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“What is the 25th Amendment for, if not designed for this exact reason?” is a question we have perpetually received regarding the current president.  We finally sought to answer it at our Nov. 14 online town hall.

Indeed, since the announcement of election results, Donald Trump has refused to concede, has withheld critical information for the transition team, has fired and replaced top officials responsible for the nation’s security, and has contemplated a catastrophic war with Iran.  On top of this, he continues to ignore a surging pandemic that is now infecting almost 200,000 and killing 2000 Americans per day and collapsing medical systems he has refused to support.

Every hour of every day that he delays and disrupts a peaceful transfer of power, he is obstructing the critical preparations that are necessary for proper vaccine distribution and is risking a massive loss of lives.  Could we have imagined, even a few months ago, keeping in charge a person who would kill a quarter-million Americans, and be poised to kill a half-million very soon?  We already dubbed him “killer-in-chief,” but the phrase almost fails to do justice to fully describe the magnitude of destruction he is inflicting on the nation and the world medically, politically, and mentally.

Since Donald Trump’s election, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone exhibiting dangerous mental impairments.

Yet this is exactly what was predicted.  Since Donald Trump’s election, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone exhibiting dangerous mental impairments.  We held an ethics conference with the most highly respected psychiatrists and then published The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.  The latter became an unprecedented bestseller of its kind, and we donated all proceeds from the book to remove conflicts of interest.  Unfolding events over the past four years merely played out the multi-dimensional dangers we warned against, with almost impeccable precision.

While it is not our place to opine on whether or not the 25th Amendment should be invoked—this goes beyond our expertise—we as mental health professionals can and should say if a president must be removed for public health and safety reasons, whatever the means.  Indeed, thousands of mental health professionals followed suit since the start of this presidency, and more than 800 petitioned Congress about the dangers.  Now, 100 senior mental health professionals have gone on video record to declare the current president too psychologically dangerous and mentally unfit to be in the presidency or candidacy for reelection.  We recently published more than 300 pages of our letters, petitions, and conference transcripts in an attempt to alert the authorities.  We also reconvened top experts in the fields of law, history, political science, economics, journalism, social psychology, climate science, and nuclear science at an emergency interdisciplinary conference.  This followed a meeting with the same speakers at the National Press Club in early 2019, to discuss the critical situation of a president’s unfitness in our dangerous world, with the full three hours broadcast on C-SPAN.  Finally, the continued lack of intervention brought on our town hall on the 25th Amendment.

According to legal scholars, this is the expected approach.  Dr. Lee has had exchanges with the author of the 25th Amendment, Attorney and professor John Feerick, at a 50th-Anniversary conference on the Amendment and at student workshops at Fordham University Law School.  He discussed that the intention of the Amendment was that “the data would drive the process, and medical professionals are a source of data.”  Professor John Rogan, his close collaborator on the 25th Amendment, clarified on another occasion: “physicians have a supererogatory obligation to share specialized knowledge.  This is especially important when discussing psychiatric conditions, which may be hard to apprehend.”  The vice president, instead of being the driver of the process, would agree when “leaned upon” by the cabinet or the “other body” that Congress appoints to supplant the cabinet, compelled by the data.

We are in just such a situation where the president’s dangerousness yields overwhelming data.  These data are consistent with the hundreds of years of scientific evidence and many thousands of hours of clinical experience we collectively brought to our warnings about the current president, in accordance with our “responsibility to society,” as outlined in the first paragraph of the preamble of our ethics code.  A peer-reviewed panel of independent experts has already performed a standardized assessment of mental capacity, when the right information became available, in which the president failed every criterion.  This means he would be unfit for any job, let alone president.  Our evaluation fully predicted that he would disastrously mismanage a pandemic, as our blow-by-blow account documents.

A question that came up at our town hall was: “What is wrong with our Constitution?”  Why would it fail to protect the nation at the most basic level?  Representative and constitutional scholar Jamie Raskin’s (D-Md.) lecture (recorded at a previous gathering) to us on the 25th Amendment in 2019 gives an answer: we must make use of the provisions that are available.  His lecture is current again with his recent reintroduction of legislation for a commission to oversee presidential capacity, of which physicians and psychiatrists would comprise half.  Attorney and professor Richard Painter, former chief White House ethics counsel for the Bush/Cheney Administration and former chair of Citizens for Responsibility and Ethics in Washington (CREW) confirms that the 25th Amendment needs to be used, with an “other body” to replace the cabinet a critical component.

Their legal assertions align with our therapeutic ones.  Politicians must do their part, as must mental health professionals.  Political bodies should consult with mental health experts, the purpose for which we even set up an independent expert panel, and mental health professionals should continue to inform the public of the dangers, until political bodies can succeed in removing them.  The public is a stakeholder, not to mention the president’s employer, now at the receiving end of unacceptable levels of abuse and potential, imminent victimization; mental health professionals do not have the luxury merely to stand by.  The Declaration of Geneva clarifies that we must prevent harm and injustice, especially when they are arising from a destructive government—and, if not now, when?

James R. Merikangas, M.D., is a forensic neuropsychiatrist, co-founder of the American Neuropsychiatric Association, and former president of the American Academy of Clinical Psychiatrists.  His and Dr. Lee’s activities can be followed at worldmhc.org.

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