Psychoanalyst says Trump's 'mental pathology' means he 'hates reality'

Donald Trump is a living, breathing national emergency. Our president has repeatedly encouraged violence against his perceived enemies — and at least some of his supporters are following his lead. These are not isolated incidents. There are dozens of court cases where Donald Trump has been cited for "inspiring" acts of violence and other crimes.There are also the most odious examples such as the recent white supremacist terror attack in El Paso in which the alleged mass murderer wrote an online "manifesto" that almost verbatim channeled Trump's threatening rhetoric towards nonwhite people.

In response to the white supremacist terrorist attack in El Paso and another mass shooting that same weekend in Dayton, Ohio, Trump specifically avoided a message of healing in a country reeling from multiple mass murders. Instead, Trump participated in ghoulish, vainglorious photo-ops at hospitals where the dying and injured were cared for after these incidents. Incapable of grace or dignity, Donald Trump lashed out at his political opponents. He even insulted the Republican mayor of El Paso during his visit to that city, calling him a "RINO" because he dared to push back against Trump's disparaging comments about the city.

Donald Trump has publicly lied more than 12,000 times since becoming president, an average of 13 lies a day. These lies have created a cult-like alternate reality for Trump and his supporters.

And then there is the Mueller Report, which — in addition to detailing Trump's repeated efforts to obstruct justice and his de facto conspiracy with a hostile foreign power — is a damning portrait of a president who is mentally unwell.

Donald Trump is the common denominator across these events. His mind is the unifying factor. Why are so many Americans in the general public and the news media still unable to comprehend Trump's bad dangerous behavior? How are Trump's mental health issues influencing his supporters?

Given his habitual breaking of social norms, disregard for the law, and other alleged criminal behavior — including sexual assault, financial corruption and extensive obstruction of justice — is Donald Trump even capable of feeling shame or guilt? Does Trump feel any empathy for the people he is hurting, especially the migrant and immigrant families being separated or abused in border facilities? What would have become of Donald Trump if he had not been born into an affluent white family?

In an effort to answer these questions I recently spoke with Dr. Justin Frank. This is our third conversation for Salon. Frank is a former clinical professor of psychiatry at the George Washington University Medical Center and a physician with more than 40 years of experience in psychoanalysis. He is the author of the bestselling books "Bush on the Couch" and "Obama on the Couch." His most recent book is "Trump on the Couch: Inside the Mind of the President."

This conversation has been edited for clarity and length. You can also listen to my full conversation with Dr. Justin Frank through the player embedded below.

There is a part of Donald Trump that has never really believed that he is president. It's almost as if Trump does not know that he is president of the United States because he's an actor. Unconsciously Trump is so identified with his role in "The Apprentice" that he has to have written-out parts that he recites. When he's left to his own devices, he goes off script, as it were. Trump has always been scripted. The people who worked with him on "The Apprentice" were always very disturbed by Trump's behavior because he would always go off script.

Trump is against any kind of rules or regulation. He sees everything as a kind of psychological straitjacket. For example, when he was reading his statement about condemning racism he acted like a prisoner, a hostage. But in reality Donald Trump is a prisoner — on an unconscious level — of his father. Trump's father insisted that he had to behave a certain way. When Trump was a juvenile delinquent and his father discovered it, he was sent away. The only other person around who knows about his delinquency, at least in Trump's mind, is special counsel Robert Mueller.

How hard is it for Donald Trump to simply do what is expected after these horrible events — that is, to lay low for a few days, before re-emerging and going back to his regular behavior? He could go back to his attacks and other vile behavior later on. All that was expected was a few days of pretend decency.

He can't. You think it's a choice. Donald Trump cannot act another way. He's unable to because he becomes enraged at anything that restricts him. Trump wants to be able to grab women whenever he can. He wants every golf ball to go into the hole, and if it doesn't he'll just cheat. He wants everything his way. Donald Trump probably has the lowest frustration tolerance of any president I have ever witnessed. Look at what Trump did when he went to El Paso and Dayton. He was attacking his enemies there too. Donald Trump cannot help but to act this way. It is who he is. Anytime Trump is at all criticized, or there are expectations put on him regarding his behavior, it makes him very upset. Donald Trump hates rules.

How can people who are relatively normal and mentally healthy understand the behavior of a mentally disordered person such as Donald Trump? Is that even possible?

It is very important for the American people to be able to see someone like Donald Trump who is actually not normal. It is very hard for most people to accept that Donald Trump is not normal, because it is such an unusual situation. He doesn't believe in rules. Not ever. Look at how he acts with Congress and the rule of law. In that sense Donald Trump is like a two-year-old child.

Does Trump have either a shame or a guilt response? He chose to make El Paso and Dayton into celebrations of his presidency. What is going on inside his mind in such moments?

There are some people who we could label or describe as "sociopaths" or "psychopaths" who actually have no shame. They are not able to think about the consequences of their actions. They're not able to empathize with others. They are not able to feel guilt. Shame and guilt are also related. These sociopaths and psychopaths can say whatever they want because they have no shame about their behavior.

Because Trump feels no shame, he can go to Dayton or El Paso and have no memory of his sadistic, destructive rabble-rousing speeches full of hate where he talks about sending Americans back to "where they came from." He can call whole groups of people rapists. Donald Trump actually forgets that he ever said those things. My guess is if you showed Donald Trump a video of him saying those things he might look at you and say, "I think that's fake, I think you doctored that." That's disturbing. As psychoanalysts we understand how one of the things that makes for a certain kind of mental pathology is a hatred of reality and an attack on thought. Donald Trump hates reality.

When Donald Trump talks about "fake news," that is a type of projection. Trump is the one who is fake — Trump really believes that anybody who criticizes him is fake. Trump also projects his own dishonesty and fakeness onto the press and the news media in general. Trump really feels that they are dishonest. He believes it. He believes that they're making stuff up about him. Trump says things such as, "Of course my words bring people together. How could they not?" "I don't have a racist bone in my body!" Trump means it. This is very hard for many people to understand. Trump's behavior really is jaw-dropping.

Donald Trump goes to a hospital in El Paso and sees people who were hurt, killed, maimed and emotionally scarred because of his words and deeds. How does he navigate that emotionally and cognitively? Is there a moment when Donald Trump says to himself, "I say these vile racist things. People listen and then they write manifestos quoting me before they commit mass murder?"

That is disassociation. Trump is disconnecting what he sees from what he feels. Trump is also disconnecting what he sees from his own responsibility for what is happening. It's an unconscious process. It is so deep that a person would not feel or see it. They would not feel responsible for their behavior.

How does Donald Trump think about his responsibilities as president?  

It has to be about him. Trump feels responsibility in a genuine way, even though he is actually not doing anything to create good outcomes. The problem with Trump is that, first of all, there are so many different factors psychologically and emotionally that are involved with his behavior that to really understand Donald Trump would mean that you would understand of all of psychiatry. You would understand every single pathology, you'd understand paranoia. You would understand sociopathy. You'd understand sadism. You'd understand grandiosity and malignant narcissism. You would understand every single thing about psychiatry, because Donald Trump has all of the characteristics writ large. Donald Trump should not be president. He should be removed immediately.

Donald Trump is a political cult leader. There are these white supremacists and right-wing terrorists who are killing people. Other supporters have committed acts of violence as well. Then there are his rallies, which also feature themes of violence and hatred. How are Trump's supporters feeding off him?  

One of the functions of a president is that they are like a superego figure for a society. They're the leader. We're all in the same pack, if you will, as Americans. Internally we have a set of rules and regulations that the president embodies. As a kind of superego, the president is the person who says what's right and wrong. Most people's superegos dictate that we cannot go around doing whatever we want. We may have certain impulses and feelings but we know how to resist them because they're hurtful to other people or they're illegal or what have you. Donald Trump gives people permission to do such things, to be unrestrained.

That is why his supporters love him. Trump does not believe in "political correctness." A person just can't just walk around and attack people or say negative things about people. You have to be proper, thoughtful and respectful. But Trump is saying, "You don't have to do that. I'm sick of being respectful." Because Donald Trump is giving people permission to do whatever they want, that makes him an immoral and amoral leader. Alcoholics drink in order to narcotize their superego so that they can act without guilt. In that way Donald Trump is the ultimate glass of vodka for his followers.

From El Paso to the "MAGA bomber" and other incidents, some of them lethal, Trump's people are engaging in acts of political violence all across the country. The United States seems ready to explode. What is going on in the collective minds of Donald Trump's supporters?

In the United States under Donald Trump the country is dealing with a new level of imminent mass paranoia. This is something that we've seen throughout history in one form or another. It's much worse now because of television and the internet. With Trump and his movement's racism and overall hostility towards Hispanics and other people of color, that paranoid anxiety is very contagious. With his rallies and and news media, Trump's paranoia goes beyond an individual psyche because certain kinds of restrictions are compromised in a group setting. This means Trump's supporters can quickly become rabid and paranoid in a way that's much more virulent than in past eras. But the specific problem with Donald Trump is that his tweets and other relentless attacks can provoke lots of people to violence, many of whom are already on the edge.

In court cases all over the country, Trump's supporters and their attorneys are citing him as an excuse for their violence.

The issue is complicated because most Americans possess an internal fantasy that the president of the United States is like some kind of parent figure. But Trump as the parent figure is inciting violence and giving permission to do things most people would not do. Trump's influence allows for people to justify and express their hatred. Instead of calming and soothing the American people so they can get through and triumph over a time of crisis, Donald Trump works people up and makes things worse.  Donald Trump does not fully understand what it means to be president. He really doesn't.

Looking at recent events here in America, ICE agents are stealing children from their families, there are concentration camps for nonwhite immigrants, refugees and migrants, the world sees images and other accounts of children suffering horribly because of Trump's choices and policies. There are so many examples of Trump and his administration's cruelty that it would be difficult to list them all. What is this doing to the American people?  

Donald Trump actually hates loving families. He hates a deep connection between mothers and children. Donald Trump hates loving families and those deep connections, as shown, for example, by the fact when his wife Ivana was focused on other things it made him crazy and he started running around on her as a result. Donald Trump could not stand Ivana's focus on the children. Donald Trump hates mothers and children. He cannot control those feelings.

Therefore Trump's goal is to separate mothers and children. he wants to punish them. These feelings are very deep. I think it's obviously unconscious, and he would deny it. But look at Trump's behavior with migrants and refugees and immigrants from Mexico and South America. It is everything Trump is doing. All those pictures of the kids in his detention centers and other kids who are having their parents taken from them because of those ICE raids are horrible. But those images do not move or otherwise touch Donald Trump. They don't tug at his heartstrings.

What of the image of Donald Trump holding a now-orphaned baby in El Paso, the parents killed because of Trump's stochastic terrorism and scripted violence against Latinos and Hispanics? Trump was actually giving a "thumbs up" while holding an orphaned baby whose parents were killed because of the white supremacist terrorism that he encouraged.

The uncle of that baby wanted to meet Trump. So between him and whoever was around Trump, they got the baby brought back to the hospital. The uncle sees Trump as a hero. That's what becomes very difficult for emotionally healthy people to understand. Donald Trump is obviously and clearly depraved. He turned a tragedy into a happy photo-op. Why? Because Donald Trump cannot really experience empathy or compassion. That is not an option for him. It is very disturbing that other people support that horrible part of Trump's personality and behavior.

If Donald Trump were not president, but instead the American people were his family and he was the father, what would the relationship look like?

There are no options that are good. If Donald Trump is your father and you are the child, you can't leave the home because you need your father. This is what's called the "double bind." You need the person who is supposed to take care of you, and yet the person who's supposed to take care of you doesn't love you. Then you don't know what to do. One of the options people have is to shut down and go off and distract themselves. People develop a fantasy life to escape into.

Other people identify with the aggressor, the abuser. This is what Donald Trump did. He became cruel, like the parent, as a way of protecting himself from his own anxiety. People who adapt in that manner become the way the parent is towards them. Then they become that way towards other people, which is where bullies come from. So there are lots of different ways of coping. None of them are very good. If a person in this situation is lucky, a kind relative or other adult will rescue them.

If the parent is president of the United States, what options are there?

The only option is to impeach Donald Trump or vote him out. But then there is a problem: There are many people who will rush to Trump's defense. There are many people who love Donald Trump in a defensive way, because they are afraid of him and what he could do to them if they betray him or show disloyalty. There are other people who feel freed by Donald Trump. They are full of resentment and anger. More people are willing to to act on those emotions.

They now have permission from Trump to do so. This bad behavior encouraged by Donald Trump can become an epidemic.

If Donald Trump had not been born into money and had not become president of the United States, what would he likely be doing now?

Donald Trump is a leader. He is a strong person in that way. Donald Trump would either be a gang leader or some version of Al Capone. Trump would likely be a mob boss. That's who he is. That's how he'd be on the street. He might be in jail. Hopefully. What military school did for Donald Trump was it sublimated his active destructiveness. In other words, he stopped throwing rocks at people and beating people up and he became verbally destructive. He also became destructive in the business world.

Donald Trump's father always wanted him to be a killer. So psychologically Donald Trump functions like a killer — but he doesn't kill directly. Donald Trump has other people that do it. In America there is an epidemic of violence about to happen because of Donald Trump. Donald Trump has to be quarantined to stop it.