Back in August 2016, Angel M. Castillo, based on what was being said and done on the campaign trail, proposed as an analogy from psychiatry that Donald Trump and his supporters were suffering from a collective case of political Munchausen Syndrome. Boiled down, this means that although they were leading reasonably good lives, they acted in the political sphere like they were somehow marginalized victims being done harm by other social groups.

This political diagnosis is close, but it misses a key point of President Trump’s behavior as a leader that recent developments have made clear. Trump and his followers are not the victims here, nor are they any longer pretending to be. The victims are the American people as a whole. The correct analogy is to Munchausen Syndrome by Proxy (hereafter MSP), also known as Factitious Disorder Imposed on Another (FDIA).

MSP as a psychological disorder is exhibited by caretakers who injure their dependents, make them ill or put them in danger, in order to revel in the praise they receive when they get their dependents medical care or otherwise rescue them. The illnesses, injuries and dangers here may be real or make-believe.

Perpetrators of MSP are usually parents and the dependents are usually children or infirm adults. But we think the syndrome is also useful analogically in studying behaviors of actors in the political realm. Presidents and other high officials should act as responsible caretakers of the citizens they serve. But the harmful public actions of President Trump are clear instances of what we would call political MSP.

For example, in 2017 President Trump manufactured the crisis of imminent nuclear warfare with North Korea. After North Korea conducted several nuclear tests, Trump said that North Korea will “be met with fire and fury like the world has never seen,” if it did not change its behavior. In January 2018, he said that the US is “closer ... to a nuclear war with North Korea and in that region than we have ever been — I don't see the opportunities to solve this diplomatically at this particular point.” To threaten a nuclear war is to fabricate a crisis where none exists. After Trump and Kim Jong Un met in Singapore, Trump suddenly declared that North Korea was no longer a nuclear threat. He had solved an imaginary international political crisis of his own making singlehandedly, simply by declaring it solved.

Trump’s latest manifestationof political MSP has many stages. Once again he initiated the crisis by declaring a state of emergency along the Mexican-American border. He then compounded the imaginary crisis by shutting down the government after he did not get the money he demanded for his border wall.

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According to Trump, rapists, terrorists and drug dealers are streaming across our southern border and threatening our way of life. But the real crisis at the border was the decision of Trump and his Attorney General Jeff Sessions to separate young children from their parents. The false claim of violent injuries to American citizens caused by supposedly porous borders is consistent with our political MSP diagnosis.

Trump would have received the adulation he is seeking if Congress had appropriated $5 billion for his big wall. It would have allowed him in his own mind to play the protecting hero. When his effort proved unsuccessful, his craving for political adulation intensified.

His threat to “own the shutdown” did not intimidate House Leader Nancy Pelosi. Because a wall would be expensive and ineffective, she still refuses to present a budget bill to fund it. Pelosi is acting like a physician who refuses to administer a placebo to an MSP patient.

Trump is suffering now politically from wounded pride. But by shutting down a large part of our government, he has harmed millions of Americans, both federal employees who are not receiving paychecks and other citizens who are not getting government services they need and deserve.

What are the prospects for curing a perpetrator of what we have called political MSP or FDIA? A website maintained by the Cleveland Clinic says this about the behavior of people medically diagnosed with this condition: “Successful treatment of people with FDIA is difficult because those with the disorder often deny there is a problem. People with FDIA tend to be such accomplished liars that they begin to have trouble telling fact from fiction.”

Unfortunately for the health of our country, we think the same holds true for political MSP.