Following a slew of tweets after the midterm elections congratulating himself on losing control of the House to Democrats, Trump had one clear-eyed, honest promise to Americans: “If the Democrats think they are going to waste Taxpayer Money investigating us at the House level, then we will likewise be forced to consider investigating them for all of the leaks of Classified Information, and much else, at the Senate level. Two can play that game!”
Never mind that it was unclear what “Classified Information” he might be referring to, he ran with this stance at his subsequent press conference, assuring Americans that the bipartisan kumbaya that he was just longing to usher in would be immediately derailed by any attempt on the part of this new House to use its subpoena power to investigate him for corruption. “No,” he responded emphatically to a question about working together for America’s benefit even in the face of heightened investigation. “If they do that, then it’s just — all it is, is a warlike posture.” The threat was clear: Come after me, and I’ll come after you harder — even at America’s expense.
It’s a threat that explains why the relief that comes with taking back the House is tempered by awareness of how Trump will likely respond to resistance outside his base that he can’t ignore. And it’s a threat that many psychologists would have anticipated, especially those who have long been sounding the alarm about Trump’s mental health — or lack thereof. In April 2017, just a few months into Trump’s presidency, I interviewed a number of these professionals about what it might mean to have someone afflicted with Trump’s various proposed mental maladies — narcissistic personality disorder, anti-social personality disorder, sociopathy and mania among them — in the highest office. At the time, many were careful not to proffer a diagnosis of Trump, a man they’d never personally treated; they couched their concerns in a projection of how someone so afflicted might behave.
Since then, times have changed. The change.org petition “Mental Health Professionals Declare Trump is Mentally Ill And Must Be Removed” topped out at 70,760 signatures before it closed, many more shrinks have gone on the record with their diagnoses, and the attendees of an April 2017 Yale ethics conference overwhelmingly concluded that, apropos Trump, their psychiatric “duty to warn” in cases of danger to public health and safety far outweighed any other professional obligations.
“It just seems so quaint now,” says John Gartner, a clinical psychologist who started the petition, of his profession’s reluctance to use its expertise to publicly voice concerns. “I mean, everyone’s shell-shocked. It’s almost beyond this fine point of diagnosis — just the sense that someone who is very ill and dangerous is completely out of control, and no one seems to be stopping him.”
When Trump first took office, of course, it was too early to say with certainty exactly how his psychology would play out. But it was predicted that he would systematically fire those closest to him; that the laws he pushed and the policies he enacted would not benefit America overall, but would benefit him (by either lining his pockets or stoking the affirmation loop of his basest base); that he would attack civil liberties; display further delusions; lie prodigiously and lash out against anyone who opposed him. Now we’ve seen that these predictions have come to pass.
“To be honest, I don’t think he’s done anything that I didn’t anticipate,” says Lance Dodes, a former professor of psychiatry at Harvard Medical School who, when I interviewed him previously, said that Trump’s attacks on the media would only increase and that his reality-testing would only get worse.
But of course, being right is cold comfort for mental health professionals, especially when it comes to Trump’s sense of his own persecution as the Democratic House prepares to take office armed with the power of subpoena, his approval rating continues to lag (it’s now at 42 percent), and his fear of the Mueller investigation and paranoia about traitors in his midst continue to increase (“one of the fundamental components of narcissism is paranoia,” points out Gartner).
“People like Donald Trump who have severe narcissistic disturbances can’t tolerate being criticized,” says Dodes, “so the more they are challenged in this essential way, the more out of control they become. They change reality to suit themselves in their own mind.” And, as Dodes explains, it creates a vicious cycle: The more out of control Trump becomes, the more reason others have to challenge him, which only makes him more out of control. When he tells a rally crowd that America will become “a third-world country” if he gets impeached, that’s this defensive/delusional coupling playing out in real time.
According to Gartner, as the pressure mounts — as it likely will with a Democratic House investigating the Trump syndicate — the situation will only continue to deteriorate. “The more desperate he is, the more aggressively and the more recklessly he’s going to lash out — and not just lash out on Twitter, but really lash out in ways that are destructive to the bones of our institutions. So, he’ll try to declare criminal investigations on his enemies or anyone who criticizes him. He’ll fire everyone involved in the Mueller investigations. He’ll fire Sessions” —which, of course, he actually did last Wednesday. “He’ll ramp up his attack on civil liberties and the rule of law. He’ll escalate his incitement to violence, whether it’s supporting white nationalists or demonizing minority populations. Things that we think, ‘Oh, he could never do that, because that would be so outrageous,’ he can and he will. There’s no restraints here. There’s nothing he won’t do. And if it’s enormously destructive, that’s not actually a negative for him, that’s a positive.”
Especially because the more destructive something is, the more it will create a distraction from what riled him up in the first place. “Anything you can imagine is not off the table,” Gartner continues. “Starting a war is very possible to distract from his wrongdoing and try to rally the country around him — that whole wag the dog scenario isn’t a joke. I think it’s actually very, very possible. I think he would love to do that. It’s going to be like a scorched-earth swath of destruction.”
It’s that prospect that terrifies Bandy Lee, an assistant clinical professor at Yale School of Medicine who specializes in the psychology of violence and was the editor of the New York Times bestseller The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. She hosted the Yale ethics conference, even before receiving a call in October 2017 from two White House officials “because the president was behaving in a manner that ‘scared’ them, and they believed he was ‘unraveling.’”
Of the call, “I was stunned,” she says. “I was, for a moment, at a loss as to what to do” (she referred them to the George Washington University Hospital emergency room ).
Yet Lee doesn’t think that it’s Trump’s diagnosis that matters but rather the context of it. “Mr. Trump as a person could be removed from office and no longer be dangerous,” she points out. But in office, his dangerousness is so profound that she believes he meets the criteria for immediate intervention. “He, through his own words, has expressed an attraction to nuclear weapons, a preoccupation with nuclear weapons, and has even asked why we have them if we won’t use them,” she says. “When someone is dangerous, that is considered an emergency, so you try to get the person’s consent, but if they don’t offer it then you have no choice but to treat. And that’s an obligation; that’s not a choice on the part of the physician. There ought to be a political equivalent.”
Now, with Democrats about to take control of the House, maybe there will be — if Trump and his “warlike posture” don’t burn the whole thing down first.