A CLINICAL CASE FOR THE DANGEROUSNESS OF DONALD J. TRUMP

DIANE JHUECK, L.M.H.C., D.M.H.P.

Mental illness in a U.S. president is not necessarily something that is dangerous for the citizenry he or she governs. A comprehensive study of all thirty-seven U.S. presidents up to 1974 determined that nearly half of them had a diagnosable mental illness, including depression, anxiety, and bipolar disorder (Davidson, Connor, and Swartz 2006). Notably, however, personality disorders were not included in this study, even though they can be just as debilitating. This addition would most certainly have increased the number of presidents with mental illness to something well past 50 percent. Yet, psychiatric illness alone in a president is not what causes grave concern. A second and crucial part of the equation is: Is the president dangerous by reason of mental illness?

Favoring civil liberties, U.S. law gives a lot of latitude for behavioral variation. When the law allows, even requires, that mental health professionals and physicians detain people against their will for psychiatric reasons, they must demonstrate that those people are a danger to themselves or others, or are gravely disabled. Initially, we need to look at what it means to be a danger to others due to mental illness. It is important to separate mental symptoms from things such as poor judgment or opinions and points of view that differ from one’s own, which the law clearly permits. In the United States, it must be a disturbance of cognition, emotion regulation, or behavior, as described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), that is driving the patterns of dangerous behavior. Additionally, the magnitude of the perceived harm must be considered. Is it that feelings are being hurt? Or is there actual damage being perpetrated? Are there patterns of behavior and statements of intent that reasonably indicate that harm is imminent? Does the person carry weapons or any other instruments of harm?

People holding high political office inevitably cause some form of harm, whether they intend to or not. Leaders must often select what they think are the best options from a list of bad ones in areas as complex as military policy, the allocation of limited resources, or the line between safety nets and deregulation. When an individual in high office makes decisions, some people may be hurt in some way because of the sheer magnitude of that individual’s power. A good leader will attempt, to the extent he or she can, to minimize that harm and to comfort those impacted, but damage is still unavoidable. This remains an unfortunate effect of governing large groups of people. This is also the very reason it is more, not less, important that the leader of the United States be mentally and emotionally stable. As president, Donald J. Trump has control over our executive branch and its agencies; is commander in chief of our military; has unilateral authority to fire nuclear weapons (which the secretary of defense authenticates but cannot veto). For the leader of the free world, inappropriate words alone may create a snowball effect that ultimately results in devastating harm to others.

The MacArthur Violence Risk Assessment Study has a number of indicators for whether an individual will commit future violence. Some examples include: a past history of violence, a criminal or substance-abusing father, personal chemical abuse, having a generally suspicious nature, and a high score on the Novaco Anger Scale. In regard to categories of mental health disorder, and perhaps counterintuitively, major illnesses (such as schizophrenia) have a lower rate of harm to others than personality disorders. “Psychopathy, [antisocial personality disorder] as measured by a screening version of the Hare Psychopathy Checklist, was more strongly associated with violence than any other risk factor we studied” (Monahan 2001). The twenty-item Hare checklist measures interpersonal and affective presentation, social deviance, impulsive lifestyle, and antisocial behavior (Hart, Cox, and Hare 1995).

The president, in a position of great power and making critical decisions, should theoretically meet higher standards of mental stability. Also, having access to a nuclear arsenal capable of destroying the world many times over, he should be of lower risk of violence than the average citizen. Despite these higher standards, our response is the opposite, for there is protection of public perception to consider: the president is supposed to be our protector, and he is unwell and harmful. The more unwell and unwilling to admit of any disturbance (in an extreme-case scenario), the more a mental health detention may need to be considered—and how would that appear to the public? Or, if we did not act, would we continue to deny until we were at a point of no return? Additionally, those who dare apply these mental health principles, such as those who dare apply justice to our First Citizen, may find themselves at risk of their jobs, their security, or even their personal safety—by the president or that segment of our society currently feeling empowered by the rise of the present regime, who would be driven around the emotional bend if these actions were successful. A complex web of factors requires consideration, which is why public education and collaboration with other professionals (e.g., politicians, lawyers, social psychologists) is highly important.

There is a preponderance of information in the public record regarding Donald J. Trump’s aberrant behavior. The following list of incidents is neither all-inclusive nor deeply analytical. Each topic is a potential theme for an entire book in its own right. The intent here is to isolate enough indicators of record to reach a reasoned conclusion about whether President Trump’s patterns of behavior indicates a clinically relevant “danger to others.”

During a rally in Wilmington, North Carolina, Trump stated, “Hillary wants to abolish, essentially abolish the Second Amendment.… And by the way, if she gets to pick her judges, nothing you can do, folks. Although [for] the Second Amendment people, maybe there is, I don’t know.” A reporter covering this incident was moved to say, “While the remark was characteristically glib, it finds Trump again encouraging violence at his rallies. Worse, it marks a harrowing jump from threatening protestors to suggesting either an armed revolt or the assassination of a president” (Blistein 2016). It was not just journalists who heard Trump’s statement in these terms: “The former head of the CIA, retired Gen. Michael Hayden, told CNN’s Jake Tapper, ‘If someone else had said that outside the hall, he’d be in the back of a police wagon now with the Secret Service questioning him’” (Diamond and Collinson 2016). It is true also for medical and mental health professionals: if a patient had said that, an emergency certificate would have been signed, and the person taken to the nearest emergency room for further questioning and evaluation.

Trump has said that he did not mean the statement the way it sounded. A common explanation by his defenders of aggressive and untoward remarks made by him in public settings is that what he said was a joke. This in no way discounts the dangerousness of his remark. In fact, his deeming the remark so lightly as to consider that it could be a joke would in itself be concerning. Moreover, his holding life-and-death matters themselves to be inconsequential may indicate serious pathology and risk—which cannot fully be ruled out without a detailed examination. This statement, in this context, exemplifies the “willingness to violate others” and the lack of empathy that characterize antisocial personality disorder (American Psychiatric Association 2016, pp. 659–60). In modern history, no other candidate for president of the United States has joked about his followers murdering his opponent.

In his response to the release by the Washington Post of the now-infamous “Grab ’em by the pussy” video, Trump the candidate stated that the audio was recorded more than ten years ago and did not represent who he is. The recording was made by Access Hollywood’s Billy Bush on September 16, 2005. It includes the following comments from the newly married Trump when he sees actress Arianne Zucker outside the bus where he is being recorded: “I better use some Tic Tacs, just in case I start kissing her.” (Sound of Tic Tacs being dispensed). “You know I’m automatically attracted to beautiful—I just start kissing them. It’s like a magnet. Just kiss. I don’t even wait” (Fahrenthold 2016). During the course of the video, he is on record as saying even more disturbing and assaultive things regarding women.

After this video was aired, a significant number of Republican senators, representatives, governors, political appointees, and others stated publicly that they would not endorse Trump for office. Lisa Murkowski, Republican senator from Alaska, stated, “The video that surfaced yesterday further revealed his true character,” she said. “He not only objectified women, he bragged about preying upon them. I cannot and will not support Donald Trump for President—he has forfeited the right to be our party’s nominee. He must step aside” (2016). Brian Sandoval, Republican governor from Nevada, declared, “This video exposed not just words, but now an established pattern, which I find to be repulsive and unacceptable for a candidate for President of the United States” (Graham 2016). While senators and representatives have a more complicated relationship to Trump as president, governors and political appointees are more removed from him politically and warrant closer inspection. Of note, with less to lose politically, both these groups had a higher percentage of members state that they would not endorse Trump. Of the fifteen Republican governors who went on record, 53 percent stated that they would not endorse the nominee for president. Two of the seven who said they would endorse him now have jobs in his administration, as vice president and United Nations ambassador. Of the twenty-three Republican political appointees who made statements on record, an astounding 87 percent of them said they would not endorse or vote for Trump. Only three said they would (Graham 2016). Therapists of mental health across the country report having to expand their practices to include what is being called “election trauma.” “What I’m seeing with my clients, particularly with women who experienced sexual abuse when younger, is that they are being re-wounded, re-traumatized,” said Atlanta licensed professional counselor Susan Blank. “They can’t escape it. It’s all around them, written large on the national stage” (LaMotte 2016).

Among the many truly disturbing behaviors of this man now serving as the leader of the free world is his relationship to his daughter Ivanka. What follows are some of the more unsettling things Trump has said about her while knowingly being recorded:

• “You know who’s one of the great beauties of the world, according to everybody? And I helped create her. Ivanka. My daughter Ivanka. She’s 6 feet tall, she’s got the best body” (King 2016).

• During an interview with Howard Stern when Ivanka was twenty-two years old (Cohen 2016): “I’ve said that, if Ivanka weren’t my daughter, perhaps I’d be dating her” (“Donald Trump Nearly Casually Remarks…” 2006).

• And in another appearance on the Howard Stern radio show, in response to Stern’s saying, “By the way, your daughter…” Trump responded, “She’s beautiful.” Stern added, “Can I say this? A piece of ass,” to which Trump replied, “Yeah” (Kaczynski 2016).

• To a reporter about Ivanka: “Yeah, she’s really something, and what a beauty, that one. If I weren’t happily married and, ya know, her father…” (Solotaroff 2015).

• On Fox’s Wendy Williams Show, in 2013: “Ivanka, what’s the favorite thing you have in common with your father?” Williams asked. “Either real estate or golf,” Ivanka replied. “Donald?” Williams asked Trump. “Well, I was going to say sex, but I can’t relate that to…” Trump answers, gesturing to Ivanka (Feyerick 2016).

One of the first acts of mass citizen resistance against Trump’s presidency occurred the day after his inauguration, when much of the country went to the streets in protest. The 2017 Women’s March was the largest protest gathering in the history of the United States. Researchers Jeremy Pressman and Erica Chenowith (2017) estimate that more than four million people participated nationwide. They calculate that approximately three hundred thousand people marched in other countries, partly in response to an assaultive attitude and behavior against women unprecedented in a U.S. president.

A great danger to vulnerable groups and the potential for human rights abuses arise from the type of individuals Trump’s psychopathy leads him to look to for affirmation and support. Unable to tolerate criticism and perceived threats to his ego, and with a documented obsessive need to be admired, he has notably selected as his advisers either family members or people who, in clinical jargon, “enable” his illness. This is one of the more significant ways in which he has become a danger to others as president. Members of vulnerable communities often write and speak about grave concerns regarding those whom he is choosing to guide him. Using his proposed federal budget as a lens, Jessica González-Rojas writes, “It outlines President Trump’s spending priorities and program cuts that make clear his utter contempt for communities of color, and it edges this country and its moral compass closer to the nativist vision espoused by the likes of White House advisers Steve Bannon and Stephen Miller, and Attorney General Jeff Sessions” (González-Rojas 2017).

His mental health symptoms, including impulsive blame-shifting, claims of unearned superiority, and delusional levels of grandiosity, have been present in his words from his very first campaign speech: “They’re bringing drugs. They’re bringing crime. They’re rapists, and some, I assume, are good people” (Elledge 2017). “I would build a Great Wall, and nobody builds walls better than me, believe me, and I’ll build them very inexpensively. I will build a great, great wall on our southern border and I will have Mexico pay for that wall, mark my words” (Gamboa 2015). Regarding U.S. district judge Gonzalo Curiel, who was born in Indiana, Trump claimed it was a conflict of interest for the judge to hear a fraud case against Trump University, telling CNN, “He’s a Mexican. We’re building a wall between here and Mexico” (Finnegan 2016).

Trump’s unhinged response to court decisions, driven as they appear to be by paranoia, delusion, and a sense of entitlement, are of grave concern. While president of the United States, he has on more than one occasion questioned the legitimacy of the court, as in this example: “We had a very smooth roll-out,” he insisted, claiming that “the only problem with the [Muslim] ban was the ‘bad court’ that halted it” (Friedman, Sebastian, and Dibdin 2017). In February 2017, he tweeted, “The opinion of this so-called judge, which essentially takes law-enforcement away from our country, is ridiculous and will be overturned!” To which Representative Jerry Nadler responded, on February 8, 2017: “@realDonaldTrump’s conduct—attacking judges + undermining independent judiciary—is inappropriate and dangerous.” According to the Department of Homeland Security, at least 721 individuals and their families were denied the entry they had expected at U.S. borders under a ban soon deemed illegal by more than one court. At least 100,000 visas were revoked, according to a Justice Department lawyer (Brinlee 2017).

“We’re hearing from really, really scared people,” said Rachel Tiven, CEO of Lambda Legal, a nonprofit legal advocacy organization for LGBTQ rights. She adds, “We’re seeing a fear of an atmosphere of intolerance that began with Trump’s campaign.” In the same article, Kris Hayashi, executive director of the Transgender Law Center, states, “It was clear in 2016 that we saw an upswing in anti-trans legislation, more than we’d ever seen before … We anticipated that was not going to lessen but increase in 2017” (Grinberg 2016). “These are situations that put fear, not just into the individual who is targeted, but the entire community,” said Heidi Beirich, director of the Southern Poverty Law Center’s (SPLC) Intelligence Project, in a Boston Globe article about increased hate-based crimes at schools in Massachusetts. The SPLC reports that a record 16,720 complaints were filed nationwide with the Office for Civil Rights of the U.S. Department of Education in 2016, which they state is a 61 percent increase over the previous year (Guha 2017).

The American Association of University Professors’ national council has approved the following resolution (2016): “Since the election of Donald J. Trump almost two weeks ago, the US has experienced an unprecedented spike in hate crimes, both physical and verbal, many of them on college and university campuses.… These have been directed against African Americans, immigrants, members of the LGBTQ community, religious minorities, women, and people with disabilities. In some instances, the perpetrators have invoked the president-elect in support of their heinous actions.” Within the resolution, the council affirms the concept of free speech, stating, “No viewpoint or message may be deemed so hateful or disturbing that it may not be expressed. But threats and harassment differ from expressions of ideas that some or even most may find repulsive. They intimidate and silence.”

Two social psychologists at the University of Kansas conducted a study on prejudice that involved surveying an even split of four hundred Trump and Clinton supporters. The scientists noted that “Trump’s campaign over the preceding 18 months featured a procession of racist and ethnocentric rhetoric, with repeated insults, gross generalizations, and other derogatory speech hurled at Mexicans, Muslims, and women.” So they asked one hundred of the Trump and one hundred of the Clinton supporters to rate their personal feelings toward a variety of social groups that the Trump campaign had disparaged at one time or another over the course of the race: Muslims, immigrants, Mexicans, fat people, and people with disabilities. All study participants were also polled on groups that Trump had not publicly maligned: alcoholics, adult film stars, rich people, members of the National Rifle Association, and Canadians. When the participants were surveyed again after the election, Crandall and White found that “Both personal and general prejudices remained unchanged for both sets of supporters with regard to the groups that Trump had not publicly targeted. But for the groups that Trump had disparaged, both Trump and Clinton supporters reported slightly lower levels of personal animus, and significantly higher levels of perceived acceptance for discriminatory speech.… In short: The perceived norm had shifted.” Research suggests that individual expressions of prejudice and potential violence depend highly on perceived social norms; Trump surely had the effect of changing those norms (Crandall and White 2016).

Sometimes overlooked is the extent to which this president’s mental health issues are harming our children. His impact is pervasive enough to have earned a label: “the Trump Effect.” It has been used specifically to describe the trauma American children are experiencing because of Trump’s candidacy and now presidency. “We have a bully in our midst, some therapists and school counselors say, traumatizing the most vulnerable of us. That bully is the 2016 presidential campaign, including the so-called ‘Trump Effect.’” SPLC Teaching Tolerance director Maureen Costello has said, “I’m concerned children are coming to school every day terrified, anxious, disappointed, fearful. Feeling unwanted” (LaMotte 2016).

As the issue of Trump’s mental illness was not of intense national concern until he ran for office and assumed the presidency, assessment by individuals with intimate understanding of what that job entails are useful for analyzing his dangerousness. It is instructive to remove the variable of political ideology from our determination and narrow our review to the perspective of Republicans only. In August 2016, a letter signed by fifty such individuals was published in the New York Times. While some of their concern centers on lack of experience, a portion of the letter made more direct reference to Trump’s mental and emotional stability: “The undersigned individuals have all served in senior national security and/or foreign policy positions in Republican Administrations, from Richard Nixon to George W. Bush. We have worked directly on national security issues with these Republican Presidents and/or their principal advisers during wartime and other periods of crisis, through successes and failures. We know the personal qualities required of a President of the United States. None of us will vote for Donald Trump. From a foreign policy perspective, Donald Trump is not qualified to be President and Commander-in-Chief. Indeed, we are convinced that he would be a dangerous President and would put at risk our country’s national security and well-being.” A president, they continue, “… must be willing to listen to his advisers and department heads; must encourage consideration of conflicting views; and must acknowledge errors and learn from them … must be disciplined, control emotions, and act only after reflection and careful deliberation … must maintain cordial relationships with leaders of countries of different backgrounds and must have their respect and trust,” and must be able and willing “to separate truth from falsehood” in order to aspire to be president and commander in chief, with command of the U.S. nuclear arsenal. They conclude: “We are convinced that in the Oval Office, he would be the most reckless President in American history.”

Hillary Clinton’s remark “A man you can bait with a tweet is not a man we can trust with nuclear weapons” was not just campaign hyperbole (Broad and Sanger 2016). The president of the United States has approximately 2,000 deployed nuclear warheads at his or her disposal and has the authority to order these weapons to be launched even if our country has not yet been attacked. Weapons fired against the United States from a submarine would take about twelve minutes to hit Washington, DC. Missiles fired from most continents would reach this country in around thirty minutes. The nightmare scenario of this unstable, impulsive, blame-shifting, and revenge-obsessed individual having mere minutes to make the kind of decision required in such a scenario is of the gravest concern possible in our era.

In an interview on Fox News, then–Vice President Dick Cheney stated, “He [the president] could launch a kind of devastating attack the world’s never seen. He doesn’t have to check with anybody. He doesn’t have to call the Congress. He doesn’t have to check with the courts. He has that authority because of the nature of the world we live in” (Rosenbaum 2011). The entire focus in the missile launch decision process is on whether the launch command is authentic, not whether it is reasonable. Ron Rosenbaum describes the case of Maj. Harold Hering, who, during the period when Nixon was displaying erratic behavior, was troubled by a question he was not allowed to ask. “Maj. Hering decided to ask his question anyway, regardless of consequences: How could he know that an order to launch his missiles was ‘lawful’? That it came from a sane president, one who wasn’t ‘imbalance[d]’ or ‘berserk?’ as Maj. Hering’s lawyer eventually, colorfully put it.” Hering was a career military officer and asked the question while attending a missile training class. He was discharged from the air force for asking it. To this day, Harold Hering’s question remains unanswered.

If we who have come together to write this book are accurate in our assessments, one must ask why Donald J. Trump’s dangerousness was not addressed earlier in his life? The extensive public record on him shows that he has been insulated by inherited wealth and that his father had similar mental health disturbances. As we are all witnessing now, with his politically inexperienced daughter and son-in-law taking key advisory positions at the White House, Trump has distanced himself from possible checks and balances while enabling his own disorder: a lack of insight and confirmation-seeking that make certain mental disorders particularly dangerous in a position of power.

A substantive change in the level of his dangerousness came with his assumption of the role of leader of the free world. Although an argument can be made that, by taking this office, he has shaken the global political structure to the extent that the U.S. presidency is rapidly losing that standing. His narcissistic traits (manifesting in blatant lying, impulsive and compulsive decision making against rational interests, and immature relational abilities) are creating a leadership gap that other political actors may well seek to fill. Yet, it is impossible for him, through the lens of his mental dysfunction, to evaluate his actual presentation and impact.

As the ultimate representative of our nation, Donald J. Trump is normalizing previously outrageous behaviors, negatively impacting everyone from leaders of other nations to our own children. From the outset of his presidency, although clearly absent a mandate from the population he now governs, he has repeatedly declared himself “the greatest,” or “tremendous,” or “knowing more than anyone,” and other statements consistent with narcissistic personality disorder, with regard to an “expectation of being viewed as superior without commensurate achievements” (American Psychiatric Association 2013, p. 669). He exhibits extreme denial of any feedback that does not affirm his self-image and psychopathic tendencies, which affords him very limited ability to learn and effectively adjust to the requirements of the office of president. Rather, he consistently displays a revenge-oriented response to any such feedback. Holding this office at once feeds his grandiosity and claws at the fragile sense of self underneath it. His patterns of behavior while in the role of president of the United States have potentially dire impact on every individual living not only in this nation but across the entire globe. The earth itself is in peril, both from the urgent issues that are not being addressed while an unstable man sits in the Oval Office and by the new urgencies he creates. Mr. Trump is and has demonstrated himself to be a danger to others—not just one person or a few, but possibly to all others.

Diane Jhueck, L.M.H.C., D.M.H.P., has operated a private therapy practice for several decades. In addition, she performs mental health evaluations and detentions on individuals presenting as a danger to self or others. In a previous social justice career, she was a women’s specialist at the United Nations, in New York City. She founded the Women’s and Children’s Free Restaurant, an empowerment project that has been in operation for thirty years. She also founded the People’s AIDS Project and was an assistant regional manager for Feeding America. She has directed agencies addressing food aid, domestic violence, apartheid, low-income housing, and LGBTQ rights.

Acknowledgments

I thank Bandy Lee, M.D., for her exceptional assistance in the preparation of this chapter.

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