What If A President Is Too Impaired To Lead?

A president unable to separate the world from self can do America untold damage.

Based on his public behavior, ever more psychiatrists assert that Donald Trump is emotionally impaired. In doing so, they raise the gravest of questions: what are the implications of such a judgement?

In essence, these psychiatrists argue that a profound and disabling character disorder is the organizing principle for Trump’s uniquely erratic conduct in office. John Gartner of Johns Hopkins states flatly: “Donald Trump is dangerously mentally ill and temperamentally incapable of being president.”

To the same effect, three other prominent professors cite Trump’s “grandiosity, impulsivity, hypersensitivity to criticism, and an apparent inability to distinguish between fantasy and reality... “A letter signed by 40,000-plus mental health professionals invokes the constitutional provision for removing a president “unable to discharge the powers and duties of his office.”

This ardent but controversial chorus expands on the professions’ “duty to warn” those to whom a patient poses an imminent threat. Psychiatrists who deem Trump unfit to serve employ varied lenses. One leading psychoanalyst cites the essential requirements of the Army’s Field Manual for Leader Development: “Trust”; “Discipline and self– control”; “Judgment and critical thinking”; “Self-awareness”; and “Empathy.”

Others point to the elements of narcissistic personality disorder. According to the Mayo Clinic, these include unwarranted self-importance; fantasies of unlimited success; a belief that one is special and unique; a craving for excessive admiration; a deep sense of entitlement; a penchant for exploitation; and absence of empathy for others.

The ultimate value of the psychiatric profession’s warning is to challenge the delusion that Trump can be controlled.

Taken together, these professionals argue, such traits create a presidency captive to Trump’s pathology. Narcissism, says Dr. Julie Futrell, “impairs his ability to see reality…” Yale’s Robert Jay Lifton opines that Trump “can’t bear the humiliation of being exposed as wrong...”

One inevitable result, argues Dr. Lance Dodes of Harvard, is his pervasive and destabilizing mendacity: “the lies he tells others… and those he tells himself.” Leonard Glass of Harvard cites Trump’s “inability to tolerate divergent opinions”; “vindictiveness”; “repeated complaints of being victimized”; and” chaotic emotional needs” which overwhelm “his capacity for deliberative, thoughtful problem-solving.”

Trump’s defenders will invoke the American Psychiatric Association’s bar against opining on public figures without a personal examination, epitomized by the so-called Goldwater Rule. This proscription emanated from a 1964 survey for Fact Magazine, in which psychiatrists opined that Barry Goldwater was too dangerous to be president in the nuclear age.

Goldwater sued – and won; the rule followed. But now another influential group, the American Psychoanalytic Association, has freed its members to comment on what is clearly a matter of vital public interest. Argues Glass of Harvard, “there is an extraordinary abundance of speech and behavior on which one can form a judgment.”

Others will dismiss this warning as the febrile fulminations of a liberal elite. But it is expressly rooted in what anyone can see: the consuming war against external realities which so clearly distorts Trump’s presidency.

So profound is Trump’s discomfort with losing the popular vote that he constituted a commission to uncover statistically nonexistent voter fraud. Lie upon lie – Obama wiretapped him; his inaugural crowd was history’s largest ― serves a seemingly insatiable need to obliterate from the public mind every fact which threatens his self-concept, until truthful discourse loses all objective meaning.

This fierce imperative, psychiatrists believe, drives his reflexive attacks on any institution which can hold him accountable – the media; the intelligence community; the Justice Department; the judiciary; the enforcers of ethical norms. To protect his vulnerable ego, he must destroy their credibility. And so he drags America’s governance into his psychic force field.

Hence his frenzied efforts to thwart the Russia investigation by threatening, disparaging or terminating senior law enforcement officials. Recently, Trump’s compulsive lying about Russia led him to dictate a false statement for Donald Jr. concerning his meeting with Russians who offered supposedly damaging information about Hillary Clinton – thus endangering his son as well as another participant, his son-in-law Jared Kushner. Such self-centered self-immolation augers a potential psychodrama with no good end: an effort to terminate Mueller and his investigation, dividing the country by posing as Mueller’s victim.

But whether his antagonist be Mueller, China or Kim Jong-un, psychiatrists admonish, there may be nothing to constrain his impulses. Trump’s “failure of judgment in a crisis,” says psychiatrist Lawrence Post, is aggravated by “a sycophantic leadership circle afraid to question him.” Little wonder – Trump lashes out against critics or criticism, real or perceived; scorns advice which contravenes his instincts; pits advisors against each other; and treats staff who displease him like termites.

Thus handlers screen out bad news in order to sustain Trump’s alternate reality. Routinely, they lie to us on his behalf – Sean Spicer became a serial prevaricator in Trump’s service, and his communications shop constantly misleads and dissembles to placate its obsessive audience of one.

Their work environment reflects the debilitating internal chaos perceived by Trump’s professional critics. In six months Trump ran through three communications directors, a national security advisor, a Chief of Staff, an FBI director and numerous lesser but important officials. He demeans national security advisor McMaster and gelds Secretary of State Tillerson. In the Hobbesian world of Donald Trump, public service is often mean, brutish and short ― and ruinous to the independence and integrity of those who serve him.

Their degradation captures the larger threat he poses to our institutions, our discourse and our collective sense of reality ― including how Americans view each other. The presidency has not transformed Donald Trump. Rather, he has transformed the presidency to mirror his unstable and dystopian inner landscape. The ultimate value of the psychiatric profession’s warning is to challenge the delusion that Trump can be controlled.

We have already paid too dearly for the GOP establishment’s fantasy that a claque of gray-haired white men would tutor a docile Trump in statecraft. The pattern cited by his psychiatric critics argues that neither his characterological opposite John Kelly nor life itself can transform his essential nature, for Trump’s consuming agenda lies within.

A president unable to separate the world from self can do America untold damage, whether in extremity or through the day-to-day corrosion inflicted by his pathology. But no matter what havoc he visits on the country he purports to govern, political reality in these polarized times dictates that we will not be rid of him easily – or soon.

As of now invoking constitutional remedies is, quite obviously, a fantasy. The 25th amendment requires that the vice president or cabinet adjudge a president unfit to serve, and must be ratified by two-thirds of Congress. Impeachment, though broader, requires the consent of the House and two-thirds of the Senate. Given the ferocity of Trump’s base, and the passivity of his party, neither is conceivable unless his behavior provokes an electoral tsunami in 2018.

Still, we see the first resistance among certain Republican senators. Our principal hope must be that more will relocate their conscience to guard against presidential misconduct.

By whatever means and regardless of party, our elected leaders must combat any actions which threaten our institutions, social comity, or national security. It is this obligation, above all, which Trump’s psychiatric profilers have so vividly illuminated. For Trump’s behaviors suggest that our president cannot cure himself – or the country on which he is already inflicting such grievous harm.