'Beyond our current worst nightmares': Mental health experts warn about the likely effects of a Trump comeback

Donald Trump's presidency and the destructive forces it unleashed are a mental health emergency — as well as a public health emergency in general. Trump may no longer be president, but his fascist political movement and the political party he controls continues to cause harm.

Trumpism is both a political cult and a manifestation of collective narcissism. Tens of millions of his followers now live in an alternate reality sustained by the Big Lie, an upside-down world in which Donald Trump is still the "real" president of the United States. Many of Trump's followers believe that he should be returned to power by any means available, including terrorism and other political violence.

The Trump regime and Republican policies more generally have literally caused trauma — physical, emotional, psychological and spiritual — for millions of Americans, including of course the deaths of at least 700,000 people from the coronavirus pandemic.

In a recent essay, author and pastor John Pavlovitz addresses this:

[F]or the first time in America's history the latent ugliness in people was revealed and validated and celebrated by a sitting president — it was officially normalized. And what we're experiencing now; this staggering, insensitive posturing in the face of so many people's suffering, is the late-ripening fruit of something that has been set into the bedrock of half our nation. It is the malicious entitlement that MAGA was designed to nurture from the beginning....
This quickly metastasizing moral cancer is something we've never experienced on this level in our lifetimes and it's something we're going to have to reckon with regardless of the political outcomes of the next four years. If the former president somehow takes that office again, these stories will surely grow exponentially more violent and more commonplace, but either way, the ugliness is here now.
The Trump Effect on America, is that once reasonable, rational human beings whose prejudices, fears, and phobias were all bound by some baseline decorum and common courtesy that kept them from intentionally harming others — have been empowered to revel in the worst of themselves. They believe cruelty is their birthright.

As early as 2015, many mental health experts began to warn that a Trump presidency would be disastrous for America and the world. They were correct in nearly all of their predictions.

It is likely that Donald Trump will be the Republican Party's presidential nominee in 2024. (In fact, the only unknown variable is whether he will actually decide to run.) Contrary to the naïve thinking of those Americans who believed Trump might magically go away, as president or otherwise he will be a fixture in American life for the foreseeable future.

What will happen to the American people's collective mental and emotional health if Donald Trump runs for president again — or if he is elected? What kind of damage would Trump inflict on America and the world in a second term? And how do we explain why so many Americans — both ordinary citizens and members of the political and media classes — continue to be "surprised" by the torrent of revelations about Trump's mental pathologies and his antisocial, anti-democratic behavior?

I recently asked several leading mental health experts — all of whom I have previously interviewed for Salon — to offer their warnings and predictions.

Dr. Lance Dodes is a retired assistant clinical professor of psychiatry at Harvard Medical School and a training and supervising analyst emeritus at the Boston Psychoanalytic Society and Institute.

The latest revelations about Trump confirm what we have known for years. Stephanie Grisham, his former press secretary, says, "The truth was that pretty much everyone eventually wore out their welcome with the president." This points to Trump's inability to comprehend or value other people; he can only use them while they serve his endless need to aggrandize himself, then discard them when they do not.

Grisham says, "When I began to see how his temper wasn't just for shock value or the cameras, I began to regret my decision to go to the West Wing." Here, she finally sees that Trump is not "crazy like a fox" but is truly a severely disordered person, in poor control and a danger to others. In Bob Woodward's book, as reported in the Guardian [and elsewhere], on Trump's way out of office, he drops F-bombs, "spewing expletives" and screaming at cabinet colleagues: "I don't care a fuck. You're all fucked up. You're all fucked."

This is an example of his paranoia, in which he denies responsibility for his multiple failures and losses, projecting these to others whom he condemns as worthless. Each of these revelations points to one or another aspect of Trump's delusional sociopathy: his absence of a conscience, incapacity to care about or empathize with others, projection of blame to others (paranoia) and his psychotic distortion of reality in order to maintain his belief that he has a godlike superiority.

Trump's primitive emotional state make him an enormous danger to democracy, which he cannot abide. As a consequence, if he were to again become president, the end of democracy in this country would become a realistic possibility.

Dr. Justin Frank is a former clinical professor of psychiatry at the George Washington University Medical Center. He is the author of "Bush on the Couch" and "Obama on the Couch." His most recent book is "Trump on the Couch: Inside the Mind of the President."

Trump once had an internal conflict between being a builder and a destroyer. No longer is it a conflict; he is a destroyer, plain and simple. Unconsciously, his destructive force was originally directed against his tyrannical and punitive father, displaced onto investors, the media, banks, etc. But his ultimate displacement has been on the founding fathers of America's democratic experiment.

He attacks basic institutions, from the CIA to the FBI to Congress itself. And since November 2020, he has put our entire electoral process in his crosshairs. If he were nominated and elected in 2024 — accounting for skewed results, in the event that right-wing voter suppression tactics are successful — it would mean that more Americans than ever embrace authoritarianism, and that would deliver the deepest blow to our democratic process in our history.

Psychologically, people yearn for strong leadership. However, they fail to understand that sorrow is the vitamin of growth, of strength. President Biden has been strengthened over his lifetime by facing sorrow and loss. Trump denies loss by triumphing over it with powerful defensive grandiosity. A leader who breaks things is also admired, interestingly, by adoring followers. They admire his ability to say and do things they themselves could never say or do in public. Trump fills that need perfectly.

The other major effect of a Trump victory in 2024 would be the likely apathy and despair felt by those who fought against him.

Elizabeth Mika is a psychotherapist and contributor to the 2017 bestseller "The Dangerous Case of Donald Trump."

The "revelations" really just confirm what we have known about Trump for years, long before he was elected. People with his character defect, malignant narcissism, are sadly predictable: They are driven by insatiable drives for adulation and power, and an unceasing desire for revenge on those who may interfere (or be perceived as interfering) with the realization of those drives.

It is really too bad that our media, broadly speaking, has remained in the dark about Trump's well-defined character pathology. Therefore, many journalists, mostly among the mainstream news media, continue to be shocked by these "revelations" as if unable and/or unwilling to finally arrive at an understanding of Trump's disordered character.

If Trump runs and wins in 2024, we will see an accelerated continuation of our demise. Every negative trend we are experiencing now will be augmented, especially our polarization, inequality and violence.

As of now, 21 million Americans believe that Trump, whose presidency was stolen from him, should be restored by violent force — and they are ready to make it happen.

Dr. David Reiss is a psychiatrist, expert in mental fitness evaluations and contributor to "The Dangerous Case of Donald Trump."

I am totally unsurprised. But vindication does not soothe the national tragedy or my personal frustration and even bitterness (which are of much less significance) at having been ignored by those who had power to intervene.

No one could have predicted Trump's specific actions while in office or now: His specific behaviors are inherently unpredictable. But the nature of his behaviors, the irrationality of his behaviors, the immaturity of his behaviors and the dangers brought about those behaviors were all quite predictable and in fact, were predicted.

You asked: What do I think will happen to America if Trump runs for office and wins in 2024?

In my opinion, the even more frightening question is this: "What would it mean had happened to the American people and American society if Trump were returned to office in 2024?"

It would mean there had been: 1) a complete breakdown of rationality within the social order; 2) the destruction of our democratic system of elections and government; or 3) that something so horrible had transpired that all hope was lost and, due to fear and desperation, totalitarianism or fascism had been embraced.

As to what would happen afterward, it would depend upon who was actually "pulling the strings" of the totalitarian/fascist regime for which Trump was the figurehead. Trump himself, at age 78 certainly would not actually be in command. I cannot begin to predict the exact manner or type of dystopia that would be enacted. I can predict that it would be beyond our current worst nightmares.

Dr. John Gartner is a psychologist, psychoanalyst and former professor at the Johns Hopkins University Medical School, and the founder of Duty to Warn. He was also a contributor to "The Dangerous Case of Donald Trump."

Democracy would be dead, and the coup complete. All future "elections" would be Putin-style shams, where the electorate never actually has the power to remove the Republicans from power.

We could expect criminal prosecutions against Democratic leaders, the press and anyone who opposed the regime. Experts of all types would be persecuted. "Patriots" would be encouraged to expose, punish and marginalize citizens at all levels of society who are not MAGA. Fox would become de facto state-TV propaganda. Only loyal "party members" would be allowed to work in government.

Hate crimes would skyrocket. Hundreds of thousands of immigrants would be incarcerated in concentration camps.

Thousands of ordinary citizens would join cells of an "underground resistance," which would become progressively more violent. This "terrorism" would be used to justify martial law and heavy surveillance. Millions would flee to Canada and Europe.

Internationally, the U.S. would become a Russian puppet state. NATO and our international alliances would crumble. The economy would contract. Global warming would spiral out of control. And we might well stumble into war.

Dr. Seth D. Norrholm is a translational neuroscientist and one of the world's leading experts on PTSD and fear. He is currently scientific director at the Neuroscience Center for Anxiety, Stress, and Trauma (NeuroCAST) in the Department of Psychiatry and Behavioral Neurosciences at Wayne State University School of Medicine.

The revelations that are merging from various sources who had access to the Trump White House are not at all surprising. As I and others have commented on for years now, no matter how you label or classify the former president's behavior (malignantly narcissistic, sociopathic, psychopathic, abusive), there is an underlying thread of immaturity. This immaturity plays itself out as an inability to regulate emotion, a behavioral profile typically seen in children and adolescents. It is therefore not surprising to hear about the former president's uncontrollable rage and the allegation that he had a handler specifically tasked with soothing him like a toddler. I expect similar stories to continue to come out.

What happens if the former president runs for office again in 2024 – and possibly wins? This would be a complete failure of several social, political, governmental, ethical and professional "guardrails."

From the perspective of the former president as an abuser, a future Trump candidacy and potential presidency would be a psychological slap in the face to all of his victims from the past six years. I've often used the analogy of an abusive relationship when it comes to the former president and his approach to governing. If the watering-down of the Mueller investigation and the acquittal following evidence-heavy impeachment proceedings was akin to the arrest and subsequent release of a criminally abusive spouse, a return to office would indicate zero accountability for, and an acceptance of, physical and emotional abuse from our leadership; a trend that has been gathering steam for some time now.

Considering the former president incited an attack on his own country and has continued to push the Big Lie undermining our electoral process, our democracy (already on life support) would suffer likely irreversible damage if this is further ignored and already eroded norms are obliterated beyond repair.

Moreover, considering that more than 700,000 Americans have died from a pandemic that could have been better controlled, which the former president downplayed to protect his political future, allowing a return to the campaign trail and potentially the White House would frankly forgive an accessory to negligent homicide on an unprecedented scale.

Taken together, the nation and the world would be presented with the psychologically untenable position of having to accept the worst that humanity has to offer, according to almost all of the "standards" established by modern society, as its leader once again.