a way of proving their superiority and gaining power.

What I keep trying to communicate to such people is that they are actually not helping themselves when they behave in such a way. In the long run, such behavior hurts them as well as others. It destroys relationships. It destroys their capacity for love. You can’t exploit people and love them. Leaders and other people who cause pain are really hurting themselves, even though they may not realize it.

By adopting this sort of dog-eat-dog moral and political philosophy, such people really wind up isolating themselves. The power that they think they’re getting cannot ultimately be satisfying.

We see that with Donald Trump. He has gotten a lot of power by means of lying to everybody and cheating people and not paying his bills. Trump has even gotten to the White House by behaving badly. But now look at Trump. People from every side are coming down on him. He’s going to have to fight off being sent to prison for the things he’s done. You don’t really help yourself in the long run if you just become antisocial.

You are a professor of psychiatry. If you had an opportunity to counsel Donald Trump, what would your approach be? What would you say to him?

I would say, “Relax, Donald. You don’t need to fight with everybody or insult everybody in order to respect yourself. In the long run, that really doesn’t work. You’ll respect yourself a lot more, and other people will respect you more, if you can learn to treat other people with the same respect you want for yourself. People are not out to harm you. Nobody wants to do that unless you provoke them to. If you simply treat other people with respect, they’ll respect you more and you’ll respect yourself more.”

But on the other hand, I don’t think he would listen to anything unless I first ask him to tell me what’s on his mind. With Trump you would have to begin with questions.

I’d say the main question that I would ask is this: “How well is your strategy for living working for you?” He would likely say, immediately, "Look, I’m perfect. I’m president and I’ve got all this money.” I would respond, “Well, OK, how well is life actually working out for you?”

Then, he’d have to start confronting the fact that people hate him and the criminal justice system is gunning for him. All his associates are being sent to prison, and they’re testifying against him. At some point, Trump is going to have to realize that his strategy for living is not working well for him. Perhaps that would give him some motivation to get better and change his behavior.