Drs. Nanette Gartrell and Dee Mosbacher were among the first to open a national conversation about this problem, joining Dr. Judith Herman in writing a letter to then-President Barack Obama about the then-president-elect’s need for a thorough neuropsychiatric evaluation. The actions they took to make the letter known are how the authors of The Dangerous Case came together, and how thousands of mental health professionals would follow from around the world.
Briefly, Dr. Gartrell is a psychiatrist, researcher, and writer who was formerly on the faculties of Harvard Medical School and the University of California, San Francisco. Her half-century of groundbreaking scientific investigations have contributed greatly to our understanding of sexual minority parent families, and have brought her numerous awards, including a recent Alexandra Symonds Award for her outstanding contributions to the advancement of women.
Dr. Mosbacher is a psychiatrist and Academy Award–nominated documentary filmmaker who was formerly on the faculty of the University of California, San Francisco. As a public-sector psychiatrist, she served as San Mateo County’s medical director for mental health and as senior psychiatrist at San Francisco’s Progress Foundation. Her films are also contained within the Smithsonian National Museum of American History collection.
Together, they authored the essay, “He’s Got the World in His Hands and His Finger on the Trigger” for The Dangerous Case of Donald Trump, outlining how a medical advisory body for the 25th Amendment should form.
Lee: The 25th Amendment to the U.S. Constitution addresses presidential disability and succession, and your recommendations, almost four years ago, for a body to be set up in its context seem remarkably prescient now. The president’s recent erratic behavior seems to have driven even Speaker Nancy Pelosi into introducing new legislation. She stated that the legislation would create a “Commission on Presidential Capacity to Discharge the Powers and Duties of Office” that includes outside experts tasked with evaluating his mental and physical health. Would you remind us of the recommendations you yourselves gave?
Gartrell: Under Section 4 of the 25th Amendment to the U.S. Constitution, Congress may constitute an independent, nonpartisan panel of mental health and medical experts to evaluate Donald Trump’s capability to fulfill the responsibilities of the presidency. We have recommended that the panel should consist of three neuropsychiatrists (one clinical, one academic, and one military), one clinical psychologist, one neurologist, and two internists. Our model states that the panel should be based on medical criteria, and appointed by an agency such as the nonpartisan, nongovernmental National Academy of Medicine nominating panelists, who may serve six-year terms.
Mosbacher: We stated that Congress should enact legislation to authorize this panel to perform comprehensive mental health and medical evaluations of the president and vice president on an annual basis. Also, the legislation should require the panel to evaluate all future presidential and vice-presidential candidates, and should be empowered to conduct emergency evaluations should there be an acute change in the mental or physical health of the president or vice president.
This is without doubt one of the greatest needs of our time. Yet it appears that the proposed commission will not form before 2024, and it may even die in the process if there is no presidential signature to allow it to become law. This seems a lesson not to wait until matters become very dire. What are your thoughts now?
Mosbacher: Speaker Pelosi stated that the legislation applies to future presidents, but Donald Trump’s behavior reminds us of the importance of the president’s mental fitness in a nuclear age. We call on our elected officials to heed the warnings of thousands of mental health professionals who have requested an independent, impartial neuropsychiatric evaluation of Donald Trump. The world as we know it could still cease to exist with a 3:00 a.m. nuclear tweet.
Gartrell: Throughout U.S. history, presidents have suffered from serious psychiatric or medical conditions, most of which were unknown to the public. For example, Presidents Pierce and Lincoln had symptoms of depression. Nixon and Johnson, paranoia. Reagan, dementia. And President Wilson experienced a massive stroke that resulted in severely impaired cognitive functioning. Although military personnel who are responsible for relaying nuclear orders must undergo rigorous mental health and medical evaluations that assess psychological, financial, and medical fitness for duty, there is no such requirement for the Commander in Chief.
With Dr. Herman, you—a team of three brave women—became the inspiration for our book, The Dangerous Case of Donald Trump, when you came forth with the first substantial public warning, which was pioneering for our profession. Would you describe what you did to get there?
Gartrell: Over the course of the U.S. 2016 presidential campaign, it became increasingly apparent that Donald Trump’s inability or unwillingness to distinguish fact from fiction, wanton disregard for the rule of law, intolerance of perspectives different from his own, rageful responses to criticism, lack of impulse control, and sweeping condemnations of entire populations rendered him temperamentally unsuitable to be in command of the nuclear arsenal. When he became the president-elect, we, as psychiatrists, had grave concerns about his mental stability and fitness for office. In November 2016, we received a call from our psychiatrist friend and colleague Dr. Judith Herman, who shared our concerns about Mr. Trump’s grandiose, belligerent, and unpredictable behavior. She proposed that we send a private letter to President Obama outlining our observations, and recommending an impartial psychiatric evaluation of the president-elect.
We agreed that such an assessment was warranted as a matter of national security. Dr. Herman offered to draft the letter. At the end of November, the letter was sent to President Obama, stating that Mr. Trump’s “widely reported symptoms of mental instability—including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish fantasy from reality—lead us to question his fitness for the immense responsibilities of the office.” We also strongly recommended that the president-elect receive a “full medical and neuropsychiatric evaluation by an impartial team of investigators.” We heard nothing from the White House.
Mosbacher: In December 2016, a journalist contacted us, and we decided that we were willing to take the step of sharing our letter, in the interest of placing our recommendation in the public discourse. This led to the letter being published in the Huffington Post and going viral. We declined all requests for further comment, since most journalists wanted us to specify psychiatric diagnoses for the president-elect, even though we had not personally evaluated him. Instead, Gloria Steinem posted the article on her Facebook page, and contacted Dr. Herman to brainstorm about who in the government could implement our recommendation. Robin Morgan suggested that we convey our letter to Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, and reminded us of the series of events that transpired during the final days of the Nixon administration. Because President Nixon was drinking heavily and threatening war, the secretary of defense, James Schlesinger, instructed the military not to act on orders from the White House to deploy nuclear weapons unless authorized by Schlesinger or the secretary of state, Henry Kissinger.
In January 2017, we sent our letter to Chairman Dunford, with the subject line: “An urgent matter of national security.” A week later, Dr. Gartrell met a woman who worked in government intelligence. Dr. Gartrell inquired if she would be willing to convey our recommendation to other professionals at the agency. The woman agreed to distribute our letter among key individuals who shared our views about Mr. Trump’s mental instability. As Inauguration Day grew closer, Dr. Gartrell, Dr. Mosbacher, Dr. Herman, Gloria Steinem, and Robin Morgan decided to send our letter to members of Congress whom we know personally or to whom we had access. We also agreed to publicize our recommendation whenever there was an opportunity. Our message was that, all in all, Mr. Trump’s hostile, impulsive, provocative, suspicious, and erratic conduct poses a grave threat to our national security.
If they had listened to you, we may not be where we are today, the most dangerous point of this presidency. It is frightening to observe his potential for apocalyptic self-destructiveness, as his fragile ego is injured, and he is filled with rage at the prospect of people falling away from him and his power diminishing. Do you have any thoughts on how our profession can help the public meet this moment?
Gartrell: One of the greatest travesties with regard to the mental health emergency that has descended upon our nation is the stifling of expert voices. Mental health professionals can alert to the need for all future presidential and vice-presidential candidates to have fitness-for-duty evaluations before they take office, just as military personnel do.
Mosbacher: When a historic movement of mental health professionals had garnered the attention of the public so as to become the number one topic of national conversation, the American Psychiatric Association extinguished the discussion rather than supported it. When independent professionals and journalists are silenced, it is usually a first sign of tyranny. We must still speak the truth to protect people everywhere.
Read previous interviews with Dr. Robert Jay Lifton, Dr. Judith Herman, and Dr. James Gilligan.
Follow Dr. Lee at bandylee.com.
