General Discussion

DU Exclusive: Interview with Dr. Bandy X. Lee ! [View all]

Recently, I had a conversation with DU community member “Mike 03” about Yale Professor Bandy X. Lee's book, “The Dangerous Case of Donald Trump.” Originally published in 2017, this important book featured the contributions of 27 psychiatrists and mental health experts. Last year, an updated and expanded version was published, which features contributions of 37 psychiatrists and mental health experts.

When my daughter Chloe gave me my copy of the book, she said that while she knew I did not want to have any books on Donald Trump in my library, she believed that this one was essential reading. From the moment I read the book's dedication – to Dr. Lee's Grandfather and Mother – I knew that I'd have difficulty putting the book down. And while I have since added a few other books that expose the madness of the Trump presidency to my library, I recognize “The Dangerous Case of Donald Trump” to be by far the most important.

During my conversation with Mike 03, , I decided toask Dr. Lee if she might take part in an interview for this forum. For if you want something important done, ask a busy person. They are most likely to do important things. I would like to thank Dr. Lee ….for the book, her appearances in the media to discuss the topic, and for this interview. I hope that community members will thank her, and read and discuss her book.



Q: Dr. Lee, as you would expect, there are people who feel depressed and discouraged about the process and outcome of the Senate’s impeachment trial. They are anxious about our country’s future. Others recognize that while the House impeachment was a significant victory, that the president is now more likely to engage in dangerous ways. In that context, can you please explain the “duty to warn” that has resulted in your speaking out?

A: It is entirely understandable that people are feeling depressed and discouraged; that he is more likely to engage dangerously is correct from our perspective, also. The error, from our view, has been in trying to solve a mental health problem through a purely political approach, which is why we petitioned the Congress to consult with us (https://www.independent.co.uk/news/world/americas/us-politics/trump-mental-state-impeachment-psychiatrist-petition-congress-a9232386.html). We had cautioned that impeachment could go either way: psychologically, delaying impeachment was risky, because it would cause a sense of unlimited power and impunity to balloon. A rapid progression after delay then maximized the potential for paranoia and narcissistic rage, while the combination of impeachment and acquittal now has created conditions that would heighten the drive for revenge. With each failure to contain the president psychologically, there has been an expansion of dangers as well as worsening of symptoms. We can learn from this experience and recognize that a nuanced, psychological understanding of the situation is paramount—even if political processes are the only interventions we have for psychological limit setting and containment, which are still a lot.


Q: In 1973, Erich Fromm published “The Anatomy of Human Destructiveness.” In it, Fromm detailed how certain social factors, combined with specific personality types found in those in power at the time, create fertile ground for what he referred to as “malignant narcissists” to rise to the top. Do you see instances – saying, putting children in steel cages on the southern border – in our society that concern you?

A: Traumatizing children in a way that will breed injury and violence for society concerns me a great deal! Erich Fromm understood dynamically what I have been studying statistically and epidemiologically. I have always conceived of this presidency as a reflection of the poor state of collective mental health in our society. In fact, I have been fearing this result for about twenty years while watching public mental health decline and what I call “structural violence” increase. Structural violence, such as economic inequality, is one of the most potent causes of behavioral violence, be it homicides, suicides, or warfare, and when the groundwork is laid for a culture of violence, people will be attracted to a leader who does them violence. It was not time to be complacent because homicide rates were declining, even as suicides were rising. My research has been mostly about “connecting the dots,” which I am making great use of now. We have become locked in a vicious circle, where the more violence powerful people do to the population, the more vulnerable it becomes to manipulation and attraction to violence in ways that give violent people more power. It is an abusive relationship cycle at societal scale.



Q: Older people such as myself remember the publisher and an editor of “Fact” being sued for a story that questioned Senator Barry Goldwater’s stability during the 1964 presidential election. This was in spite of the Senator’s wife telling reporters that he had previously suffered a “nervous breakdown.” The “Goldwater Rule” kept this general topic from being reported upon for many years. There are potential dangers in diagnosing someone the clinician has not met. This raises a question: is it possible that what an expert sees in the media, including films of speeches and press conferences, and legal documents, might be more accurate sources of information than the self-reporting of those being evaluated with the Hare Checklist? (This is not to suggest that Senator Goldwater was in that group.)

A:This is absolutely correct. We must distinguish the quality and reliability of information, not just discount all media as a source. For certain impairments, such as personality disorders that cause others suffering but are not bothersome to the self, it is far more accurate to have reports from the person’s acquaintances, the sworn testimony of close associates, and external, direct observation of behavior. If the media presentation is not all staged but shows reasonably candid moments, actual interactions with other people, extensive coverage, and progression over prolonged periods of time, then it can be one of the best sources of information. Interviews, on the other hand, are known to be harmful in some cases, especially when a person is trying to present oneself in the best light and hiding important information. The most dangerous individuals are charming or manipulative, and even the most seasoned clinicians are fooled in a one-hour interview.
“The Goldwater rule” is problematic on many fronts: it should have been invalid since 1980, when our diagnostic system changed from reliance on introspection to observation of external behavior. It also treats the public figure like a patient, when our responsibility is to actual patients and to society, not to public figures we are not treating. Finally, currently it has no exceptions, which means it is the only rule in medicine where danger—an emergency—exception does not apply. This means you must violate the core tenets of medical ethics, and the humanitarian goals that all health professionals pledge to, in order to keep with this one “rule”.



Q: Do those people who are malignant narcissists, psychopaths, or sociopaths ever have periods of psychosis when under extreme pressure?

A: Psychosis is defined as detachment from reality, and since malignant narcissism, psychopathy, and sociopathy can be seen as defects in coping mechanisms, extreme pressure will make them more prone to psychotic spirals. For example, extreme narcissism can lead one to have such difficulty coping with normal human limitations, that one must create an alternative reality where one is superhuman, an expert in all fields, and even heaven-sent. Psychopathy or sociopathy can lead one to believe one is “the walking dead” to help explain the hollowness one feels inside.



Q: Do those referenced in prior question have the capacity for insights on how others view them? Are they capable of experiencing self-doubt or guilty feelings?

A: Insight and empathy are often what individuals with these disorders are missing. Because they have not developmentally gone beyond the stage of distinguishing between “me” and “not me,” other people are merely extensions of themselves or instruments to use for their purposes. They experience self-doubt or guilty feelings through projection: in other words, they perceive the anxiety they feel inside—such as doubt, confusion, and fear—as danger coming from the outside. Unfortunately, attempts to escape or to defeat that feeling translates into attack perceived enemies or, if they are lacking, to seek scapegoats.


Q: If such a person were to be found “not guilty” in a trial for a crime they definitely committed, are they more likely to engage in other anti-social behaviors in the future?

A: Absolutely. Because they are lacking in self-control, if the control does not come from the outside, they will keep pushing their limits. Setting firm boundaries of behavior, and consistently returning with immediate and commensurate consequences for behavior that violates those boundaries, is one of the most important ways to deal with such defects. Trying to elicit remorse, insight, or understanding about one’s behavior will not work. Trying to get them to understand objective laws or rules of fairness will not work, either, for everything will be predicated around the self and whether it benefits or pleases the self.



Q: It was reported that some of the contributors to “The Dangerous Case of Donald Trump” were scheduled to meet with elected officials in Washington, DC. When Democratic floor manager Adam Schiff spoke during the impeachment trial, he summed the president’s personality up quite well. Do you think elected officials fully recognize the threat the president poses?

A: We directly met with groups of lawmakers in December 2017 and January 2018, and they were already “fully on board,” as they told us then. In fact, they showed great concern, and many of them stated that the president’s access to nuclear weapons was of particular concern. Whereas we were looking to lawmakers for a solution, astonishingly, they seemed to be looking to us! Mostly Democrats, they said they could not do anything without being the majority party, while Republicans either would not express how they truly felt or would refuse to meet with us (even though their concerns seemed to be well-known behind the scenes). The lawmakers encouraged us to continue educating the public, for, if public opinion shifted, then they could act.

When we went to the media, however—and the media were extremely responsive at the time—the American Psychiatric Association stepped with press releases and articles, stating we were being unethical and practicing “armchair psychiatry,” using psychiatry as a “political tool” for “self-aggrandizing purposes.” It even mobilized the New York Times to state that psychiatrists need not be heard from, and, after this, press inquiries dried up instantly and almost permanently. Thus, by the time the Democrats had the majority in the House, the topic could no longer even be spoken about, and our situation was worse than before. Our book, however, was distributed by citizen groups to all members of the Senate and a substantial portion of the House. When members of the public approach lawmakers about the book, most say they have at least heard about it, if not read and have avidly recommended it to colleagues.



Q: On MSNBC’s “The 11th Hour with Brian Williams, Columbia University’s John McWhorter told a story about Trump that he leaned from a reliable source. As a teen, Trump hung a small child out of a window by his ankles, and enjoyed the child’s suffering. Would such behaviors add to or reinforce your thoughts about him?

A: It is not a surprising anecdote, and consistent with the story of throwing rocks at an infant neighbor when he was a child, and punching a music teacher in the face while in primary school. Those with psychopathic or sociopathic tendencies enjoy others’ suffering, as they envy others for having something that they lack. The human ability to sense others’ feelings, to care about one another, and to do things that help rather than harm others, is something they do not have. Everyone has this, no matter one’s background, personality quirks, or lifestyle—unless one is a psychopath or a sociopath—and this exclusion from the communion of human beings can be very painful. Instead of facing this inner feeling, they transfer the pain onto others, which manifests as cruelty and pleasure at others’ suffering.



Q: In 2019, the updated edition of “The Dangerous Case of Donald Trump” was released, with insights from 37 psychiatrists and mental health experts. Has the year that followed changed your mind on the threat he poses?

A: Not at all. As expected, the psychological dangers we saw translated into social, cultural, political, and global dangers through the office of the presidency. He followed exactly the course we predicted, on the timeline we estimated. Not only that, we have gotten so good at predicting his actions, we sent in a letter of warning to the Congress (https://dangerouscase.org/urgent-letter-to-congress/) three days before he withdrew troops from northern Syria and caused the massacre of our Kurdish allies. We sent in another warning about an impeachment proceeding without guardrails
(https://dangerouscase.org/petition-to-the-judiciary-committee/), and one month later there was the assassination of Qassim Soleimani of Iran. We warned of the continued need to contain the psychological dangers (https://dangerouscase.org/urgent-communication-to-congress/), and now the president is on a revenge spree against those who lawfully testified against him and pardoning criminals while declaring himself the law of the land. Because someone with his condition grows worse in a position of power, no matter what—whether you give into his pressures for more power or try to restrict him does not matter—we have not seen the worst yet.



Q: For those who are feeling depressed and anxious about current events, do you have any suggestions?

I have often said that “the Resistance” is like the immune system of the body: we must replenish ourselves, know our target, and keep healthy! We should take mental hygiene seriously and practice it regularly. It may sound strange, but this means setting boundaries to protect our personal and leisurely lives. Far from being selfish or complacent, doing the things we enjoy and giving time to our loved ones are all a part of responsible action. Allot in advance a reasonable time for the fight, and do not go beyond it. When in it, use the time intelligently and creatively—and this includes listening to the mental health experts! What is exhausting to others is what mental health professionals deal with on a daily basis, and we ourselves protect our mental health through boundaries while treating the sickest individuals! Correctly understanding what is happening is most of the battle, and there are proven techniques for managing the difficult behavior we see. Even if some methods cannot be applied to a president, the principles still apply, and there are lots of things that the public can do. In fact, if only one recognized that true power rests with the people, and the posturing and bullying are actually façades—or fake power, like the Wizard of Oz—the people could achieve a great deal!