by Bandy X. Lee
In that regard, one final clarification is in order. Trump is now the most powerful head of state in the world, and one of the most impulsive, arrogant, ignorant, disorganized, chaotic, nihilistic, self-contradictory, self-important, and self-serving. He has his finger on the triggers of a thousand or more of the most powerful thermonuclear weapons in the world. That means he could kill more people in a few seconds than any dictator in past history has been able to kill during his entire years in power. Indeed, by virtue of his office, Trump has the power to reduce the unprecedentedly destructive world wars and genocides of the twentieth century to minor footnotes in the history of human violence. To say merely that he is “dangerous” is debatable only in the sense that it may be too much of an understatement. If he even took a step in this direction, we will not be able to say that he did not warn us—loudly, clearly, and repeatedly. In that case, the fault will not be his alone. It will also be ours.
James Gilligan, M.D., is Clinical Professor of Psychiatry and Adjunct Professor of Law at New York University. He is a renowned violence studies expert and author of the influential Violence: Our Deadly Epidemic and Its Causes, as well as Preventing Violence and Why Some Politicians Are More Dangerous Than Others. He has served as director of mental health services for the Massachusetts prisons and prison mental hospital, president of the International Association for Forensic Psychotherapy, and as a consultant to President Clinton, Tony Blair, Kofi Annan, the World Court, the World Health Organization, and the World Economic Forum.
References
Burns, Sarah. 2016. “Why Trump Doubled Down on the Central Park Five.” New York Times, October 17.
“Donald Trump’s Lewd Comments About Women.” 2016. Transcript and video. New York Times, October. 8.
Fisher, Max. 2016. “Donald Trump, Perhaps Unwittingly, Exposes Paradox of Nuclear Arms.” New York Times, August 3.
Gilligan, James. 2001. Preventing Violence: An Agenda for the Coming Century. London and New York: Thames and Hudson.
______. 2011. Why Some Politicians Are More Dangerous Than Others. Cambridge, UK: Polity Press.
Haberman, Maggie. 2016. “Donald Trump Again Alters Course on Torture.” New York Times, March 15.
Heilpern, Will. 2017. “Trump Campaign: 11 Outrageous Quotes.” CNN.com, January 19. cnn.com/2015/12/31/politics/gallery/donald-trump-campaign-quotes/index.html.
Lee, Bandy X., Bruce E. Wexler, and James Gilligan. 2014. “Political Correlates of Violent Death Rates in the U.S., 1900–2010: Longitudinal and Cross-Sectional Analyses.” Aggression and Violent Behavior 19: 721–28.
New York Times Editorial Board. 2016. “The Trump Campaign Gives License to Violence.” New York Times, March 15. www.nytimes.com/2016/03/15/opinion/the-trump-campaign-gives-license-to-violence.html.
Weber, Max. 1917. “Science as a Vocation.” In From Max Weber, tr. and ed. by H. H. Gerth and C. Wright Mills. Repr. New York: Free Press, 1946.
A CLINICAL CASE FOR THE DANGEROUSNESS OF DONALD J. TRUMP
DIANE JHUECK, L.M.H.C., D.M.H.P.
Mental illness in a U.S. president is not necessarily something that is dangerous for the citizenry he or she governs. A comprehensive study of all thirty-seven U.S. presidents up to 1974 determined that nearly half of them had a diagnosable mental illness, including depression, anxiety, and bipolar disorder (Davidson, Connor, and Swartz 2006). Notably, however, personality disorders were not included in this study, even though they can be just as debilitating. This addition would most certainly have increased the number of presidents with mental illness to something well past 50 percent. Yet, psychiatric illness alone in a president is not what causes grave concern. A second and crucial part of the equation is: Is the president dangerous by reason of mental illness?
Favoring civil liberties, U.S. law gives a lot of latitude for behavioral variation. When the law allows, even requires, that mental health professionals and physicians detain people against their will for psychiatric reasons, they must demonstrate that those people are a danger to themselves or others, or are gravely disabled. Initially, we need to look at what it means to be a danger to others due to mental illness. It is important to separate mental symptoms from things such as poor judgment or opinions and points of view that differ from one’s own, which the law clearly permits. In the United States, it must be a disturbance of cognition, emotion regulation, or behavior, as described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), that is driving the patterns of dangerous behavior. Additionally, the magnitude of the perceived harm must be considered. Is it that feelings are being hurt? Or is there actual damage being perpetrated? Are there patterns of behavior and statements of intent that reasonably indicate that harm is imminent? Does the person carry weapons or any other instruments of harm?
People holding high political office inevitably cause some form of harm, whether they intend to or not. Leaders must often select what they think are the best options from a list of bad ones in areas as complex as military policy, the allocation of limited resources, or the line between safety nets and deregulation. When an individual in high office makes decisions, some people may be hurt in some way because of the sheer magnitude of that individual’s power. A good leader will attempt, to the extent he or she can, to minimize that harm and to comfort those impacted, but damage is still unavoidable. This remains an unfortunate effect of governing large groups of people. This is also the very reason it is more, not less, important that the leader of the United States be mentally and emotionally stable. As president, Donald J. Trump has control over our executive branch and its agencies; is commander in chief of our military; has unilateral authority to fire nuclear weapons (which the secretary of defense authenticates but cannot veto). For the leader of the free world, inappropriate words alone may create a snowball effect that ultimately results in devastating harm to others.
The MacArthur Violence Risk Assessment Study has a number of indicators for whether an individual will commit future violence. Some examples include: a past history of violence, a criminal or substance-abusing father, personal chemical abuse, having a generally suspicious nature, and a high score on the Novaco Anger Scale. In regard to categories of mental health disorder, and perhaps counterintuitively, major illnesses (such as schizophrenia) have a lower rate of harm to others than personality disorders. “Psychopathy, [antisocial personality disorder] as measured by a screening version of the Hare Psychopathy Checklist, was more strongly associated with violence than any other risk factor we studied” (Monahan 2001). The twenty-item Hare checklist measures interpersonal and affective presentation, social deviance, impulsive lifestyle, and antisocial behavior (Hart, Cox, and Hare 1995).
The president, in a position of great power and making critical decisions, should theoretically meet higher standards of mental stability. Also, having access to a nuclear arsenal capable of destroying the world many times over, he should be of lower risk of violence than the average citizen. Despite these higher standards, our response is the opposite, for there is protection of public perception to consider: the president is supposed to be our protector, and he is unwell and harmful. The more unwell and unwilling to admit of any disturbance (in an extreme-case scenario), the more a mental health detention may need to be considered—and how would that appear to the public? Or, if we did not act, would we continue to deny until we were at a point of no return? Additionally, those who dare apply these mental health principles, such as those who dare apply justice to our First Citizen, may find themselves at risk of their jobs, their security, or even their personal safety—by the president or that segment of our society currently feeling empowered by the rise of the present regime, who would be driven around the emotional bend if these actions were successful. A complex web of factors requires consideration, which is why public education and collaboration with other professionals (e.g., politicians, lawyers, social psychologists) is highly important.
There is a preponderance of information in the public record re
garding Donald J. Trump’s aberrant behavior. The following list of incidents is neither all-inclusive nor deeply analytical. Each topic is a potential theme for an entire book in its own right. The intent here is to isolate enough indicators of record to reach a reasoned conclusion about whether President Trump’s patterns of behavior indicates a clinically relevant “danger to others.”
During a rally in Wilmington, North Carolina, Trump stated, “Hillary wants to abolish, essentially abolish the Second Amendment.… And by the way, if she gets to pick her judges, nothing you can do, folks. Although [for] the Second Amendment people, maybe there is, I don’t know.” A reporter covering this incident was moved to say, “While the remark was characteristically glib, it finds Trump again encouraging violence at his rallies. Worse, it marks a harrowing jump from threatening protestors to suggesting either an armed revolt or the assassination of a president” (Blistein 2016). It was not just journalists who heard Trump’s statement in these terms: “The former head of the CIA, retired Gen. Michael Hayden, told CNN’s Jake Tapper, ‘If someone else had said that outside the hall, he’d be in the back of a police wagon now with the Secret Service questioning him’” (Diamond and Collinson 2016). It is true also for medical and mental health professionals: if a patient had said that, an emergency certificate would have been signed, and the person taken to the nearest emergency room for further questioning and evaluation.
Trump has said that he did not mean the statement the way it sounded. A common explanation by his defenders of aggressive and untoward remarks made by him in public settings is that what he said was a joke. This in no way discounts the dangerousness of his remark. In fact, his deeming the remark so lightly as to consider that it could be a joke would in itself be concerning. Moreover, his holding life-and-death matters themselves to be inconsequential may indicate serious pathology and risk—which cannot fully be ruled out without a detailed examination. This statement, in this context, exemplifies the “willingness to violate others” and the lack of empathy that characterize antisocial personality disorder (American Psychiatric Association 2016, pp. 659–60). In modern history, no other candidate for president of the United States has joked about his followers murdering his opponent.
In his response to the release by the Washington Post of the now-infamous “Grab ’em by the pussy” video, Trump the candidate stated that the audio was recorded more than ten years ago and did not represent who he is. The recording was made by Access Hollywood’s Billy Bush on September 16, 2005. It includes the following comments from the newly married Trump when he sees actress Arianne Zucker outside the bus where he is being recorded: “I better use some Tic Tacs, just in case I start kissing her.” (Sound of Tic Tacs being dispensed). “You know I’m automatically attracted to beautiful—I just start kissing them. It’s like a magnet. Just kiss. I don’t even wait” (Fahrenthold 2016). During the course of the video, he is on record as saying even more disturbing and assaultive things regarding women.
After this video was aired, a significant number of Republican senators, representatives, governors, political appointees, and others stated publicly that they would not endorse Trump for office. Lisa Murkowski, Republican senator from Alaska, stated, “The video that surfaced yesterday further revealed his true character,” she said. “He not only objectified women, he bragged about preying upon them. I cannot and will not support Donald Trump for President—he has forfeited the right to be our party’s nominee. He must step aside” (2016). Brian Sandoval, Republican governor from Nevada, declared, “This video exposed not just words, but now an established pattern, which I find to be repulsive and unacceptable for a candidate for President of the United States” (Graham 2016). While senators and representatives have a more complicated relationship to Trump as president, governors and political appointees are more removed from him politically and warrant closer inspection. Of note, with less to lose politically, both these groups had a higher percentage of members state that they would not endorse Trump. Of the fifteen Republican governors who went on record, 53 percent stated that they would not endorse the nominee for president. Two of the seven who said they would endorse him now have jobs in his administration, as vice president and United Nations ambassador. Of the twenty-three Republican political appointees who made statements on record, an astounding 87 percent of them said they would not endorse or vote for Trump. Only three said they would (Graham 2016). Therapists of mental health across the country report having to expand their practices to include what is being called “election trauma.” “What I’m seeing with my clients, particularly with women who experienced sexual abuse when younger, is that they are being re-wounded, re-traumatized,” said Atlanta licensed professional counselor Susan Blank. “They can’t escape it. It’s all around them, written large on the national stage” (LaMotte 2016).
Among the many truly disturbing behaviors of this man now serving as the leader of the free world is his relationship to his daughter Ivanka. What follows are some of the more unsettling things Trump has said about her while knowingly being recorded:
• “You know who’s one of the great beauties of the world, according to everybody? And I helped create her. Ivanka. My daughter Ivanka. She’s 6 feet tall, she’s got the best body” (King 2016).
• During an interview with Howard Stern when Ivanka was twenty-two years old (Cohen 2016): “I’ve said that, if Ivanka weren’t my daughter, perhaps I’d be dating her” (“Donald Trump Nearly Casually Remarks…” 2006).
• And in another appearance on the Howard Stern radio show, in response to Stern’s saying, “By the way, your daughter…” Trump responded, “She’s beautiful.” Stern added, “Can I say this? A piece of ass,” to which Trump replied, “Yeah” (Kaczynski 2016).
• To a reporter about Ivanka: “Yeah, she’s really something, and what a beauty, that one. If I weren’t happily married and, ya know, her father…” (Solotaroff 2015).
• On Fox’s Wendy Williams Show, in 2013: “Ivanka, what’s the favorite thing you have in common with your father?” Williams asked. “Either real estate or golf,” Ivanka replied. “Donald?” Williams asked Trump. “Well, I was going to say sex, but I can’t relate that to…” Trump answers, gesturing to Ivanka (Feyerick 2016).
One of the first acts of mass citizen resistance against Trump’s presidency occurred the day after his inauguration, when much of the country went to the streets in protest. The 2017 Women’s March was the largest protest gathering in the history of the United States. Researchers Jeremy Pressman and Erica Chenowith (2017) estimate that more than four million people participated nationwide. They calculate that approximately three hundred thousand people marched in other countries, partly in response to an assaultive attitude and behavior against women unprecedented in a U.S. president.
A great danger to vulnerable groups and the potential for human rights abuses arise from the type of individuals Trump’s psychopathy leads him to look to for affirmation and support. Unable to tolerate criticism and perceived threats to his ego, and with a documented obsessive need to be admired, he has notably selected as his advisers either family members or people who, in clinical jargon, “enable” his illness. This is one of the more significant ways in which he has become a danger to others as president. Members of vulnerable communities often write and speak about grave concerns regarding those whom he is choosing to guide him. Using his proposed federal budget as a lens, Jessica González-Rojas writes, “It outlines President Trump’s spending priorities and program cuts that make clear his utter contempt for communities of color, and it edges this country and its moral compass closer to the nativist vision espoused by the likes of White House advisers Steve Bannon and Stephen Miller, and Attorney General Jeff Sessions” (González-Rojas 2017).
His mental health symptoms, including impulsive blame-shifting, claims of unearned superiority, and delusional levels of grandiosity, have been present in his words from his very first campaign speech: “They’re bringing drugs. They’re
bringing crime. They’re rapists, and some, I assume, are good people” (Elledge 2017). “I would build a Great Wall, and nobody builds walls better than me, believe me, and I’ll build them very inexpensively. I will build a great, great wall on our southern border and I will have Mexico pay for that wall, mark my words” (Gamboa 2015). Regarding U.S. district judge Gonzalo Curiel, who was born in Indiana, Trump claimed it was a conflict of interest for the judge to hear a fraud case against Trump University, telling CNN, “He’s a Mexican. We’re building a wall between here and Mexico” (Finnegan 2016).
Trump’s unhinged response to court decisions, driven as they appear to be by paranoia, delusion, and a sense of entitlement, are of grave concern. While president of the United States, he has on more than one occasion questioned the legitimacy of the court, as in this example: “We had a very smooth roll-out,” he insisted, claiming that “the only problem with the [Muslim] ban was the ‘bad court’ that halted it” (Friedman, Sebastian, and Dibdin 2017). In February 2017, he tweeted, “The opinion of this so-called judge, which essentially takes law-enforcement away from our country, is ridiculous and will be overturned!” To which Representative Jerry Nadler responded, on February 8, 2017: “@realDonaldTrump’s conduct—attacking judges + undermining independent judiciary—is inappropriate and dangerous.” According to the Department of Homeland Security, at least 721 individuals and their families were denied the entry they had expected at U.S. borders under a ban soon deemed illegal by more than one court. At least 100,000 visas were revoked, according to a Justice Department lawyer (Brinlee 2017).
“We’re hearing from really, really scared people,” said Rachel Tiven, CEO of Lambda Legal, a nonprofit legal advocacy organization for LGBTQ rights. She adds, “We’re seeing a fear of an atmosphere of intolerance that began with Trump’s campaign.” In the same article, Kris Hayashi, executive director of the Transgender Law Center, states, “It was clear in 2016 that we saw an upswing in anti-trans legislation, more than we’d ever seen before … We anticipated that was not going to lessen but increase in 2017” (Grinberg 2016). “These are situations that put fear, not just into the individual who is targeted, but the entire community,” said Heidi Beirich, director of the Southern Poverty Law Center’s (SPLC) Intelligence Project, in a Boston Globe article about increased hate-based crimes at schools in Massachusetts. The SPLC reports that a record 16,720 complaints were filed nationwide with the Office for Civil Rights of the U.S. Department of Education in 2016, which they state is a 61 percent increase over the previous year (Guha 2017).