Is President Trump mentally fit to lead the country through this national emergency? Answer: No.

Update, April 19, 2020:  Trump is now engaged in a concerted effort to undermine governors trying to return their states to some semblance of normality while still keeping citizens safe. He is openly advocating movements to “liberate” Michigan, Virginia, Minnesota and other states. His refusal to wear a mask and mocking reference to social distancing as “political correctness” are all part of the effort.

Jonathan Chait had this to say in The Intelligencer:

Trump is fomenting anarchy in his own country, undermining the prospects for the orderly recovery he needs in order to win reelection, and creating the risk of a violent tragedy. (The Confederate-flag-waving protesters blocking the entrance to a hospital in Michigan yesterday is the sort of episode that, if repeated, could go very badly.) He is raging angrily against the system because he is hopelessly out of his depth.

Chait correctly pointed out that rage by Trump is not strategic in nature. Yes, his base eats it up, but his cult-like followers eat up anything he says. And, rather than distracting from the continuing consequences of his failure to adopt and implement a national strategy for making available a sufficient number of COVID-19 test kits, it draws attention to it: States cannot reopen safely because of the lack of federal attention to test kit production, the “original sin” of the federal pandemic response.

What you are seeing is the consequence of the walls falling in on Trump’s ego. Public humiliation is the most severe threat to a narcissist. Here is a useful, plain-language description from a  Suzanne Degges-White, a licensed professional counselor:

A narcissist’s ego is an extremely fragile thing and when she feels she is being laughed at or is losing the respect of others, it can be tremendously upsetting. The narcissist’s ego is the only protection they have from the world and when their ego integrity is breached, narcissists often respond in ways that seem markedly out of proportion to the circumstances for average people. 

I appreciate Dr. White’s use of the pronoun “she.” As it happens, however, most of the experience that psychotherapists have with narcissists lies in trying to help wives deal with narcissistic husbands. Be that as it may, her comment about an ego breach triggering responses that are “markedly out of proportion to the circumstances” is apt, if a bit of an understatement when it comes to Trump.

Again, all of this was predictable, and predicted. Don’t make the mistake of believing that it cannot get any worse. It can. This may be hard to get your head around, but Trump would rather see the country destroyed than be personally humiliated. If he sees his prospects of re-election in November dimming, there is no limit on the havoc that he could wreak, even if it involves political self-immolation.

PS. I’ve added an answer to the question posed by the title of this post. That answer is a by now obvious “no.”

Update, April 13, 2020: Today’s meltdown speaks for itself. He’s now reduced to infantile temper tantrums and grandiose pronouncements: “When somebody’s the president of the United States, the authority is total.” As predicted over and over again, this only gets worse as Trump feels the pressure on him increasing. Vice President Pence and members of the cabinet have a clear duty to act under the 25th Amendment; in other contexts, it would constitute gross negligence (reckless disregard of an obvious risk) to allow this man to make decisions on when stores can reopen and people can safely return to work and gather publicly.

Update, April 10, 2020 – and a red alert: For me, the pathological highlight of today’s news conference was Trump’s obvious enjoyment as he described the immense power that he had to determine the fate of the nation through his decision when to re-open the country for business. He was almost giddy as described “the most important decision” he had to make as president.

A normal president would be sobered and humbled by such a monumental responsibility for the lives of others. Not one with a severe and disabling narcissistic personality disorder. Trump is gleefully intoxicated by the thought of having such dominion over others. It is his dreams of omnipotence coming true. 

When he was asked what “metric” he would use to make his decision, he pointed to his own empty skull. That’s reason for us to very scared. If today’s news conference didn’t cause red flags to go up for everyone who was watching, then nothing will.

Of course, being as uninformed as he is, he was wrong about his authority to override governors who may not agree with him on when businesses should be reopened, etc. But any pronouncement he makes on the subject will be followed by the half-dozen or so GOP governors who seem incapable of defying him, and more lives will be lost, especially in the populous states of Florida and Texas.

As if to underscore his stupidity, he persisted in discussing the lack of efficicacy of antibiotics against COVID-19. I wonder how many people in the country don’t realize by now, if they didn’t know it before, that antibiotics kill bacteria, not viruses.

The president will make the decision when to declare the country “back open for business” based on his own self-interests. And that probably means well before it is safe to do so. He is anxious to put this crisis in the past by declaring “victory” over COVID-19 well ahead of the election. He believes that voters have memories as short as his, and that they will forget about his mishandling of the pandemic if it is over by summer.

If he is allowed to make critical decisions on when and under what circumtances businesses resume operating normally, public gatherings are allowed to resume, etc. he will kill tens of thousands of additional people. And he won’t even care, as long as it is not him – and maybe Ivanka.

Update, April 7, 2020: I initially considered regular updates to this post, written on March 23, 2020, as Trump’s behavior predictably deteriorated, as sort of a running social history on how a person with severe narcissistic personality disorder responds to pressure, especially criticism. I found the concept too depressing, however, and elected not to do it for the sake of my own mental health.

But I decided that it was worth a case note on Trump’s increasing anger and hostility as he lashes out at critics and even potential critics, in an effort to intimidate and suppress critical feedback. He hasn’t been able to answer a question that he regards as “nasty” during his daily briefings without attacking the character of the reporter asking the question for weeks.

And it’s getting worse. A navy captain is relieved of command of an aircraft carrier because of a letter that Trump and his proxies deemed an embarrassment to his administration. Although Trump’s role has not yet been made clear, the Acting Secretary of the Navy who relieved Captain Crozier reportedly stated that Trump wanted him fired.

It is clear that, in quick succession, Trump himself fired Michael Atkinson, the intelligence community IG who told Congress about the whistleblower complaint that led to Trump’s impeachment, and then removed the acting IG of the Defense Department, Glenn Fine, who would have overseen scrutiny of the pandemic relief effort. Fine, in his position since Trump took office, has a reputation for being an independent and aggressive watchdog. It likely won’t be the last of the IG firings in light of the letter signed by many of them protesting Atkinson’s dismissal.

There is only one way that Trump will react to increasing criticism, and it won’t be with self-reflection. It will be by escalating efforts to suppress it. Even normally obeisant members of the GOP expressed concern at the firings of Crozier and the IGs. That won’t matter; Trump’s judgment is declining at the same pace as his impulse control.

Expect Trump’s scorched-earth tactic of replacing any perceived adversary or critic (to Trump those are the same things) to intensify as the pandemic and economic downturn becomes a growing threat to his re-election. Nothing matters more to Trump in any situation than “winning.” Nothing.

As desperate as he is to suppress criticism, Trump is becoming just as desperate (and bizarre) in his efforts to deflect blame from himself onto others. His latest target is the World Health Organization (WHO), which Trump said “blew” the coronavirus crisis. He accused it of being “very China centric,” and threatened to reduce its funding. Maybe he thought he was not gaining enough traction in his efforts to blame his predecessor, Barack Obama.

As an aside, someone suggested to me on Twitter that it was Trump’s intellectual shortcomings that are the biggest problem. I disagree, although I do believe that former Secretary of State Rex Tillerson gave the most accurate description of Trump’s intellectual capacity, using precise clinical language: “He’s a fucking moron.”

History is replete with successful leaders who did not have extraordinary intellects; other qualities are more important, including a healthy level of self-awareness. But put together Trump’s modest intellectual capacity with grandiosity on a delusional scale, and we have a major problem: An uninformed, mentally unbalanced leader who believes that he is “a very stable genius.”

A bit of “good” news: An opinion writer for the New York Times, Jennifer Senior, wrote a column putting Trump’s mismanagement of the pandemic in the context of his personality disorder. I am not obsessed with psychoanalyzing every human activity (I’ve been a lawyer a lot longer than I was a psychiatric social worker), but I don’t see how you can talk knowledgeably about Trump’s actions right now without understanding what you are seeing and hearing.

There is a very real danger in not recognizing Trump for the malignant narcissist that he is – the danger that we don’t remove him from office before his impaired judgment puts even more lives at risk. Maybe Ms. Senior’s column will prompt others, including her own editorial board, to start ringing the alarm bells.

Update, March 28, 2020: The post that appears below was published on March 23rd. Since then it has been viewed many times. In the meantime, things on the “ground” have gotten worse – both in terms of the impact of the pandemic and in terms of President Trump’s behavior. I decided to add an update in the event more people view the post in the future.

Two days after I posted my comments, an article written by Dr. Bandy X. Lee was published in The Independent. Lee is the Yale psychiatrist who edited “The Dangerous Case of Donald Trump” referenced in my original post. Her article updates her own concerns in light of the COVID-19 coronavirus pandemic, urging that Trump be removed for the safety of the American people.

Lee and her co-authors hardly are the only mental health professionals who have described Trump as having narcissistic personality disorder. Despite the so-called Goldwater Rule, many psychiatrists and psychologists have stepped forward to offer their diagnoses, undoubtedly for the same reason that Lee and her colleagues did: Fear of the consequences if Trump is not removed from office.

A noted exception was Dr. Allen Frances, a prominent psychiatrist who in 2017 opined that Trump did not have narcissistic personality disorder, although he did not downplay the threat posed by Trump’s conduct. In any case, I would invite Frances to revisit his findings in light of what we have observed in the past three years.

I wonder why more mental health professionals have not stepped forward recently to sound the alarm. Have they become like many of the rest of us, inured to the fact that we have a severely disordered individual running the country at a time of national emergency? Are they becoming a bit fatalistic? If so, it’s easy to understand why.

Trump is becoming more inappropriate, and his judgment is worsening.

On March 27th, Trump said something especially stunning, even by his standards:

“You can call it a germ, you can call it a flu, you can call it a virus, you know you can call it many different names. I’m not sure anybody even knows what it is.”

This was more than ignorance; this was the megalomaniacal dismissal of scientific and medical expertise going on inside Trump’s troubled head. Translation: “Why should I listen to Dr. Fauci, et al? They don’t really know what they’re doing. I’ll figure this out before they do.”

As an aside, Trump made the above comment shortly after Dr. Deborah Birx said this about him:

“He’s been so attentive to the scientific literature and the details and the data. And I think his — his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues.”

Bullshit, Dr. Birx. Does that sound like he gives a rat’s ass about the scientific literature? He isn’t listening to a word you say other than to assess how your advice might conflict with what he believes to be in his own narrowly defined interests. That’s what malignant narcissists do.

Because his boasting and lies will ring more and more hollow as the crisis worsens, he will have to resort to more extreme measures to protect his fragile ego. That means his words and actions are likely to become more inappropriate, even bizarre.

For example, his unconscionable threat to withhold medical supplies from Michigan unless Governor Gretchen Whitmer showed more “appreciation” for his largesse illustrated how desperate he is becoming for social validation in the face of growing public criticism over his handling of the pandemic. He fabricated a conflict with General Motors out of whole cloth for the same reason.

Weaponizing the Defense Production Act, Trump claimed that he used it to bring GM to heel over the price GM wanted to charge for ventilators. He criticized GM for not moving quickly enough. As it turns out, GM already was working with Ventec, a major ventilator manufacturer, to produce the ventilators and sell them at cost, retooling GM’s facilities as rapidly as possible to begin production. Trump flat out lied.

Trump lies for many reasons, and this one about GM was for a familiar purpose: To generate a conflict (even a faux one) in which there was a loser and a winner, and he was the winner. Trump craves “winning” like an opioid addict craves opioids. The lengths to which he will go to validate himself as should frighten all of us.

And oh, by the way, do you believe that it was a coincidence that the governor of Michigan and the CEO of GM both are women? As he grows more frantic, he will be less inclined or able to hide his well-documented misogyny.

Today’s threat by Trump to quarantine New York and possibly parts of New Jersey and Connecticut follows another one of his patterns: He sows the seeds of division by inventing enemies or selecting scapegoats. Doing so not only is useful for deflecting blame (“the Chinese virus”), it also enables to him to take on the mantle of savior, asserting that “only he” is willing to do what it takes to save us from the forces that threaten us.

It was a tactic that worked remarkably well for him in the 2016 election, using immigrants as the “threat.” Now he is going to turn the tactic on citizens from “blue” states in the Northeast, even to the extent of blaming them for the spread of the pandemic in the “red” state of Florida.

He hasn’t suggested building a wall, but don’t be surprised by anything that he says or does to turn the pandemic response into a political war between “his” side and everyone else. His political base certainly got the message from his quarantine threat, and I fully expect citizen militia groups shortly will be volunteering to patrol the borders between red states and blue states.

The mainstream media are dithering on this issue.    

Why aren’t editorial boards in major United States newspapers weighing in the president’s precarious mental state, which is becoming obvious even to laypersons? Why are no reporters from the Washington Post or the New York Times seeking out psychiatrists like Dr. Lee or psychologists like Dr. John Gartner, formerly of Johns Hopkins University, who has talked about Trump’s increasing mental instability?

As I stated in my original post, there may a reluctance to broach such an explosive topic as the president’s fitness for office in the middle of an emergency – people are scared and confused enough. When I re-read my post, I recognized my own trepidation. I concluded that invoking the 25th Amendment to remove Trump was too drastic a step; it is a process that would not happen quickly.

The thought of the country mired in a political crisis at the same time that it is mired in a public health emergency is almost unfathomable. Nevertheless, the president’s judgment seems to be increasingly impaired, and the use of the 25th Amendment should not be ruled out.

We can hope and pray that Trump’s mental state does not continue to deteriorate. I am just not sure that hoping and praying will be enough.

Original post follows:

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You don’t have to be Dr. Anthony Fauci to realize that the United States is in the middle of a public health emergency. And I don’t believe that you need to be a board-certified psychiatrist to recognize that we may have a psychiatric crisis on our hands as well. One involving President Donald Trump.

My training in psychopathology and experience as a psychiatric social worker are far in the past. But even I recognize that the president’s megalomania is getting worse. As his megalomania gets worse his judgment becomes more impaired.

A president with impaired judgment is absolutely the last thing that we need during a pandemic when his decisions can make the difference between life and death for many thousands of people. Some type of intervention is needed before Trump’s impaired judgment makes the death toll of the COVID-19 pandemic higher than it otherwise would be.

In 2017, 27 psychiatrists and psychologists co-authored a book in which they concluded that Trump suffered from narcissistic personality disorder. (“The Dangerous Case of Donald Trump,” edited by Bandy Lee, MD.) They warned “that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency.” The book was revised in 2019, adding ten co-authors and the observation that Trump had become more erratic and dangerous during the intervening years as pressures on him mounted.

Megalomania as a feature of narcissistic personality disorder refers to an exaggerated sense of knowledge, importance, and power. It is pathological when it causes significant problems in personal or professional judgment. With Trump it now appears to have reached delusional magnitude.

His defense of his “confidence” that a cocktail of the drugs hydroxychloroquine and azithromycin would prove to be a successful treatment for the COVID-19 coronavirus set alarm bells ringing.  Reacting to push back from Fauci and others because of the unproven efficacy of the drugs, Trump predicted at a March 20th news conference that “People may be surprised by the way [the drugs] would be a game-changer.” He added that “I feel good about it. That’s all it is — just a feeling. [I’m a] smart guy.”

That was the tell. He feels good about it, and the hell with what world-renowned experts say about basing conclusions on a limited, preliminary study: He’s a smart guy and knows things that they do not.  His willingness to make such a reckless statement is a sign of just how impaired his judgment has become, posing a real threat to substantive decisions.

Make no mistake about it, he believes what he said. It was not ordinary arrogance or simple ignorance, nor even intentional misrepresentation. Trump is convinced that he is intellectually superior, and that his thoughts and ideas have special status.

It would be one thing if it was just an ill-advised attempt to create a ray of hope, but it was not. Trump no longer can tell the difference between wishful thinking that goes on inside his head and reality.

Part of megalomania is an insatiable need for social validation. As described in a recent Washingon Post article, Trump “craves a constant diet of flattery,” which officials serve up during his televised news conferences on the pandemic.

As the crisis deepens and hospitals are overwhelmed, people will become scared and angry, and many of Trump’s allies will turn on him. There is no predicting how erratic Trump could become if praise gives way to general condemnation and the defenses that protect his fragile ego begin to collapse.

Almost as an aside, I note that Trump’s grandiosity is not the only facet of his narcissistic personality disorder impairing his judgment. His complete lack of empathy and his extreme egocentricity – his inability to see beyond his own narrow interests when evaluating any situation – are dramatically affecting his decision-making.

Invoking the 25th Amendment to remove the president during a quickly evolving national emergency would be a bad idea even if Vice President Mike Pence and members of the president’s cabinet had the fortitude to use it. But some intervention short of that may be possible by using his narcissism against him, if you will.

Perhaps he can be persuaded that he will be politically and personally destroyed if he continues to be the public face of the federal response, and that he should step back. Once out of the limelight, he will have less inclination or opportunity to demonstrate his own omnipotence by flouting expert advice.

Such intervention includes confronting the president with the fact that his statements and actions are doing harm. The task faced by Barry Goldwater, Hugh Scott, and John Rhodes in convincing Richard Nixon to resign pales in comparison.

Am I optimistic that such an intervention will be attempted and, if attempted, that it would succeed? No, because I’m not the one who is delusional.

_____________________

This commentary originally was submitted to the Washington Post as an op-ed, but not accepted for publication. Conceding that this topic might better be addressed by someone with more relevant and current credentials – as well as the fact that the Post always has many op-eds from which to select, and this one simply may not have made the cut – I nevertheless wonder if there was a reticence to broach an unnerving subject like this at the height of a national emergency. I believe that would be a mistake.

Although I would respect that point of view, I believe that many lives depend on our recognition that Donald Trump is unfit to lead us through this crisis. Rachel Maddow of MSNBC is leading the charge to stop live coverage of Trump’s news conferences as a way of minimizing his ability to do harm by propagating lies and other misinformation. She’s absolutely correct. A majority of the nation’s governors seem to recognize that it is going to up to them to save the people of their states because the federal government is being paralyzed by Trump’s psychopathology and impaired decision-making.

In my opinion, ignoring the truth may make matters even worse. The public needs to be made aware that they need to look to someone other than the president for guidance and support, scary as that may be.

March 23, 2020

Get ready for the performance of your life, Bernie.

After taking his most recent drubbing in the Democratic primaries this week, presidential candidate Bernie Sanders announced that he will be “reassessing” his campaign in the days and weeks ahead. I’d like to offer my assistance with that reassessment.  The executive summary: Get ready to deliver the performance of your life, Bernie.

A lot rides on the performance, including Sanders’ legacy. It will determine whether history remembers him as a Don Quixote – or as an unforgivable villain.

First of all, full disclosure. I don’t like Senator Sanders. As far as I am concerned, he is and always has been a rather unpleasant, self-centered, and self-righteous jerk. A loner by nature, his status as a registered independent in Congress is the perfect cover for him as he snipes at both Democrats and Republicans. He seldom is at the center of debates over important issues, and even less frequently accomplishes anything worthwhile.

He describes himself as a democratic socialist and has worked tirelessly to build a movement of people at the left end of the political spectrum, including those who occupy the “progressive” wing of the Democratic Party. The problem is that he has used a considerable level of demagoguery, based mainly on class-warfare rhetoric, to appeal to the passions of his supporters.

The result of that demagoguery over the years has been to attract a zealous core of followers, mainly young, white males – the Bernie Bros. It is no surprise that a man who seems perpetually angry and aggrieved, and is always yelling and pointing his finger, cultivated a group of angry, nasty loyalists who see themselves as aggrieved by society – and by anyone who does not agree with them. Many of them are threatening to refuse to vote for the Democratic nominee if it is not Bernie. It is a threat that has to be taken seriously.

Bernie, here is the task ahead of you in a nutshell: To withdraw from the race in a manner that does not end up making you the second most despised man in the United States behind Donald Trump. Because if you screw this up and somehow help get Trump re-elected, that is what you will be.

This is what you must do: Announce that you are ending your campaign because the voters have decided that Joe Biden is the best person to unseat Donald Trump, that you accept their judgment, and that from now on working and voting to unseat Donald Trump is the most important thing that progressives can do not only for themselves, but for their country.

Tell your supporters that electing Joe Biden keeps progressive dreams alive, and that Donald Trump wants to kill those dreams; that Joe Biden will work with progressives to reduce the wealth and income inequality in this country, but that Donald Trump couldn’t care less about wealth and income inequality and will ignore progressives.  In fact, point out to them that Trump likes the wealth and income disparity just like as it is.

The primary policy goal of your movement is universal health care. That goal is toast under Trump, as he has made clear by trying to dismantle the Affordable Care Act. But it is a goal shared by Biden and most Democrats. President Clinton tried and failed to implement universal health care, President Obama had to accept an imperfect compromise, but we’ll get there if we can oust Trump from office and gain control of Congress.

As an unrepentant know-it-all, you believe that Medicare for All is the only viable option. Tell your supporters that, while that remains the ultimate goal, compromises will have to be accepted along the way, and that’s fine, because that is how politics work in the real world – i.e., in the world outside your head.

And your delivery is as important as your message. There can be no hint of rancor. No mention of “the Democratic establishment” or other code words to inflame your base. Be gracious to Biden. Try to sound optimistic, and enthusiastic about returning the White House to Democratic control. And then work like hell over the next eight months to deprogram your supporters from the Bernie or bust mentality that you helped instill by your maddening my-way-or-the-highway attitude.

In other words, make clear by both your words and deeds that sitting out the election in November rather than voting for Biden is disloyal and destructive to the progressive movement that you helped to inspire. 

Can you do any of the above? I have my doubts. But here are the stakes: If Trump wins in November and his victory can be tied to the failure of your supporters to turn out and vote for Biden, you will be the second most despised man in America, after Donald Trump. You will live the rest of your life as a pariah. Your followers will move on to someone else, remembering you as little more than a false prophet. People will stand in line to piss on your grave.

Your situation reminds of a Western I remember seeing decades ago. It may have been an episode of “The Rifleman” or “Gunsmoke.”

A hardened criminal was about to be hung for his crimes. He lacked remorse, laughed in the face of death, and was prepared to die with the defiance and bravado with which he had lived.

He had a young son who, despite the man’s crimes, idolized him. Lucas or Matt (or whoever it was) told the man that if he died a hero to his son, his son well may follow in his footsteps and live a life of crime. As the condemned man stood on the gallows, he glanced toward Lucas and then began whimpering and begging for his life, dying like a coward for the sake of his son.

Putting aside the schmaltz (and the dubious child psychology), that condemned man did what you must do, Bernie. You need to give the greatest performance of your life for the sake of your supporters, the rest of us, and your own legacy. This is your Last Hurrah, Bernie. You want to be remembered for your nobility at the end, not for the pique and pettiness that you too often exhibit.

I honestly wish you the best of luck, Bernie. Trust me, the internet is waiting to review your performance. It better be damn good.