Our Back Story

My report is intended as a public service. An unprecedented report meant for unprecedented times, it seeks to keep with the principles and standards of psychiatry over format of typical presentation, since, for an extraordinary situation, trying to keep with the latter will result in distortion. It is written because, if not for dealing with a global mental health emergency, wherein at stake could be nothing less than humanity’s survival, I do not know what psychiatry is good for. The public will understand this, as it has from the moment it made the request….

So how did a clinician consultant and academic psychiatrist with no background or interest in politics come to speak up nationally about the president? I often say politics invaded my area of expertise, and that would be true. I was in forensic psychiatry, with an almost twenty-year career working with violent offenders. I consulted widely on prison reform and collaborated with governments and international organizations on public health approaches to violence prevention.

In the context of my work increasingly turning global, with an eye on preventing genocides, gender-based violence, and civil wars, domestic U.S. politics was the last on my mind. Yet I was unexpectedly summoned the morning after the 2016 presidential election, starting at 8:00 a.m., when my phone was ringing off the hook and emails were flooding in from civil society organizations, patient advocacy groups, lawyers, students, activists, civil servants, and documentary filmmakers — mostly because of my work with a high-profile prison reform project in New York City. They were contacting me because they were afraid of the violence that was to come, and they were right. In the midst of answering those calls, I had to ask myself: If I have devoted my career to studying, predicting, and preventing violence, could I turn away now, in the face of potentially the greatest risk of violence we could ever confront?

It was the morning Donald Trump was elected to the presidency. Growing up in New York City, I knew of him as a libertine tabloid personality, a failed businessman, and somewhat a crook, but I did not consider him necessarily dangerous. He came to a Broadway producer friend of mine while in his early twenties, trying to get into show business, but as he was only interested in the credits and the showcasing of his name, my Tony Award-winning friend told him to go back to real estate (my friend regrets giving this advice to this day, for he believes his words were not without influence at a pivotal point). A handful of other friends, all women, had direct encounters with him and, despite being from high society themselves, experienced uniformly hurtful, degrading treatment with gratuitous humiliation mixed into their otherwise simple, passing interactions. Still, I may have considered him an odious personality, but not dangerous.

Then, in 2015 I saw him televised during one of his direct interactions with followers, and by now a seasoned psychiatrist who saw things differently, I recognized the personality patterns and the interpersonal dynamic I specialize in treating among offenders of violence — and this was very dangerous. Still, I was too preoccupied with personal affairs at the time, taking care of my mother who had gone from a seeming perfect state of health to passing away in less than a year. Glioblastoma is what Senator John McCain and Vice President Joseph Biden’s son, Beau Biden, also had, and its course is swift. While my mother had followed politics, it was never my area, and I had just returned from taking a trip abroad after her departure — until the citizen calls came on the morning after the election. Still, things seemed remote, even otherworldly. My mother had been far more socially conscious than I, and my public role was about to coincide with my determination to take on her legacy.

At that time, a former colleague from Harvard, Dr. Judith Herman, had written to President Barack Obama, along with two other psychiatrists, Drs. Nanette Gartrell and Dee Mosbacher, asking that the president-elect undergo a neuropsychiatric evaluation. Delighted to find like minds, I reconnected with Dr. Herman after more than a dozen years and became acquainted with her colleagues, with whom I formed invaluable friendships. I started composing letters myself, but those around me, while unanimously agreeing that the situation was dangerous, would not put their names to any letter. They were essentially afraid that they would spend the rest of their careers fighting for their licenses in light of the litigious and vindictive president, or that they may have to fear for their and their family’s safety in light of his violence-prone followers. I thought to myself all the more that a breaking of ice was necessary and decided to organize a conference at my institution, the Yale School of Medicine.

Foremost on my mind was ethics — how can we meet our societal responsibility, while speaking ethically and responsibly? I wished to give consideration to an ethical guideline we informally call “the Goldwater rule,” which encourages educating the public in general terms when asked about public figures without diagnosing them, under the rubric of improving the community and bettering public health. It was simply a repetition of good standards of practice not to diagnose anyone without a personal examination and not to publicize it without authorization. But what was alarming was the fact that the American Psychiatric Association, shortly after Donald Trump’s inauguration, had expanded the discouragement to cover far beyond just diagnosis to any comment of any kind — even in an emergency, without exception. No other ethical guideline held such absolute status. In other words, it was turned into a prohibition, or a gag order, which meant that the educating part had to be eliminated, and improvement of the community and the betterment of public health — not to mention all other core medical obligations — had to be subordinated to protecting a public figure!

Never mind what history has shown us regarding the obvious results silencing relevant voices has under dangerous regimes. The question we addressed was, if there were a restriction on our speech about a public figure, like a patient (because a public figure isn’t a patient), then shouldn’t there be situations where there is a positive obligation to speak, as with a patient (since even confidentiality, as sacrosanct as it is in psychiatry, has exceptions)? To answer this question, I invited top members of my field, each of whom I had known for at least fifteen years and could attest to their exemplary ethical stances from other dark times: Dr. Judith Herman, certainly, and also Drs. Robert Jay Lifton and James Gilligan, and Dr. Charles Dike, a colleague from my division who was on the American Psychiatric Association’s ethics committee, whom I invited to speak first.

At the end of the conference, our conclusion was that we had a duty to warn and that the dangers were too great: the public was in the process of believing that the new president was finally settling in and about to “pivot” to normalcy. We, however, knew too much about the mind for any conclusion other than that Donald Trump’s mental instability would place the country and the world in existential danger — not to mention be a threat to governmental institutions, social norms, and, ultimately, the fabric of the country. In other words, that psychological dangerousness in the most powerful office on the planet would translate into social, cultural, and geopolitical dangerousness was only a matter of time.

Even though we had held the conference in a large auditorium, the audience did not exceed two dozen. This “failure” soon turned into the realization that hundreds had tuned in online, confirming that there was great interest but also considerable fear — and as the meeting received national and international attention, eventually thousands of mental health professionals from all over the country as well as from multiple continents got in touch. I realized that this was unprecedented, that we had a medical consensus, and from that arose the National Coalition of Concerned Mental Health Experts, now the World Mental Health Coalition.

Immediately after the conference, the publishing house Macmillan contacted me, as we were just putting together the proceedings of the conference into a public-service book. When it was released in early October, it became an instant New York Times bestseller — unusual for a multi-authored book of specialized knowledge. We could see that it spoke to the public’s hunger for understanding. The book was The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, later updated by public demand with ten more mental health experts. In it, we warned that his condition was more serious than people assumed, that it would grow worse with actual power, and that he would eventually become uncontainable. By the end, it was on the bestseller list for seven weeks and the Washington Post dubbed it “the Most Courageous Book of the Year.”

Meanwhile, various Congress members who heard of the conference began reaching out. Initially, I consulted with them privately over the phone. One influential former Majority and Minority House Leader said he would like to arrange for me to testify before the whole Congress and proposed early September, when the Congress would have just returned to session. For various political and other reasons, this did not happen, and both September and October passed.

By November, Special Counsel Robert Mueller, who had been appointed to investigate Russia’s role in influencing the 2016 presidential election, released his first indictments, and the president began showing signs of deterioration. Two White House officials got in touch with me about their concerns over his “unraveling,” but with so few mental health professionals speaking up, I did not wish to compromise my educative role by taking him on as “patient”. Hence, I elicited only limited information and referred them to the emergency room, hoping that this might lead to the recruitment of another psychiatrist. When I called the on-call psychiatrist after the referral, however, he was hostile and made clear he did not wish to get involved; no matter the condition of the president, his main concern was to be left alone. This is another regret I have: I underestimated the reluctance to apply standard psychiatric procedures, simply because it concerns a president. If I had been more experienced in the media world at that time — in other words, knew what I do now — I would have requested a public statement from the two gentlemen, or an appearance in the media with me to spell out our concerns to the public. I was still thinking in terms of choosing between the roles of provider and educator. Of note, people have asked me if either of them seemed to be the famous “anonymous” White House official who wrote a New York Times opinion piece and later a book; I have said no, since the anonymous official was initially confident in his and other insiders’ ability to handle the situation, whereas the two gentlemen who got in touch with me were more correct in their assessment that they could not.

In early December 2017, impatient of hearing about no movement regarding my congressional testimony, former Assistant U.S. Attorney Sheila Nielsen arranged for me to meet with a dozen Democratic Congress members of her own contacts. I asked Dr. James Gilligan, a foremost violence expert, to join me, and we found that the lawmakers were eager beyond expectation: one senator even stated that it was his most awaited meeting in eleven years! Overall, I was impressed that our country had such seemingly capable, informed, and concerned leaders; I was immensely humbled when one of them called me his “hero”. Nevertheless, they said that, while they shared our concerns, they did not feel they could do anything, being in the minority party. Surprisingly, they looked to us! They stated that they had little power, but if we continued to educate the public as we had been, from a professional point of view, then they might be able to garner the public’s support to do something. They confided that they knew of Republican lawmakers who were also very concerned about the president but doubted they would act on those concerns, and so this would be the only way. They turned out to be right: even fears that the president would trigger “World War III,” as one Republican senator put it, did not prevent Republican lawmakers from rallying behind him when it became time to pass tax legislation.

Therefore, in January 2018, when the president tweeted that his “Nuclear Button … is a much bigger & more powerful one” than North Korean leader Kim Jong-Un’s, I gave up waiting for Republican Congress members to consult with me and went to the press. For several days, I was interviewing for fifteen hours a day without a break, and invitations came in from all the most prominent prime time programs on CNN, MSNBC, network television, and even Fox News. I put aside all other tasks to attend to this national need, while the president’s mental health was the number one national conversation and in the news every day. I declined the biggest shows that could only promise five to ten minutes of discussion, however, to allow for a slower, more serious buildup of discussion that did not sensationalize — another decision I would regret later. I regretted this because, just as it seemed we were getting somewhere, the American Psychiatric Association (APA) stepped in and made public accusations I thought I would never encounter: claiming we were practicing “armchair psychiatry,” using psychiatry as a “political tool,” and doing for “self-aggrandizing purposes.” The irony of these attributions was that it was violating its own, stricter version of “the Goldwater rule” that it adopted with the Trump presidency, prohibiting not just diagnosis but making any comment of any kind on public figures, without a personal examination and without authorization — and I was a public figure at this point! What was puzzling apart from its claim to know my innermost intentions was that its arguments did not make any sense from an ethical or scientific point of view. The highly acerbic, seemingly unprofessional attacks also seemed unbecoming of a professional organization. Later, I would come to learn that this is characteristic of institutions that choose to side with power over principle. By this time, numerous chairs of psychiatry departments and other prominent psychiatrists from around the country had reached out to me with compliments and gratitude, but the APA’s position halted their ability to come forth publicly. Even my own department chair had to separate himself from me publicly, even as he gave me every possible support privately. Is this how it goes, no matter how wrong the APA is? I wondered to myself. And I wonder to this day what might have happened if all these figures in power positions felt free to come out in unison; it was a much riskier proposition now. Meanwhile, exasperatingly, a past president of the APA went on the very primetime programs I declined to keep the conversation nuanced and bludgeoned our viewpoint with misrepresentation and lies. They were too outrageous to be believed, but it was my brutal introduction to the world of false publicity, where this type of distortion gains traction.

It did not stop there: an extraordinary article appeared in the New York Times, authored by the editorial board, stating that psychiatrists had nothing to offer the public and should not comment on the president’s mental health. Yet on the opposite page was a lengthy companion piece by the said past president of the APA doing just that, except that the president was “just a jerk.” Hence, alerting about signs of danger in a president and the need for an evaluation was not permitted, but a piece concluding that he is not dangerous but just a jerk is? Also, how does a newspaper determine what experts should and should not say? Boundaries are usually determined within the areas of expertise — yet it was clear that the APA was behind this, as the ethically and scientifically dubious language was duplicated in the editorial. Furthermore, no amount of requests from a past president of the Times editorial board or a former high-ranking White House official and current opinion contributor, who was sympathetic to us, could procure even a meeting with them, and both admitted the adamant refusal was unusual. The Times continued to publish only psychiatrists who were willing to state that the president does not have a certain disorder — which is a diagnosis — or that psychiatrists should not comment, until it stopped publishing psychiatrists altogether.

After gradually building up, our media exposure came to a sudden and permanent halt after the New York Times editorial, and there were no more avenues for contributing to public discourse — at least not significant ones. It is worth noting that the medical code of ethics says we have a “responsibility to patients … as well as to society,” and while public health is one of our primary duties, we have no separate obligation to a public figure who is not a patient. Pointing out signs of danger to the public in a public servant should require no examination, especially when there is more than abundant relevant information (whatever information that a personal examination can offer is less relevant in terms of societal danger), repetitively observable patterns of dangerousness, and plentiful empirical proof of danger that has already happened. But since the new “gag order,” the APA essentially eliminated any public health responsibility in favor of protecting public figures, in all circumstances without exception — which meant that it was placing them higher than patients, with whom we always have a safety exception! Is this truly happening? Am I missing something? I had to ask myself repeatedly.

This was far before April 2019, when I witnessed the attorney general getting ahead of public messaging through a media campaign, violating legal norms and legal ethics to misrepresent the special counsel’s report on Russian interference, when he was supposed to represent the law. Before this incident with the Department of Justice, I did not know such things were possible. In retrospect, that is what happened: a professional organization was getting ahead of our public messaging through a media campaign, violating its own professional norms and ethics to misrepresent what we are doing, so that it could support power.

Without yet imagining that the American Psychiatric Association could be this disingenuous, in late January 2018, Drs. Lifton, Herman, and I wrote to the APA asking for a discussion on “the Goldwater rule.” Whereas I had resigned eleven years earlier because of the APA’s pharmaceutical industry ties, Drs. Lifton and Herman were without doubt the two most distinguished among its distinguished life fellows. Yet the leadership gave us a runaround, pretending that it was going to publish our letter in its Psychiatric News. While unexpected, we thought that a public discussion would perhaps be more beneficial. Only, when we pushed for information a month later, it finally revealed that it had no such intention. After I demanded a response to our earlier request, it turned the issue over to the trustees, who wrote back after two months that discussions had already been held and there was no reason for another discussion. Yet I knew from members that no small number had protested when “the Goldwater rule” was modified, asking for a vote among the membership, and dozens had resigned over it, including a high-ranking officer. A member of the twelve-member ethics committee that signed off on the modification assumed that they would be reconvening because of the sheer flood of protest letters, but no such reconvening happened. While the APA never did a poll of its members or psychiatrists in general, later in the month, the American College of Psychiatrists did an informal poll and found that an overwhelming majority of psychiatrists opposed the current version of “the Goldwater rule.” To close off discussion under these heated circumstances only indicated that the APA wished to rule “by fiat,” as Dr. Lifton angrily responded to the APA Board of Trustees (See Appendix 2.9).

In June 2018, Dr. Leonard Glass, an ethics scholar and former distinguished life fellow of the APA who resigned from the APA over its ethical modifications, chaired a committee that submitted to the APA a highly thoughtful “Goldwater rule revision proposal.” Many agreed that it preserved the essence of the rule while allowing for reasonable considered exceptions, co-signed by twenty-two others, but the APA did not even acknowledge receipt. I later learned that a foremost Goldwater rule scholar offered to chair a commission to reexamine the rule, and the APA turned him down. The effort to keep out thoughtful input on its misguided ethical guideline was remarkable. Dr. Glass published his revision proposal instead, and a psychiatrist following the events recorded what he agreed was an incredible slight in his new book, Diagnosing from a Distance (Martin-Joy, 2020).

By the fall of 2018, the nation was reeling after the deadliest anti-Semitic attack in U.S. history and an extraordinary “pipe bomber” sending sixteen explosives to prominent Democrats, including the former president, former vice president, and former presidential candidate, as well as critics of the president. The immediate source? The incendiary rhetoric of a president who would do anything to sway mid-term elections. By then, white supremacist killings had already more than doubled, hate crimes jumped 226 percent in counties that hosted his rallies, mass shootings rose to an all-time high, and gun deaths more generally rose to their highest in twenty-five years, not to mention widespread schoolyard bullying in his name, a more hostile civic life, and a more divided country with common threats of a civil war to defend the president. This is all without mentioning the creation of thousands of young orphans and bereaved families at the U.S.-Mexico border, the emboldening of despots around the world as they committed human rights abuses and murders of journalists with impunity, the heightened risk of war in many unstable regions, and a renewed nuclear arms race.

Crises only deepened through 2019, which began with the longest government shutdown in U.S. history, because of the president’s insistence on funding for a wall on the southern border, creating needless hardship for 800,000 federal employee families. Public pleas for us to speak more never ceased to pour into our web site despite the drying up of media inquiries. Meanwhile, the World Mental Health Coalition had grown multifold in size, with membership from four continents, and it incorporated into a nonprofit organization with officers and a full board of directors.

The new Democratic-majority House of Representatives was sworn in in January 2019, but it did not proceed immediately with impeachment as expected. In March 2019, with the release of the second edition of The Dangerous Case of Donald Trump, now updated with ten more mental health experts to make thirty-seven, we held an interdisciplinary conference to bring attention to the need. Thirteen top experts from the fields of psychiatry, law, history, political science, economics, social psychology, journalism, propaganda studies, nuclear science, and climate science came together in unprecedented ways to explain how the president was unfit from each of their perspectives. Renowned economist Jeffrey Sachs moderated the event, which was held in the National Press Club Grand Ballroom, and C-SPAN broadcast it. But even though we contacted over fifty news outlets, none of them would cover us, astonishingly citing, “the Goldwater rule.” It did not matter that none but one of the panelists was a psychiatrist. Attendees, stunned at the caliber and sheer number of illustrious experts on a single panel, stated that the lack of news coverage was “shocking.” Some asked: “What does it say about our country that a monumental, unparalleled event such as this is attracting no attention?”

The American Psychiatric Association’s public campaign had worked: its gag order had turned an obscure guild rule into a household phrase, which was now taken to be universal. Indeed, when a dozen scheduled MSNBC and CNN appearances around this event, some with prominent, regular contributors, were all canceled, a Washington reporter remarked at how unusual that was, stating: “There must be a memo!” He observed that our experience seemed to indicate that reporters and producers desired our input, but a memo had circulated, alerting about “the Goldwater rule” and how mental health experts should not be aired. Since we were holding the event, it appeared that they were excepting even regular commentators. It seemed to fit a pattern that was forming: reporters and producers did not entirely stop interviewing or to invite us, indeed even scheduled and arranged transportation for us to get there, but we were apparently getting cut at the top by editors or supervisors. Over time, more than fifty such last-minute cancelations for network and cable television programs had accumulated; several full-scale completed interviews, sometimes at great expense with travel and professional photography, by the New York Times, Fox News, and Haaretz had gone unpublished; and over one hundred op-eds collectively submitted by us, including several of the world’s most renowned psychiatrists, to the major newspapers went without a single acceptance. A friendly editor at CNN confided to us, after an article was accepted and then rejected after they learned we were mental health professionals, that there was indeed an internal policy not to publish experts on the issue of the president’s mental health. My quotes would be the only ones consistently deleted from articles in the New York Times, sometimes to the great surprise of seasoned reporters, and 100 percent cancelations of invitations to appear on air seemed unusual even for the producers. After one-and-a-half years of trying, one of them said to me at the studio: “Finally we got to have you, after having to cancel over fifty times!” She said enthusiastically, openly expressing her hope that it would be an opening for more. That one appearance was to be my first and last major cable program since the APA’s intervention.

Decades of movements to gain mental health parity with the rest of health, or with any other field, seemed to go up in smoke. Now, psychiatry and psychiatric issues have been stigmatized by one of its own organizations as a topic so secretive that it should never be spoken of but rather be relegated to the extreme margins. Can one imagine, for example, similarly gagging the legal field on issues of national consequence? It would be the equivalent of insisting: “You must personally interview the president and then receive authorization before speaking about any aspect of his case, or not speak at all.” Even the legal field distinguishes between personal representation and a public duty to share general expertise. Worst of all, the APA did this through misleading public campaigns about the importance of its “Goldwater rule”: the public is often surprised to learn it is not the law, that the APA is the only mental health association that has the rule, that the rule is not even admissible to state licensing boards because it conflicts with the First Amendment! Furthermore, it was a rule that was considered outdated from the day it entered the books and almost irrelevant by 1980, when the change of diagnostic systems took place. However, an “ethical guideline” that was essentially a political compromise after Barry Goldwater’s presidential campaign, not a necessity out of scientific evidence or professional practice, was prone to being politically abused from the start.

The result was as we predicted: without expert input, pundits and lay commentators continued to underestimate and to normalize the dangers. Their concerns could also be easily dismissed as insults, partisan opinion, and a view that only half the country holds, instead of the consensus that experts held. A malignant normality set in, providing fertile ground for pathology to spread. What ensued was psychological conditioning for the continual gutting of institutions, the replacement of career personnel with unqualified flatterers, and the catering to a president’s emotional needs at the expense of public good, until presidential powers were used only to expand personal power. The lack of media coverage did not match public demand: our web site was only increasingly flooded with messages asking: “Where are the psychiatrists? Where are the psychologists?”

We tried our best to perform our professional societal duty. When Special Counsel Robert Mueller released his report on a two-year investigation into the Russian government’s interference in the 2016 elections and the role of Mr. Trump’s campaign in it, we issued our own “report on the Mueller report.” Attorney General William Barr had preempted its public release with his own summary of the report, falsely interpreting as it an exoneration of both conspiracy and obstruction of justice. An alarmed special counsel issued a letter that attempted to correct the interpretation, requesting that his own summary be released, but the psychological conditioning for dismissal was already complete. Mr. Mueller’s report, when released a month later, revealed an alarming pattern of numerous attempts at or requests for cooperation from the Russians, regardless of whether or not there was a formally agreed-upon conspiracy, and a dozen counts of obstruction that merely could not be prosecuted while the president was in office, but it did not matter. The attorney general had paved the way for the president’s ability to claim: “total exoneration.” If Mr. Mueller’s report was not usable for prosecution, it allowed us the perfect information to perform a mental capacity evaluation, which we did as a public service: it contained within it abundant, high-quality reports from coworkers and close associates of direct interactions with the president, under sworn testimony. Drs. Edwin Fisher, Leonard Glass, James Merikangas, James Gilligan, and I formed a panel to prepare the report: “Mental Health Analysis of the Special Counsel’s Report on the Investigation into Russian Interference in the 2016 Presidential Election.” This assessment showed, definitively, that the president did not meet any of the standard criteria for rational decision-making, and therefore lacked the basic mental capacity to discharge the duties of his office. We offered a chance for the president to interview with us if he believed himself fit, but while we learned that he received our communication, he did not respond within our timeframe. We therefore went ahead and published our recommendations that: (a) the president be removed from access to the nuclear codes; and (2) his war-making powers be curtailed.

However, without inroads into a public conversation, our report went ignored. We had planned a town hall with several Congress members the day before Mr. Mueller’s Congressional testimony in July 2019, but his last-minute postponement of it gave us only the option to hold it online. We organized a conference at Yale Law School in September 2019, with former Chief White House Ethics Counsel Richard Painter as speaker, only to learn that the Law School, having gradually changed from a public interest focus to power-centeredness over the sixteen years I had been teaching there, was quite hostile. It may not even have been possible without the sponsorship of former Dean Robert Post, a champion of free speech and academic freedom. Then, everything changed later that month. A whistleblower revealed that the president had allegedly abused his powers and the governmental purse by pressuring Ukrainian President Volodymyr Zelensky to investigate the front-running Democratic presidential candidate’s son, Hunter Biden, so that it could be used for campaigning advantage. In response, Speaker of the House Nancy Pelosi, who had long resisted calls for impeachment, finally announced an impeachment inquiry.

Upon this news, we had to get to work. While we had long encouraged early impeachment for behavioral containment reasons, proceeding now after a protracted delay, after having allowed the president to balloon in his false sense of omnipotence and impunity, was dangerous. In early October 2019, Drs. Stephen Soldz, Fisher, and I, along with more than 250 mental health professionals, sent in an urgent letter to the Congress warning of the president’s psychological dangers. Three days later, he ordered the withdrawal of troops from northern Syria, without warning and catching our European allies by surprise, that caused the massacre of our Kurdish allies and destabilized the whole region. In early December 2019, Drs. John Zinner, Jerrold Post, and I, along with over 800 mental health professionals, sent in another warning against proceeding with impeachment without guardrails. One month later, the president ordered the assassination of a top Iranian general, Qassim Soleimani, without justification, taking us to the brink of war with Iran. We still tried, issuing a final warning from the World Mental Health Coalition of the need urgently to contain his psychological dangers, but the House proceeded to the end without consulting with us, voting to impeach and then handing over the articles of impeachment, which we had already advised were too few and should be held onto. As a result, the House’s hesitations only enraged him and failed to contain him when the Senate acquitted him through a sham trial without witnesses or evidence. Once he was clear, the president went on a revenge spree against those who lawfully testified against him, while pardoning and hiring war criminals. He then declared himself the law of the land.

Our final warning came less than two weeks before the first case of the novel coronavirus was to be detected within the United States. Now, the same danger we were warning against turned into a domestic threat: a president who fights facts and reality for psychopathological reasons was now in charge of leading the nation through a deadly pandemic. Not only had he defunded the Centers for Disease Control and Prevention (CDC) and dismantled the pandemic response teams that had been lauded throughout the world, out of pathological envy of his predecessor, he had fired the CDC team in China whose job it was to detect and prevent the very kind of respiratory infectious disease as was to arise in China just months later. The world had the misfortune of two similarly impaired leaders simultaneously ruling over China and the United States at the onset of the pandemic, and they reacted similarly: instead of responding to the crisis at hand, they stifled expert voices, continually gave out misinformation, and allowed the virus to take tenacious hold.

Donald Trump went further, going as far as to call the pandemic a Democrats’ “hoax”, resisting widespread testing, and pushing for policies that only put lives at greater risk — until the United States became the world’s leader in deaths and infections. At the time of this writing, deaths from the pandemic have exceeded 100,000 in the United States and is showing no signs of waning, whereas China has shifted its approach to contain it better. All the countries surrounding China, with far less notice, have managed to contain it, and almost all European countries have done better than the United States. None of this has been surprising but is the exact result we expected from the evidence we outlined in The Dangerous Case of Donald Trump and a result that was essentially inevitable based on our mental capacity evaluation of the Mueller report.

As a psychiatrist, I believe there is no greater oppression than the hijacking of the mind, and critical information at a critical time, which would have empowered the public to be able to protect itself and to act when it was still possible, is what was lost when access to expertise was blocked. Precisely when mental health professionals were most needed to address a national mental health crisis, which originated or exacerbated all subsequent crises, we failed in our professional societal responsibility. Some may question my concept of professional responsibility, but professionals are supposed to act on the principles of their field, and to be their own moral agents, not act as technicians who follow fiats. This is why the Declaration of Geneva was established, and what the Nuremberg Trials were for; we were never supposed to privilege a powerful political figure above all the foremost principles of medical ethics. This distortion, in my view, set the stage for a person’s psychopathology to spread through society, its institutions, and its citizenry. The mind is considered tyranny’s battleground because thought reform works through the process of “milieu control,” or the control of information in the environment. This is what I hope to change, if just a little, through this report.

Forensic psychiatrist, violence expert, president of the World Mental Health Coalition (worldmhc.org), and editor of "The Dangerous Case of Donald Trump.”

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