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How Extreme is the Danger at the Border of Presidential Psychosis?

By Ernest A. Canning

The segment of The Last Word with Lawrence O’Donnell (see video below) was truly unnerving.

O’Donnell began by playing an earlier clip pertaining to a previous occasion in which Donald J. Trump was asked to comment on the “Access Hollywood” videotape which depicted him boasting about his having committed past sexual assaults. “I said it,” then candidate Trump said. “I was wrong, and I apologize”. O’Donnell then asked his guest, Dr. Lance Dodes, M.D., what we should make of Trump’s recent effort to challenge the tape’s authenticity.

Dr. Dodes replied:

It’s another example of his being close to psychosis when he is stressed…When he goes back and denies reality, people have trouble understanding that.

The simple explanation for it, which people don’t want to hear, is that he’s not in control of himself.  This is what we mean when we say someone is becoming psychotic or is briefly psychotic…All of his delusional ideas come up when he is stressed in some way, and he loses track of reality because it doesn’t fit what he needs to believe.

Dodes, a retired Assistant Clinical Professor of Psychiatry from Harvard Medical School, explained:

The problem has been that we think of psychotic people as being folks who think that they’re Napoleon, and that’s easy to tell.  But if you’re not that, people think you’re not psychotic.

Unfortunately, the world is more complicated.  And people like Donald Trump are on the border. They slip into delusional thinking when they are stressed — an extremely dangerous thing…for anybody, especially somebody who has been so wantonly unconcerned about the welfare of others and willing to do anything to promote himself.

He’s an enormous present danger to us from the standpoint of creating a nuclear war, and even from the standpoint of what he can do to destroy democracy and attacking ethnic groups the way that he’s done.

Later, during the same Last Word segment, Dodes went on to note that the President “is truly very sick” and that his “delusional thoughts are not surprising.”

Once you understand that he is about him — and it’s a very deeply disturbed issue — he needs to, not just that he wants to.  He needs to.  He’s not clever at all.  He has to protect himself from what he sees as an existential threat by denying reality.

Once you understand that, everything else follows. And it’s extremely dangerous.

Dr. Dodes is of the opinion that the gravity of Trump’s mental illness is such that he wouldn’t be shocked if the President tried “to dissolve the constitution…fire the Supreme Court, wage nuclear war on North Korea.”

Dodes is not alone in that dire assessment.  To the contrary, he is but one of 27 of this nation’s leading nation’s leading psychiatrists and mental health professionals who contributed to the recently published compendium of professional essays, The Dangerous Case of Donald Trump.

The book was the product of the seemingly conflicting ethical duty imposed by the American Psychiatric Association, pursuant to the Goldwater Rule, to the effect that psychiatrists should refrain from rendering a diagnosis with respect to public figures who they have not personally examined and their judicially recognized legal duty to warn the public of an imminent danger.

As set forth by Yale’s Bandy Lee, M.D. in the introduction, although the authors of The Dangerous Case of Donald Trump “respect” the Goldwater rule, they “deem it subordinate to the single most important principle that guides our professional conduct: that we hold our responsibility to human life and well-being as paramount.”

The contributors apply various methods for skirting the Goldwater Rule.  For example, in his essay, “Why ‘Crazy Like a Fox’ versus ‘Crazy Like a Crazy’ Really Matters”, Clinical Psychologist Michael Tansey, Ph.D. presents “the exceedingly rare diagnosis of delusional disorder, which may help us understand why DT makes such jaw-dropping statements.”  While he proclaims that the discussion is not intended “to diagnose”; that he only intends to “educate the general public so that each person can make his or her own assessment,” it’s pretty clear from the content of the essay that Dr. Tansey believes he’s latched onto the correct diagnostic criteria.

Although there are multiple diagnostic criteria set forth in the compendium, Dr. Dodes’s essay, “Sociopathy”, in the author’s view, appears to most effectively capture the essence of Donald J. Trump.

The central feature that is found in sociopathy is the absence of the “normal empathy” — “the ability to understand and share feelings of another.”

Because empathy is a core component of what makes us human, in Dr. Dodes view, its absence is a reason “why sociopathy is among the most severe mental disturbances.” It is, he writes, “synonymous” with the what is described by the latest iteration of the Diagnostic & Statistics Manuel (DSM-5) as an “antisocial personality disorder,” to wit: “individuals who habitually and pervasively disregard or violate the rights and considerations of others without remorse.”

Amongst the diagnostic criteria recognized by DSM-5 are “a disregard for the rights of others since age 15, that include one of seven sub features: to wit, “lying, deception, and manipulation, for profit or self-amusement”; “impulsive behavior”; a “pattern of irresponsibility and, lack of remorse for actions.”

Amongst those suffering from severe sociopathy, Dr. Dodes distinguishes between “those who are unskilled at manipulating and hurting others” from “successful sociopaths” like Donald Trump, who “are good at manipulation, at…concealing their immoral or illegal behavior, and can bully their way to the top.”

After setting forth pertinent traits: Lack of empathy for others; lack of remorse; lying and cheating; loss of reality, rage reactions and impulsivity, Dodes concludes:

Mr. Trump’s sociopathic characteristics are undeniable. They create a profound danger for America’s democracy and safety. Over time these characteristics will only become worse, either because Mr. Trump will succeed in gaining more power and more grandiosity with less grasp on reality, or because he will engender more criticism, producing paranoia, more lies, and more enraged destruction.

The newly revealed circumstance in which former National Security Advisor, General Michael Flynn has entered a guilty plea as part of an agreement that could potentially have him playing a role similar to that of John Dean during Watergate is both good news for the rule of law and cause for concern.

Trump’s stress level must be through the roof. One shutters to think what might come next if Dr Dodes is correct in his assessment that ours is a President who, when stressed, departs from reality.

Lawrence’s O’Donnell’s interview of Dr. Lance Dodes follows…