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?????????????????????????????????????????????????Sunday, May 28, 2017
'We Have an Obligation to Speak About Donald Trump's Mental Health Issues... Our Survival as a Species May Be at Stake'
"Malignant
reality is taking hold" in American politics, says psychiatrist Bandy
Lee, who held a conference on Trump's mental health.
Photo Credit: Daniel Juřena / Flickr
President Donald Trump is a clear and present danger to the United States and the world.
He has reckless disregard for democracy and its foundational principles.
Trump is also an authoritarian plutocrat who appears to be using the
presidency as a means to enrich himself and closest allies as well as
family members. Trump’s proposed 2018 federal budget is a shockingly
cruel document that threatens to destroy America’s already threadbare
social safety net in order to give the rich and powerful (even more)
hefty tax cuts. His policies have undermined the international order and
America’s place as the dominant global power. It would appear that he
and his administration have been manipulated and perhaps (in the case of Michael Flynn) even infiltrated by Vladimir Putin’s spies and
other agents. The world has become less safe as a result of Trump’s
failures of leadership and cavalier disregard for existing alliances and
treaties.
Donald Trump’s failures as president have been compounded by his
unstable personality and behavior. It has been reported by staffers
inside the Trump White House that he is prone to extreme mood swings, is cantankerous and unpredictable, flies into blind rages when he does not get his way, is highly suggestible and readily manipulated,
becomes bored easily and fails to complete tasks, is confused by basic
policy matters and is unhappy and lonely. And despite bragging about his
“strength” and “vitality” during the 2016 presidential campaign, Trump
appears to tire easily and easily succumbs to “exhaustion.” Trump is
apparently all id and possesses little if any impulse control. He is a chronic liar who ignores basic facts and empirical reality in favor of his own fantasies.
Between the scandals and the emotionally erratic behavior, Donald Trump
would appear to be a 21st-century version of Richard Nixon, to date the
only American president forced to resign under threat of forcible
removal. In all, this leads to a serious and worrisome question: Is
Donald Trump mentally ill? Moreover, what does Trump’s election reveal
about the moods and values of his voters? How are questions of societal
emotions and collective mental health connected to the rise of fascism
and authoritarianism in America? Do psychiatrists, psychologists and
other mental health professionals have a moral obligation to warn the
public about the problems they see with Donald Trump’s behavior?
In an effort to answer these questions, I recently spoke with Dr. Bandy Lee, a psychiatrist at Yale University who specializes in public health and violence prevention. She recently convened a conference that
explored issues related to Donald Trump’s emotional health and how
mental health professionals should respond to this crisis. The
proceedings from this conference will be featured in a forthcoming book
expected later this year.
Our conversation has been edited for length and clarity. A longer version can be heard on my podcast, available on Salon’s Featured Audio page.
How did a person like Donald Trump become president?
My being a psychiatrist, I will inevitably see things from that lens. I
also tend to think about the social context that gives rise to the
current conditions. For me the big shift in our society has been the
increasing inequality, and with that a certain segment of the population
will end up suffering from an undue amount of poverty — a relative
poverty actually, deprivation, a lack of education, a lack of health
care and mental health care. All those things will contribute to
worsening of collective mental health.
As a clinician, when you watch Trump’s behavior day after day —
his lying and obfuscation, his apparent confusion and anger management
issues — what are you thinking?
I’ve been thinking from the very beginning that he exhibits many signs
of mental impairment. I recently organized a conference on this at Yale.
Afterwards, there has been almost an army of people who have shared
with me how they have been wanting to speak about this issue. I did not
expect to get such a massive response.
What are your peers’ specific concerns and what are they afraid of?
This situation has come to such a critical level. In fact, a state of
emergency exists and we could no longer hold back. We have an obligation
to speak about Donald Trump’s mental health issues because many lives
and our survival as a species may be at stake.
What are two or three things you could cite about Donald Trump’s behavior that causes you the greatest concern, worry or alarm?
There are certainly the symptoms that he displays. He has a great need
for adulation. He is angry if reality does not meet his needs. People
have been expecting him to settle into his role and become normal or
more “presidential,” but that does not ordinarily happen among those
with such personality traits. In fact, what we’re seeing is a creation
of his own reality, a reality that will meet Trump’s own emotional needs
and the need to impose that reality on others. It is his
imperviousness to facts and reality that could place us all at great
risk.
On one hand, he can just be cantankerous, moody, angry and a
spoiled child. I’ve described him as a man-child or a clown king. But
how do we separate that from saying, “OK, there is something going on
clinically”?
One does not make the other mutually exclusive. In fact, one can both be
immature and a jerk, dangerous and ill-intentioned. In other words, bad
as well as mad. It’s really the combination that makes it so toxic and
unpredictable that we felt that there was a need to speak out.
How should the “Goldwater rule,” the ethical requirement not to
diagnose a person you have not examined, be balanced with mental health
professionals’ responsibilities as American citizens and members of the
global community?
In an ordinary situation where matters were not so intense, we could
balance out our political activism and separate that from our
professional goals and actions. But when there is such a grave mental
disability that is affecting the public sphere, the political sphere,
such as in the current position of power, then those lines get blurred.
Given that all human health exists in an ecological system, there is no
rule that politics will never enter the sphere of health or the mental
health profession. Right now we’re seeing that it does.
When we have a president who asks, What is the point of having nuclear
weapons if we cannot use them?, who urges our government to use torture
or worse against prisoners, who urges his followers at political
rallies to beat protesters up so badly that they’ll be taken out in
stretchers, and suggests that his followers could always assassinate
Hillary Clinton if she were to be elected president, there is something
very wrong. All this attraction to violence, threats of violence, boasts
of his own violence and sexual assaults, and incitements to violence —
all these have an effect.
As a clinician, how do you figure out the causal arrows? Is
Trump causing an increase in violence or is his presidency a reflection
of deeper cultural problems in America?
Certainly it’s not a one-way path. It happens both ways in that we have
elected a president who was somehow very attractive to his voters. But
then he stokes and amplifies certain elements in the population that in
turn create more conditions for violence and danger.
Why do you think more of your peers have not spoken about these
concerns? Are they afraid of professional consequences? Personal threats
of violence?
One of my colleagues said this was not the way she wished to spend her
life — in other words, to spend the rest of her life paying for an
expression of her opinion by fighting lawsuits, by fighting for her
license. There was a fear of having her license taken away. Yes, the
fear was present then and it is present still now, such that when I was
editing this book, I had two co-editors who initially signed on, but the
more they heard about the possibility that their license could be in
danger, that they could somehow be targeted for this, they pulled out.
How did you overcome that fear and anxiety? It’s easier to be a
bystander to history. It’s easier to say, “I’ll let somebody else do
it.” Instead you actually chose to do something.
In my case, it became a grave enough emergency that my conscience would
not let me rest in peace if I did not do something about it.
As a psychologist, as a human being, as a citizen, why do you
think some people choose to be bystanders and others decide to act?
Bystanders do make a lot of difference. Human rights abuses could not happen if bystanders spoke up or did not approve.
On a practical level, how do you think a president should be
psychologically evaluated before taking office? What do you think the
actual remedies could be for dealing with Donald Trump now? Can we
invoke the 25th Amendment, so that if enough people diagnose this man
and there is enough of an outcry he will be removed?
I think by sounding the alarm about his mental instability and position
of power that some kind of consensus as to a process would be developed.
As for the 25th Amendment, I don’t think that’s really a psychiatrist’s
domain. But that is certainly one avenue that has been proposed and
it’s the only one that would be possible in terms of a case of mental
impairment. I think what needs to happen next is a collaborative
discussion among people of different fields. We could speak to the
president’s mental impairment, the effects of that impairment and the
dangerous situation we’re in. Other people could speak to the best
political and procedural way to do something about that finding. Those
would be lawmakers and politicians.
What do you think the United States is going to look like after Donald Trump leaves office?
He has exacerbated the pathological patterns of our culture. What would
happen if the presidency continues? I think more damage will be done. In
fact, the latter part of the book consists of some of the effects of
his policies, including repealing the Affordable Care Act, his
immigration policies, his tax laws and his military policies. All these
things could have ramifications and reverberations throughout —his
environmental policies, his educational policies. In fact, Dr. Robert
Jay Lifton said at the conference that Trump’s style of governing could
be described as “anti-governing.” I believe we’re at a crossroads.
We can either amplify and encourage Trump and his followers’ pathology,
or we can stop it and look for ways that are more life enhancing,
healing, corrective. When you see a person falling into illness, the
deeper the illness grows, the less aware they will be of their illness.
The more insistent they will be on destructive ways rather than ways
that are healing and constructive. At a later point, doctors and
hospitals will be the thing that they will avoid at all costs. That is
why sometimes physicians have to hospitalize against the person’s will
or put them on a stretcher. The reason why the law allows that, that
society allows that is because they feel better and then they thank you
for it.
That is why simply respecting the choices of the electorate when the
electorate is not entirely well can spiral into situations like fascism.
Remember fascism is not necessarily an ideology. It could be on the
right or the left. It is also an emotional experience to a certain
political structure, and people will cling to it regardless of how
destructive it is to their lives, regardless of what path it takes them
toward. The pull is emotional, not ideological or even rational. It’s a
situation that needs intervention, healing and treatment. The way to do
that is to improve societal conditions.
Why do Trump’s voters continue to support him even when his and
the Republican Party’s policies will hurt them economically and in other
ways as well?
Because it’s an emotional compulsion. It’s an emotional reaction. It’s
not anything rational. Trying to reason with them will not help. It’s
really the conditions that have to change. Malignant reality is taking
hold. It’s a kind of pathology cohesion that normalizes corruption,
violence and harm, and there will come a the point where we’re no longer
disturbed by it. At that point, all kinds of human rights violations,
wars and loss of life become possible. Mental health professionals have
to become witnessing professionals who continually point out this
dynamic and call it out for what it is, so that it does not become
normalized.
The Trump administration, and I might argue to a large extent the
Republican Party, has been leading up to a need to impose a distorted
reality and a kind of imperviousness to facts onto others. Facts and
evidence almost do not matter. What matters is the emotional commitment
to either an ideology or what they believe will make America great
again, restore their position, or give them the kind of pride or
self-esteem that they feel they have lost.
Chauncey DeVega is a politics staff writer for Salon. His essays can also be found at Chaunceydevega.com. He also hosts a weekly podcast, The Chauncey DeVega Show. Chauncey can be followed on Twitter and Facebook.