Last week, Alan Dershowitz accepted to be on Donald Trump’s defense team—in whatever form—and the need to highlight him as a potential personification of a wider, “shared psychosis” with the president has become more urgent. We may worry about blackmail, criminal co-conspiracy, or other conflicts, but being incapable of representing someone because of shared symptoms, such as delusions, is a far more serious matter.
Permit me first to comment on methodology. I have not considered it possible to assess any public figure other than Donald Trump, for the considerable amounts of relevant, high-quality information he makes available are rare, and I have declined all other requests. Decades of lengthy interviews, abundant collateral information from close associates, reports of interactions under sworn testimony, and voluminous, unfiltered, hourly expressions of thoughts through Twitter make it possible with Trump (current science does not deem a personal examination always mandatory). In this context—and as an extension of Trump’s psychology, not as an individual of interest—I find it not only possible but necessary to comment on Dershowitz.
Dershowitz's psychological investment in his willingness to overcome obstacles, which shows where he has emotional commitment, predisposes him to take on symptoms of the president and compromise his rationality.
A couple of weeks ago, despite complaining that I “diagnosed” his odd use of the word “perfect” (like the president) at the accusation of wrongdoing, and publicly expressing a desire for a dialogue, he declined my invitation, citing age and distance as reasons. Yet he welcomed the opportunity to be on the president’s defense team without the same conditions seeming to apply. The psychological investment in his willingness to overcome obstacles, which shows where he has emotional commitment, predisposes him to take on symptoms of the president and thereby compromising his rationality.
It is well-documented that the transmission of symptoms can happen behaviorally and mentally, just as they can physically. A dear colleague at the World Health Organization, Dr. Gary Slutkin, speaks of how violence is contagious. The highly emotional nature of the bonds that Trump generates among his followers and his unprecedented, copious direct exposure to the public, coupled with the severity of the president’s symptoms, make contagion highly probable. Just last fall, three of my colleagues published books on the influence of this presidency on the mental health of his followers: Losing Reality: On Cults, Cultism, and the Mindset of Political and Religious Zealotry (by Robert Jay Lifton); Dangerous Charisma: The Political Psychology of Donald Trump and His Followers (by Jerrold Post); and The Cult of Trump (by Steven Hassan). Non-professional commentators in the news and elsewhere have also remarked on this trend.
'Madness in Two'
So what is shared psychosis, and what are the consequences? Shared psychosis, since 2014, is categorized as an observation rather than a diagnosis. Once called “folie à deux” (madness in two), it can extend into “folie à trois, quatre, plusieurs…,” and even into “folie à millions,” as has been coined. Common in households or in prison settings among gangs or criminal co-conspirators, it happens when a severely impaired person goes untreated. The otherwise “healthy” persons in close contact succumb to similar symptoms as if they had the illness themselves, and their “illness” may be indistinguishable from the primary disease. However, when the relationship with the primary person is interrupted, the symptoms largely subside, and the secondary persons return to their earlier state.
Normal enthusiasm for a person may be “infectious”, but there are no symptoms to transmit when the person of influence is healthy. When a leader has considerable mental impairments, on the other hand, this phenomenon is more likely to happen than not, and we see evidence among Trump followers: those who contact me on a daily basis, for example, have grown markedly more emotional and less amenable to logic than two years ago.
This hypothesis for Dershowitz fits with reports by numerous observers among the public (and one family member who studied under him) who are puzzled at his transformation since this presidency, as it helps to explain changes in Rudolph Giuliani, as discussed earlier.
Doctors' Duty to Public Health
Lawyers have a mechanism for speaking about general legal issues that matter to society—Dershowitz himself openly discusses people he is not representing—and this is distinguished from the strict confidentiality that is a part of attorney-client privilege. Doctors have the same: we have a responsibility to public health, which is distinguished from our confidential relationship with individual patients. Public health involves education of the public and consultations with other sectors that may lead to policy. I and thousands of mental health experts who have joined to voice our concerns about Donald Trump are trying to fulfill our public health duty.
With the duration and expansion of this presidency, it has become necessary to warn against “extensions” of the president’s dangerousness. Shared psychosis is real, and the most common symptoms are not psychosis but delusions, such as those of persecution, grandeur, omnipotence, impunity, perfection, and of being God-ordained or heaven-sent. Alternative explanations to shared psychosis include similar personalities, similar disorders, indoctrination, and other possibilities, but these should be seen as reinforcing rather than mutually exclusive. The reason to be vigilant of shared psychosis is because of its power: it would not only compromise a lawyer’s ability to represent a president rationally and fairly, but would further enhance his ability to draw fervent, irrational support on the part of the president's followers, regardless of legal merit.
When the mind is compromised, it is no longer about ideology, political party, religion, or other beliefs. The ability to choose freely has disappeared, and disease mechanisms that allow us to betray our own best interests, even our country, family, and ultimately the self, take over. It may follow some rational interests at first, such as the desire to belong or to benefit from being on a high-power team, but the ultimate outcome is harmful to all interests. Since this course follows stereotypic disease patterns, and since health is a prerequisite to all rational systems, including the law, politics, and social order in general, mental health professionals can point out when we are beginning to lose that order, for the protection of society.
Dr. Bandy X. Lee is a forensic psychiatrist who teaches at Yale School of Medicine and Yale Law School, a prison psychiatrist of 22 years, and editor of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. She represents the views of the World Mental Health Coalition as its president.