by Bandy X. Lee
In “Why ‘Crazy Like a Fox’ versus ‘Crazy Like a Crazy’ Really Matters,” Tansey shows that Trump’s nearly outrageous lies may be explained by delusional disorder, about which Tansey invites the reader to make the call; even more frightening are Trump’s attraction to brutal tyrants and also the prospect of nuclear war. In “Cognitive Impairment, Dementia, and POTUS,” Reiss writes that a current vulnerability in our political system is that it sets no intellectual or cognitive standards for being president, despite the job’s inherently requiring cognitive clarity; this lack of clarity can be even more serious if combined with other psychiatric disorders. In “Donald J. Trump, Alleged Incapacitated Person,” Herb explains how, as a guardianship attorney (in contrast to a mental health professional), he is required to come to a preliminary conclusion about mental incapacity before filing a petition, which he does in his essay, while reflecting on the Electoral College and the Twenty-Fifth Amendment to the U.S. Constitution.
The second part of the book addresses the dilemmas that mental health professionals face in observing what they do and speaking out when they feel they must. In “Should Psychiatrists Refrain from Commenting on Trump’s Psychology?” Glass argues against a technicality that would yield a simple yes-or-no answer to the Goldwater rule; instead, he advocates for a conscientious voicing of hazardous patterns, noting that the presence of mental illness is not as relevant as that of reliable functionality. In “On Seeing What You See and Saying What You Know,” Friedman notes that technological advances that allow assessment and treatment from a distance, especially in underserved areas, have changed the clinician’s comfort level with remote evaluations, even when detecting a totalitarian mind-set or a multidimensional threat to the world. In “The Issue Is Dangerousness, Not Mental Illness,” Gilligan discusses the ethics of not diagnosing a public figure versus the duty to warn potential victims of danger; when invoking the latter, he emphasizes, what matters is not whether a person is mentally ill but whether he is dangerous, which is possible to assess from a distance.
In “A Clinical Case for the Dangerousness of Donald J. Trump,” Jhueck notes that the United States legally confers mental health professionals and physicians considerable power to detain people against their will if they pose a danger due to likely mental illness—and Trump more than meets the requisite criteria. In “Health, Risk, and the Duty to Protect the Community,” Covitz offers an ancient reference and two fables to illustrate just how unusual the mental health profession’s response is to a dangerous president, as we do not to speak up in ways that would be unthinkable for our role with other members of society. In “New Opportunities for Therapy in the Age of Trump,” Doherty claims that the Trump era has ruptured the boundary between the personal and the public, and while clients and therapists are equally distressed, integrating our roles as therapists and citizens might help us better help clients.
The book’s third part speaks to the societal effects Mr. Trump has had, represents, and could cause in the future. In “Trauma, Time, Truth, and Trump,” Teng points out the irony of seeing, as a trauma therapist, all the signs of traumatization and retraumatization from a peaceful election; she traces the sources of the president’s sudden military actions, his generation of crises, his shaken notions of truth and facts, and his role in reminding patients of an aggressive abuser. In “Trump Anxiety Disorder,” Panning describes a unique post-election anxiety syndrome that has emerged as a result of the Trump presidency and the task that many therapists face with helping clients manage the stress of trying to “normalize” behavior that they do not feel is normal for a president. In her essay “In Relationship with an Abusive President,” West illustrates the dynamics of “other blaming” in individuals who have feelings of low self-worth and hence poor shame tolerance, which lead to vindictive anger, lack of accountability, dishonesty, lack of empathy, and attention-seeking, of which Trump is an extreme example.
In “Trump’s Daddy Issues,” Wruble draws on his own personal experiences, especially his relationship with his strong and successful father, to demonstrate what a therapist does routinely: uses self-knowledge as an instrument for evaluating and “knowing” the other, even in this case, where the other is the president and his followers. In “Birtherism and the Deployment of the Trumpian Mind-Set,” Kessler portrays the broader background from which “birtherism” began and how, by entering into the political fray by championing this fringe sentiment, Trump amplifies and exacerbates a national “symptom” of bigotry and division in ways that are dangerous to the nation’s core principles. In “Trump and the American Collective Psyche,” Singer draws a connection between Trump’s personal narcissism and the American group psyche, not through a political analysis but through group psychology—the joining of group self-identity with violent, hateful defenses is as much about us as about Trump.
In “Who Goes Trump?” Mika explains how tyrannies are “toxic triangles,” as political scientists call them, necessitating that the tyrant, his supporters, and the society at large bind around narcissism; while the three factors animate for a while, the characteristic oppression, dehumanization, and violence inevitably bring on downfall. In “The Loneliness of Fateful Decisions,” Fisher recounts the Cuban Missile Crisis and notes how, even though President Kennedy surrounded himself with the “best and the brightest,” they disagreed greatly, leaving him alone to make the decisions—which illustrates how the future of our country and the world hang on a president’s mental clarity. In “He’s Got the World in His Hands and His Finger on the Trigger,” Gartrell and Mosbacher note how, while military personnel must undergo rigorous evaluations to assess their mental and medical fitness for duty, there is no such requirement for their commander in chief; they propose a nonpartisan panel of neuropsychiatrists for annual screening.
A Disclaimer
In spite of its title, I would like to emphasize that the main point of this book is not about Mr. Trump. It is about the larger context that has given rise to his presidency, and the greater population that he affects by virtue of his position. The ascendancy of an individual with such impairments speaks to our general state of health and well-being as a nation, and to how we can respond: we can either improve it or further impair it. Mental disorder does not distinguish between political parties, and as professionals devoted to promoting mental health, including public mental health, our duty should be clear: to steer patients and the public on a path toward health so that genuine discussions of political choice, unimpeded by emotional compulsion or defense, can occur. Embracing our “duty to warn,” as our professional training and ethics lead us to do at times of danger, therefore involves not only sounding an alarm but continually educating and engaging in dialogue our fellow human beings, as this compilation aspires to do.
* * *
I am grateful to all the authors who have generously contributed their insights without an expectation of personal reward. I especially thank Drs. Judith Herman and Grace Lee for their very helpful advice in editing this manuscript and for their help in organizing the Yale conference; Drs. Nanette Gartrell and Dee Mosbacher for their additional assistance; and Drs. Lance Dodes and John Gartner for their help in conceiving this publication in the first place. I would also like to express my appreciation for Dr. Robert Rohrbaugh, who as deputy chair for education made the conference possible; Dr. Howard Zonana, who as director of the Law and Psychiatry Division, and as a role model, supported me with legal advice along with Dr. Madelon Baranoski; and Dr. John Krystal, who, as department chair, bore the brunt of the controversies surrounding the conference. I thank Mr. Scott Mendel, the most intellectually astute literary agent one could ask for; and Mr. Stephen Power, the most enthusiastic editor one could have. I am grateful to Atty. Glen Feinberg, specialist of psychiatric law, and Atty. Max Stern, civil rights counsel, who have graciously donated hours of their time to what they deemed “a worthy cause”; as well as Atty. Ronald London, First-Amendment lawyer, and Atty. Henry Kaufman, the publisher’s co
unsel. Finally, I would like to share my gratitude for my grandfather and physician, Dr. Geun-Young Lee, who is the inspiration for all my work in the world.
Bandy X. Lee, M.D., M.Div., is Assistant Clinical Professor in Law and Psychiatry at Yale School of Medicine. She earned her degrees at Yale, interned at Bellevue, was Chief Resident at Mass General, and was a Research Fellow at Harvard Medical School. She was also a Fellow of the National Institute of Mental Health. She worked in several maximum-security prisons, cofounded Yale’s Violence and Health Study Group, and leads a violence prevention collaborators group for the World Health Organization. She’s written more than one hundred peer-reviewed articles and chapters, edited eleven academic books, and is author of the textbook Violence.
References
American Psychiatric Association. 2017. “APA Remains Committed to Supporting Goldwater Rule.” www.psychiatry.org/news-room/apa-blogs/apa-blog/2017/03/apa-remains-committed-to-supporting-goldwater-rule.
Bulman, May. 2017. “Donald Trump Has ‘Dangerous Mental Illness,’ Say Psychiatry Experts at Yale Conference.” Independent, April 21. www.independent.co.uk/news/world/americas/donald-trump-dangerous-mental-illness-yale-psychiatrist-conference-us-president-unfit-james-gartner-a7694316.html.
DeVega, Chauncey. 2017. “Psychiatrist Bandy Lee: ‘We Have an Obligation to Speak About Donald Trump’s Mental Health Issues … Our Survival as a Species May Be at Stake.’” Salon, May 25. www.salon.com/2017/05/25/psychiatrist-bandy-lee-we-have-an-obligation-to-speak-about-donald-trumps-mental-health-issues-our-survival-as-a-species-may-be-at-stake/.
Dodes, Lance, and Joseph Schachter. 2017. “Mental Health Professionals Warn About Trump.” New York Times, February 13. www.nytimes.com/2017/02/13/opinion/mental-health-professionals-warn-about-trump.html?mcubz=1.
Fisher, Edwin B. 2017. “Trump’s Tweets Attacking Obama.” New York Times, March 6. www.nytimes.com/2017/03/06/opinion/trumps-tweets-attacking-obama.html?mcubz=1.
Greene, Richard. 2016. “Is Donald Trump Mentally Ill? 3 Professors of Psychiatry Ask President Obama to Conduct ‘A Full Medical and Neuropsychiatric Evaluation.’” Huffington Post, December 17. www.huffingtonpost.com/richard-greene/is-donald-trump-mentally_b_13693174.html.
Herman, Judith L., and Robert Jay Lifton. 2017. “‘Protect Us from This Dangerous President,’ 2 Psychiatrists Say.” New York Times, March 8. www.nytimes.com/2017/03/08/opinion/protect-us-from-this-dangerous-president-2-psychiatrists-say.html?mcubz=1&_r=0.
Milligan, Susan. 2017. “An Ethical Dilemma: Donald Trump’s Presidency Has Some in the Mental Health Community Re-Evaluating Their Role.” U.S. News and World Report, April 21. www.usnews.com/news/the-report/articles/2017-04-21/mental-health-professionals-debate-ethics-in-the-age-of-trump.
PART 1
THE TRUMP PHENOMENON
UNBRIDLED AND EXTREME PRESENT HEDONISM
How the Leader of the Free World Has Proven Time and Again He Is Unfit for Duty
PHILIP ZIMBARDO AND ROSEMARY SWORD
In the summer of 2015, we commenced what would become an ongoing discussion about Donald Trump. He had just thrown his hat in the ring as a Republican presidential candidate, and our initial conversation was brief: he was in it for the publicity. For us, as for many Americans, Donald Trump had been in the periphery of our consciousness for years, first as a well-publicized New York City businessman and later as a mediocre television personality. And like most, we didn’t take him seriously. Why would we have? He had no political experience, and he failed to show any real interest in philanthropy, much less in helping the American people or non-Trump businesses. His products were made outside the United States, and multiple lawsuits indicated he didn’t pay those small businesses that supplied him with goods and services. He had also created Trump University, for people who wanted to get certified in business administration, at a fee of $43,000 for one year. It was a scam—the same lessons were available online for free for anyone, and the mentors who were supposed to give students personal guidance were rarely available. Students who took Trump University to court won their lawsuits, and Trump U got dumped. Simply put, Donald Trump was a businessman interested primarily in personal gain, sometimes using unscrupulous methods.
We also knew that, for decades, Trump had flip-flopped, switching political parties—first a Democrat, then a member of the Reform Party, then a Republican, then a Democrat, and finally a Republican again. Surely, it seemed, “The Donald” was in the running merely to gain media coverage, to place himself in a better position to make even more big deals and to up-level his product line: Donald J. Trump.
Then, as the months progressed, we became increasingly concerned that, given his “straightforward” or “outsider” presentation and his charisma, he would appeal to people who were unaware of the dangers of narcissism in extremis, or of the offensive behaviors that can accompany it. While we are not trying to diagnose here (which would be close to impossible in any case), we would like to call the reader’s attention to associated behaviors that include but are not limited to condescension, gross exaggeration (lying), bullying, jealousy, fragile self-esteem, lack of compassion, and viewing the world through an “us-vs.-them” lens. Having observed the schoolyard bully tactics Trump employed during the Republican debates, and his absurdly boastful presentation during interviews, we felt it was important to raise awareness about this set of behaviors. So, in January 2016, we published an online Psychology Today column about bullies and the hostile social environments they create in schools and businesses (Sword and Zimbardo 2016a).
As Trump’s campaign, and his narcissism, gained momentum, so did our efforts to make people aware of the potential dangers he posed for our democracy. In March 2016 we published a column about the narcissistic personality (Sword and Zimbardo 2016b). In it, we shared clinically documented narcissistic behaviors, hoping it would be easy for readers to come to their own conclusions that Trump fit every example. We did not mention his numerous romantic dalliances, or the growing number of sexual harassment lawsuits he faced, or his three marriages, in which he traded up for younger, more beautiful women. Each of these, on its own, is not exceptional, but it doesn’t take a mental health professional to determine that these behaviors, coupled with his ever-shifting political party affiliations (changes that could be viewed as having been made to bolster his image and ego), indicated that this person’s main focus was self-interest, and were incongruent with one important character trait the American people have come to appreciate in their president—at least up until November 2016: stability.
Furthermore, through our observations, it was glaringly apparent, based on Zimbardo’s time perspective theory (Zimbardo and Boyd 2009), later developed into time perspective therapy by Sword and Sword (Zimbardo, Sword, and Sword 2012), that Trump embodied a specific personality type: an unbridled, or extreme, present hedonist. As the words suggest, present hedonists live in the present moment, without much thought of any consequences of their actions or of the future. An extreme present hedonist will say whatever it takes to pump up his ego and to assuage his inherent low self-esteem, without any thought for past reality or for the potentially devastating future outcomes from off-the-cuff remarks or even major decisions. Trump’s behavior indicates that his time perspectives are totally unbalanced. It’s not necessary for him to take the Zimbardo Time Perspective Inventory (either the long or short forms) in order for us to come to this conclusion. Our assertion that Trump qualifies as among the most extreme present hedonists we have ever witnessed comes from the plethora of written and recorded material on him, including all his interviews, hundreds of hours of video, and his own tweets on his every personal feeling.
What follows is meant to help readers understand how we’ve come to the conclusion that Donald Trump displays the most threatening time perspective profile, that of an extreme present hedonist, and is therefore “unfit for duty.”
Time Perspective Theory and Time Perspective Therapy (TPT)
We are all fam
iliar with the three main time zones: the past, the present, and the future. In TPT, these time zones are divided into subsets: past positive and past negative, present hedonism and present fatalism, and future positive and future negative. When one of these time perspectives is weighed too heavily, we can lose out on what’s really happening now and/or lose sight of what could happen in our future. This can cause us to be unsteady, unbalanced, or temporally biased.
Being out of balance in this way also shades the way we think, and negatively impacts our daily decision making. For instance, if you are stuck in a past negative experience, you might think that from now on everything that happens to you will be negative. Why even bother planning for your future? you might think. It’s just going to continue to be same old bad stuff. Or, if you are an extreme present hedonist adrenaline junky intent on spiking your adrenal glands, then you might engage in risky behaviors that unintentionally endanger you or others because you are living in the moment and not thinking about the future consequences of today’s actions. If you are out of balance in your future time perspective, constantly thinking and worrying about all the things you have on your endless to-do list, you might forget about or miss out on the everyday, wonderful things happening in your life and the lives of your loved ones in the here and now.
SIX MAIN TIME PERSPECTIVES IN TPT
1. Past positive people focus on the good things that have happened.
2. Past negative people focus on all the things that went wrong in the past.
3. Present hedonistic people live in the moment, seeking pleasure, novelty, and sensation, and avoiding pain.
4. Present fatalistic people feel that planning for future decisions is not necessary because predetermined fate plays the guiding role in one’s life.