But of course the problem is much more serious than that. And it is rooted in Trump’s quintessential conflation of the nation with his own ego. In response to remarks by Denmark’s prime minister, Mette Frederiksen, that the offer was “a joke,” Trump said , “She’s not talking to me. She’s talking to the United States of America.” But, in fact, she was talking to him, and she was rejecting his absurdly retro, imperialistic proposal. Denmark’s alliance with the United States was not being rejected — Trump’s grandiose idea was.

President Trump’s thin skin is an international liability. Because he is so notoriously sensitive to real and imagined slights, his personal grievances become national problems. One recent lighthearted portrayal of this phenomenon is that Denmark’s rebuff of his offer to purchase Greenland will lead us into a Cold War with our NATO ally.


Trump views everything, domestically and internationally, as rooted in and reflective of himself: his image, his shrewdness, his power, his brilliance, his capacity to win the respect, affection, and “love” of foreign autocrats. Similarly, at home, he unfailingly perceives his allies as “good people,” while opponents are beneath contempt: They are “losers,” “traitors,” and “invaders.”

Because Trump’s personality is the warped lens through which American power and laws are distorted and applied, my colleagues and I have focused on the centrality of Trump’s emotional impairments as a cause for national concern. Two years ago, we wrote “The Dangerous Case of Donald Trump,” emphasizing the danger represented by Trump’s incapacity to make reasoned and informed assessments of the country’s needs and vulnerabilities untainted by his own overwhelming and predominant need to preserve and inflate his own self-image.

Our calling attention to the ongoing threat that Trump’s impaired mental processing represents has been wrongly decried as “diagnosing” the president. We are not diagnosing the president, nor do we invoke mental illness. (We have not confused Trump’s impairments with mental illness, which itself has not interfered with great leadership, e.g., Abraham Lincoln and Winston Churchill.)


We are describing an alarming deficiency that is inherent in the president’s emotional needs, which drive his perception of people and events. This deficiency represents a hazard of enormous proportions, one that is increasingly glaring and widely acknowledged. The reality is that the president fits a gamut of criteria used by forensic psychiatrists to identify dangerous individuals, i.e., those with poor control of impulses who represent a recognizable heightened level of danger to their community: lack of empathy, sense of grievance, entitlement, cruelty, exaggerated sense he is being attacked, and access to means of attack.

Our concern has been with the danger that arises from having Trump, with his easily wounded ego, erroneously conflating himself with the nation at large, while simultaneously holding preeminent power as commander in chief.

If Trump were confined to feeling aggrieved by other real estate developers, there would be no great danger and hence no need for heightened national vigilance, no pressing need for legislative containment of his exercise of executive power.

But that is not the case. Failure to recognize the inherent danger of Trump’s emotional lability as chief executive could have us one day ruefully recall the Greenland fiasco as another trivialized and ignored canary in the coal mine.


Leonard L. Glass is associate professor of psychiatry at Harvard Medical School and senior attending psychiatrist at McLean Hospital.