When we published The Dangerous Case of Donald Trump in 2017, we emphasized that, despite its title, Donald Trump was not our main focus. His presidency was more a statement about the nation and its state of public mental health, of which he was a barometer at the time of election and then the chief accelerant and exacerbator of its defects once in office.

Over the course of the last four years, we have witnessed how his "base" remained consistently at more or less 40% of the population despite continuous scandals and policy failures, including vastly increasing the death toll from COVID-19 through malfeasance and misfeasance and even a deadly assault on the Capitol. We had warned that this unwavering adherence was not a product of healthy, rational and well-informed decision-making, but followed more the pattern of pathological, abusive relationships.

Trump followers' unwavering adherence was not a product of healthy, rational and well-informed decision-making, but followed more the pattern of pathological, abusive relationships.

This does not mean that each follower of the Trump will exhibit abnormal psychology; on the contrary, they will resemble more victims of abuse and members of a cult, predisposed not just because of personal trauma history but because of a state of poor collective mental health. Societal mental health is not the same as the sum of the mental health of individual members, and the themes and conflicts of groups are not the same as personal struggles, even though they interact.

Some problems are better conceived of as cultural disorders, as the World Mental Health Coalition recently labeled racism and white supremacy. Violence, in general, fits more the category of a societal disorder than an individual one—indeed, violence does not depend as much on individual characteristics, such as individual mental illness, as it does on social ones, such as levels of inequality in a society.

U.S. Primed for Abuse

It is important to note how the United States as a whole in the last few decades has been primed for nationwide vulnerability to narcissistic abuse, no matter the individual variations in resistance. After four years of the Trump presidency, many of us who opposed him feel traumatized and victimized by his emotional abuse. What may be surprising to some is that his followers are also victims of his abuse.

Donald Trump has attempted to manipulate reality for all of us, but the millions of people who support him are deeply under his spell. He even manipulated them to invade the Capitol, both for his own strategic gain to pressure Congressional Republicans to oppose Electoral College tallies and to serve his emotional need to continue the lie that he won the election. Some insurrectionists may spend years in prison all so their leader could temporarily perpetuate a self-delusion to feel better about himself.

'Love Bombing'

Extreme narcissists often begin relationships with what is called "love bombing," a false expression of affection that frequently involves over-praising and over-promising.

Trump actually said in private that he dislikes his followers, even noting about the insurrection that it looked "low class." He likely holds contempt, furthermore, that they have failed—never mind that, according to an FBI agent, the nation barely escaped a massacre of its lawmakers by a minor miracle.

Yet at rallies, he praises supporters effusively and in a video after the insurrection told them: "We love you. You're very special." This love bombing forms a trauma bond in the victim of enmeshed patterns of dependency or emotional addiction. Trump followers crave his attention and approval, and he gives it to them, mainly because they then feed him the attention he craves. For the victim, it can lead to loss of sense of self, confusion and a relentless clinging to the abuser.

The extreme narcissist, however, views all relationships through the lens of: "What's in it for me?" This transactional pattern is revealed in Trump's abrupt abandonment of those he perceives to be disloyal to him or even fails to "win" on his behalf. If the former president is convicted in the Senate and barred from running for office in 2024, his followers may be surprised at how immediately his need for their attention and financial support disappears. Those who understand abusive personalities will not be surprised at all.

'Flying Monkeys'

Cult leaders use "deluded dupes" for their own purposes, mostly to generate narcissistic supply or attention. Also, a priority is harvesting assets for personal use, as we see from the hundreds of millions of dollars Trump raised after he lost the election and monetized his presidency as never before.

Another way abusers victimize is by recruiting others to unwittingly do their dirty work. A popular psychological label for them is "flying monkeys," who are the "henchmen" and "henchwomen" surrounding abusers to support their warped view of reality and self-centered behavior. Manipulation, intimidation, or opportunism and corruption may have caused their collusion with the extreme narcissist, but they serve to legitimize and maintain the abusive status quo.

Those in the population who are narcissistically wounded and insecure like to feel "in the know," or part of a secret "in group," which makes them feel powerful with a sense of belonging. As a result, they are attracted to conspiracy theories and cult-like organizations, a pattern that those at the Jan. 6 insurrection embodied, through membership in groups such as QAnon and Proud Boys.

When a society is made psychologically vulnerable through relative deprivation, then large segments of the population come to be drawn to narcissistic abuse or even "shared psychosis." Sometimes called "folie à millions" or "madness among millions," shared psychosis refers to the infectiousness of severe symptoms when a highly symptomatic individual is given an influential position.

Delusions Worse than Lies

When "mistruths" are not just strategic lies but delusions, for example, they spread much more rapidly. We can see this in how dramatically polls changed: only a small minority of Republicans thought in early November that Joe Biden did not win, but in a recent poll three out of four do not believe Biden won the election legitimately.

Removal of the highly symptomatic person from influence and exposure, such as from social media platforms, have already dissipated much of Donald Trump's influence and ability to incite violence.

Further accountability, prosecution, and limit setting will help discredit and "deprogram" his stronghold on his hitherto steadfast followers. We have learned how powerful the spread and reach of mental pathology can be—to the point of almost losing our democracy!—but we must also recognize that these are well-known dynamics throughout history that are preventable. Next time, we can do better through greater mental health awareness and by holding our leaders to a mental health standard.

Harper West, M.A., L.L.P. (harperwest.co) is a licensed psychotherapist, award-winning author and developer of self-acceptance psychology. Both she and Dr. Lee (bandylee.com) have participated in town hall series that are available here and here.