A Little Nuts The Way We All Are? Or Is Trump Dangerously Insane?

Yesterday, writing for New York, Gail Sheehy looked at psychiatrists willing to break tradition and do their duty to warn people about how mentally unfit Trump is to be president. I don't know anyone who thinks he's sane. Do you? But how insane and how dangerous?

A few minutes ago a friend of mine, a psychologist, e-mailed me a note about a sign she had seen at the Science March: "How are Trump and atoms alike? They make up everything." Delusional is pretty crazy but pretty crazy isn't what Sheehy had in mind. "Psychiatrists and psychologists," she wrote, "operate under a norm-- the so-called Goldwater Rule-- that their professional organizations made up in 1973, forbidding them from evaluating public figures they haven’t been able to question in person. In the face of minimal trust at home and abroad in President Donald Trump’s stability and his tenuous grasp of reality, a group of eminent professionals are daring to depart from the party line." They're worried about what harm "this abnormal president" could do to 300 million Americans. They're increasingly calling him "mentally ill."

This moment (which itself is “unprecedented”) led to an open town-hall meeting on Thursday, at Yale Medical School, to discuss the elephant in the room. Dr. Bandy X. Lee, a diminutive Yale psychiatry professor who along with Dr. [John] Gartner called the meeting, puts it this way: “We have a ‘Duty to Warn,’ about a leader who is dangerous to the health and security of our patients.” She has formed a coalition by that name, and it now comprises almost 800 mental-health professionals who are “sufficiently alarmed that they feel the need to speak up about the mental-health status of the president.” Gartner has posted a similar petition on the web, and it has attracted 41,000 signatures, a high proportion of them from mental-health practitioners. Anyone can look it up and sign it.

“Duty to Warn” is a term with some history. In 1974, a trial known as the Tarasoff case established the law-- now in force in 38 states-- saying that if a patient is in imminent danger of physically hurting someone, his or her doctor may break confidentiality and alert the likely victim or call the police. As for the Goldwater Rule itself, it is essentially a gag order, part of the code of ethics of the American Psychiatric Association. It was created in the years after the 1964 presidential election, when the fiery conservative Barry Goldwater won the Republican nomination. (Goldwater ran on anti-communist rhetoric suggesting that he just might start a nuclear war, on the slogan “In Your Heart You Know He’s Right”; Lyndon Johnson’s counter-slogan was “In Your Guts You Know He’s Nuts.”) Press outlets, notably a magazine called Fact, asked psychiatrists and psychologists to diagnose Goldwater, and they did, enthusiastically and damningly. Goldwater sued Fact and won. The APA set down its rule a few years later.

One of the speakers was Dr. Robert Jay Lifton, former Yale professor of psychiatry and author of the ur-text about the ways Nazi doctors were perverted into killers.

He told the tiny audience he had an important concept to discuss: “malignant normality.” Lifton defines it as “arrangements put forward as being normal when in fact they are dangerous and destructive.” An extreme example on which he has done studies is that of German doctors who were assigned to Auschwitz. Their job was to be active in the mass killing. They were given perverted training to defeat their fears and shame and brainwash them into believing it was normal to gas Jews to death. (As, it’s worth noting, Syrian president Bashar al-Assad must do something similar to “normalize” the gassing of babies and women by their countrymen in his army.)

Dr. Judith Herman spoke next. She’s a renowned professor of psychiatry trained at Harvard and Cambridge and, after Trump’s election, she wrote a letter to President Obama expressing alarm at the symptoms of mental instability she saw in the president-elect. Was there some way to insist on a neuropsychiatric evaluation, she wrote, “before this man assumes the terrifying power of a U.S. president?” Only two of her colleagues were willing to co-sign the letter, which went viral and was read at the Women’s March on Washington.

Dr. James F. Gilligan, a senior clinical professor of psychiatry at NYU Medical School, was on next and offered that Trump’s mental unfitness had multiple causes. And before the meeting was over, the following diagnoses had been brought up: narcissism combined with a sociopathic personality, pathological lying, and paranoia, which makes him vulnerable to conspiracy theories. Anyone who doesn’t flatter him extravagantly is meant to be destroyed. He engages in exploitation and violation of the rights of others, and sometimes goes as far as sadism, with no evidence of remorse. “When you add all these elements,” Gilligan observed, “this is a class of people of whom Hitler is a member.” Only at the end did Gartner introduce a note of gallows humor. Imagine tomorrow’s grandparents, he suggested, stuck in a refugee camp in icy Idaho, trying to warm their hands over a fire while asked to explain it all to the grandkids. “Grandpa, you knew there was a dangerous man running our country — why didn’t you say something?

“Well, you see, in 1967 there was a lawsuit brought by a candidate for president called Barry Goldwater — “

“Wait, Grandpa — what’s a lawsuit?”

Chagrined, the grandfather tries to explain that a magazine had warned that Goldwater was unstable and had been sued.

“Wait, Grandpa — what’s a magazine?”

After the session ended, Lifton spoke to me, and I asked whether he sees Trump as an abnormal personality. “Trump creates his own extreme manipulation of reality,” he explained. “He insists that his spokesmen defend his false reality as normal. He then expects the rest of society to accept it-- despite the lack of any evidence.”... I pressed him to interpret the angry meltdown that seized President Trump when he was told, after the fact, that his closest campaign cohort, Jeff Sessions, had recused himself from the Justice Department investigation of Trump’s Russian connections. “Trump’s version of reality did not include Sessions having done anything wrong,” he explained, “despite evidence of his reported contacts with the Russian ambassador.” Trump himself, he explained, cannot bear the humiliation of being exposed as wrong, and is “ultra-sensitive” about the Russian connection. “He’s more than a little threatened by the idea of a full independent inquiry. A sudden influx of new information about his business holdings could create an explosive situation.”

Can our institutions that guarantee a separation of powers survive such a manipulative presidency? “Open institutions are still in effect, but he’s doing his best to ignore them and break them down,” says Lifton. “Trump is a person bent on authoritarian behavior.” He continued with a sobering quote from the contemporary poet Craig Morgan Teicher: “In a dark time, the eye begins to see.”

And, oh, the stories Melania could tell about the psychotic whack-job she's been stuck with longer than anyone deserves to be! (Yeah, that Vanity Fair link is pretty scary.)

OK, he's a hustler, but does that make him insane?