We no longer have a president but a patient

The Beautiful Narcissus, Honore Daumier, 1842, WikiArt.org

I am not the only person who is observing the actions of president Trump with grave concern. As a neurologist with over 30 years of clinical experience, I am disturbed by the unraveling of Mr. Trump’s decision-making process. This is not a political statement, but a medical one; the most powerful person on earth is no longer president Trump, but patient Trump.

My assessment is only one in a long trail of similar assessments by medical professionals. In 2017, Dr. Brandy Lee, Assistant Clinical Professor of Psychiatry at Yale edited analyses from 27 mental health professionals in the book “The Dangerous Case of Donald Trump.” In 2018, more than 70 psychologists, psychiatrists and neurologists drew up a letter to Mr. Trump’s physician Dr. Ronny Jackson, asking that mental health tests be performed on the president. Among the issues of concern in their letter were things like difficulties listening, suspect judgement and planning, poor problem solving and poor impulse control, declining vocabulary and increased reliance on superlatives. At the time of the president’s impeachment hearings, 350 mental health professionals submitted a petition to Congress warning that his mental health was deteriorating rapidly.

The problem with Mr Trump is, that he was a pathological narcissist long before he ran for office. Once in the White House, things held steady for a while, albeit at the high price of continuing to alienate all non-emulators. Narcissists do not compromise, unless they can be assured that they will receive adulation. And if they do not get it from others, they heap it on themselves. Over the last four years, Europe and the rest of the world progressively turned their backs on the president. The final straw came in November, when the majority of Americans did the same.

When the world of the narcissist collapses, there is a standard progression of events, which actually represent a regression into more primitive behavior. First comes denial and counter attack. Narcissists are perfect. They never lose, they never fail. It is always someone else’s fault. No matter what the consequences. As the threat of failure and abandonment sets in, anxiety and frustration increase. Caution is thrown to the wind, plots are made with the support of the few surviving worshippers, protocols broken, the law is cast aside. For the ingrained narcissist that Mr Trump is, failure has turned into desperation, since his entirely self-choreographed world is now crumbling. There is no other world that he has known, no other outlets to explore or to engage with. There is only true fear brought on by his first confrontation of true failure with that of his construed self-image.

On a side note, Mr Trump’s recent Covid-19 illness was labelled by experts as quite possibly “very serious.” (NY Times Oct 6, 2020). Today we know that in such cases, many patients are left with subtle but discernible deficits in their thinking process, or a worsening of previous deficits.

Virtually every media outlet as well as politicians on both sides of the isle have used increasingly stronger language to describe Mr. Trump’s behavior, with terms such as “erratic” and “delusional.”

I write this piece out of concern and as a warning. It is time to move past the labelling of the president’s actions and to view him as a true patient. Anyone dealing with the president during this time knows that he has become a different person. His fight to overturn the legitimate election results is a metaphor for his fight with the fear that is consuming his ego. His stoking of mob supporters to invade the Capitol is further proof of his ongoing and deteriorating mindset. His process of regression is not complete and there is a very real probability that more impulsive and dangerous acts are to come, particularly as the days just before the inauguration and his departure from the White House draw near. Freezing his Facebook and Twitter accounts is not enough, in fact, it will worsen the pathological process, as his social media barrages were essential for the nurturing of his ego, for perpetuating the lies and for stoking his blinded followers. Trump is now an even greater danger to his country as well as to himself. He should be removed from office immediately, medically evaluated, and treated.