Questions about Donald Trump’s mental fitness to serve as president keep mounting. A historically unprecedented number of mental health professionals have mobilized to express concern about the dangers of the mental instability we see in Trump, coupled with the power of the presidency. Through the National Coalition of Concerned Mental Health Experts, we called for a full neuropsychiatric examination and a capacity to serve evaluation.

When Trump presented for his annual physical exam last week, however, even a standard mental health screen was omitted. He had dismissed concerns by stating he is a “very stable genius,” which only further raises concerns. Mental health experts who tried to raise legitimate questions about his serious psychological, neurological and cognitive signs have been chastised into silence. Leading this effort, sadly, is the American Psychiatric Association, which has denounced what we are doing as “armchair psychiatry.”

By publishing “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President,” we hoped to fulfill our duty to the public by providing information that could help preserve its well-being and safety. An alarm may be loud because of the gravity of a danger, but the solution is not simply to shut it off.

To be clear, we are not diagnosing or trying to break “the Goldwater rule.” Armchair psychiatry is precisely what we are trying to avoid by calling for an urgent evaluation based on dangerousness. A reader compared our action to that of a state trooper: When a trooper observes a car being driven recklessly, she isn’t assessing that the driver is an alcoholic or a drug addict. The trooper pulls the driver over because he is presenting danger to life and property and must be taken off the road.

What are the danger signs here? Psychologically, past violence is the best predictor for future violence, and Trump has engaged in verbal aggression, boasted about sexual assaults, incited violence in his followers and continually provoked a hostile nation with nuclear power. He has also shown impulsivity, recklessness, paranoia, a loose grip on reality, a lack of empathy, rage reactions and a constant need to demonstrate power -- and, with the greatest arsenal in human history under his sole command, even a nuclear holocaust is not off the table.

Cognitively, he has shown a noticeable decline in his ability to form complete sentences, to stay with a thought, to use complex words and not to jump from one topic to another. Given the critical importance of mental sharpness in the office that he now holds, these are also dangerous signs. In terms of functioning, we cannot be sure that he has the capacity to take in needed information and advice, to process that information, and to consider consequences so as to make sound, logical, reality-based choices. Yet he is in charge of the most powerful military and the future of all humankind.

Sometimes it takes a specialist to see that something is not normal rather than a “brilliant strategy” or just “Trump being Trump.” For instance, when the president had an episode of slurred speech in a public address, a layperson may be content with the explanation of dry mouth. But a neurologist knows to suspect that it could very well be a temporary stroke that is a harbinger to a permanent stroke -- even if not, the chances are not worth taking. In another instance, when he used expletives to describe entire regions of the world, some may see it as his being his usual childish and crude self, but a psychiatrist may recognize patterns of deterioration that has long been worried about -- and even if not, the risks are too great to let the dangers continue.

Those who recognized the dangers knew that they would be subjecting themselves to the very dangers they warn about. For some of us who took seriously our obligation to the public and not just to our private patients, the dangers are unfolding right now. While the physical threats and false rumors by Trump’s supporters have long been expected, and public numbing or denial before the magnitude of danger are a natural part of the course, the silencing on the part of our own professional organizations is incomprehensible. Silence allows danger to breed, and if our president will not assure us, and the US Congress will not act, then it is up to the people, who have a right to know -- and the power to determine the country’s course.


Bandy X. Lee
Bandy X. Lee is a forensic psychiatrist on the faculty of Yale School of Medicine. She wrote this for the Hartford Courant. -- Ed.

(Tribune Content Agency)