Close to a psychotic break? Harvard psychiatrist on Trump's downward spiral -- and how his paranoia may persuade him to leave office

He has shown himself to be a malignant narcissist and a habitual liar. The Washington Post’s ongoing tally of Trump lies is now at almost 14,000. These are not “misstatements” or “gaffes” or the semi-harmful utterances of a fabulist: Donald Trump behaves like a pathological liar.

Republican leaders and others in Trump’s inner circle know that he is mentally unwell. They speak of that fact in hushed tones and in “off the record” conversations with reporters. This is but another example of how Trump’s Republicans are more loyal to power, and to him, than they are the country’s well-being.

Trump’s voters and other followers are members of his political cult. They share his collective narcissism and other pathologies. To abandon or criticize their leader would require them to engage in a level of critical self-reflection they may no longer be capable of.

After a recent meeting in which Trump raged at Nancy Pelosi and other leading Democrats for criticizing his abrupt abandonment of the Syrian Kurds, the House speaker said the president had had a “meltdown”.

Of course, many of America's and the world’s leading mental health professionals have been sounding the alarm for several years about Donald Trump’s behavior and pleading that he be removed from office as a matter of public safety.

America is facing two crises in the same person with Donald Trump. He will likely be impeached for high crimes and misdemeanors. He probably should also have been removed from office months or years ago under the 25th Amendment because of his mental instability.

The stress of impeachment and a looming sense that perhaps, after 70-plus years of life, he may face some accountability for his wrongdoing is apparently causing Donald Trump to retreat into a delusional alternate reality.

On Thursday, CNN described Trump's response to the Ukraine scandal: “The President did what he often does when an unappealing political reality threatens: He simply invented a more advantageous one, launching misleading attacks on the conduct of the inquiry and picking new fights.”

On Wednesday, New York magazine reported that Trump is now making up quotes praising him, including one from Senate Majority Leader Mitch McConnell:

Trump’s apparent fabrication of McConnell’s quote is part of an increasingly common pattern in which he passes along praise from a third party that’s impossible to source and then gets called on it, typically by reporters and occasionally by the person who supposedly uttered the compliment. It’s a departure from Trump’s long-held habit of inventing quotes and attributing them to unnamed “anonymous validators,” or making up quotes that purportedly came from his political opponents.

Donald Trump's personal consigliere, Attorney General William Barr, is undermining the rule of law and the U.S. Constitution by giving legal weight to absurd conspiracy theories that Trump is the victim of a "coup" by the Democrats, the FBI and Robert Mueller. Conspiracy theories are the bedrock of Trump's alternate reality. Conservatives and their propaganda media provide outside validation for the president's delusions. Collectively they are enablers of the Mad King.

During a recent interview with MSNBC’s Laurence O’Donnell, psychiatrist Dr. Lance Dodes described Trump’s overall mental condition as a “psychotic-like state.”

I recently spoke with Dodes, formerly an assistant clinical professor of psychiatry at Harvard Medical School (retired) and now a training and supervising analyst emeritus at the Boston Psychoanalytic Society and Institute, about Trump’s apparent downward spiral of mental and emotional health.

Dodes is also a contributor to the bestselling volume “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.”

In this conversation, he explains why Trump’s supporters will not abandon him and what will likely happen if Trump is forced out of office, by impeachment or other means. Dodes warns that it is difficult for mentally and emotionally healthy people to understand Donald Trump’s behavior — which in turn amplifies Trump’s ability to engage in lawlessness, corruption and the debasement of American democracy.

As is customary, this conversation has been edited for clarity and length.

Is there anything Donald Trump is not capable of?­

No. He literally commits crimes against humanity, the sort of things that were taken up at the Nuremberg trial. Caging children away from their parents is a crime against humanity, and it's hideous to think that there's anybody supporting that, although we know there are many people who are. The abandonment of the Kurds, our allies, to a possible genocide is another potential crime against humanity. So, no, I don't think there's anything he's not capable of doing.

How do Trump’s minions and agents justify such horrible behavior and the harm they are causing to other human beings? What are they telling themselves? 

These people are looking after their own skin. They know that it's wrong but they lack courage or honor. They're protecting their political self-interest ahead of protecting humanity. I believe the politicians who support Trump will turn against him as soon as they realize that staying with him will prevent their being re-elected, but not for any moral reason.

A key element in Trump’s enduring power is that his supporters are in love with him. He is a fantasy figure for the rank-and-file Trumpists, especially his famous “white working class” supporters. His supporters wish they could do all the horrible things Trump does without suffering any consequences. 

Yes. And they love him because they buy his Big Lie that he cares about them and will fight for them. The tragedy is that this is an intentional con, an exact reversal and concealment of the truth that Trump cares only for himself and his need to see himself as great. He does not care at all about them. The large version of that is that Trump does not care at all about America. His slogan, too, is exactly backward and would honestly be "Make Me Great, Again and Again."

If Trump is forced from office, what will happen with his followers? Will they suffer a mass psychotic break? Do you think there will be violence?  

If Trump is actually ever forced out it will have to be with Republican support. Consequently, his supporters will have people in their own party to turn to, and they and their politicians will create a version of reality that they can live with. There will likely be a mass denial that they ever really supported Trump.

A lot of people have said that he won't leave peacefully. I think that he will. He's clever that way; he perceives it would not be in his personal interest to have to be carried out of the Oval Office by the FBI. His focus on his personal benefit at any cost is why he's a successful sociopath.

My guess is that he will find a way to leave with an invented rationalization. He'll say he was pushed out by the bad people: the Mexicans, the crooked media, etc. He'll continue to portray himself as a victim, and he'll encourage people to rally around him and, not incidentally, around his companies. He'll maintain the near-psychotic view that he is not diminished at all but has been attacked by heathens. And a certain number of people will follow him.

The Mueller report is a profile of how clever and guileful Donald Trump really is. He is very wily. 

Absolutely. That's what makes Trump successful, but it doesn't make him mentally healthy. People keep getting those things mixed up. Rising to the top of a political system is a kind of success, but too often is associated not with mental health but with deep sadism, paranoia and lack of conscience. Trump shares these traits with tyrants throughout history. They are based on a fundamental lack of empathy, an absence of the capacity to see other human beings as having their own existence and value.

This capacity is so fundamental that we usually don't even think about it. Correspondingly, when it is absent, as in Trump, it is among the most severe mental abnormalities. And yes, it can coexist with being wily, manipulative and "successful."

Trump has also repeatedly showed that he loses contact with reality when his need for greatness is challenged. He has what we would call a psychotic core. It's not on the surface, but you see it, for example, when he insisted that he had the largest inauguration crowd in history. It doesn't matter that there is absolute evidence to the contrary; his need to believe it is essentially a delusion.

This vulnerability to fall into a psychotic-like state is consistent with his lack of a conscience and lack of ability to care about others. These are all characteristics of very severe psychological impairment. His disability makes him far less competent, and far less safe, to be president than virtually every one of his admirers.

The image of Trump in El Paso after the mass shooting there, where he held a child who had been orphaned in part because of Trump’s own hateful rhetoric and behavior is damning. It encapsulates who Trump really is.

The reason I'm so calm about it is that I see Donald for who he really is. It's very hard to get this across to the public, because every time people talk about him, they start out with the unspoken unconscious assumption that he's basically like the rest of us.

But in order to explain and predict Trump’s behavior, you have to begin with awareness that he is essentially a predator. Once you keep in mind that Trump lacks a conscience and lacks empathy, he becomes very easy to follow. Unlike normal people, who are complex, he's basically running on a very simple and very disordered program.

Trump is now is his third year as president. At this point, how would you assess his mental health?

The more pressure Trump is under, the worse he gets, the more desperate he gets. Challenges are a fundamental threat to him, so Trump will become more and more panicked by them. He will do more and more impulsive things — really anything — and will look crazier and crazier because he'll become more and more paranoid. The more people say to him, “You are the problem,” the more he's going to say exactly the same thing to others. For example, as soon as people take seriously the idea of his being impeached, he uses the same word, he says those people should be impeached. Trump is acting like a very young child. But he can't do any better than that.

In the end, if they finally get Trump out of office, he will declare that they're all bad and that he's the victim of a coup — which is what he has already said. Trump will leave intact — in his own mind.  He retreats to his tower in New York and gathers around him all the people who are still loyal to him. Donald Trump will try to continue to scam the world in the future.

Is Trump’s behavior as simple as the type of “projection” that a student learns about in Psychology 101?

There's a version of projection called “projective identification.” This is the sickest form of projection. In projection, you say, “I'm not the one who hit you. You hit me.” But projective identification is not only that you hit me, but that you as a whole person, your entire being, is evil. I identify you globally; everything about you is bad. Trump does this, for instance, through his name-calling. If you give somebody a name, like "Crooked Hillary," you're defining them. That's a very primitive, although effective, way to projectively identify other people. It's normal in childhood, by the way. Very young kids do that to each other all the time.

How does a person with an emotional state like Donald Trump’s respond to a crisis, that moment when the red phone rings in the middle of the night in the White House because something horrible has happened?

I think Trump sees it as an opportunity. It's all about him. There's nothing else. If there isn't a crisis, Donald Trump will make one. He would love nothing better than to have an attack take place on America or the country’s allies. That's the best thing that could happen to Trump. Now he stands before the country, representing the country and being the country, saying, “We have to stand together,” which in reality means, “Stand with me.”

During a recent interview with Laurence O’Donnell on MSNBC, you warned that Donald Trump is spiraling into a psychotic state. Given what has happened with impeachment, Ukraine and other events since then, how do you assess Donald Trump’s psychotic state right now?

The more pressure Donald Trump is under, the more he will be obviously out of touch with reality. I think in the last moment of his psychotic state as president, rather than lying on the floor shouting in a psychotic way, I think he will make up his own reality. Trump will declare that everybody is evil. He'll leave to be in his own tower, in his own world, in his own gold house. He'll gather his followers around him, so he doesn't ever have to deal with reality. Like a cult leader, Donald Trump will always have the Trump followers and he'll always believe himself to be a god.

Are Trump’s supporters capable of shame? When this is all over will they be able to look back on their behavior and say, “Oh my God, I'm embarrassed.” Will they then deny ever having supported Donald Trump? 

I think some will say, as Trump would, because he's incapable of shame, “We were right all along.” They'll buy the story of Trump as victim, or they'll rationalize it. They'll say, “Well, you know, the whole country was behind him. We didn't know what we were doing. We didn't realize.” To your question about what they believe internally, I think some Trump supporters will feel ashamed. Obama won in 2008 and 2012. Some of those people later voted for Trump. These are the same human beings who are perfectly able to admit they were conned by Donald Trump. And that's understandable, given Trump's ability as a master sociopath. There's an old saying, "Fool me once, shame on you; fool me twice, shame on me." I think the American public, which is a lot healthier and wiser than Donald Trump, is too smart to be fooled twice.

Is Donald Trump one of the most dangerous people on the planet?

Yes. He is the most dangerous person on the planet.