Dr. Kenneth Paul Rosenberg and Norman Ornstein
One of us is a psychiatrist, the other a political scientist. We have watched the fiasco since the election with mounting trepidation, from two very different perspectives. But we have a common bond: For more than a decade, each of us has worked to advocate for people with serious mental illness to get treatment. We are coming together now to advocate for immediate intervention for our president.
Since President Donald Trump’s election, the psychiatric community has debated calling out his illness(es). The American Psychiatric Association says we should remain silent out of fear that we would violate the Goldwater Rule — an APA rule adopted largely to prevent the partisan misuse of psychiatric diagnoses to unduly influence an election. But it is clear what many psychiatrists know privately, and a few have said publicly. The threat to our democracy is too great to remain silent.
Not just tantrums or selfishness
It may be no surprise that Trump railed against a 2020 election process that promised a major increase in turnout through early voting and voting by mail. He and many Republicans have advocated for ways to suppress votes, and suggested repeatedly that when everybody votes, Republicans lose. Remember, Trump had said before the 2016 election that if he lost, it was rigged; if he won, it was fair.
It also may be no surprise that Trump denied the outcome of the 2020 election in the days that followed it, despite the fact that President-elect Joe Biden’s margins in battlegrounds Michigan and Pennsylvania were larger than Trump’s four years ago and he flipped Arizona and Georgia to the Democratic column. And it is true that there is neither a legal nor constitutional requirement for a presidential candidate to concede when he has lost.
But Trump’s behavior since is antithetical to every norm we have in a democracy that values as much as anything the legitimacy of elections and the peaceful and orderly transfer of power after voters have spoken.
The president’s actions — ordering his minions to deny all the elements of a transition to the president-elect, including access to intelligence and pandemic briefings, access to agencies to plan the next administration, access to the FBI to begin security clearances for incoming appointees — are not just wrongheaded, they are dangerous to the security and health of the American people.
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The president’s moves to fire key officials, including those in charge of the safety of our nuclear stockpile and those in charge of our national security, suggest that the loyalty test — loyalty to the president and not to the Constitution — is going to be applied more often, hollowing out our pandemic teams and intelligence and defense capabilities, and leaving in charge a group of sycophants willing to do his bidding in his remaining weeks in office. The fact that he has not attended a meeting on the pandemic in months and has barely mentioned it as it explodes across the country is another sign of alarm.
Many say that Trump’s refusal to agree to a peaceful and orderly concession is just a threat from a selfish man who can’t accept defeat. President-elect Biden calls Trump’s failure to concede an “embarrassment.” It is worse. When someone says they are planning their suicide, mental health professionals don’t call it a “cry for attention.” They hospitalize them immediately to prevent harm. When someone threatens homicide, violence or child abuse, we act swiftly to protect potential victims. It is naïve to consider the current acts of President Trump as childish tantrums and nothing more than fodder for late night comedians.
Signs of personality or mood disorder
To any first-year psychiatric resident, Trump’s sleepless nights filled with ranting tweets suggest irrational exuberance and lack of control, possibly a sign of a mood disorder called hypomania. His life-long history of disregard for others and deceit, if correct as reported, are characteristic of a personality disorder on the narcissistic and even sociopathic spectrum.
To be sure, definitive psychiatric diagnoses cannot be made without an in-person examination And certainly, psychiatric diagnoses themselves don’t make someone unfit to be president. But President Trump’s particular history and actions create a high index of suspicion for destructive mental processes which are putting the country and its safety and security in jeopardy.
If we had a functioning Republican Party, this would be the time either to pressure the president to resign early and let Vice President Mike Pence handle the remainder of the term (with the promise of a pardon to sweeten the deal) or to invoke the 25th Amendment. At minimum, we would hope that key figures, like Senate Majority Leader Mitch McConnell, House Republican Leader Kevin McCarthy and other senior officials, would act to embrace the reality of the election outcome and put constraints on Trump to stop destructive acts. Instead, they are enabling his worst instincts and behaviors.
But it is important to at least call it out for what it is. Whatever President Trump does leading up to Jan. 20 — whether it is reckless actions abroad or lawless and destructive acts of commission or omission at home — it should be clear that these are not normal nor acceptable actions by an American president.
Dr. Kenneth Paul Rosenberg is a psychiatrist affiliated with Weill Cornell Medical Center. His award-winning 2019 documentary “Bedlam” chronicles the roots of the broken mental health system in America and was shown on PBS’ Independent Lens. Norman Ornstein (@normornstein) is a resident scholar at the American Enterprise Institute. His family foundation spearheaded “The Definition of Insanity,” a 2020 PBS documentary on the criminal justice system and how it deals with those with serious mental illness.
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