John D. Gartner, David Reiss and Steven Buser

Opinion contributors

Is being unfit grounds to impeach a president? James Madison appears to have thought so when he said, during the debates of the Constitutional Convention of 1787, that a president could be removed for “incapacity, negligence or perfidy.” Rep. Al Green, D-Texas, has put forward articles of impeachment on those very grounds, saying, “An unfit president can be impeached for those misdeeds that corrupt and harm society.”

Last week, House Speaker Nancy Pelosi, in essence, publicly implied that Trump is too mentally impaired to function as president. If that’s true, doesn’t she have a constitutional duty to act?

Trump arrived late to his meeting on infrastructure with Pelosi and Senate Democratic leader Chuck Schumer. He did not shake anyone’s hand, he did not sit down, but instead, according to Pelosi, he pounded the table and launched into a diatribe about her comments accusing him of having engaged "in a cover-up" before he stormed out of the room. The entire “meeting” lasted maybe more than three minutes.

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“I walked into the room and I told Senator Schumer and Speaker Pelosi, 'I want to do infrastructure. … But, you know what? You can’t do it under these circumstances,” Trump said in the Rose Garden minutes later, announcing that he will refuse to carry out his legislative duties as president, unless Congress agrees to stop carrying out their duties of oversight. “You probably can’t go down two tracks. You can go down the investigation track and you can go down the investment track.” (“You can’t investigate and legislate simultaneously — it just doesn’t work that way,” he later tweeted.)

Presumably, by definition, Trump is “unable to discharge the powers and duties of his office” — the 25th Amendment standard — if he simply refuses to do his job. Presidents aren’t allowed to go on strike.

Mental stability of Trump in question

The next day, Pelosi was still visibly shaken: “The president again stormed out.” She said “again” because Trump previously did the same thing during a meeting with Pelosi and Schumer aimed at ending the government shutdown. Pelosi then slapped the dais with her hand and said, “Pound the table. Walk out the door. What? … Another temper tantrum." Pelosi made it clear that this was far more serious than just bad behavior. “Again, I pray for the president of the United States. I wish that his family, or his administration or his staff would have an intervention. … Maybe he wants to take a leave of absence.”

“Your prayer comments almost suggest you’re concerned about his well being,” said a reporter.

“I am.”

News reports described Pelosi as “joking” about the 25th Amendment when reporters asked her whether she was suggesting a “statutory intervention.”

“I thought you saidstatutory intervention. That would be good. Article 25. ... That's a good idea. ... I'll take it up with my caucus, not that they haven't been thinking about it," she said.

Indeed, members of the Democratic caucus have been thinking about it. After Pelosi’s remarks, Rep. Jackie Speier of California said, "I have felt for some time that the mental stability of the president of the United States is in question … and I suggested invoking the 25th Amendment,” citing mental health professionals who have diagnosed him as a "malignant narcissist," showing symptoms of anti-social behavior, paranoia and sadism.

This is not the first time Pelosi has confronted the issue of whether Trump is psychologically fit for office. In March, she told The Washington Post that Trump was “ethically unfit. Intellectually unfit. Curiosity-wise unfit. No, I don’t think he’s fit to be president of the United States.” On April 10, she told The Associated Press that “in every way he is unfit to be the president of the United States.”

Trump's diagnosis: mentally unfit for office

Many of us in the mental health community have been arguing for years that Trump should be removed because he is psychologically unfit. We posted a professional petition online stating that “in our professional judgment … Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of president of the United States.” It garnered over 70,000 signatures and formed a professional organization, Duty To Warn, dedicated solely to this issue and has held rallies across the country.

Most recently, "Dangerous Case" editor Bandy Lee and a group of colleagues issued a mental health analysis of the Mueller report in which they concluded “there is compelling medical evidence” that Trump “lacks the capacity to serve as president.” He manifests “impaired capacity to make responsible decisions free of impulsivity,” as well as an "inability to consider consequences before taking action, detachment from reality, paranoid reactions, creation of dangerous conditions, and cognitive and memory difficulties."

While some have tried to dismiss these professional assessments as partisan, that charge is belied by the members of Trump’s own administration, who have privately mused about the 25th Amendment. "Given the instability many witnessed, there were early whispers within the Cabinet of invoking the 25th Amendment,” wrote the anonymous author of a famed New York Times op-ed. White House staff frequently texted “#TFA” among themselves whenever Trump “did something that was just so insane, and so crazy, and unhinged,” Omarosa Manigault Newman told MSNBC. Deputy Attorney General Rod Rosenstein, according to reports, admitted that he proposed invoking the 25th Amendment, though he later claimed (unconvincingly it seems to us) to have been joking.

However, the Republican Cabinet will never invoke the 25th, so where does that leave Democrats?

After Trump's temper tantrum in the White House last week, Rep. Jamie Raskin of Maryland said, “Most of us on the Judiciary Committee have just thrown up our hands” and said “let’s go ahead and launch an impeachment inquiry.”

Impeach Trump to protect office of president

In the same interview on NBC News, he said, “Today the 25th Amendment has come resurging back into focus because of these extraordinary events that took place in the White House. ... Speaker Pelosi showed her compassionate side when she said there should be a family intervention. Unfortunately, some conditions are way beyond the capacity of a family intervention to address. This might be far more serious."

Citing Lee’s mental health analysis of the Mueller report, Raskin said, “The president is failing at every level of basic mental and cognitive health. He cannot take in information successfully. He cannot process information successfully. He cannot engage in decision-making without bias, distortion, impulsivity, impetuosity, and he cannot keep himself and others free from danger.”

Though Raskin did not directly cite Trump’s lack of mental fitness as the constitutional ground for opening an impeachment inquiry, the context suggests that it was certainly on his mind, and adds to the urgency to the need for such an inquiry, if nothing else. Clearly Congress has an obligation, as James Madison said, to protect the nation against a chief executive who has demonstrated “incapacity.”

Pelosi has thus far resisted calls for impeachment on the grounds that it would arouse the ire of Trump’s base going into the 2020 election. But she seems to ignore the opposite risk: Underreacting desensitizes us to the dangerous severity of Trump’s dysfunction, normalizing the abnormal.

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