Mental health experts explain why Joe Biden needs to throw the book at Donald Trump
President Donald J. Trump listens to Vice President Mike Pence addresses his remarks Wednesday, April 22, 2020, in the James S. Brady White House Press Briefing Room of the White House. (Official White House Photo by Shealah Craighead)

President-Elect Joe Biden has continually said he hopes to reforge a bipartisan governing consensus when he takes office next month.  He has called for a more collegial atmosphere in Washington and “reaching across the aisle” to get the nation back on its feet.

No doubt there is a need for healing divides and finding a common language.  Pathological personalities do not respond well to conciliatory gestures, as this may be experienced as coddling, indulging, and giving license to further transgressions.  This has been seen with Donald Trump and his cronies, who have used others’ allowance to expand a subculture of violence and abuse.  Instead, what gains respect with these personalities are firm boundaries and limit setting, despite their protest.

Additionally, we should show enough respect to hold our fellow human beings accountable to a higher standard even if—and especially if—they cannot do so themselves.  As psychiatrists who have a duty to the public’s health, we must also point out that not to collect on the president’s debts and not to compensate the workers he has failed to pay by shifting funds to his family or declaring bankruptcy, would legitimize abuse of the law and be harmful to society.

Not to prosecute for human rights abuses at the southern border or for the assassination of an Iranian general, which could yet plunge the nation into a devastating war, would further encourage a culture of lawlessness.  As part of the healing process, Congress should enact or strengthen appropriate legislation.

Boundaries Set the Tone for All Society

Human beings have a strong impulse for a cause greater than themselves.

The draft ended in 1973, and yet currently there are close to 2 million active and reserve members in the United States military.  About 2 percent of our current population have served.  These are men and women who have volunteered to spend their working lives serving our country and are willing to die for us if it comes to that.  This does not include the covert forces of the CIA and contractors in combat zones.  Throughout history, humans have suffered martyrdom for faith, gone into battle to serve a king, or fought oppression without considering the real probability of dying.  What causes people to disregard basic impulses for survival?  Commonly, it is a powerful sense of meaning that comes from belonging to a greater cause.  Whether it is a high school pep rally chanting, “We are the Tigers!” or a group of Marines storming a beach against enemy fire, it is our human need to belong that carries us along.

Whereas healthy boundaries and standards can lead this impulse to greater heights, demagogues can alternatively hijack it to darker places by offering quick, easy “belonging” to their ulterior motivations and plans.  The contemporary exemplification of this phenomenon is Trumpism and the mass rallies chanting, “Lock her up!” or “USA, USA!”  The sense of belonging to an elite group that is more “American” and more “patriotic” that the “other” gives great pleasure and pride, a false sense of superiority that is rewarding—especially to those famished of this feeling.  When an otherwise educated and civilized population is subjected to constant propaganda, these appeals to existing prejudices and base impulses can lead to the erosion of ethics and morality, to Nazi Germany.  “I was just following orders” is the defense of those who do unthinkable things for group acceptance and approval.  A constant barrage of lies and norm violations become doctrine if repeated enough by those in authority, especially when others around them do the same thing.

Mental Impairment Seldom Leads to Exoneration

What of the leaders?  Adolf Hitler escaped accountability at Nuremberg by committing suicide, and to avoid the public desecration of his body as happened to fellow criminal Benito Mussolini, he had his body incinerated with gasoline.  For what crimes could he have been tried?  Lying to the people? Orchestrating mass murder?  Persecuting political enemies?

In his defense he could claim mental illness with paranoia, megalomania, brain damage from measles encephalitis, or posttraumatic stress disorder from serving in World War I, but none of these would exonerate.  He was clearly acting with premeditation and deliberation as outlined in his bestselling book.

We are not saying Donald Trump is the same as Hitler because as of this date he has not started a World War or invaded Mexico or Canada,. But he is under investigation for numerous state and federal crimes and is the subject of civil suits for libel, defaulted debts, and loans.  Should he be exempt from federal prosecution because of a pardon?  Should his debts be forgiven because he is an ex-president?  Should he not be subject to the law “for the sake of national unity and reconciliation” and, “to avoid a long national nightmare”?

We don’t think so.  As forensic psychiatrists, it is not difficult for us to say that an insanity defense for President Trump does not pass the smell test, and failure to prosecute crimes for which the evidence is clear would undermine the very foundation of our justice system.  In fact, we are of the opinion that healing cannot—and should not—occur without prosecution.

Holding Leaders Accountable Is Correct Treatment

Bringing a high-profile criminal to justice can actually be healing for our collective mental health. After four years of “alternative” realities toppling our sense of right and wrong, health and pathology, almost half of the nation finds refuge in his cult of supremacy and anger, while the other half is traumatized.  Prosecution and clear boundaries can help bring reality back to both parties that have been gaslit into believing untruths, usually at the expense of their interests, their livelihoods, and even their lives.

Firm boundaries are necessary because tolerating intolerance, paradoxically, leads to intolerance and persecution.  Likewise, blurring the distinction between health and pathology leads to pathology’s flourishing at the expense of health.  As psychiatrists, not politicians, we have an obligation to provide an antidote to delusional thinking and violent behavior, even if the propaganda systems pervading mass media and the Internet will not.  The remedy for psychosis is reality checks.  In the case of a pathological and criminal president, recommending prosecution is an essential part of setting standards and doing our job as healers.

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.  He and Bandy X. Lee are coauthors of “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.”