In a world spinning radically out of control, can we trust President Trump to rely on his famous “instincts” as he plays brinksmanship with North Korea?

How much closer does the day of reckoning have to come on charges of collusion with Russia before he needs a war to provide the ultimate distraction?

The fundamental bedrock of human development is the formation of a capacity to trust, absorbed by children between birth and 18 months. Donald Trump has boasted of his total lack of trust: “People are too trusting. I’m a very untrusting guy.” (1990) “Hire the best people, and don’t trust them.” (2007) “The world is a vicious and brutal place. Even your friends are out to get you: they want your job, your money, your wife.” (2007)

His biographers have recorded his world view as saturated with a sense of danger and his need to project total toughness. As we know, his father trained him to be a “killer,” the only alternative to being a “loser.” He has never forgotten the primary lesson he learned from his father and at the military school to which he was sent to toughen him up still further. In Trump’s own words: “Man is the most vicious of all animals, and life is a series of battles ending in victory or defeat.”

Trump described to Michael D’Antonio in his biography, Never Enough, his father “dragging him” around tough neighborhoods in Brooklyn when he collected rents. He always told the boy to stand to one side of the door. Donald asked why: “Because sometimes they shoot right through the door.”

Today, this man lives alone in the White House, without a wife or any friends in whom to confide, which he would never do anyway because that would require admitting vulnerability.

Leon Panetta, former CIA director and Defense chief under Clinton, stated on Fox Business Channel in February 2017: “The coin of the realm for any president is trust--trust of the American people in the credibility of that president.” In the nearly two years that Donald Trump has been in our face almost daily, he has sown mistrust in all of his Republican rivals, alienated the conservative Republican bloc he needs in the House for legislative success, ignored congressional Democrats, and viciously insulted Democratic leaders, calling them liars, clowns, stupid, and incompetent, and condemning Barack Obama as “sick” and Hillary Clinton as “the devil.” When he picks up the phone to speak to leaders of our closest allies, like Australia, he rips apart the comity built over decades. But he never hesitates to congratulate despots, like Turkey’s Erdogan, Egypt’s General Sisi, or Russia’s Putin.

As President, he is systematically shredding trust in the institutions he now commands. Having discredited the entire 17-agency intelligence community as acting like Nazis, he also dismissed the judiciary because of one judge’s Hispanic background and another’s opposition to his travel ban. Even his Supreme Court justice, Neil Gorsuch, said it was “disheartening” and “demoralizing” to hear Trump disparage the judiciary. Not content to smear the media on a daily basis, Trump borrowed a phrase used by Lenin and Stalin to brand the media as “enemy of the people.”

By his own words, Trump operates on the assumption that everyone is out to get him. The non-medical definition of paranoia is the tendency toward excessive or irrational suspiciousness and distrustfulness of others. As a man who proclaims his distrust of everyone, it is not surprising that Trump drew closest to him two legendary conspiracy theorists—Stephen Bannon and Gen. Michael Flynn.

And even after he was forced to fire his choice as his top national security advisor after Flynn blatantly lied, Trump’s White House is desperately stonewalling congressional investigators to keep them from getting their hands on documents that may prove Flynn’s paid collusion with Russia on Trump’s behalf. The closer that case comes to a criminal referral to the Justice Department, the closer Trump’s survival instincts will propel him to a wag-the-dog war.

A leader who does not trust his subordinates cannot inspire trust. Though Trump boasts of fierce personal loyalty, he himself is loyal only until he isn’t. Among his anxious aides, only Jared Kushner is safe, deputized as the Trump’s de facto Secretary of State. Where he succeeds in inspiring trust is by giving his subordinates the courage to lie. The virus of licentiousness has spread from the White House to congressional Republicans, to wit the stunt that exposed Rep. Devin Nunes as unfit to lead the House Intelligence Committee probe into the Trump campaign’s possible collusion with Russia.

We hear repeatedly that Trump as a manager likes chaos. I asked a deputy White House counsel under Obama, Mike Breen, a decorated former officer in Iraq and expert on foreign policy at the Truman National Security Project, how that style impacts trust. “Trump explicitly or implicitly manages the situation so it’s never possible for his advisers to know where they stand,” Breen says. “It’s the opposite of what you want in a high-functioning organization. “ Trump’s anxious aides must know just how easy it is to fail his loyalty test, or to be the fall guy if a scapegoat is needed. While publicly they may defend him, it is clear to reporters that White House staffers are leaking and leaking constantly. The leaks can only exacerbate Trump’s mistrust, perpetuating a vicious circle.

His failure to trust and to inspire trust is even more dangerous on a global scale. He sees alliances like NATO as suspicious (until he changes his mind); he sees trade agreements like NAFTA as ripping off America (until he changes his mind three or four times in the same week). “This is because Trump’s worldview is that we live in a snake pit where everybody is out for themselves,” observes Breen. He and his co-conspiracy advisor, Bannon, take everything that the left-behind white working class hates about globalization and they turn it into personalized enemies--Muslims, Mexicans, refugees they believe are taking away their jobs. “Those people aren’t like us,” is the alt.right message, “they’re polluting our culture.”

Back as far at August 2016, 50 senior national security officials who have advised Republican presidents during wartime issued a letter starkly rejecting candidate Trump: “We are convinced that he would be a dangerous president and would put at risk our country’s national security and well-being. “ They excoriated him as lacking in character and values as well as basic knowledge. What is stunning is the precision of their foresight. They predicted that Trump, “lacking belief in the U.S. Constitution,” would compromise our most precious institutions including “religious tolerance, freedom of the press, and an independent judiciary.”

In the course of his first hundred days, Trump has appeared to be increasingly out of touch with the reality in which the majority of us live. His pathological propensity to lying is not the worst of it. It’s his monomaniacal attachment to lies as transparent as his March 4 twitterstorm accusing President Obama of putting a tap on his phone. It raises the question, is this president floating in his own alternative reality?

We asked Dr. Robert Jay Lifton, the eminent former professor of psychiatry at Yale University and today at Columbia University: Is Trump an abnormal personality? “Trump creates his own extreme manipulation of reality,” he says. “He insists that his spokesmen defend his false reality as normal. He then expects the rest of society to accept it — despite the lack of any evidence.” This leads to what Lifton calls “malignant normalcy”—in other words, the gradual acceptance by a public inundated with toxic untruths until they pass for normal.

Dr. James F. Gilligan is a psychiatrist and author who has studied the motivations behind violent behavior over his 25 years of work in the American prison systems. “If we psychiatrists who have experience in assessing dangerousness, if we give passive permission to our president to proceed in his delusions, we are shirking our responsibility,” Gilligan says. Today a senior clinical professor of psychiatry at NYU Medical School, Gilligan last week told a town hall meeting at Yale, “ I don’t say Trump is Hitler or Musolinni, but he’s no more normal than Hitler.”

We don’t have to rely on psychiatrists to see that this president is not consistent in his thinking or reliably attached to reality. We have had vastly more exposure to Donald Trump’s observable behavior, his writing and speaking, than any shrink would have after listening to him for years. So it is up to us, the American public, to call him on it. And some of the most experienced hands in and around the White House are doing so.

Presidential historian Douglas Brinkley believes that Donald Trump represents a very different subculture from any commander in chief. “He represents the New York building business -- where you don’t let your right hand know what your left hand is doing,” says Brinkley. “In Trump’s world, he must win at all costs. It’s not about character or public service or looking out for your band of brothers.”

The president to whom Trump is most often compared is Richard Nixon. John Dean, the famous White House counsel who testified against his fellow conservative Republican, compared Trump to another notably paranoid president. “Nixon was two personae – in public, he would score passably on the manual’s leadership checklist: he trusted his top aides, Haldeman and Erlichman, and was trusted by his cabinet,” says Dean. “But in private, his deeply paranoid and vengeful dark side came out.”

Asked for the best example, Dean snapped, “He had zero empathy!” Just like Trump. “Nixon let 22,000 more Americans die in Vietnam [after he sabotaged the 1968 Paris Peace Talks], plus who knows how many Cambodians and Laotians and Vietnamese, all to ensure his election.” It took 40 years before Nixon’s worst crime was revealed—treason. That war president was heard on Lyndon Johnson’s tapes scuttling the Vietnam peace talks to derail the reelection campaign of the Democratic candidate. He sent a message to the South Vietnamese negotiators that they should withdraw from the peace talks and wait for Nixon to be elected, who would give them a much better deal.

Sound familiar? Fifty years later, Donald Trump’s go-between with Russian officials, Gen. Flynn, hinted to Putin’s ambassador that Russia could get a much better deal if it didn’t retaliate against Obama’s sanctions and sat tight until Trump was elected. And Trump frequently tweeted about his eagerness to lift those sanctions – until his fantasy bromance with Putin came under federal investigation. Trump’s appetite for vengeance is also matched by Nixon’s with his long “enemies list.” No two modern presidents have had a more serious case of “political hemophilia,” in the phrase of the latest Nixon biographer, John Farrell, by which he means: “Once wounded, these men never stop bleeding.”

To the dismay of even conservative observers, Trump appears totally indifferent to the truth. A Wall Street Journa l editorial from March 21 denounced the damage done by “his seemingly endless stream of exaggerations, evidence-free accusations, implausible denials and other falsehoods,” concluding, “if he doesn’t show more respect for the truth, most Americans may conclude he’s a fake President.” But merely repeating a malignant lie often enough—for five years in the case of his birther smear against the first black president—it sticks with his supporters despite proof to the contrary.

Time magazine gave Trump an opportunity to clarify his refusal to correct the long string of his falsehoods. What the March 23 interview produced instead was an astonishing revelation of the president’s thinking: He states what he wants to be true. If his statement is proven false, he is unfazed and confidently predicts that the facts will catch up with his belief: “I’m a very instinctual person, but my instinct turns out to be right.” Even when the top sleuth in the country condemns him as a fabulist, Trump ignores the public rebuke by FBI director James Comey, and brags about his ability to persuade millions that his version of events is the real truth.

“Narcissistic people like Trump want more than anything to love themselves, but desperately want others to love them, too,” wrote professor and chair of the Psychology Department at Northwestern University, Dan P. McAdams, in The Atlantic. “The fundamental goal in life for a narcissist is to promote the greatness of the self, for all to see.”

But what is an extreme narcissistic personality like Trump to do when he fails to win glorification for his first hundred days in office? “Trump, from his own writings, has shown massive hypersensitivity to shame or humiliation, “ says Dr. Gilligan, of the NYU Medical School. “Anybody who criticizes him will get a 3 am tweet.” What happens if Trump feels humiliated by being pronounced a “loser” in politics? Does he give in to his “right instincts” and fire off an incendiary tweet to the nuclear-obsessed leader in Pyongyang? Most world leaders have agreed with former South Korean President Park, who last year pronounced Kim Jong-un’s mental state as “uncontrollable.”

As Dr. Gilligan warns, “There is no evidence of sensitivity in Trump’s awareness of other people’s vulnerability. I think everyone is in danger from this most dangerous of presidents.” When narcissists begin to disappoint those whom they once dazzled, their descent can be especially precipitous. As the biblical book of Proverbs warns: “Pride goes before destruction, and haughtiness before a fall.”

Beneath the grandiose behavior of every narcissist lies the pit of fragile self-esteem. What if, deep down, the person Trump trusts least is himself? The humiliation of being widely exposed as a “loser” –unable to bully through the actions he promised to accomplish in his first 100 days—could drive him to prove he is, after all, a “killer.” He has already teed up three choices for starting a war: Syria, Afghanistan, and North Korea. It is up to Congress, backed up by the public, to restrain him.