Harvard trauma expert: There's a 'very real threat of a racist, misogynist and deadly dystopia' if Trump wins in November

This continues the series, “The Dangerous Case of Donald Trump Revisited: Mental Health Experts on the Devastating Mishandling of a Pandemic.”  Whereas we could not have predicted a pandemic three-and-a-half years ago, the authors of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President anticipated how the president would respond, should there be a crisis.  We tried to warn the public of the very consequences that are unfolding today: abuse of power, incompetence, and loss of lives and livelihoods of many Americans.

Dr. Judith L. Herman opened the conversation in many ways, by sending a letter to then-President Barack Obama, asking for a full neuropsychiatric examination of the then-President-Elect Donald Trump.  She is professor of psychiatry at Harvard Medical School, a renowned expert on the traumas of interpersonal violence, and author of the now-classic Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror.

Lee: You stated at the 2017 conference at Yale that, as professionals, there is a difference between getting involved in politics on behalf of the power of the state, and getting involved in politics on behalf of the rest of us who are at risk from the abuse of powers of the state.  You also argued that to the extent that we have knowledge that would be pertinent, we have a duty to share it with the public.  What is your position today, in light of what has happened in the interim? 

Herman: It doesn’t take a psychiatrist to recognize that Donald Trump is seriously impaired.  But from the moment he was elected, many mental health professionals have felt an obligation to share with the public whatever professional knowledge we have that might shed light on his mental instability.  My friend and our co-author, the psychiatrist Robert Jay Lifton, who has studied Chinese thought reform, Nazi doctors, and Aum Shinrikyo, the Japanese apocalyptic cult that released sarin gas in the Tokyo subway, speaks about the duty of “witnessing professionals” to warn about the dangers of political and religious zealotry.  Today, as the Trump administration has become ever more dangerous to our lives, our economy, and our democracy itself, I feel even more strongly that it is our duty as citizens and as professionals to bear witness.

In a talk he gave recently to the American Psychoanalytic Association, Dr. Lifton spoke of the authoritarian leader’s claim to command and “own” reality.  Truth is whatever the cult leader says it is.  The leader’s grandiose claims are based on a fantasy of violent purification and renewal that appeals to his aggrieved followers.  In the case of Donald Trump, whose slogan, “Make America Great Again,” emblazoned on a red hat, has become a symbol of cult membership, the aggrieved are mainly white men who long for a return to a time when women and people of color knew their place.  His enablers, those who know better but have made a devil’s bargain to maintain him in a position of power, are people and corporations of vast wealth who have their own fantasies of world domination.  As those who have studied the history of the twentieth century well understand, this combination of charismatic cult leader, aggrieved cult followers, and powerful enablers is terrifying.

As witnessing professionals, what can we say about the president’s psychopathology?  Chapters in our book reviewed the various entities that might be considered in a differential diagnosis: Is he a malignant narcissist?  A sociopath?  Is he psychotic?  Cognitively impaired?  Is he “crazy like a fox” or just plain crazy, i.e., when he lies constantly, does he know he’s lying, or does he believe his own lies?  When he makes wild accusations and promotes conspiracy theories of the far right, is he truly paranoid, or is he consciously manipulating the media?

My own answer might be yes to all of the above.  In the end, we can’t know his true state of mind, which may fluctuate in any case.  Diagnosis of a public figure at a distance is not only impossible, but also contrary to our professional ethics.  But we don’t need to know his true state of mind or his full diagnosis to make a professional assessment of his dangerousness.  As our co-author, the forensic psychiatrist James Gilligan, an expert on violent offenders, explained: “If we are silent about the numerous ways in which Donald Trump has repeatedly threatened violence, incited violence, or boasted about his own violence, we are passively supporting and enabling the … naïve mistake of treating him as if he is a ‘normal’ president….  He is not, and it is our duty to say so … He is unprecedentedly and abnormally dangerous (Dangerous Case p. 178).”

You led our book, The Dangerous Case of Donald Trump, with the warning that, with access to power, the flattery of underlings, and the chants of crowds, the new president’s grandiosity might morph into grotesque delusions of grandeur.  You also worried that his sociopathic traits would amplify as he discovered that he could violate the norms of civil society and even commit crimes with impunity—which turned out to be very prescient.  How have these tendencies affected his Covid-19 response? 

On July 1 of this year, the daily number of new cases of Covid-19 in the US surpassed 50,000 for the first time, breaking all previous records.  On the same day, President Donald Trump predicted, once again, that the virus would soon sort of “just disappear.”  He has made this prediction repeatedly since the outset of the pandemic.  First he promised that it would be gone by Easter.  In April, when cases of the virus were growing exponentially, he predicted that by summer it would magically disappear.  Summer is almost over, and the full scope of this utterly predictable disaster has become apparent: The U.S., with 4% of the world’s population, now has roughly one quarter of its Covid-19 fatalities.  Nevertheless, the president persists in his denial, clinging to his belief that he can dictate reality, that the pandemic will “disappear” (or has already disappeared) and the economy will come “roaring back” because he says so.  At the Republican National Convention he proclaimed that “We did the exact right thing,” and “We saved millions.”  New York Times columnist Nicholas Kristof writes: “I feel well equipped to cover the Republican National Convention, having covered personality cults in China, Iraq, and North Korea.  But this grotesque manipulation … dishonors and erases the 180,000 Americans confirmed to have died from Covid-19” (New York Times, August 27, 2020, p. A26).

How do you expect he will respond in the coming critical months of the presidential election and beyond, as he becomes ever more isolated and senses that his power may be slipping away? 

What is most frightening to me, as we approach this endgame, is the potential for apocalyptic self-destruction as Dear Leader becomes ever more isolated and senses that his power may be slipping away.  Two months ago, the president attempted to revive the mass meetings that have sustained his fragile egomania, The Virus Be Damned!  He was enraged and humiliated when, instead of the “hundreds of thousands” he expected, only some 6,000 supporters actually turned out, and the stadium was seen to be over half empty.  Apparently, quite a few supporters who might be happy to yell  “Trump, Trump, Trump!” “Build the Wall!” and “Lock Her Up!” in a crowd under ordinary circumstances had retained sufficient reality testing so that they were unwilling to risk their lives in a packed indoor space, where devoted cult followers refused to wear masks as a sign of loyalty to the leader.

The president has also been publicly rebuked, by present and former military leaders, for his decision to deploy military forces against peaceful citizens.  Polls consistently show that a majority of the U.S. public has had enough of him.  He is at risk of losing the election, and losing is something his narcissism cannot bear.  Moreover, he has probably retained enough of his own reality testing to know that without the shield of the presidency, he may be called to account for any number of his crimes.  Like many dictators under such circumstances, he may want to take the country, or the world, down with him.  Prepare for a very dangerous time.

You have been a pioneer for our efforts as professionals with a societal role.  Is there anything we might have done differently, and what lessons for the future can we draw from this experience?  

I very much regret the fact that my professional organization, the American Psychiatric Association has refused to take a stand of resistance to this president’s multiple abuses of power and his appalling failure to protect the public health during this pandemic.  In fact, without any consultation with the membership, soon after the election of this president, the organization’s leaders expanded ethical guidelines to silence any professional commentary on a public figure, no matter how disturbed and destructive he might be.  I consider this to be a pathetic act of cowardice on the part of the APA, and I have chosen to disregard their new rule in the service of what I consider a higher ethical principle of bearing witness.  I am grateful to my many colleagues who have done the same.

Is there anything you would like to add? 

What is most heartening to me, in the midst of our multiple disasters, is the mass mobilization that has taken place in response to the very real threat of a racist, misogynist, and deadly dystopia.  In two months we are due to have an election.  As it has become clear that the fate of our democracy is at stake, we have seen unprecedented activism and leadership from people of color, women, and young people who want to live peacefully in a just and sustainable world.