One of the most notable things about the 34,000 tweets that Rachel Montgomery culled through for this new book is their sheer quantity. It’s like looking at your phone in the morning, the night after a brief dinner date, and finding thirty-seven nasty texts from your date. The quantity alone warns that this person may not be mentally stable, and then the gratuitous nastiness confirms it. Donald Trump’s manic dark energy drives him to vaunt himself and denigrate his fellow human beings relentlessly: all day, all night, every day, and every night.

To make sense of his aberrant behavior, you need to understand, specifically, what is psychologically wrong with Donald Trump. His diagnosis is the Rosetta Stone to cracking the Trump Twitter code, revealing its underlying structure, and unfortunately, how much ­danger all the rest of us are in as a result. He is a malignant narcissist who is also on the bipolar spectrum. From a psychiatric perspective, the prognosis could not be more dire—for us.

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Much has been written about Trump having Narcissistic Personality Disorder. For example, Trump embodies the diagnostic criteria of believing himself to be “uniquely superior,” (“Only I can fix it”) to a degree that would be comical if it weren’t so frightening. He appears to literally believe that he knows more about everything than everybody, despite his lack of experience, study, intellectual curiosity, or even normal attention span. An amusing video montage made its way through social media, where through the miracle of editing, in the course of three minutes Trump brags about being the world’s greatest expert in twenty different subject areas, literally using the exact same sentence—just fill in the blank. “No one knows more about (fill in the blank) than me,” he repeats over and over, while it becomes more absurd, as his imagined portfolio of expertise expands with each improbable bombastic claim. When candidate Trump was asked from whom he sought foreign policy advice, he responded, “I’m speaking with myself, number one, because I have a very good brain.” Just how good a brain he has is up for debate, but the narcissistic fantasy that any brain is so good it doesn’t need a brain trust bigger than me, myself, and I, is scary and crazy. “I know more about ISIS than the generals, believe me,” he boasts. Trump has more ways to say, “I am the best” than anybody. Believe me.

But as critics have pointed out, merely saying a leader is narcissistic is hardly disqualifying. Most are. But malignant narcissism is to garden variety Narcissistic Personality Disorder what a malignant tumor is to a benign one. Both are bad, but only one will kill you.

“The quintessence of evil,” was how Erich Fromm described malignant narcissism, a term he introduced in 1964. Fromm, a refugee from Nazi Germany, developed the diagnosis to explain Adolf Hitler. While Fromm is most well-known as one of the founders of Humanistic Psychology—the basic premise of which is, ironically, that man’s basic nature is good—the Holocaust survivor had a lifelong obsession with the psychology of evil. Malignant narcissism was, according to Fromm, “the most severe pathology. The root of the most vicious destructiveness and inhumanity.” Erich Fromm saw evil up close and applied his genius to boil it down to its psychological essence. A malignant narcissist is a human monster. He may not be as bad as Hitler, but according to Fromm he is cut from the same cloth: “The Egyptian Pharaohs, the Roman Caesars, the Borgias, Hitler, Stalin, Trujillo—they all show certain similar features.”

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My former teacher Otto Kernberg is the modern figure most associated with the study of malignant narcissism. He defined the syndrome as having four components: 1) Narcissistic Personality Disorder, 2) antisocial behavior, 3) paranoid traits, and 4) sadism. Kernberg told the New York Times that malignantly narcissistic leaders like Hitler or Stalin are “able to take control because their inordinate narcissism is expressed in grandiosity, a confidence in themselves and the assurance that they know what the world needs.’’5 At the same time, “they express their aggression in cruel and sadistic behavior against their enemies: whoever does not submit to them or love them.’’

As G. H. Pollock wrote, “the malignant narcissist is pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and sadism.”

When you combine these four ingredients—narcissism, antisocial traits, paranoia, and sadism—you have a leader who feels omnipotent, omniscient, and entitled to total power, who rages at being persecuted by imaginary enemies, which includes anyone who disagrees with him, as well as vulnerable minority groups who represent no threat whatsoever. All who are not part of the in-group or those who do not kiss his ring must be destroyed. And destroying them in the most humiliating and painful way will be an exquisite pleasure. Once you understand the logic of malignant narcissism, all of Trump’s tweets make perfect sense.

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Paranoia

In the same week, the New York Times and the Washington Post both ran front-page stories about Trump as a conspiracy theorist. Before the election, Rightwing Watch accumulated a list of fifty-eight conspiracies proclaimed by Trump. And of course, the list has grown since then. Many are truly bizarre. For example, not only is Barack Obama a Muslim born in Kenya, but according to Trump, Obama had a Hawaiian government bureaucrat murdered to cover up the truth about his birth certificate:

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How amazing, the State Health Director who verified copies of Obama’s “birth certificate” died in plane crash today. All others lived Dec 12, 2013 04:32:44 PM

Antonin Scalia was murdered: “They say they found a pillow on his face, (which is a pretty unusual place to find a pillow.)”

Later, fake news websites sponsored by the Russians laid this “murder” at Hillary Clinton’s feet. Fellow candidate Ted Cruz’s father even aided the Kennedy assassination—the mother of all conspiracy theories. “What was he doing with Lee Harvey Oswald shortly before the death? Before the shooting? It’s horrible.”

Yet, the world was shocked when Trump accused Barack Obama by tweet of illegally wiretapping Trump Tower. Why were we surprised when this tweeting about conspiracy theories has been going on for years, as the author’s research shows?

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Antisocial Personality Disorder

Trump also meets criteria for Antisocial Personality Disorder. Antisocials lie, exploit, and violate the rights of others, and have neither remorse nor empathy for those they harm.

Politifact estimated 76 percent of Trump’s statements were false or mostly false, and Politico estimated Trump told a lie every three minutes and fifteen seconds. So in his tweets, Trump freely and frequently lies. He doubles, triples, quadruples, and quintuples down on transparently disprovable falsehoods.

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We have ample evidence of Trump’s pervasive pattern of exploiting and violating the rights of others. According to New York Attorney General Eric Schneiderman, Trump University was a “straight up fraud…a fraud from beginning to end.” Dozens of lawsuits attest to his pattern and practice of not paying his contractors. Finally, there is Trump’s pattern of serial sexual assault, which he bragged about on tape, even before a dozen women came forward, who he then called liars.

Trump is allergic to apology and appears to feel no remorse of any kind. It is as if being Trump means never having to say you’re sorry. When Frank Luntz asked Trump if he had ever asked God for forgiveness, Trump said “I’m not sure I have…I don’t think so.” His unrepentance notwithstanding, he also boasted that he loves God and his church.

Sadism

Because he is a sadist, the malignant narcissist will take a bully’s glee in persecuting, terrorizing, and even exterminating his “enemies” and scapegoats. When a protester was escorted out of a Trump rally, Trump famously said “I’d like to punch him in the face,” in a tone that suggested it would genuinely bring him great pleasure. He relished the thought of throwing another protester out in the cold without his coat. “I love the old days. You know what they used to do to guys like that when they were in a place like this? They’d be carried out on a stretcher, folks.” Narcissists often hurt others in the pursuit of their selfish interests. A noteworthy difference between the normal Narcissistic Personality Disorder and the malignant narcissist is sadism, or the gratuitous enjoyment of the pain of others. A narcissist will purposely hurt other people in pursuit of their own desires, but may regret and, in some circumstances, show remorse for doing so, while a malignant narcissist will damage others and enjoy doing so, showing little compassion or shame for the damage they cause. People with simple Narcissistic Personality Disorder often feel shame when being forced to confront the reality that they have hurt other people in pursuit of their selfish or self-centered goals. For malignant narcissists it’s a bonus. It’s part of the fun.

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Trump loves to “punch down” people that he views as weaker than himself by demeaning and humiliating them. Not only are sizable portions of Trump’s 34,000 tweets dedicated to cyber-bullying, but sometimes, he will send the same nasty tweet six times across a day’s news cycle day to maximize his victim’s humiliation.

Trump lives in a paranoid zero sum world divided into two types of people: Winners and Losers. Strong and Weak. Victors and Vanquished. Bullies and Victims. Predator and Prey. The guys who get to grab the pussies and those that get their pussies grabbed. All that matters is coming out on top.

Winning Takes Care of Everything

As the author points out in her illuminating chapter “They Are Laughing at Us!” the worst thing Trump can say is they are winning. They are taking advantage. They are laughing at us. We should strike back at those bastards. Turn the tables, make them pay, and laugh in their faces.

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Lets fight like hell and stop this great and disgusting injustice! The world is laughing at us. Nov 6, 2012 8:30 PM The United States better address China’s exchange rate before they steal our country and it is too late! China is laughing at us. Feb 25, 2013 6:54 PM “The Chinese laugh at how weak and pathetic our government is in combating intellectual property theft.” (cont) http://tl.gd/g70qiu Mar 1, 2012 12:28 PM

Like the myth that the Inuit have one hundred words for snow, Trump has one hundred phrases to express his contempt (and that’s not a myth). The quantity and tone of these insults say more about the insulter than about the people he is publicly verbally abusing. Here is a sample of some of the phrases used throughout his tweets: low life!, overrated, 3rd rate, lightweight incompetent clown, major sleaze and buffoon, total dud!, mental basket case, true garbage.

Trump’s put-downs break into two basic categories: bad and weak. Losers are weak, and haters are bad. Indeed, haters and losers are his shorthand for anyone not on the Trump train:

Happy Thanksgiving to all--even the haters and losers! Nov 27, 2013 2:22 PM Happy Veterans Day to ALL, in particular to the haters and losers who have no idea how lucky they are!!! Nov 11, 2013 7:59 AM To EVERYONE, including all haters and losers, HAPPY NEW YEAR. Work hard, be smart and always remember, WINNING TAKES CARE OF EVERYTHING! Dec 31, 2014 4:15 PM

The narcissist in him imagines he is superior to everyone in every way, so he must constantly assert he is more powerful in every respect. During the campaign he effectively diminished his Republican rivals as weak, making him the winner of the primate alpha male competition in a simple contest of fitness, size, and strength.

Leightweight chocker Marco Rubio looks like a little boy on stage. Not presidential material! Deleted after 1 hour at 11:17 AM on Feb 26 Low energy candidate @‌‌JebBush has wasted $80 million on his failed presidential campaign. Millions spent on me. He should go home and relax! Jan 21, 2016 6:32 AM

He loves to call his critics stupid—essentially accusing them of mental weakness. As in:

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Highly untalented Wash Post blogger, Jennifer Rubin, a real dummy, never writes fairly about me. Why does Wash Post have low IQ people? Dec 1, 2015 12:46 PM

How many ways can Trump call someone stupid? Let us count the ways: dumb as a rock, truly dumb as a rock, dummy dope, total dope!, very, very dumb!, dumbest of them all, lowest IQ on television, a spoiled brat without a properly functioning brain, gets dumber each & every year--& started from a very low base.

Sorry losers and haters, but my I.Q. is one of the highest -and you all know it! Please don’t feel so stupid or insecure,it’s not your fault May 8, 2013 9:37 PM

If his critic is a woman, he will always find a weakness in her appearance:

There are many editorial writers that are good, some great, & some bad. But the least talented of all is frumpy Gail Collins of NYTimes. Mar 17, 2014 2:03 PM Frumpy and very dumb Gail Collins, an editorial writer at The New York Times, is so lucky to even have a job. Check her out - incompetent! Mar 15, 2014 4:31 PM Huffington Post is just upset that I said its purchase by AOL has been a disaster and that Arianna Huffington is ugly both inside and out! Apr 20, 2014 4:57 PM

At his rallies, he said about one of the women who accused him of sexual assault, “Believe me, she would not be my first choice, that I can tell you,” implying she wasn’t attractive enough to assault.15 When asked about his rival Carly Fiorina, he said: “Look at that face! Would anyone vote for that? Can you imagine that, the face of our next president?!”

At the Republican debate Megyn Kelly confronted him with this pattern: “You’ve called women you don’t like fat pigs, dogs, slobs, and disgusting animals.”

“Only Rosie ODonnell,” was his tone-deaf answer, illustrating the very problem Kelly was talking about. But apparently he thought his answer was hilarious:

Rosie O’Donnell was the best answer of that whole debate Aug 7, 2015 4:05 AM

And then he turned the same treatment on Kelly:

I refuse to call Megyn Kelly a bimbo, because that would not be politically correct. Instead I will only call her a lightweight reporter! Jan 27, 2016 3:44 AM

Because Trump is also paranoid. Those who stand in his way are not just weak (i.e., stupid, ugly losers), they are also all bad. Really bad. Liars, connivers, scum, maliciously trying to attack and destroy him because they are such haters. He is a victim of their malice—which is really a projection. No one is nastier than Donald Trump. He is a victimizer who feels like a victim.

The failing @‌nytimes is truly one of the worst newspapers. They knowingly write lies and never even call to fact check. Really bad people! Mar 13, 2016 11:53 AM .@‌AP continues to do extremely dishonest reporting. Always looking for a hit to bring them back into relevancy—ain’t working! Nov 23, 2015 8:22 AM .@‌politico has no power, but so dishonest! Oct 7, 2015 8:47 AM I was viciously attacked by Mr. Khan at the Democratic Convention. Am I not allowed to respond? Hillary voted for the Iraq war, not me! Jul 31, 2016 9:32 AM

To Trump all negative facts about him are lies. And all who tell them are liars who should be punished with the harsh treatment they deserve, which is why he has branded the entire press, “the enemy of the people.” It’s not accidental that leaders like Stalin have used such phrases in an attempt to delegitimize a free press and justify a deadly purge. From Trump’s language you would think, if only he had the power, he would do the same.

Many journalists are honest and great - but some are knowingly dishonest and basic scum. They should.be weeded out! Apr 6, 2015 11:42 PM

Because in the world of the malignant narcissist, those who you imagine are unfairly attacking you deserve the most severe retaliation.

When someone attacks me, I always attack back...except 100x more. This has nothing to do with a tirade but rather, a way of life! Nov 11, 2012 8:56 AM When somebody challenges you unfairly, fight back - be brutal, be tough - don’t take it. It is always important to WIN! Jun 27, 2015 10:50 AM

Though he can’t actually kill reporters like his friend Vladimir Putin, Trump can kill them in fantasy, which is almost as good, because Trump believes his fantasies are real (like having the biggest crowd in history at his inauguration, for example). So the bad newspapers that are spreading lies about him are dying, and they deserve it. Trump has not executed them, instead their own weakness and badness is the cause of their death. But because of his sadism he takes immense pleasure in the suffering of his enemies and couldn’t be more manically gleeful about their imagined demise. It never gets old rejoicing in the blood of your enemies.

I was so happy when I heard that @‌Politico, one of the most dishonest political outlets, is losing a fortune. Pure scum! Oct 8, 2015 4:49 PM I love watching the dishonest writers @‌NYMag suffer the magazine’s failure. Oct 18, 2013 11:27 AM The reporting at the failing @‌nytimes gets worse and worse by the day. Fortunately, it is a dying newspaper. Aug 19, 2016 5:43 AM Sad thing is Rolling Stone was (is) a dead magazine with big downward circulation and now, for them at last, people are talking about it! Jul 17, 2013 6:17 PM National Review @‌NRO may be going out of business because of the really pathetic job being done by @‌JonahNRO. No talent means death - sad! Apr 20, 2015 7:12 PM One of the country’s dumbest newspapers—The Palm Beach Post--should be put to sleep. It’s dying. @‌pbpost Jan 25, 2013 8:37 AM

In this next set of tweets, Trump simultaneously exults in the imaginary death of one his hometown newspapers, the New York Daily News, but still manages to compliment himself, because it’s his photo that sells their newspapers:

.@‌NYDailyNews, the dying tabloid owned by dopey clown Mort Zuckerman, puts me on the cover daily because I sell. My honor, but it is dead! Jun 28, 2015 4:23 PM

Like all narcissists he attributes the success of others to his own reflected glory:

Face The Nation’s interview of me was the highest rated show that they have had in 15 years. Congratulations and WOW! @‌CBSNews @‌jdickerson Jan 11, 2016 6:42 PM .@‌ChuckTodd just informed us that my interview last week on @‌MeetthePress was their highest rated show in 4 years. Congrats! Oct 6, 2015 11:46 AM Just announced that in the history of @‌CNN, last night’s debate was its highest rated ever. Will they send me flowers & a thank you note? Sep 17, 2015 10:17 AM

There is no greeting card for this indirect form of self-congratulation. What would a card like that look like?

To my son on the day of his graduation. Congratulations on inheriting my fantastic DNA and having all the advantages my hard work has provided for you. Love, Dad

At times, Trump’s tweets reflect his glaring lack of basic human empathy—a hallmark of the psychopath. The most horrific human tragedies are, for Trump, merely opportunities to indulge his compulsive need to attack, denigrate, and boast:

If the morons who killed all of those people at Charlie Hebdo would have just waited, the magazine would have folded - no money, no success! Jan 14, 2015 9:13 AM Sorry to hear @‌msnbc was dead last, in the gutter, in their Boston bombing coverage http://bit.ly/15A4Msm @‌hardball_chris @‌Lawrence Apr 22, 2013 11:35 AM

After the Orlando massacre:

Appreciate the congrats for being right on radical Islamic terrorism, I don’t want congrats, I want toughness & vigilance. We must be smart! Jun 12, 2016 9:43 AM

But where we may really see Trump’s antisocial side at work is in how he took advantage of, and may even have colluded with, the fake news and hacks perpetrated by the Russians to sway the election. At the time of this writing, new information pours in every day to support the unthinkable conclusion that our president may be the agent of a hostile foreign power with whom he allied to steal an election. If that proves true, Trump will be more than simply antisocial. He will go down in the all-time villain hall of fame, somewhere between Benedict Arnold and Judas.

Trump’s Twitter account may be implicated in at least two respects. First, Russia flooded our social media with fake news, a technique they call “active measures.” When asked by Senator James Lankford (R-OK) about why Russian President Vladimir Putin decided to make more of an effort to interfere in the 2016 presidential election than in years past, former FBI agent Clinton Watts said, “the answer is very simple and it’s what nobody is really saying in this room…Part of the reason active measures have worked in this US election is because the Commander-in-Chief [Trump] has used Russian active measures at times, against his opponents.” Knowingly or unknowingly, Trump regularly retweeted Russian propaganda to his twenty-six million followers: “In some instances, Trump and his campaign team propagated fake stories they appear to have learned about directly from Russian state media.” So the whoops-I-didn’t-know-it-was-Russian defense doesn’t hold water. Trump used his Twitter account as a Russian propaganda laundromat.

The Russians were also fine-tuned in their understanding of Trump’s Twitter habits. According to Watts, they “tweet at President Trump during high volumes when they know he’s online and they push conspiracy theories.” Watts provided an example: Trump “denies the intel from the United States about Russia. He claimed that the election could be rigged; that was the number one theme pushed by RT Sputnik news.”

Of course, in addition to active measures, the Russians hacked the DNC and released emails right before the Democratic convention, revealing internecine conflict within the party. Specifically, that party chairwoman Debbie Wasserman Schultz had favored Hillary Clinton, the establishment candidate. The dump was exquisitely timed to wreak maximum damage, to drive a spike between the Bernie and Hillary supporters, just as they needed to bury the hatchet and come together at the convention. Now that we know Trump’s team may have had something to do with that dump, his exploitation of it seems even more dastardly.

The Wikileakes e-mail release today was so bad to Sanders that it will make it impossible for him to support her, unless he is a fraud! Deleted after 18 minutes at 11:25 AM on Jul 24,2016 I always said that Debbie Wasserman Schultz was overrated. The Dems Convention is cracking up and Bernieis exhausted, no energy left! Jul 24, 2016 3:30 PM Bernie should pull his endorsement of Crooked Hillary after she decieved him and then attacked him and his supporters. Oct 2, 2016 4:48 PM Crooked Hillary Clinton knew everything that her “servant” was doing at the DNC - they just got caught, that’s all! They laughed at Bernie. Jul 25, 2016 6:19 AM How much BAD JUDGEMENT was on display by the people in DNC in writing those really dumb e-mails, using even religion, against Bernie! Jul 25, 2016 6:57 AM Bernie Sanders is being treated very badly by the Democrats - the system is rigged against him. Many of his disenfranchised fans are for me! May 18, 2016 6:20 AM Bernie Sanders is being treated very badly by the Dems. The system is rigged against him. He should run as an independent! Run Bernie, run. May 16, 2016 5:00 AM

And Trump’s denials that the Russians were involved, even when all seventeen of our intelligence agencies said that they were seems particularly suspicious:

The “Intelligence” briefing on so-called “Russian hacking” was delayed until Friday, perhaps more time needed to build a case. Very strange! Jan 3, 2017 8:14 PM Russia talk is FAKE NEWS put out by the Dems, and played up by the media, in order to mask the big election defeat and the illegal leaks Feb 26, 2017 1:16 PM Totally made up facts by sleazebag political operatives, both Democrats and Republicans - FAKE NEWS! Russiasays nothing exists. Probably... Jan 13, 2017 6:11 AM Russia just said the unverified report paid for by political opponents is “A COMPLETE AND TOTAL FABRICATION, UTTER NONSENSE.” Very unfair! Jan 11, 2017 7:13 AM Julian Assange said “a 14 year old could have hacked Podesta” - why was DNC so careless? Also said Russians did not give him the info! Jan 4, 2017 7:22 AM

But in contradiction to the idea that the Russians were not involved, Trump directly appealed to Russia to release Hillary’s missing emails during the campaign. He said on national TV, “Russia, if you’re listening, I hope you’re able to find the 30,000 emails that are missing. I think you will probably be rewarded mightily by our press.” A similar sentiment he then echoed again on Twitter:

If Russia or any other country or person has Hillary Clinton’s 33,000 illegally deleted emails, perhaps they should share them with the FBI! Jul 27, 2016 11:16 AM

It’s clear that Trump is one bad hombre, but one of the recurrent debates, and genuine mysteries, is to what extent is Trump just a really unscrupulous person and to what extent is he really divorced from reality? Is Trump “crazy like a fox,” or just crazy? It’s often hard to know because, as Harvard psychoanalyst Lance Dodes put it, Trump tells two kinds of lies: The ones he tells others and those he tells himself: “He lies in the way anybody who scams people does. He’s trying to sell an idea or a product by telling you something that`s untrue. There’s that lie. There’s also the kind of lie he has that is in a way more serious. That he has a loose grip on reality.”

Before the election, I wrote in the Huffington Post a warning that Trump was a dangerous malignant narcissist. At that point, in June of 2016, there was still a strong hope that Trump would “pivot” and become more presidential—a slim hope based on a best-case scenario: Trump is a wicked con man, but still a rational actor, and thus he would pivot when it was in his own best interest. I wrote that “the idea that Trump is going to settle down and become presidential when he achieves power is wishful thinking. Success emboldens malignant narcissists to become even more grandiose, reckless and aggressive. Sure enough, after winning the nomination, there has been no ‘pivot’ towards more reasonable behavior and ideas, just the opposite. He has become more shrill, combative and openly racist.”

“Malignant narcissism is a madness that tends to grow in the life of the afflicted person,” wrote Fromm. They don’t get better. They get worse.

After riding his angry base to the White House, to pivot to a saner presentation after the election would have been in Trump’s best interest, to say the least. Many have wondered why Trump didn’t just stop acting mentally ill. Because his illness is not a ruse, and can’t just be turned off when it’s convenient. In the Huffington Post, Michael J. Tansey, PhD wrote:

Surpassing the devastation of climate, health care, education, diplomacy, social services, freedom of speech, liberty, and justice for all, nothing is more incomprehensible than the now-plausible prospect of all-out nuclear war…Because of this existential threat, it is absolutely urgent that we understand the differences between a president who is merely “crazy like a fox” (shrewd, calculating, the truth is only spoken when it happens to coincide with one’s purposes) versus what I have termed “crazy like a crazy” (well-hidden core grandiose and paranoid delusions that are disconnected from reality).

Insight into this question came from, of all sources, Joe Scarborough, host of the popular MSNBC show Morning Joe. Trump tweeted that Barack Obama had bugged Trump Tower:

Terrible! Just found out that Obama had my “wires tapped” in Trump Tower just before the victory. Nothing found. This is McCarthyism! Mar 4, 2017 3:35 AM

Scarborough tweeted in response:

His tweets this weekend suggest the president is not crazy like a fox. Just crazy. Mar 5, 2017 1:30 PM

Some of Trump’s false claims can be seen as having a perverse strategic advantage for him. For example, his claim that Obama was not born in the United States appealed to the racist portion of the electorate who were already inclined to see a black president as foreign and illegitimate. But other false statements seem more blatantly crazy, precisely because they offer him no discernable strategic advantage.

Take his false claim that he had the biggest inaugural crowd in history. On the first day of his presidency, he lost credibility with the entire world with that demonstrably false claim (as Chico Marx, disguised as Groucho, said in "Duck Soup," “who are you going to believe, me or your lying eyes?”), when there was no longer any need to motivate his base, which was already ecstatically celebrating his inauguration. At that point, he needed to broaden his base and shore up his authority as president, not pander to those he’d already won over. But he did the opposite.

For these same reasons, Michael Tansey argued that Trump meets Diagnostic and Statistical Manual of Mental Disorders Fifth edition criteria for Delusional Disorder, which simply requires evidence of a delusion lasting longer than a month in the absence of a more serious psychotic disorder such as schizophrenia or Bipolar 1 Disorder, which would in themselves explain the presence of delusional thinking.

Trump isn’t schizophrenic. That’s one diagnosis we can definitively rule out. But we should explore where he fits on the bipolar spectrum. I believe Trump has the hypomanic temperament I wrote about in my two books, "The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot) of Success in America" and "In Search of Bill Clinton: A Psychological Biography." Hypomanic temperament is genetically based, and runs in the families of people with bipolar relatives, but represents a milder and more functional expression of the same traits as mania. Historically, hypomanic temperament has received little attention compared to Bipolar Disorder, but the founders of modern psychiatry—Eugen Bleuler, Emil Kraepelin, Ernst Kretschmer—first described these personalities early in the twentieth century. In an article in the New Republic, I summarized the traits of hypomanic temperament as follows:

Hypomanics are whirlwinds of activity who are filled with energy and need little sleep, less than 6 hours. They are restless, impatient and easily bored, needing constant stimulation and tend to dominate conversations. They are driven, ambitious and veritable forces of nature in pursuit of their goals. While these goals may appear grandiose to others, they are supremely confident of success—and no one can tell them otherwise. They can be ­exuberant, charming, witty, gregarious but also arrogant. They are impulsive in ways that show poor judgment, saying things off the top of their head, and acting on ideas and desires quickly, seemingly oblivious to potentially damaging consequences. They are risk takers who seem oblivious to how risky their behavior truly is. They have large libidos and often act out sexually. Indeed all of their appetites are heightened.29

This description sounds an awful lot like Trump, who reports that he usually only sleeps four hours a night (and recommends others do the same in his 2004 book, "Think Like a Billionaire"), which by itself is a pretty reliable indicator of hypomania. He boasts about it in the book: “How can you compete against people like me if I sleep only four hours?” He claims to work seven days a week, and in a typical eighteen-hour day make “over a hundred phone calls” and have “at least a dozen meetings.” “Without energy you have nothing!” tweeted Trump in 2015, hence his taunt of Jeb Bush as “a low energy person” by contrast, which proved quite effective.

Like most hypomanics, Trump is distractible. We could add Attention Deficit Disorder (ADD) to the Trump diagnostic list, except ADD almost always goes with the territory for most hypomanics. “Most successful people have very short attention spans. It has a lot to do with imagination,” Trump wrote. He is correct. The same rapidity of thought that helps engender creativity makes it difficult to stay on one linear track of ideas without skipping to the next. Like most hypomanics, Trump trusts his own ideas and judgment over any and everybody else, and follows his “vision, no matter how crazy or idiotic other people think it is.”

Of course, who sends 35,000 tweets and who tweets at three a.m.? Only a hypomanic. One of my dictums when working with hypomanic patients is that “nothing fails like success.” If they succeed in achieving one of their wildly ambitious goals, there is often a noticeable uptick in their hypomania, sometimes even precipitating a full-blown hypomanic episode, which, unlike hypomanic temperament, is a diagnosable disorder. They become more aggressive, irritable, reckless, and impulsive. Now seemingly confirmed in their grandiosity, they drink their own Kool-Aid, and feel even more invincible and brilliant. They pursue even bolder, riskier, and more ambitious goals, without listening to dissent, doing their due diligence, or considering contradictory facts. Their gut is always right.

Once Trump was asked who he goes to for advice. With a straight face he said “myself.” Trump is Trump’s most trusted advisor. In the same vein, with the increase in grandiosity in a hypomanic, there is a corresponding increase in paranoia about the fools and rivals who might naysay their insights, impede their progress, or destroy them out of jealousy or ignorance.

In fact, this is a pattern for Trump. In 1988, after the publication of his bestselling "The Art of the Deal," Trump’s celebrity took off. His response was an increase in his hypomania, according to Politico writer Michael Kruse in his article, “1988: The Year Donald Lost his Mind.” “It was the year Trump’s insatiable appetites and boundless ego—this early, spectacular show of success—nearly did him in,” Kruse wrote.

He continued:

His response to his surging celebrity was a series of manic, ill-advised ventures. He cheated on his wife, the mother of his first three children. In business, he was acquisitive to the point of recklessness. He bought and sold chunks of stocks of companies he talked about taking over. He glitzed up his gaudy yacht, the yacht the banks would seize less than three years later. He used hundreds of millions of dollars of borrowed money to pay high prices for a hotel and an airline—and his lenders would take them, too…his third casino in Atlantic City, the most expensive, gargantuan one yet, the Trump Taj Mahal, which led quickly to the first of his four corporate bankruptcy filings.

Flash forward eighteen years to 2016, where Trump once again achieved success beyond anyone’s wildest imagination. He became addicted to rallies where he excited crowds with his hypomanic charisma and they in turn threw gasoline on the fire of his hypomanic grandiosity, ­culminating in the Republican National Convention where he made the grandiose proclamation:

“Only I can fix it.”

David Brooks is not a mental health professional but he astutely commented in August 2016 on what appeared to him to be Trump’s increasing hypomania:

He cannot be contained because he is psychologically off the chain. With each passing week he displays the classic symptoms of medium-grade mania in more disturbing forms: inflated self-esteem, sleeplessness, impulsivity, aggression and a compulsion to offer advice on subjects he knows nothing about. His speech patterns are like something straight out of a psychiatric textbook. Manics display something called “flight of ideas.” It’s a formal thought disorder in which ideas tumble forth through a disordered chain of associations. One word sparks another, which sparks another, and they’re off to the races. As one trained psychiatrist said to me, compare Donald Trump’s speaking patterns to a Robin Williams monologue, but with insults instead of jokes.

But while Trump’s 1988 hypomanic crash only resulted in a few bankruptcies, as president, the consequences could be on a scale too disturbing to contemplate.

When going through the following collection of Trump’s tweets, one of the trends the reader should note is the progression over time. The author has organized them chronologically, in part to show what she observed in compiling them. Trump appears to get worse over time, to become even more nasty, boastful, paranoid and threatening, and even more compulsively driven to tweet around the clock. Some of his most off-the hook Tweets came in at three a.m., when all good non-hypomanics are supposed to be asleep. When that proverbial three a.m. phone call comes in, you don’t want the president to be awake, agitated, irritated, and in the middle of a Twitter rant. Most likely at that moment he is causing a crisis of his own making. And if the world also happens to be having a crisis at that moment, is this the man equipped to solve it?

In "The Heart of Man," Fromm argues that malignant narcissism “lies on the borderline between sanity and insanity.” In more benign forms of narcissism, “being related to reality curbs the narcissism and keeps it within bounds,” but the malignant narcissist recognizes no such boundaries. With the magnetic force of his will and personality he bends reality to fit his grandiose fantasy.

The thing that distinguishes the malignant narcissistic leader from other patients we might diagnose as having grandiose (biggest crowd size) and persecutory (Obama wiretap) delusions is his power to impose those delusions on the populace. Per Fromm, “This Caesarian madness would be nothing but plain insanity were it not for one factor: by his power Caesar has bent reality to his narcissistic fantasies. He has forced everyone to agree he is god, the most powerful and wisest of men—hence his megalomania seems to be a reasonable feeling.”

The organization that I founded, Duty To Warn, is comprised of mental health professionals who believe it is their ethical duty to warn the public about Donald Trump’s dangerous mental illness. Fifty-two thousand of us have signed a petition requesting Trump be removed under the twenty-fifth amendment for his severe and dangerous mental illness. At a meeting about Duty to Warn at Yale Medical School, a keynote speaker, Robert J. Lifton, warned that malignantly narcissistic leaders can shift and distort reality for an entire society, a process he called “malignant normality.” The abnormal becomes normalized and alternate facts, conspiracy theories, racism, denial of science, and delegitimization of the free press become not only acceptable, but the new normal. Trump has the power to impose his madness on the populace, a kind of mass folie à deux. Perhaps we should call it a folie des millions?

To drink the Kool-Aid, just open your Twitter feed.