Now, an op-ed in The New York Times by an anonymous “senior White House official” describes how deeply the troubles in this administration run and what effort is required to protect the nation.
None of this is a surprise to those of us who, 18 months ago, put together our own public service book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.”
My focus as the volume’s editor was on Trump’s dangerousness because of my area of expertise in violence prevention. Approaching violence as a public health issue, I have consulted with governments and international organizations, in addition to 20 years of engaging in the individual assessment and treatment of violent offenders.
The book proceeded from an ethics conference I held at Yale, my home institution. At that meeting, my psychiatrist colleagues and I discussed balancing two essential duties of our profession. First is the duty to speak responsibly about public officials, especially as outlined in “the Goldwater rule,” which requires that we refrain from diagnosing without a personal examination and without authorization. Second is our responsibility to protect public health and safety, or our “duty to warn” in cases of danger, which usually supersedes other rules.
The Woodward book and the New York Times op-ed confirm many of these characteristics. The rest have been evident in Trump’s behavior outside the White House and prior to his tenure.
That the president has met not just some but all these criteria should be reason for alarm.
Other ways in which a president could be dangerous are through cognitive symptoms or lapses, since functions such as reasoning, memory, attention, language and learning are critical to the duties of a president. He has exhibited signs of decline here, too.
Furthermore, when someone displays a propensity for large-scale violence, such as by advocating violence against protesters or immigrant families, calling perpetrators of violence such as white supremacists “very fine people” or showing oneself vulnerable to manipulation by hostile foreign powers, then these things can promote a much more widespread culture of violence.
The president has already shown an alarming escalation of irrational behavior during times of distress. Others have observed him to be “unstable,” “losing a step,” and “unraveling.” He is likely to enter such a state again.
Violent acts are not random events. They are end products of a long process that follow recognizable patterns. As mental health experts, we make predictions in terms of unacceptable levels of probability rather than on the basis of what is certain to happen.
Trump’s impairment is a familiar pattern to a violence expert such as myself, but given his level of severity, one does not need to be a specialist to know that he is dangerous.
I believe Woodward’s book and the revelations in the New York Times op-ed have placed great pressure on the president. We are now entering a period when the stresses of the presidency could accelerate because of the advancing special counsel’s investigations.
The degree of Trump’s denial and resistance to the unfolding revelations, as expressed in a recent Fox interview, are telling of his fragility.
From my observations of the president over extended time via his public presentations, direct thoughts through tweets and accounts of his close associates, I believe that the question is not whether he will look for distractions, but how soon and to what degree.
At least several thousands of mental health professionals who are members of the National Coalition of Concerned Mental Health Experts share the view that the nuclear launch codes should not be in the hands of someone who exhibits such levels of mental instability.
Just as suspicion of crime should lead to an investigation, the severity of impairment that we see should lead to an evaluation, preferably with the president’s consent.
Mental impairment should be evaluated independently from criminal investigations, using medical criteria and standardized measures. A sitting president may be immune to indictments, but he is subject to the law, which is strict about public safety and the right to treatment when an individual poses a danger to the public because of mental instability. In the case of danger, the patient does not have the right to refuse, nor does the physician have the right not to take the person as a patient.
This evaluation may have been delayed, but it is still not too late. And mental health professionals have extensive experience assessing, restraining and treating individuals much like Trump — it is almost routine.