Why are editorial boards afraid to talk about Trump’s mental illness?

The editorial boards of major newspapers in the United States have shied away from the topic of President Donald Trump’s mental health. That must change.

I have given up on the idea that the editorial boards will publish opinions stating the obvious: That the mental health of the president has deteriorated to the point at which he is dangerously unfit to lead the country and should be removed from office under the 25th Amendment.

I am left hoping that editorial boards will at least give their readers what amounts to a surgeon general’s warning to accompany his press conferences and other public statements, letting them know that what they hear from the president comes from a person whose tenuous grip on reality is slipping away. In other words, editorials that put readers on notice that believing anything that the president says may be hazardous to their health.

I thought that the so-called newspapers of records in this country might feel compelled to address Trump’s fitness for office after his rambling, bizarre press conference on June 5th — you remember, the one in which he said that George Floyd, killed by a Minneapolis policeman, was having a “great day.” Or after the video showing him having difficulty drinking from a glass and walking down a ramp at West Point on June 13th.

The West Point video heightened existing concerns over his increasingly jumbled thoughts, slurred and incoherent speech, and memory lapses. Experts are pointing out that these are signs of a possible neurological impairment. Add neurological impairment to the severe narcissistic personality disorder that those experts say that he suffers from, and it seemed time for the expression of editorial concern. Crickets.

Editorial boards could have warned supporters about Trump’s rally in Tulsa on June 20th, letting them know that they were invited to an event that had as its sole purpose satisfying the need for adulation of a man whose narcissism is so malignant that he did not care that he was putting their lives and the lives of their families and friends in danger from COVID-19. Would such an admonition have made a difference? Well, maybe not, but perceived futility is no excuse for not trying when the stakes are so high.

The threat to this country posed by Trump’s mental illness obvious has become manifest. The editorial boards of newspapers have a moral duty, rooted in their constitutionally protected status as the voice of the people, to speak up. So far, those editorial boards have fallen far short of fulfilling that duty.

Facing a frightening truth

People, and that includes government officials, must be made aware just how dangerous Trump is so that they can prepare themselves as best as possible for what lies ahead. Psychiatrists and psychologists have been warning us for years about his malignant narcissism. Devoid of empathy, spiteful and mean, Trump would sooner see the country destroyed than turn it over intact to Joe Biden.

If Trump is going to suffer in November, he will try to make everyone suffer. If you believe that is an exaggeration you are seriously mistaken, probably because you do not fully understand the nature of his mental illness. The mainstream media shares much of the blame for that lack of understanding.

The best way to understand his pathology is to look at Trump as a terrified little boy because, in essence, that is exactly what he is. Everything that he says and does is to protect his perilously fragile ego, ranging from bluff and bluster to crafting a reality that exists only inside his own head. If he cannot make it true, he imagines it to be true. He does not want to be obese and at heightened risk of COVID-19, so in his mind he is in “perfect shape” as he recounted at a press conference on June 5th. And on and on it goes in the diseased mind of Donald Trump. Yes, he lies, but at times he is also delusional.

Because of the fragility of his ego, no slight, no matter how small, can go unchallenged. Every critic is a mortal enemy. He is paranoid, constantly on guard against insults to his ego. He resents and lashes out at those who make him feel threatened.

And therein lies the gravest danger to the country. Of all the things that he fears, Trump fears personal rejection and humiliation the most. As he sees the chances of his re-election slipping away, he will seek to punish us all for that humiliation by dragging the country down with him. Is that not something readers of newspapers should know before it is too late?

The experts tried to warn us that the sky would fall — and now it has

In 2017, 27 psychiatrists and psychologists co-authored The Dangerous Case of Donald Trump, in which they concluded that Trump suffers from severe narcissistic personality disorder, with a perilously fragile ego. 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 even more erratic and dangerous. In December, a group of 350 psychiatrists and other mental health professionals submitted a petition to Congress stating that Trump’s mental health was rapidly deteriorating under the pressure of impeachment. And that was before he came under intense criticism because of the inadequacies of the federal response to a deadly global pandemic.

I thought that editorial boards might weigh in on Trump’s mental health when he talked about injecting disinfectant into people with COVID-19 to cleanse their lungs. Or when he took an unproved, potentially unsafe drug to “prevent” the disease.

But those indications of his mental deterioration did not do the trick. Neither did his rants about “Obamagate,” whatever the hell that is. Or his promotion of a conspiracy theory essentially accusing former congressman and talk show host Joe Scarborough of murdering an intern in 2001. He got stranger and stranger as the walls of public opinion came crashing in on him and his chances of re-election began to fade.

Clinical psychologist John Gartner is one of the co-authors of The Dangerous Case of Donald Trump. Gartner describes Trump as a malignant narcissist, creating chaos and instability so that he can feel powerful. But that is not all, as he explained:

“Trump enjoys causing harm and suffering…the bullying, the violence, the destruction, frightening people, humiliating people, getting revenge and the like — such behavior is what Donald Trump has done his whole life. It is who Donald Trump really is.”

Bandy X. Lee, a Yale psychiatrist and another co-author of The Dangerous Case of Donald Trump, pointed out that

“[Trump’s] bottomless need to place his own psychic survival above any protection of the public should rather be a warning. This means he would be equally inclined to destroy the nation or the world …if he were to feel humiliated from the loss of an election, for example.”

As if that is not bad enough, Lee notes that Trump also appears to be suffering from age-related cognitive impairment, making his behavior even more erratic.

I was a psychiatric social worker before I was a lawyer. I will explain what the doctors are telling us in layman’s terms: Trump is a highly dangerous man against whom we must protect ourselves.

Keep in mind Lee’s admonition about what a desperate Trump is capable of when you read the opinion by Greg Sargent in the Washington Post on Trump’s strategy to get through the pandemic. Sargent observed that Trump believes that his chances for re-election hinge “on his magical ability to create the illusion that we’re rapidly returning to normalcy, rather than taking the difficult concrete steps that would make that more likely to happen.”

It is a cynical and deadly strategy based on the bald-faced lie that the federal government provided to the states the resources, including testing capacity, to reopen safely. Mocking masking and social distancing measures, Trump washed his hands of responsibility and pushed governors to act as if the virus was vanquished.

No president with an ounce of compassion would do such a thing, and it can be understood only in the context of Trump’s psychopathology, including his willingness to chart a course that he believes will help him win re-election even if it causes many more Americans to die. It is a course only a madman would follow, but still we saw nothing from editorial boards on Trump’s mental fitness for office.

And then came the killing of George Floyd, and the protests. Those protests revealed the darkest side of the president’s mental illness.

The authoritarian impulses

Trump’s infatuation with authoritarian and even despotic leaders like Vladimir Putin, Xi Jingping, Kim Jung-un, and Recep Erdoğan is well-documented. The basis of the attraction is envy: Total control is a malignant narcissist’s dream, and the means of achieving it do not matter.

If left to his own devices, how far would Trump go in pursuit of his impulses to suppress dissent and crush opposition? Unencumbered as he is by moral principles and incapable of suffering pangs of conscience, there are no limits. He came perilously close to deploying active duty military troops against peaceful protesters, an action that would have shaken this country to its constitutional core.

Please do not think that it cannot get any worse. It can and likely will as Trump’s poll numbers and approval ratings, things of outsized importance to him, continue to drop. Dr. Lance Dodes, a retired assistant clinical professor of psychiatry at Harvard Medical School, warns that Trump’s capacity to sink into a paranoid rage is an aspect of his disorder.

Dodes predicts that Trump will try to turn America into a police state and prevent or overturn the election if he loses. “In order to have an excuse for ending democracy, he is likely to have his own ‘Reichstag fire’ incident, perhaps via starting a war with China or Iran,” according to Dodes.

Does that dire prediction seem far-fetched to you? Here is a Trump tweet from June 22nd:

“RIGGED 2020 ELECTION: MILLIONS OF MAIL-IN BALLOTS WILL BE PRINTED BY FOREIGN COUNTRIES, AND OTHERS. IT WILL BE THE SCANDAL OF OUR TIMES!”

Does that sound as if Trump will go away quietly if he loses the election? Sometimes when a person sounds crazy, he or she is crazy, and we must respond accordingly.

Why have editorial boards been silent?

The psychiatric establishment, led by Dr. Jeffrey Lieberman, chairman of the department of psychiatry at Columbia University College of Physicians and Surgeons and a former president of the American Psychiatric Association (APA), responded sharply to the publication of The Dangerous Case of Donald Trump. Dr. Lee and her co-authors were rebuked for violating the so-called “Goldwater Rule.”

The Goldwater Rule is an ethical canon precluding psychiatrists from offering professional opinions in the media about public figures whom they have not examined. It was named for former senator and presidential candidate Barry Goldwater, who successfully sued Fact magazine for a 1964 article questioning his mental fitness to be president that contained derogatory comments from psychiatrists on Goldwater’s mental health. Of the 2,417 psychiatrists who responded to a survey by the magazine, 1,189 said Goldwater was unfit.

None of the psychiatrists had examined Goldwater, and the comments disparaging Goldwater’s mental health were widely discredited as politically motivated. Most psychiatrists believed that the embarrassing episode damaged the credibility of their profession and were determined that nothing similar would happen in the future. The Goldwater Rule was the result.

The Goldwater Rule since has been criticized as an overreaction to a single unfortunate situation, and potentially dangerous. Should there not be an exception for public officials who psychiatrists deem truly dangerous because of a mental illness? In my career as a lawyer, I have seen very few rules for which no exceptions should be allowed, and the Goldwater Rule is not one of them.

What about the reticence of editorial boards? They are not bound by the Goldwater Rule. But they may be intimidated by the position taken by the editorial board of the New York Times in January 2018 that not only joined in the APA’s criticism of Lee and her colleagues as practicing “armchair psychiatry,” but also dismissed the relevance of a psychiatric disorder to the question of Trump’s fitness for office, stating:

“[Trump’s] behavior may be evidence of some underlying disorder, or it may not. Who knows? But even if his behavior were diagnosed as an illness, what would that tell us that we don’t already know?”

I find it remarkable that the Times editorial board failed to appreciate the predictive value of understanding how the mind of someone with a severe narcissistic personality disorder works. The Times conclusion that psychiatrists could not tell them anything about Trump’s behavior that they did not already know was startlingly ignorant. Predicting how someone is going to respond in any given situation is not an exact science, but Trump’s behavior follows patterns that he is incapable of changing.

For example, it was perfectly predictable that Trump would mishandle the COVID-19 pandemic. Lacking any compassion, he sees it only in personal terms as “bad news” threatening his re-election. His initial reaction therefore was to wish it away (like his obesity) and lash out at advisers who tried to get him to face the unpleasant truth.

Because he is characterologically unable to admit a mistake, there was no possibility that he would alter course when it became apparent that his failure to adopt a national strategy for testing and contact tracing, in combination with other missteps, was having disastrous consequences. Anyone who thought that Trump would “step up” to lead this country through the pandemic had absolutely no clue about his psychopathology.

Would such advance knowledge of Trump’s likely response have helped White House advisers in January, when Trump refused to take the pandemic seriously? Maybe. As Dr. Lee has pointed out, malignant narcissists are not amenable to treatment, but they sometimes can be controlled. A persistent, unified effort by Trump’s advisers may have overcome his resistance.

Here is a message that had a chance of getting through, if delivered directly and consistently:

“Mr. President, if you fail to respond aggressively to the pandemic, many people will die, and you will get the blame. Take charge, act decisively, and you will be a hero. Those are your choices. Tell us your choice, and we will make it happen.”

In any case, briefing him and then expecting him to react as a normal president would was doomed to failure.

A duty to broach the subject?

As noted above, I have abandoned hope that editorial boards will call for removal of the president under the 25th Amendment. I still have hope that they will at least broach the subject of the president’s illness.

The president is many things. He is an incompetent and ineffective leader, and he may even be a criminal. But he also is mentally ill, with an illness that makes him unfit to govern. I find it impossible to accept that voters do not need to know that and that it is therefore not worthy of editorial comment. Which is precisely the position being taken by editorial boards across this country.

I hasten to add that just because Trump has a mental illness does not make him dangerous. He happens to have a mental illness that does make him dangerous.

The unique status enjoyed by newspapers under the First Amendment comes with responsibilities, the most important of which is to enlighten the public on things that the public should know. And the public should know that the president of the United States has a mental illness that is putting them in harm’s way.

News sources other than major newspapers now play a major part in reporting the news and publishing commentary. Newspapers of record across the country, however, still perform an important role in shaping public opinion and influencing public officials through their editorial opinions. If they fear being accused of being “armchair psychiatrists,” I would urge them to recognize that this is not the time for editorial cowardice.

I also would point out to them the cat seems to have gotten the tongues of Dr. Lieberman and his ilk for the past six months. Perhaps the idea that Trump’s mental illness played a part in causing 122,000 deaths so far from COVID-19 has caused them to rethink their attacks on Dr. Lee and her colleagues. Maybe they are feeling a bit guilty. They should.

Mental health professionals wrote “The Dangerous Case of Donald Trump” in 2017 because they believed they had a professional duty to warn citizens of the dangers they faced if Trump remained in office. Sadly, their prognosis was accurate. Editorial boards have no less a duty, and they should stop shirking it. Speak up.

Retired lawyer, former prosecutor, former social worker, Army vet — former lots of things. Commentary published in Washington Post, Baltimore Sun and elsewhere.

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