• Dr. Bandy Lee, M.D., M.Div.

Trump’s Mental Unhealth – Chapter 2: How Trump Fails Every Criterion for Mental Capacity

If you haven't already, check out Chapter 1 of Dr. Bandy Lee's 'Trump's Mental Unhealth' column.


Have you ever wondered why you don’t hear more from mental health professionals about the president’s mental health? Imagine hearing: “It is unethical for legal professionals to say anything about issues of national interest unless they legally represent the public figures they wish to speak about and have consent from them to speak.” Strange, isn’t it? Yet this is what we and the public were told about mental health since the Trump presidency, which many of us found shocking.


We do not confuse patient care and societal care but do both. Every health professional is encouraged to participate in activities that directly promote public health and safety. When it comes to the president, what is important is dangerousness or unfitness, since a public figure is not our patient; society is!


I edited The Dangerous Case of Donald Trump when thousands of mental health professionals came forth in unprecedented ways in U.S. history. We had a consensus: the president was dangerously unfit.


How do we assess dangerousness? Simply observing an individual may alert us to signs of danger. In this case, we do not wait to make a diagnosis but must act right away. If someone were behaving erratically in a subway or an airport and were a danger to the public, we have to act. If authorities are unavailable or do not respond, we must take other steps to contain the dangers. As health professionals, we cannot choose to walk away from medical emergencies, including the threat of harm to self or others. Consent is not necessary in an emergency, and if we misjudged, the person would be released after a full evaluation, but we err on the side of safety.


Diagnosis requires full medical records, since different medical conditions can look the same. But for a non-patient political figure, whether the person is suffering from narcissistic personality disorder or early dementia that looks like narcissistic personality disorder, the pathological behavior is the same. Of interest to public safety is that a public figure is: 1) not dangerous and 2) fit for duty. Cognitive issues or mental illness alone does not disqualify; dangerousness or unfitness does.


Personal interviews are of little value, since dangerous or unfit individuals are often motivated to lie. We look at objective information: Does the person have a history of violence, such as verbal aggression, boasting of sexual assaults, inciting violence in crowds, or taunting allied and hostile nations, including nuclear powers? Does the person have violent policies, such as abusing children at the border, ordering assassinations that alarm military personnel, ignoring intelligence alerting about a deadly virus, and attacking peaceful protesters without provocation?


We then look at “actuarial” data: Did the person live with both biological parents to age 16? In the president’s case, no. Did the person have discipline problems in elementary school? In the president’s case, yes. Did the person or close blood relatives have alcohol problems? In the president’s case, yes.


We look for personality traits: Is the person glib with superficial charm? Does the person have a grandiose sense of self, boasting about his skills and abilities? Does the person seek stimulation in constant activity, being prone to boredom? Does the person engage in pathological lying, conning, and manipulation? Does the person lack remorse and have shallow affect? Does the person lack empathy?


We look for lifestyle: Does the person lead a parasitic lifestyle, exploiting others or one’s position for financial gain? Does the person have poor behavioral controls, exhibiting irritability and verbal abuse? Is the person sexually promiscuous, impulsive, and irresponsible?


We look at behavior: Does the person have difficulty accepting responsibility for his actions? Has the person had many short-term marital relationships? Was there juvenile delinquency, or behavioral difficulties between the ages of 13 and 18? Are there signs of carelessness and criminal versatility?


It is difficult to find a trait the president does not meet.


Dangerousness alone disqualifies, but let us look at fitness, since a mentally unfit president is also dangerous. Mental capacity is basic; without capacity, there is no fitness. It was possible to do a full evaluation because of the abundant, firsthand reports of direct interactions by close associates and coworkers of the president, under sworn testimony, in Special Counsel Robert Mueller’s report.


In a capacity evaluation, we ask: Does the person have comprehension, or the ability to take in information and advice without undue influence from delusions or excessive emotional need? Can the person process information, or appreciate and make flexible use of information and advice? Is there sound decision making, or the ability to weigh different options and to consider consequences based on rational, reality-based, and reliable thinking without interference from impulsivity, magical thinking, or fluctuating consistency and self-contradiction?


The president failed every criterion for mental capacity, based on a standardized assessment by an independent panel of top experts. Evaluators must be independent, not White House-employed or subordinate to the commander-in-chief as Dr. Ronny Jackson was when he declared the president “fit” after a 10-minute screen that full-blown Alzheimer patients and hospitalized schizophrenia patients are known to “ace”. Evaluators should also not be candidates for political positions as a “reward” for their evaluation and be properly trained in mental health, not just in emergency medicine.


Unsurprisingly, Dr. Mary Trump, clinical psychologist and Donald Trump’s niece, confirms in her new book what we have independently evaluated: that the president is dangerous. John Bolton, former national security adviser and government insider, confirms in his book what we have professionally concluded: that he is unfit to do his job. His devastating response to the Covid-19 crisis is exactly what we would expect from a president who is: 1) dangerous and 2) unfit for duty.


How was such an impaired presidency allowed to continue? In 2017, Congress members had asked us to educate the public so that they could act. In early 2018, the media, after slow buildup, finally made presidential fitness the nation’s number one conversation. But then the American Psychiatric Association (APA) stepped in and shut us down with an aggressive misinformation campaign. The APA, rather than promoting public health, became dangerous to the public, as its conflicts allowed it to collect major federal funds from an administration that typically cuts funding for science it does not like. I say it is about time the public have expert-level information so it can protect itself, don’t you?


About the contributor:

Dr. Bandy Lee, M.D., M.Div., is a forensic psychiatrist at Yale School of Medicine for 17 years who taught at Yale Law School 15 of those years, was research fellow at the National Institute of Mental Health for 3 years, and a consultant with the World Health Organization since 2002.  She is author of the textbook, Violence (Wiley-Blackwell, 2019) and editor of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President (Macmillan, 2017 and 2019).  She is also president of the World Mental Health Coalition, which issued a “Prescription for Survival” and other urgent recommendations.  For donations to her organization, a tax-deductible 501(c)3, please go here.


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