A letter from 200+ mental health professionals on Trump's dangerous psychopathology

[This letter will run as a print ad in The New York Times.]

A letter from mental health professionals on Trump’s dangerous psychopathology - Anti-Psychopath Political Action Committee

As mental health professionals, we have an ethical duty to warn the public that Donald Trump is an existential threat to democracy. His symptoms of severe, untreatable personality disorder—malignant narcissism—makes him deceitful, destructive, deluded, and dangerous. He is grossly unfit for leadership.

Trump exhibits behavior that tracks with the American Psychiatric Association’s Diagnostic and Statistical Manual’s (DSM V) diagnostic criteria for “narcissistic personality disorder,” “antisocial personality disorder,” and “paranoid personality disorder,” all made worse by his intense sadism, which is a symptom of malignant narcissism. This psychological type was first identified by German psychologist Erich Fromm to explain the psychology of history’s most “evil” dictators.

Detractors object that we mental health professionals cannot render such a diagnosis without first examining the patient, citing the “Goldwater Rule.” We believe that we have an overriding ethical duty to warn the public of the danger this individual poses. History has taught us that in such circumstances, saying nothing is never the more ethical choice.

Since the Goldwater Rule was adopted, the field has modernized the DSM diagnostic system, which relies exclusively on “observable behavioral criteria.” For many years, we’ve all observed thousands of hours of Trump’s behavior, reinforced by the observations of dozens of individuals who have interacted with him personally. Using the DSM V, it is easy to see that Trump meets the behavioral criteria for antisocial personality disorder. Even a non-clinician can see that Trump shows a lifetime pattern of “failure to conform to social norms and laws,” “repeated lying,” “reckless disregard for the safety of others,” “irritability,” “impulsivity,” “irresponsibility,” and “lack of remorse.”

Because of their sadism, malignant narcissists often derive joy from inflicting suffering on others because they disregard the emotions and wellbeing of other people—especially their perceived enemies. For example, according to first-hand accounts, Trump watched the violence he unleashed on January 6 for three hours on TV with “glee,” watching his favorite parts “over and over” on “rewind.”

To make matters worse, Trump appears to be showing signs of cognitive decline that urgently cry out for a full neurological work-up, including an MRI and neuropsychological testing. These symptoms include: a dramatic decrease in verbal fluency, tangential thinking, diminished vocabulary, overuse of superlatives and filler words, perseveration, confabulation, phonemic paraphasia, semantic paraphasia, confusing people (not just names), as well as exhibiting deteriorating judgment, impulse control, and motor functioning (including a wide-based gait). We suspect the results of such an evaluation would be disqualifying. If, as we suspect, Trump does have organically based cognitive decline, it will only get worse over time, grossly degrading his already impaired judgment, impulse control, memory, attention, reality testing, and capacity to process information, while dramatically exacerbating the symptoms of his toxic personality disorder.

People suffering with mental illness are no more likely to be dangerous than the general population. Malignant narcissism is the very rare exception. Without question, malignant narcissists have been history’s most grandiose, paranoid, and murderous leaders. Inevitably, they escalate until they are completely out of control, ultimately destroying themselves and the nations they lead.

As mental health professionals we feel a desperate duty to warn our fellow citizens of this imminent catastrophic public danger before it’s too late.
https://www.psychopac.org/open-letter/