Even by Donald Trump standards, Sunday night in the White House was quite something. Amid war in the Middle East and fears of a global economic implosion, the US president was having a meltdown of his own, furiously posting to his Truth Social account between 9.49pm and the ungodly hour of 4.10am.

Those multiple incoherent posts – including a now infamous depiction of himself as Jesus – have thrown fresh focus on the president’s mind, and whether something more alarming is going on than Trump’s standard operating model of ego, chaos and lies. His threats to destroy civilisation in Iran and demands that the battered regime “open the f---in’” Strait of Hormuz or face hell, are also triggering warning bells for psychologists and psychiatrists who say discussion about the president’s mental, cognitive and physical health is not just overdue but essential for the world’s safety.

Experts have mixed views on what may be wrong with Trump, who turns 80 in June. American psychologist John Gartner believes the president suffers from “malignant narcissism” – a term coined by German psychoanalyst Erich Fromm to explain the psychology of Hitler and others. The theory is it keeps growing, like a malignant cancer. “It is the most serious personality disorder a human being can have,” Gartner tells this masthead.

“There are four components to it,” Gartner explains. “The first is narcissism: all that grandiosity and megalomania and wanting to be worshipped and feeling entitled to everything. The second is paranoia: feeling victimised, that people are ripping you off, and demonising anyone who opposes you. The third is psychopathy: a criminal personality and antisocial personality disorder. Someone who lies, cheats, steals, violates other people’s rights, has no conscience and no remorse.”

The fourth component? Sadism. Trump, Gartner says, clearly gets off on inflicting pain and suffering on others.

Gartner and others believe Trump also has signs of frontotemporal dementia, which affects a person’s personality, behaviour and language more than memory. “When people have dementia, whatever personality disorder they have gets dramatically worse because the frontal lobes start to shrink and there isn’t a brake any more,” Gartner says. “There isn’t a filter. There isn’t judgment. So now you have a malignant, evil person who has lost his internal controls, and in this administration, there are also no guardrails. God help us.”

Former Australian of the year Professor Patrick McGorry, a psychiatrist, says he could not diagnose Trump from afar but, like many, has concerns.

“There’s a bizarre element to all of it, and there are definitely examples of where his memory must be in question, where there’s a level of confusion and disorganisation of thought. That’s the observational data you can absolutely raise questions about.”

Trump’s judgments and actions can change the course of history. But despite a clear recognition that too many heads were buried in the sand about Joe Biden’s decline, it still feels uncomfortable – bordering on taboo – to discuss a president’s cognitive function or mental health. It is particularly fraught with danger for psychologists and psychiatrists in the United States. They have to deal with the MAGA base, which believes all criticisms or observations are politically motivated, and must also navigate two codes that guide how a person can be diagnosed.

The first is the Goldwater rule, which prevents psychiatrists from offering professional opinions about the mental state of someone they have not personally evaluated. The American Psychiatric Association introduced the requirement in the early 1970s after the now-defunct magazine, Fact, surveyed 1189 psychiatrists who claimed Republican presidential nominee Barry Goldwater was unfit for office. The article was widely viewed to be an outrageous hit job rather than a detailed examination of his mental capacities, and Goldwater later successfully sued the magazine.

The counter to the Goldwater Rule is the Tarasoff rule, named after a 1969 case in which Indian student Prosenjit Poddar told a psychologist of his intent to kill University of California, Berkeley classmate Tatiana Tarasoff. The therapist did not notify the victim, and Poddar went on to shoot and stab her to death. A subsequent court case established a duty of care on mental health professionals to warn potential victims.

It is this rule Gartner and others cling to when warning about Trump, arguing they have a duty to warn and protect others about the dangers faced by an unwell president. Even Allen Dyer, the sole survivor of six American Psychiatric Association members who authored the Goldwater rule in the 1970s, has said it is a misnomer and may be suppressing legitimate public discussion about Trump.

“None of this mattered too much until Donald Trump first ran for president in 2016, a man whose behaviour and thought processes seemed so unhinged as to raise concerns about ‘dangerousness’,” Dyer told this masthead this week.

Dyer, the professor emeritus of psychiatry and behavioural sciences at George Washington University, is troubled by Trump’s inability to complete some sentences and tendency to lose track of a question. He says the president is displaying signs of increasing cognitive decline, disinhibition, and impulsiveness, “but the problems go way beyond psychiatric or medical disorders”.

“Yes, he appears to be unwell and should be evaluated, but medical evaluation is usually directed towards someone who wants to understand and get treatment.” Trump himself was recently asked by a reporter what he says to critics who want his mental health to be properly assessed. The president replied matter-of-factly: “I haven’t heard that.”

In a new book, Dyer explores the difficulties of distinguishing reality from non-reality when disinformation and fake news take over, leaving people confused about what to believe. He says this potent mix is clouding debate over Trump’s fitness for office. Despite his concerns, Dyer also says medicine doesn’t explain everything about the man occupying 1600 Pennsylvania Avenue. “The real problem is stupidity, malevolence, and incompetence,” he says. “The hope for the future is the voters, who seem to be waking up from their misguided beliefs.”

McGorry has a similar view. To him, the scariest thing about Trump is a lack of decency and ethics. “It’s a moral question as much as a psychiatric question.”

Forensic psychiatrist Bandy Lee, a former Yale faculty member who edited the 2017 bestseller The Dangerous Case of Donald Trump, is more alarmed than most. Lee says she has assessed 1000 patients whose psychological structure largely matches that of the 45th and 47th president of the United States, and many were violent offenders. “It meant I was able to recognise him as a dangerous personality straight away,” she says.

Lee says of Trump’s recent behaviours: “We are seeing a man in profound psychological crisis.” And of his erratic social media activity: “He actually needs adulation and accolades from the public – like one would need oxygen – because he has so few inner resources.”

John Kelly, Trump’s chief of staff between 2017 and 2019, used Lee’s book – in which more than two dozen experts argue the case for what was driving Trump’s behaviour and why he was medically unfit for office – as a guide for dealing with his boss.

Yale sacked Lee in May 2020 for what she says was her public commentary on Trump’s health. One of Trump’s impeachment lawyers, Alan Dershowitz, had also complained to Yale that Lee breached the Goldwater rule by claiming online that he and other supporters may have taken on Trump’s symptoms and could have “shared psychosis” by contagion.

In a forum this week, Lee says she understands why most people would like to believe that a president’s actions are rational. “But the threats, reversals, and rhetorical exaggerations we have seen are, unfortunately, not likely to be strategy,” she says. In her mind, a psychiatric emergency isa medical one. “What we are seeing is not just the level of incapacitation of someone in a coma but worse, since his incapacity actively poses a danger and pressures people into not seeing it.”

Lee claims the combination of factors is more than enough to invoke the 25th Amendment to remove Trump from office. She says Congress should immediately retake its constitutional authority over war, and urged America’s four other living ex-presidents to protect the country by publicly urging military officers not to obey unlawful orders.

Joseph Fins, an expert on neuroethics, has previously said there were persuasive arguments about the danger posed by Trump’s presidency, but he does not think the 25th should be invoked. For starters, it would be incredibly hard for a panel to psychiatrically assess the president and then advise the vice-president and the cabinet. “No sane president, especially one ‘clever as a fox’, would ever submit to such an examination,” Fins wrote.

Respected investigative psychiatrist Robert Jay Lifton, who died last year, has argued the more appropriate term to describe Trump is solipsism. “Narcissism suggests self-love and even, in quaint early psychoanalytic language, libido directed at the self,” he explained. “Solipsistic reality means that the only reality he’s capable of embracing has to do with his own self, and the perception by and protection of his own self."

Lifton said Trump’s solipsism was sui generis – or in layman’s terms, firmly in a league of its own. “For a president to be so bound in this isolated solipsistic reality could not be more dangerous for the country and for the world,” he said in 2017.

The concept that an Oval Office occupant might have mental health issues should not be surprising – it has happened many times before. A study of 37 US presidents between 1776 and 1974 published in The Journal of Nervous and Mental Disease found 18 of them met the criteria for mental illness at some point in their lives. Overall, a quarter of those 37 presidents experienced symptoms while in office.

Using biographical information and strict evaluation criteria, the Duke University researchers concluded that 24 per cent of presidents likely had depression, including Abraham Lincoln. They also found 8 per cent – including Lyndon Johnson and Teddy Roosevelt – displayed signs of bipolar disorder.

Mental health conditions alone should not disqualify a candidate from elected office; many conditions can be managed by medical experts and a president’s inner circle. However, what scares those concerned about Trump is that he is surrounded by yes men and women who would likely not intervene or defy an order if needed. Lee argues it could go even further: that those around Trump may have taken on some of his symptoms, or are so used to his behaviour they can’t recognise red flags.

Those who dislike the president are accused of having “Trump derangement syndrome”. The vast majority of Republicans who were very keen to talk publicly about the legitimate concerns surrounding Biden’s cognitive function have gone to ground when questions are raised about Trump’s issues.

But of late, concerns over Trump’s capacity are not just pushed by progressives. Marjorie Taylor Greene, a former Republican congresswoman who was once joined at the hip with Trump, now thinks the 25th Amendment should be invoked because his social media commentary is “not tough rhetoric, it’s insanity”, while conservative podcaster Candace Owens called Trump a “genocidal lunatic”. Former White House lawyer Ty Cobb says the president is “insane”. Of Trump’s threat to destroy Iran, former White House press secretary Stephanie Grisham said: “This isn’t ‘just Trump being Trump’ and you all know it.”

Lee says Trump’s behavioural traits could partly explain why he went to war in Iran in February, against his earlier pledges not to repeat the military mistakes of predecessors. “He fights his feelings of inadequacy by seeing himself as all-powerful, and tries to deny his impairments through the exertion of force,” she says.

Australian criminal psychologist Tim Watson-Munro fears Trump doesn’t know how bad he is. When Watson-Munro – who has been involved in the trials of Hoddle Street mass murderer Julian Knight and corporate fraudster Alan Bond – saw the president’s now-deleted depiction of himself as Jesus, he was dumbfounded. “If a client of mine did this, I would probably say we need to up their meds,” he says.

“I haven’t examined him, but like most people on the planet – particularly mental health professionals – everything he says is ripe for clinical interpretation, if I could put it that way.

“He definitely displays signs of pseudologia fantastica, which is a fancy way of saying pathological lying. It’s a psychiatric diagnosis and the primary characteristics of the condition are chronic compulsive lies and elaborate stories that are often fantastical but partly rooted in truth. If you look at the things that the Donald says, I think that’s on the money.”

How do experts like Watson-Munro distinguish between the eccentricities of any high-profile political operator and someone who is unwell? “It’s a good question,” he says. “You don’t win the election twice, with a four-year gap, by being a complete imbecile. And it goes with the territory that if you’re going to be the leader of any country, you’ve got a pretty healthy ego. But it goes beyond hubris and ego, this stuff. It’s trending towards delusional thinking.”

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In America, about 7 million people live with Alzheimer’s, the most common form of dementia. One of Trump’s presidential heroes, Ronald Reagan, died from it, as did Trump’s father, Fred Trump Sr in 1999. Trump’s clinical psychologist niece, Mary, says there are times when she looks at the president “and I see my grandfather”.

“I see that same look of confusion,” she told a podcast last week. “I see that he does not always seem to be oriented to time and place.”

Trump is said to have been deeply affected by both his father’s emotionally abusive behaviour and his later decline from Alzheimer’s. When he was asked earlier this year about his health, Trump had to be prompted by his press secretary to remember the name of the disease that killed his father. “I don’t think about it at all,” he told the reporter. “You know why? Because whatever it is, my attitude is ‘whatever’.”

Jamie Raskin, the ranking Democrat on the US House of Representatives’ judiciary committee, wrote to Trump’s physician Sean Barbabella on the weekend asking him to conduct a comprehensive neuropsychological assessment of the president and publicly release the results, and provide a detailed report on his mental and physical health, including any medications he is taking and their potential cognitive side effects. Many Democrats have been talking to medical experts about Trump’s potential dementia problem for many months now.

Lee agrees that Trump is displaying signs of the disease. “It is getting worse very rapidly in him, and that is a very concerning sign because with his personality structure, the combination of a cognitive impairment now could escalate his impulsivity, belligerent behaviour, verbal aggression and impulsive actions.”

Gartner, who denies his criticism and observations of Trump are motivated by politics, says many people tell him they have family members with dementia, and they see in Trump what they see at home.

“When getting into what is the evidence that someone has dementia, we look for deterioration in four areas from a baseline: their language, their memory, their behaviour, and their psychomotor performance,” he says. “Well, this is just one example, but Trump used to actually be quite articulate. He was always an arsehole, but he used to speak in polished paragraphs. Now, he can’t even finish a sentence, a thought or even a word without meandering into some kind of irrelevancy.”

Could the same observations not be made of Joe Biden? They often were, and dismissed as political smear. For his part, Gartner admits he misjudged the seriousness of Biden’s cognitive decline towards the end of his term. “I thought Biden was doing better than he actually was and that people were exaggerating,” he says. “I thought some issues were signs of ageing, not of dementia or a thought disorder.

“But I think now what they were doing was hiding him. And this is actually one place where diagnosing from a distance can have a weakness. Because you know what you know. You have eyes. You know what you see. With Biden, they were hiding him in the White House. So we didn’t see.

“But with Trump, we see it every day. And it scares the hell out of me.”

https://www.smh.com.au/interactive/2026/trumps-state-of-mind/index.html

UNFORTUNATELY, THE PEOPLE AROUND HIM LIKE HEGSETH, RUBIO AND VANCE ARE ALSO PATHOLOGICAL LIARS....

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