Dr. Bandy Lee -- the Yale School of Medicine forensic psychiatrist who briefed Congress on the possibility that President Donald Trump is dangerously mentally ill -- pushed back on Friday against charges that she is acting outside her purview by discussing the mental health of a person she has not personally treated.
Lee spoke to Vox.com's Eliza Barclay and told her that she and the 27 colleagues who contributed to the book The Dangerous Case of Donald Trump are not diagnosing the president but calling for a diagnosis to explain the barrage of troubling symptoms Trump has displayed.
Lee told Vox that Trump is now in accelerating mental health crisis that intensified with special counsel Robert Mueller's indictments of former Trump 2016 campaign manager Paul Manafort and his aide Rick Gates as well as guilty pleas from former foreign policy adviser George Papadopoulos and ousted national security adviser Mike Flynn.
Trump received a certain measure of flattery and deference on his Asia trip, Lee said, which would be soothing to his constant need for flattery and reassurance. That however, "made him more volatile when he returned."
"When he returned and faced the progress of the special counsel’s investigation, he became more paranoid, returning to conspiracy theories that he had let go of for a while. He seemed to further lose his grip on reality by denying his own voice on the Access Hollywood tapes," she said.
Lee -- who has based her decades of work in the study of violence prediction and prevention -- said that Trump's recent behavior is predictive of violence.
"(T)he sheer frequency of his tweets seemed to reflect the frantic state of mind he was entering, and his retweeting some violent anti-Muslim videos showed a concerning attraction to violence. And then there were the belligerent nuclear threats this week," she explained.
A potential nuclear holocaust isn't the only imminent threat posed by an unstable president, Lee said. He could start conflict on many levels with a number of countries, further alienate U.S. allies or spark civil conflict in the U.S. by "laying a foundation for a violent culture that could give way to epidemics of violence."
This is an emergency situation, Lee stressed, and professionals faced with dangerous individuals and emergencies are not diagnosing the threatening individual, but taking protective action.
"We are assessing dangerousness, not making a diagnosis. The two are quite separate: Assessing dangerousness is making a judgment about the situation, not the person. The same person may not be dangerous in a different situation, for example. And it is his threat to public health, not his personal affairs, that is our concern," she told Vox.
"Also, once you declare danger, you are calling first for containment and removal of weapons from the person and, second, for a full evaluation -- which may then yield diagnoses," Lee explained.
With regards to Trump's willingness to undergo psychiatric evaluation, Lee said that mental health professionals are accustomed to the dilemma posed by patients who most urgently need intervention but are the least willing to accept help.
"That is the reason why in all 50 states we have not only the legal authority, but often the legal obligation, to contain someone even against their will when it’s an emergency," she said.
"So in an emergency, neither consent nor confidentiality requirements hold. Safety comes first. What we do in the case of danger is we contain the person, we remove them from access to weapons, and we do an urgent evaluation," she said, adding, "This is what we have been calling for with the president based on basic medical standards of care."