For many reasons, Donald Trump's mental health is a subject of great public concern in America. He is a compulsive liar who dissembles about facts both large and small. He is also a malignant narcissist who is desperately -- and successfully -- imposing his own version of reality on the American people. Trump is also violent and appears to lack any empathy or concern for the suffering of others. At times he seems confused and his patterns of speech have changed since taking office in January of last year. Even some of Donald Trump's closest political allies have apparently expressed concern about his mental health.

The responses to these concerns about Donald Trump's mental health are polarized. His supporters insist that he is perfectly fine and that suggestions to the contrary are acts of disloyalty approaching treason. And some people suggest that while Trump may in fact be an authoritarian who is doing horrible things to the United States and the world, concerns regarding his mental health are secondary and ultimately inconsequential.

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There are other people who believe that Donald Trump's mental health and other troubling behavior represent a fundamental threat to American society and the world. For them, an alarm must be sounded and it is a moral imperative for people of conscience to intervene.

Psychiatrist Bandy Lee is one of these voices and counts herself among the thousands of medical professionals in the United States and other countries who believe that they have a moral obligation to inform the public about the dangers posed by Donald Trump. To that end, Lee was the principal editor of The New York Times bestseller "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President."

Lee recently met with members of the U.S. Congress to discuss her perceptions of Trump's behavior and what it may signal about the danger he poses to the United States and world. Lee is also deeply concerned about Trump's access to nuclear weapons, as well as what his ascendance to power signals about social pathology, fascism, the mental health of his supporters and the impact of social inequality and other stressors in the United States.

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This is my second conversation with Dr. Lee. It has been edited for length and clarity. Our first conversation can be read here.

Your book, "The Dangerous Case of Donald Trump," was published in October of last year. Which of its predictions and warnings have come true?

First, let me say, I speak for myself and not for my university. The book predicts danger and dangerousness. We have already seen this unfold. Basically, in "The Dangerous Case of Donald Trump" we were stating that past violence predicts future violence. Trump has shown verbal aggressiveness. He has boasted about sexual assault. He has invited violence at his rallies. He has shown an attraction to violence as a powerful weapon. He had not yet taunted a hostile nuclear power at that point. But in the book we actually predicted that devastating wars and even a nuclear holocaust were not impossibilities.

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Now, it is even clearer that the danger we predicted about Donald Trump has happened on many levels. There has been an unprecedented spike in hate crimes since the day after his election. This trend has not yet abated. There has been an escalation in gun deaths since Trump's campaign. There are also reports documenting how a large proportion of extremist violence and domestic terrorism is coming from white supremacists.

The other dangers, of course, are his psychological instability. This includes Trump's impulsivity, recklessness, paranoid reactions, loose grip on reality, rage, lack of empathy, and the constant need to project and abuse power. His speech patterns have also changed. All these things have gotten worst over time. These all have profound ramifications for a person in his position of authority and power.

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Why are there still so many people who are continuing to deny the threat posed by Donald Trump's behavior?

I think it’s because we’ve been silent for so long. People have also been deprived of education about mental health issues. These are also not comfortable topics to talk about. With this administration, there has also been an expansion of the so-called Goldwater Rule. Psychiatrists are not being allowed to speak about what is taking place. Such a rule is not applied to other medical specialties.

In "The Dangerous Case of Donald Trump" we are assessing dangerousness. Dangerousness has to do with the situation, not the person. The same person in a different situation may not be dangerous. Dangerousness can be assessed from afar because you don’t need all the information; you just need enough to raise questions and to work towards a conclusion or judgment.

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Many of Trump's defenders and others are hiding behind the Goldwater Rule. There are voices in the news media and political class who actually suggest that Donald Trump is no more or less mentally unwell and dangerous than any of his predecessors, and who suggest this is some type of witch hunt.

This is why mental health professionals’ input can be helpful, because we can distinguish what is pathological behavior from what is within the wide variation of human normalcy.

What the American Psychiatric Association (APA) did two months into this administration was to take the Goldwater Rule and reinterpret it in an unprecedented way. This change in the rule actually contradicts basic principles of medical ethics.

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The APA turned it into a gag rule, where we are not to mention any aspect of a public figure's speech or any observable aspect of their behavior under any circumstance -- even in an emergency. However, we as psychiatrists and members of the APA are supposed to participate in activities that promote public health. If not speaking about a public figure actually harms public health and in fact places the public in grave danger, then the rule should be subordinate to the principle.

The silencing of dissent is directly related to the rise of authoritarianism in America under Donald Trump and the Republican Party.

Exactly. In fact, the World Medical Association adopted the Declaration of Geneva in 1948. This was done in response to the horrors of Nazism and the Holocaust. This declaration clarified the humanitarian goals of medicine because of how too many medical professionals actively participated in the Nazis' atrocities.

You recently briefed Congress about Donald Trump's mental health and the threat he represents. What was that experience like?

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It was very illuminating. I met with about a dozen lawmakers, all Democrats except for one, and their response to my concerns about Donald Trump being a threat to the public was: “You don’t have to convince us. We’ve been very concerned about this. We are looking for ways to deal with it, but as the minority party, we don’t have any power. We know of Republican lawmakers who are just as concerned, probably equally concerned, but they are not expressing it. They’re not acting on it.”

These elected officials encouraged us to go out and educate the public with the hopes that public support would allow them to do something. That is why I was keeping the testimony confidential before -- even the planning of it -- and have now decided to divulge it because the public has the right to know that one party is not acting in the public interest because of partisan political reasons.

What part of your testimony resonated with them the most?

Trump's access to the nuclear codes is the most urgent and primary concern. Someone with mental instability should not have access to weapons that are strong enough to destroy the world many times over. That was primary on the representatives' minds as well.

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Donald Trump has a core base of rabid supporters who apparently will not abandon him under any circumstances. This speaks to Trump's fascist appeal. Why do you think some personalities are so attracted to him?

Fascism has multiple dimensions. It is a psychological disorder where there is a psychological impairment of a leader and there is the impairment of the followers. There is also a general public that either remains complicit or inactive. They are silent. These ingredients need to be present for society to fall into a pathological state.

Pathology attracts pathology. A poor state of mental health to start with makes us vulnerable to being attracted to an impaired leader. The impaired leader is attractive and compelling to those who are already susceptible to such energy. From there one starts to spiral downward.

As a health professional, I think of situations in terms of illness versus health, death versus life. Regardless of ideology, regardless of political persuasion, there are choices a person will make because they’re pulled by pathology rather than their own valid choices. In other words, healthy choices are always life-affirming and bring you to greater thriving. By comparison, pathology-driven choices bring you toward disease, damage and death. That’s how we can tell them apart.

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That is why it is so important to speak out and perhaps even go against the wishes of a segment of the population who are so drawn to this kind of dangerous and pathological authoritarian leader. That type of individual and collective pathology will inevitably be destructive.

What role does loneliness play in why Trump's supporters are so attracted to him?

Loneliness is definitely a part of it. But loneliness -- coupled with feelings of inadequacy, powerlessness, finding little value in oneself and not having meaning in the world -- is also worsened by structural inequality.

And when you have inequality, what you’re doing is you’re dividing the world into the "superior" and the "inferior." Whether it’s economically so or whether it’s by race, whether it’s by sex, whether it’s by any other measure, you’re going to be in a struggle to get yourself in the superior group. It is like Donald Trump’s view of the world as a place that has winners and losers and you have to always watch your back.

Many of those who dare to speak out against Donald Trump have been attacked by his mob. You have experienced this. How are you? How have you weathered the storm of Trumpism?

I’m fine. This is what we expected. It is also what the mental health professionals who were afraid to speak out were suspecting, and it turns out that they were right. It is very difficult to put yourself out there under this climate.

My department and division have been very supportive in terms of allowing me to be able to voice my opinion and allowing for freedom of speech. They couldn’t be more supportive in that way, considering all the onslaught they have received. But it does come back to the risk of speaking out in the midst of violence.

For me there is no question. The silence itself is harmful. The longer we keep silent, the more dangerous it will become, not less. I made a decision very early on, right after the election, that there was going to be a risk and that I was going to take it because it was what I needed to do.

Right-wing defenders of Donald Trump have said many untrue things about you. In particular, they have created a narrative that you are not a licensed medical professional and therefore are not equipped to criticize Donald Trump. Would you like to rebut that?

I have been involved not just with patient care but also in policymaking. I have testified around the country for violence prevention programs. I have also been involved with projects that are working to diminish the rate of violence around the world. I haven’t confined my practice to Connecticut. I held three licenses at that one point, including a foreign license. I reduced it to one license, New York. If anything, I should be overqualified, not underqualified, to discuss these matters.

Do you think things are going to get better or worse under Donald Trump's administration?

Well, it’s almost impossible to predict because human beings are free. We have a choice to make. We can either be pulled in the direction where the momentum is going right now -- which is towards greater and greater pathology and destruction -- or we can pull ourselves out of it. We can make a conscious decision to choose health and not illness, and to choose life and thriving as opposed to all the attractions of death and destruction. It is a choice we need to make. I think humanity has pulled itself out of far worse situations. I wouldn’t say that Trump's presidency is one of the worst situations to face humanity, although it feels very bad because we as a country have not been in such a bad place in a long time.