December 8, 2017 

An article in New York Magazine is entitled "New Reports Suggest Trump Might Not Be a Liar at All, But Truly Delusional." It notes that Donald Trump generally is considered to be a "con man," i.e., a liar. "But new reporting has opened up a second possibility: The president has lost all touch with reality." That appraisal is based on "accounts from insiders suggesting Trump habitually insists upon the impossible in private. He does not merely tell lies in order to gull the public or to manipulate allies. He tells lies in private that he has no reason to tell."

 An article in The New York Times of November 29 is one such account. Trump now denies that he made the crude comments on the "Access Hollywood" tape, that the voice isn’t his, even though he admitted earlier that it is. He still claims that he lost the popular vote due to voter fraud. He has returned to claiming that Barack Obama was not born in the United States. According to "a Republican lawmaker," not identified, Trump boasts of winning districts he did not win.

Donald Trump is a bad joke as President, but we have tended to see him as a fool, a braggart, a child in a job demanding an informed adult. He also is a man full of, virtually defined by, worrisome personality quirks. Now, in addition to leaks of his possibly delusional behavior, we have expert opinion, by way of a collection of essays by mental health professionals.[58]  A few days ago, I referred to a book entitled Dangerous Convictions, describing the state of the Republican Congress; now we have The Dangerous Case of Donald Trump, which presents essays by two dozen mental health professionals, including psychiatrists and psychologists. They are of the opinion that, as stated in the Prologue, "anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency."

It’s true that diagnosing mental illness from a distance is risky, potentially misleading and controversial. For psychiatrists, it is contrary to the so-called Goldwater rule, which was adopted after the 1964 election; it "prohibits psychiatrists from offering opinions on someone they have not personally evaluated. . . ." The American Psychological Association has a similar rule. However, there is a distinction between diagnosis and informed comment about a public figure by those trained to evaluate mental health; it can be proper and useful and, at present, it is necessary.

Some of the essays come close to diagnosis at a distance and some generalize broadly about patterns of behavior. However, most offer expert insight into the behavior which all of us can see. As one contributor puts it, the Goldwater rule is not an impediment because the aim is not diagnosis, and the subject is not a patient.: "Our duty to warn is an expression of our concerns as citizens possessed of a particular expertise; not as clinicians who are responsible for preventing predictable violence from someone under our care." [59]  Put simply, "The issue that we are raising is not whether Trump is mentally ill. It is whether he is dangerous."[60]

In a sense, expert opinion isn’t required, as Trump’s deficiencies are obvious. However, many seem unaware of how serious the situation is, either from lack of attention or because they think that Trump, though he sometimes might be over the top, will solve what they see as the country’s problems. Others, harboring no illusions, hope to use him. All must be persuaded that his intellectual and emotional problems are too serious to ignore. Any input from those experienced in detecting and evaluating behavioral aberration is welcome.

Several of the essays describe Trump in terms of "malignant narcissism." One lists Trump’s traits which fit that description: lack of empathy for others, lack of remorse, lying and cheating; loss of reality; rage reactions and impulsivity. Because of this array of traits, Trump is "definitively and obviously dangerous."[61]  Another adds paranoia and sadism, illustrated by Trump’s claim that Obama wiretapped Trump Tower, and his threats aimed at protesters.[62]

Indulgence in conspiracy theories is an additional sign of instability. Trump has praised Alex Jones, who alleges wildly imaginary conspiracies to explain 9-11, the Sandy Hook massacre, Boston Marathon bombing and other events. The "birther" nonsense about Obama implies a conspiracy, and Trump claims that the Access Hollywood tape may have been altered.

One essay echoes the New York article in suggesting that Trump suffers from delusional disorder. It gives three examples; one might be dismissed as mere lying ("mere"?), but two do seem delusional: Trump’s claim of a huge inaugural crowd, in the face of photos showing the opposite, and his story that rain stopped as he began his inaugural speech, when it actually started then.[63]  The author offers solipsism, a term borrowed from philosophy, as an alternative descriptive category: "solipsism is the belief that the person holding the belief is the only real thing in the universe." Donald Trump does seem to live inside himself.

Robert Lifton, who wrote the Foreword to The Dangerous Case, in an interview also referred to solipsism in describing Trump: "Solipsistic reality means that the only reality he’s capable of embracing has to do with his own self and the perception by and protection of his own self. And for a president to be so bound in this isolated solipsistic reality could not be more dangerous for the country and for the world."[64]

Another essay sums up itself and the exercise. The issue is not mental illness, but there are "genuine, observable, and profound impediments in Mr. Trump's capacity to deal thoughtfully and reliably with the complex and grave responsibilities of being a reliable president and commander in chief." Whether or not he is delusional, he doesn’t acknowledge or, apparently, recognize having been wrong, and he doesn’t seem to learn or accept anything which might convince him of his errors.

"Donald Trump's presidency confronts the psychiatric profession and, much more important, our country with the challenge of dealing with an elected leader whose psychological style (marked by impulsivity, insistence on his own infallibility, vengeful retaliation, and unwarranted certainty in uncertain circumstances) is a profound impediment to sound decision making and presages the erratic and ill-considered exercise of enormous power."[65]

Unless "the Vice President and a majority of . . . the principal officers of the executive departments," acting under the Twenty-Fifth Amendment, declare that "the President is unable to discharge the powers and duties of his office," we’re stuck with this dangerous man for at least another year. We’d better hope for a Democratic landslide next November.

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58. The Dangerous Case of Donald Trump, Lee, ed. (2017)
59. Id., at 153

60. Id., at 172
61. Id., at 89-91

62. Id., at 96-98

63. Id., at 113

64. http://billmoyers.com/story/dangerous-case-donald-trump-robert-jay-lifton-bill-moyers- duty-warn/

65. The Dangerous Case of Donald Trump, at 158