Mental health professionals: Trump's rash Syria move looked like a 'hypomanic episode' Trump talked to Turkish President Recep Tayyip Erdogan then told the US military to withdraw from Syria. Overnight, without warning, he destabilized an entire region.

John Gartner, Steven Buser and David Reiss | Opinion contributors

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In February 2018, at a conference highlighting concerns about President Donald Trump’s psychological fitness to serve as commander in chief, a panel of mental health professionals (including the three of us) warned that under the stress of investigations into his misconduct, Trump could easily make an impulsive catastrophic error on the world stage. That moment has arrived.

After a call with the president of Turkey, Trump gave early morning orders to the U.S. military to begin withdrawing troops from Syria. Without consulting or informing anyone in his administration, Trump redrew the map of the Middle East literally overnight, betraying our allies on the battlefield, ceding the Middle East to Russia and enraging the Republican senators he needs to survive.

A pattern of rash and poor judgment

Trump began withdrawing troops without even a rudimentary plan to protect his retreating soldiers, who had to destroy their own headquarters in their mad scramble to escape. This impulsive style of decision-making yet again reveals a pattern of rash and poor judgment. Trump seems unaware of likely consequences from his actions and unwilling to delay, consider facts or listen to anyone. But this time he didn’t just post an offensive Tweet. He destabilized an entire region.

Many of us in the mental health community have been warning that Trump is dangerously disturbed. And as citizens can plainly see for themselves, he is getting progressively worse. When House Speaker Nancy Pelosi said Trump is having a “meltdown” and "now we have to pray for his health,” it’s a recognition that we are in uncharted waters.

With increasing frequency, Trump watchers have been describing his behavior as manic. “Trump’s manic tweeting was close to clinical evidence of a narcissist’s decompensating and dangerous rage,” wrote conservative writer Andrew Sullivan. “Trump’s manic performance Wednesday was distressing to watch, even for his supporters,” Republican strategist Rick Wilson wrote last month.

From a clinical perspective, without interviewing Trump but relying on the surfeit of public statements and reports at our disposal, Trump appears to have what is called a hypomanic temperament (also known as hyperthymia). He reports, for example, “I usually sleep only four hours a night,” which is usually a pretty reliable indicator, along with his easily observed impulsivity, irritability, energy, charisma, confident arrogance, aggressiveness, poor judgment and short attention span.

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Hyperthymia is not a disorder, but people with this temperament are more vulnerable than the general population to entering into a full blown “hypomanic episode,” which is a diagnosable potentially dangerous condition. In a hypomanic episode, people act impulsively on ill-considered ideas without pondering the probable consequences, and they usually cannot be persuaded to refrain from taking these actions. But while one man can ruin his own life by losing all his money overnight in penny stocks or flying to Bermuda with his secretary, Trump occupies the most powerful office in the world.

An unplanned war at 3 a.m.

It’s not only reasonable but urgent to ask whether Trump could be entering into a hypomanic episode. An existential threat to Trump such as impeachment could easily trigger such an episode, particularly as he appears to have a narcissist’s deep fear of humiliation and disempowerment, and a probable history of hypomanic episodes. In "1988: The Year Donald Lost His Mind," Politico's Michael Kruse described behavior that is consistent with a hypomanic episode. In response to the stimulation of his newfound celebrity, Trump displayed what his biographer Wayne Barrett called heightened "recklessness and arrogance," from blatant infidelity that ended his marriage to a string of deals that resulted in his apparent loss of more money than nearly any other taxpayer in America.

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Trump appears far more impaired now than he was in 1988, and there is far more at stake than his personal marriage and fortune. Many already fear that Trump is not psychologically fit to handle the proverbial 3 a.m. emergency phone call, when war and peace hang in the balance, particularly if he has already been up at 3 a.m. rage tweeting. But now Trump is literally the one making the 3 a.m. phone call precipitating an unnecessary, unplanned, immoral war that is against American interests while everyone else is sleeping.

Unlike a doctor dealing with a patient, Congress has the only remedy for this crisis. Impeachment is a grave and somber undertaking, meant to be deliberative, slow and not so easy to do. But Trump’s destructive behavior is accelerating in speed and magnitude, with no guardrails in sight. Congress must move quickly to impeach and remove him from office. Who knows what he’ll do at 3 a.m. tonight.

John Gartner is a psychologist and former assistant professor at Johns Hopkins University Medical School. Dr. Steven Buser is a clinical psychiatrist practicing in Asheville, North Carolina, and a former Air Force psychiatrist. Dr. David Reiss has been a practicing psychiatrist for more than 30 years, specializing in fitness evaluations. Gartner and Buser are editors of "Rocket Man: Nuclear Madness and the Mind of Donald Trump."