Given the broad recognition and increasing concerns about the president’s mental instability since the publication of The Dangerous Case of Donald Trump in October 2017, authors have updated their chapters on the president’s dangerousness and how that dangerousness has increased since then.

 

Isolated

By Edwin B. Fisher, who wrote, “The Loneliness of Fateful Decisions: Social Contexts and Psychological Vulnerability.”

“Alone” may be the most frightening word in the discussion of President Trump over the past months (e.g., “The president is alone,” Mike Barnicle on Morning Joe, April 10 commenting on the President’s intemperate reaction to a search of his attorney’s office and home).

Very predictably, President Trump has shown the pattern of those who have constructed a narrow circle of friends on whom they are reliant for support and confirmation, and who, when placed under great stress, put excessive pressure on that circle of friends. In The Dangerous Case, we wrote that President Trump’s noted preoccupation with himself “… may initially shape and limit those invited to the narcissistic leader’s social network, with sensitivity to slights and angry reactions to them further eroding that network… The more the individual selects for those who flatter him and avoid confrontation, and the more those who have affronted and been castigated fall away, the narrower and more homogeneous his network becomes … eventually becoming a thin precipice … [bringing to mind] … President Nixon, drunk and reportedly conversing with the pictures on the White House walls … during his last nights in office” (pp. 336-337).

In the past week, this narrow base of support has been all but obliterated with Woodward’s book documenting the scorn with which his administration’s leaders view him and, with speculation as to the author of the anonymous op-ed including the Vice President and his son-in-law. All raises the likelihood that President Trump can trust no one. Predictably, this breakup of the social circle of support and sense of betrayal has led to what has been described as rage.

Right now, the biggest threat to the security of all of us may be not whether President Trump is empathic or self-reflective or narcissistic or sociopathic, but that he is no doubt frightened, feeling betrayed, confronted with life or death decisions that could affect millions, but would seem to have nobody to whom to turn.

Enabling

By Leonard L. Glass, who wrote, “Should Psychiatrists Refrain from Commenting on Trump’s Psychology?”

After the publication of The Dangerous Case, the authors were called out by the American Psychiatric Association, through a former president of which branded the book “tawdry, indulgent, fatuous, tabloid psychiatry” and compared us to Nazi and Soviet era collaborators (https://www.medscape.com/viewarticle/889189).

The American Psychiatric Association’s “Goldwater Rule” (GWR) holds that it is unethical for a psychiatrist to offer a professional opinion about an individual unless without a personal examination and the individual’s consent for such a statement (APA Principles of Medical Ethics, Section 7.3). Several authors of The Dangerous Case took on the task of trying to bridge the gap between the GWR, written in 1973 and subsequently embraced by most other national mental health organizations, and our group’s perspective in 2018, informed by decades of new research and the reality of a dangerous commander-in-chief. We wanted to revise and update the GWR, while respecting its legitimate goals, e.g., the need to avoid stigmatization, respect for patient confidentiality, the danger of personal or political bias and of reckless misuse of professional authority.

We sought recognition of mental health professionals’ right and duty to engage with the public when, as a matter of conscience, they discerned, within their area of expertise, a danger to the public’s health and well-being posed by a public figure. That duty, prompted by conscience and grounded in professional understanding, was distinct from our duties to patients, since the public figure was not a patient and thus those constraints are inappropriate. We affirmed that such speech was ethical and should be recognized as such by the APA and related professional bodies.

After substantial debate and revision, the rest of the co-authors of The Dangerous Case gave our proposal their overwhelming endorsement. It was then formally presented to the APA by two co-authors, Drs. Robert Jay Lifton and Judy Herman, both Distinguished Life Fellows of Association. Simultaneously, we published the proposal with an accompanying op-ed in STAT, the highly regarded health blog of the Boston Globe (https://www.statnews.com/2018/06/28/psychiatrists-goldwater-rule-rollback/). Our proposal stated the GWR was lacking in scientific foundation (we cited the research), “illogical, and intrinsically undermining of mental health professionals’ efforts to protect the public’s well-being” (https://www.statnews.com/2018/06/28/goldwater-rule-broken-psychiatrists/). We called on the APA to substantially revise and update the GWR based on our proposal.

Though by now it is widely recognized that the President’s mental functioning is an important matter affecting the public’s welfare and a legitimate domain for professional comment, we have no response to our proposal from the APA.

By its active doubling down on the gag rule that is GWR it its present form and its passive avoidance of engagement with our carefully written and respectfully presented proposal for its revision and updating, the APA is continuing its complicity with and enabling of a dangerously unstable, volatile, and poorly understood dysfunctional presidency.

My Continued, if Modified, Duty to Report

By Howard H. Covitz, who wrote, “Health, Risk, and the Duty to Protect the Community.”

In The Dangerous Case, I argued that there were cascading stigmata whose collective presence indicated the most severe personality pathology (as opposed to neurotic disturbances and less dangerous personality ones) that would likely worsen in the public behavior of the elected President and cause a heightened probability of danger for the populations of the United States and beyond. All have been born out and worsened. I review them in the following.

Mr. Trump continues to behave as if he were incapable of either understanding or responding in an emotionally empathic way, except with a group of sycophants. He, in an intellectual way, has shown to be prescient about how others might react or even what they might be thinking, but this has little bearing on how he treats these others’ vulnerabilities, people who remain objects to him, like pieces on a chess board to be moved about in order to win the game.

His black-and-white thinking continues to split the World into friends and foes, into those who support him and all those others who are against him or are irrelevant. This has been so even with people whom he has selected, as soon as they show disagreement or lack of loyalty to him and virtually everything he does.

Lacking the need to evaluate how his actions impacted others, he has reacted more quickly and with less skepticism and, therefore, more dangerously without regard for the outcomes of his actions.

His lack of respect for others’ thinking, relationships, or efforts has shown him oblivious to the accomplishments of others. He has shown no ability to recognize the necessity for maintaining extant organizations, government structures, conventional practices, and laws that protect others. He goes after treaties, pacts, countries, groups and individual citizens who threaten his dominance, in even trivial ways.

Due to all the above, his thinking could be focused but lacked all nuance. His closest allies think him childish, stupid or moronic, reflecting this lack of nuance, which we associate with children for whom this is developmentally appropriate. He continues to show no apparent ability to see more than one not unreasonable view: a monomania of sorts. His positions have frequently flipped to their opposite; what has apparently made any new attitude acceptable to him has been based on his his wish to have “my will be done” – independent of what that articulated will was or how it might impact others.

Finally, Donald Trump has displayed no capacity or willingness to distinguish the real from the wished for or the imagined, and has demonstrated this with an estimated 30 spoken or published lies, each day.

My Duty to Report such behavior (as with my mandated duty to report a child or adult in danger) was initially to bring this to the attention of those constituted bodies (House and Senate) who would be capable of intervening on the danger. The authors did so by bringing a copy of our findings to each member of these Houses of Congress.

Now that Congress has ignored these clear and present dangers, our Duty to Warn must encompass a broader audience of Citizens willing to pressure these bodies to act.

Why I Wrote the Chapter Birtherism and the Deployment of the Trumpian Mind-set

By Luba Kessler, M.D., who wrote, “Birtherism and the Deployment of the Trumpian Mind-set.”

The chapters in the book The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President by other colleagues articulate Donald Trump’s psychological pathology. I concur with them all, because each presents a particular transparency of the layered mental structure of this man. Together they identify its arrested developmental state of unpreparedness for relinquishing expectations of self-entitlement. Reading them all is like constructing a likeness which is Donald Trump from every this and that angle, and then contemplating its fraught instability and potential for danger to self and all.

My own chapter “Birtherism and the Deployment of the Trumpian Mindset,” on the other hand, floats somewhere within that composite likeness, blinking alarming florescence like a diagnostic isotope locating malignant tissue on a scan. Looking back on it from the perspective of one year later, I am still arrested by the potent concentrate of its foretelling message.

It is likely that I was informed by my own history. I am not an heir to the history of back slavery and its blot on American history. I am a refugee from the Soviet bloc, taken in by this country in the acknowledgment of a different kind of historical oppression. As a Jewish child born into Stalin’s post-WWII reign of terror, I was a member of ethnic minority carrying the ever present vulnerability to historic anti-Semitism which turned deadly in his paranoid persecution of Jewish doctors and intelligentsia. The Iron Curtain was a lock: no escape was possible. The pogroms of the Tsarist Russia morphed into Stalin’s paranoia-induced purge despite the official communist stance of non-discrimination. Putin’s nationalist Russia blinks anti-Semitic ascendance once again.

Inbred prejudice never fails to announce descent into anti-democratic impulse. The corrupted DNA may lay dormant, but it will attack the healthy tissue when the conditions lessen its immunity.

If the birtherism conspiracy denying Barak Obama his American birth was a dog whistle to the racist inclinations, its portents materialized well beyond that particular encoded message. It makes me think of old-time school experiment of watching a plant seed begin to uncoil itself and grow offshoots once immersed in water. Given sufficient ‘populist’ approbation and privileges of the highest office, the corrupted seed of untruth and ugly vulgarity it represented has been unfurling ever since Donald Trump’s election to the presidency.

The blinking florescence is all around us now, in a metastatic free-for-all. It is in the corruption of the election by Russia; it is influence peddling by Trump campaign operatives; it is corruption of political chums and chosen swampy bureaucrats; it is money laundering; it is Trump family enrichment by high office; it is vulgar objectification of women; it is subversion of patriotism by sham narratives of prejudice; it is suffering by dint of cruelty and cold indifference at the borders; it is a demoralizing spectacle of ideology trumping morality and political self-interest undermining the common good. The list is partial, and grows with every day. Such are the laws of unchecked metastasis.

The Reprise of the Apple and the Tree

By Steve Wruble, M.D., who wrote, “Trump’s Daddy Issues: A Toxic Mix for America.”

When, six months into Trumps presidency, the news became public of Donald Trump’s eldest son, Donald Jr., admitting that he had met with a Kremlin-associated lawyer prior to the election in hopes of acquiring incriminating evidence against Hillary Clinton, I was not surprised. Despite the fact that he, along with everybody else involved, had adamantly denied this is par for this course which was initiated many years before Trump was elected. As is the nature of family dynamics, this type of behavior surely started long before even Donald Sr. became a father. The proverbial apple continues to land close to the tree. Donald Jr.’s style of lying is all too familiar to those who have often watched Trump navigate the murky waters employing a relentless “take no prisoners” approach while deflecting blame. Most likely, Donald sees admitting wrongdoing as a manifestation of weakness instead of considering it as taking the high road. It is interesting to note that Jared Kushner, Donald Trump’s son-in-law and senior advisor, is also the son of a powerful father who appears to have felt that rules didn’t apply to him. Charles Kushner was convicted of illegal campaign contributions, tax evasion, and witness tampering, and indeed served time in federal prison. The fact that Jared is married to Donald Trump’s eldest daughter, Ivanka, points to the possibility that she may have been attracted to aspects of Jared that felt comfortable and familiar.

The Houses That Shame Built

By Steve Wruble, M.D., who wrote, “Trump’s Daddy Issues: A Toxic Mix for America.”

There are times in life where it’s common to feel incredulous when we hear how others can think in ways that don’t make sense to us. Nazi atrocities during the holocaust, prejudice and overt racism during slavery are but a few extreme cases. As I witness our Republican Congress overlook the deteriorating and dangerous behavior of our president, I can’t help but feel the dangerousness that accompanies those complicit in holding onto power at all cost.

I wrote a chapter in the NYT best-seller, “The Dangerous Case of Donald Trump” along with 26 of my mental health colleagues. As experts in mental health, it was clear to us long ago that President Trump’s mental state would deteriorate over time due to the fact that his baseline was so limited. What his diagnosis is has never been important to us since we can’t know that for sure. None of us have ever met with him but luckily, Trump has made it easy for us to evaluate his dangerousness by expressing himself so openly in social media. We are well aware that he is in way over his head to act competently in his job as Commander-in-Chief but it seems to not effect those around him enough to do anything significant about it.

Behind every despot, behind all pedophilic clergy, behind each abusive parent there is a system of checks and balances that has broken down. Almost invariably, it’s the powerless and innocent victims who are thrown under the proverbial bus. At most, systems of power identify the leader as the necessary evil that must be removed in order to exorcize out the demons that are associated with their reign of terror. This only occurs after so much devastation that no other option is available. What usually gets lost is the fact that there were many who supported the dangerous leadership and are either still holding on to their seat of power or sneak away in the dark of night never to be held responsible for their part that prolonged the truth from being addressed earlier.

In addition to the Republican led Congress, the American Psychiatric Association has thrown their hat into this dangerous and shameful ring. By extending the Goldwater Rule in March of 2017 beyond its initial mandate in 1974, the APA has created shade for Trump to not only be protected from being diagnosed but more importantly, seen for the dangerous and deteriorating man that he is. It’s as if they knew that those of us who have an expertise to understand dangerousness and a duty to warn and protect per the Tarasoff laws would not sit by silently with a president who was so unhinged. Of course I have no proof of such a conspiracy but there is enough evidence that smells of poor leadership and abuse of power that an investigation is in order.

Many of my colleagues and I have put our medical licenses on the line, not because of political gain or partisanship but rather because that’s the law. For that, I am proud to be a psychiatrist and an American.

Connecting Trump’s Abuse of Power and Abusive Relationships

By Harper West, who wrote, “In Relationship With An Abusive President.” 

When Donald Trump began campaigning, I immediately recognized his abusive personality based on my training and my experience in an abusive marriage. In “The Dangerous Case of Donald Trump,” I compared Trump to an abusive spouse. Consequently, it is not surprising to me that commentators often say Trump is engaging in “abuses of power.”

Rep. Adam B. Schiff (D-Calif.) called Trump’s order to declassify materials from the investigation of Russian interference in the 2016 election a “clear abuse of power”. Trump’s desire to be above the law is obvious when he says things like he should have fired FBI Director James Comey “right after the convention,” when Trump was not even elected or sworn into office.

Authoritarian behavior is not some aberration that occurs only when someone achieves the title of president or prime minister. Rather, this character flaw exists in millions of people, including those who are predatory and manipulative abusers of various degrees.

I call people like Trump and my ex-husband “Other-blamers,” because they are deeply insecure and when they feel shamed or are held accountable, they use any tactic necessary to shift blame and avoid feeling unworthy, including lying, self-aggrandizing, dominating, controlling, manipulating, abuse, violence, and more. Abusers, narcissists and sociopaths exhibit behaviors that may seem unrelated, but the core emotional or characterological fault is poor shame tolerance.

Of course, rather than label these blame-shifting behaviors as psychopathology, we could describe them asvimmoral. Trump has on a daily basis provided ample evidence of his extremely poor character, integrity, and decency.

Ultimately, volatile Other-Blaming behaviors are abuses of power. To consistently blame others, deny facts and rationality, and refuse to accept accountability are predictors of a pattern of abusive relationships.

Trump has an apparent inability to acknowledge his failures. He denied even his own administration’s report that 3,000 people died in hurricanes in Puerto Rico – and then he doubled down blaming the Democrats!

Other-blamers’ stubborn inability to back down and admit they are wrong plays out as a sense of entitlement — they feel above the law. Domestic violence perpetrators are often shocked when they are arrested. They have lied to themselves so insistently they are convinced they are blameless.

Abusers dislike the justice system because it is all about holding people accountable. As the legal system encircles Trump, his sense of entitlement will be triggered and his abuses of power will worsen, because he will be desperately afraid of being held responsible.

What will the future bring? In abusive relationships, the abuser tests the victim. If she allows abuse, he knows he can get away with more. In the same way, Trump continues to lower the bar with his behaviors. If our civil institutions do not intercede, he learns he can get away with more egregious abuses of power.

When an abusive personality is given unimaginable amounts of power it is natural that he will enjoy and misuse that power for the protection that it gives his fragile psyche. Because he fears being held to account, Trump gains a jolt of relief every time he gets away with a lie, a cover-up, or a crime. It is unlikely he will decide to willingly agree to stop engaging in transgressive behaviors.

Based on extensive evidence on this personality type, it is predictable that Trump’s behaviors will almost certainly worsen and never improve. This should be deeply concerning when we consider that his dangerous tendency to feel above the law will likely escalate to dictatorial abuses power unless he is removed from office.

Addendum to Sociopathy

By Lance Dodes, who wrote, “Sociopathy.” 

In my chapter “Sociopathy” in THE DANGEROUS CASE OF DONALD TRUMP I wrote that Donald Trump more than meets the required criteria for the official diagnostic term “Antisocial Personality Disorder”.   This fact made it possible to predict that his “failure of normal empathy … marked by an absence of guilt, intentional manipulation, and controlling or even sadistically harming others for personal power or gratification” would continue and worsen as his power increased.  I noted that people with this deeply severe mental disorder do not tolerate disappointments, instead flying into rages and making up an alternative reality and insisting that it is true. This loss of the sense of reality worsens when stressed by criticism or opposition, leading to “doubling down” on delusional views with rationalizations or simply more lies.  The extreme paranoia present in these people results in seeing others not just as having different views, but as entirely dangerous people — people who have to be attacked and destroyed.  Since sociopaths lack empathy for the feelings, thoughts or values of others, they are an existential threat to democracy itself, which they attack when it opposes their self-interest.  In the same way, their paranoid rages at being challenged create a severe threat to start a war.

Since publication of our book, Mr. Trump has acted as predicted and feared.  He came close to creating a war with North Korea, vastly escalated tensions with our closest allies, including Canada and the United Kingdom, scathingly attacked the judgment and morality of his own former friends, such as the Attorney General, when they acted constitutionally rather than obediently following his dictatorial demands.  He has showed neither respect nor recognition of the value of an independent Justice Department.  He has befriended dictators whom he greatly admires for their strongman rule, which he clearly wishes for himself.  According to the Washington Post, he has told approximately 5000 false or misleading statements in his first 600 days in office (https://www.washingtonpost.com/politics/2018/09/13/president-trump-has-made-more-than-false-or-misleading-claims/?utm_term=.d78526d4d8a5).  Mr. Trump’s ongoing behavior is fully consistent with a sociopath, a person with Antisocial Personality Disorder.  His demonstrated lack of interest or concern for truth, the welfare of the citizens of his country, or the nation’s founding values such as freedom of the press and shared power among equal parts of the government, are all symptoms of his dangerous mental disorder.

Donald Trump is now the greatest threat to America as a democracy, and to world peace, since the darkest days of World War II.  Our predictions have been ignored by the nation’s elected leaders whose responsibility it is to ensure that no president is allowed to destroy the country.  Sadly, at this point, we can again predict that Mr. Trump’s gross incapacity to serve in any position of authority over others or to be allowed to control weapons, will become even more dangerous as he is threatened with loss of the personal power he demands.