Yale psychiatrist: We need a ‘speedy removal of danger’ in dealing with Trump over Ukraine
Donald Trump AFP/File / MANDEL NGAN

On Wednesday President Donald Trump released a transcript of his conversation with the president of Ukraine. The White House hoped to tamp down the controversy, but critics pointed to a number of problems with the president's conduct revealed by the transcript. On Tuesday, House Speaker Nancy Pelosi announced an impeachment investigation.

Raw Story spoke with Dr. Bandy X. Lee about the controversy and how Trump is likely to respond to impeachment proceedings.

Lee is a forensic psychiatrist at Yale School of Medicine. She has been consulting with the World Health Organization on violence prevention since 2002, has taught at Yale Law School since 2003, and is author of the textbook, “Violence.” In 2017, she held an ethics conference that led to the public-service book, “The Dangerous Case of Donald Trump,” and the World Mental Health Coalition. She also convened a panel to assess the president’s mental capacity and chairs a working group on a panel for performing presidential fitness-for-duty tests. Last week, she hosted a discussion on the importance of mental health expertise in public discourse at Yale Law School (dangerouscase.org).

Raw Story: After a week of denials, the president admitted Tuesday that he’d discussed information about Joe Biden with Ukraine’s president. Critics say that since they discussed aid as well, the president’s actions are tantamount to extortion. How do you explain this behavior, both the apparent recklessness of his dealings with a foreign leader and his subsequent denials?

He was given the powerful signal that asking for and accepting Russia’s help for the 2016 election was not an impeachable offense, and obstructing justice was not one, either. He even warned us during an interview with George Stephanopoulos that if a hostile nation offered dirt on a political opponent, he would probably “take it.” Should we be surprised, then, that he does not see anything wrong with asking for Ukraine’s help in the next election? Stuck in a “might makes right” stage of moral development, what is permissible to him is that which he can “get away” with.

Raw Story: Speaker Nancy Pelosi announced that a formal impeachment inquiry will begin. Is this a good management strategy for his mental instability as well? Can you discuss the 25th amendment?

Any method of containment or removal from power has been long overdue, worsening the stress and anxiety levels of the general population. Politicians can debate whether impeachment or the 25th Amendment is the right way to go, but our responsibility is to emphasize the need for speedy removal of danger. This is a medical need, independent of politics.

The politicians’ job is to navigate the political procedure, but our work is to educate about the dynamics and dangers accompanying the process. Many have expressed fears that impeachment could backfire for 2020 or that the appearance of Donald Trump as a victim could bolster his support. All these are possibilities.

The usual course, when dealing with pathology, is that no matter what you do, you are bound to fall into its trap. We rather need to be mindful of what is happening and not simply to react but to respond with proven techniques. For this to be possible, we need to be educated and informed. I fear that the political people will assume that this is a purely political issue and get played again.

Raw Story: That is very interesting! What are some of the proven techniques?

The key is to understand the principles underlying what we are seeing. Pathology often comes with a mask of sanity, and taking it for what it appears to be will surely topple you. The inability to accept reality, for instance, does not arise from a lack of facts or a misunderstanding of reality, and treating it like ordinary discourse will only hurt efforts. Identifying the actual dynamics and countering them accordingly, on the other hand, such as changing the conditions that give rise to the inability in the first place, can be effective. There will be many such underlying processes. His intense need to believe a more desirable version of reality will augment as pressures mount—and since a pathological drive is more influential than rational strategy, his supporters and his “base” will also resort to increasingly bizarre and fantastical distortions, splitting the nation.

Mr. Trump could be the hardest to remove from office, refusing to accept election results and inciting violence from his followers, or he could be the easiest to convince to resign instantly and uneventfully. Impeachment proceedings could also lead to greater danger through recklessness, vengefulness, and furor, or it could expediently take away his legitimacy so that he has no time to cause real damage. How we handle the situation will be critical from a psychological perspective.

Impeachment legitimizes impeachment, and the presidency itself validates Mr. Trump when it comes to his followers—not evidence or actual behavior. Since impeachment took so long, expectations are now higher, and hence the dangers surrounding impeachment may be greater, in which case circumstances may force something immediate like the 25th Amendment, in addition. Just recently the president said something about “our nuclear” being in “tippy-top shape,” not to mention his being eligible for the Nobel prize for “a lot of things”—these are all concerning signs.

Raw Story: You have described the president as both a violent man as well as a self-destructive one. Can you explain how the two are related?

The two are closely related. In fact, those who harm others just as often self-mutilate or attempt suicide. The point of my textbook on violence was to show that all forms of violence are interrelated. My research of violent death rates in this country showed that homicide and suicide rates rise and fall together.

You might draw parallels between our selecting a dangerous president and the current climate crisis, which I describe as a “collective suicidal tendency” in my text. It is no coincidence that the country with the highest levels of homicide in the developed world, the biggest military, and the greatest levels of inequality—which we call “structural violence”—has also been the most destructive of our only habitat.

Just as there has been a near-consensus among scientists about human-induced climate change since the beginning, there has been a consensus among mental health experts regarding the dangerousness of Mr. Trump’s mental state. In both cases, people chose to deny what was before them. Pseudoscientists or a handful of highly conflicted psychiatrists were mobilized to strengthen the denial or to obscure the picture, until the situation became dire. In both situations, protection of narrow interests facilitated our reaching an emergency state: the fossil fuel industry’s profit against warning about the climate crisis, and the American Psychiatric Association’s reputation against warning about a U.S. president’s dangerousness.

Having ignored the science and not having intervened when there was still plenty of time for prevention, at this late hour there is almost paralysis into inaction. We keep discovering that the situation is worse than we expected. Still, the best solution is to act resolutely, now, before it is too late.