My day job is seeing things people can't or choose not to see. In other words, I'm a psychiatrist. I don't say it to be boastful, but rather to illustrate my burden. While I take great pride in my service to my patients, I'm also forever incapable of turning off my clinical skills when I leave work. I notice speech patterns, eye contact, facial movements, tone, alertness, processing speed, linearity of thought, affect, mood, memory, insight, judgment, and risk of harm to self or others, in every single human interaction I witness or experience. I also can‘t help but recognize when people employ maladaptive coping skills and defense mechanisms in response to life’s challenges.
Needless to say, I have concerns about Donald Trump.
In my spare time, I use my thinking cap to process the latent psychosocial content in the politics of the day on Twitter. Ironically and somewhat tragically, I often de-stress best by doing a mental status exam on my news feed. I immerse myself in the painful public policy process to process the private pain disclosed in my office, but somehow it’s always felt like leisure instead of work. That was until Donald Trump announced he was running for president. Suddenly I find myself confronted with public behavioral disturbances that more closely resemble the DSM than they do politics as usual. I’ve written extensively about the political aspects of Trump’s many disqualifying attributes, from his peddling in the privileged politics of personal insult, to his disingenuous minority outreach, and his exploitation of the poorly informed; but now it’s time that we discuss his mental health.
I’m not here to formally diagnose him from afar, but I’d be lying if I said I wasn’t beginning to feel somewhat derelict watching an emergency unfold without meaningful, life-saving intervention taking place. I make my living treating acute and sub-acute mental and behavioral health emergencies, which means people don’t end up on my radar unless they’ve comported themselves in ways that are generally determined to be unstable and unsafe. In some cases it’s florid psychosis, dementia, or mania, and in others it’s severe depression and suicidality, or unbridled poly substance abuse or personality disorder. No matter the etiology, my duty is to determine if the mental status changes in question represent a lack of stability and/or portend a heightened risk to individual or public safety.
When I hear and see Donald Trump, I hear and see an emergency.
Psychiatrists are granted the authority to commit patients involuntarily to treatment based on three guiding principles: harm to self, harm to others, and evidence of significant mental deterioration to the extent that the individual is unable to practice self care in his/her own best interest. While the former risks can be ascertained by explicit threats made by the patient, the latter evidence is often gleaned from self-reported or eyewitness accounts of the patient’s concerning behaviors. To date, I have personally witnessed Donald Trump make threats against not just individuals but entire sovereign nations, and heard eyewitness accounts from individuals who report victimization at his hands. It is widely held public knowledge that he rarely sleeps, and spends the wee hours of the morning in fits of rage out of proportion to his perceived slights. It is widely known that he hasn’t supplied comprehensive medical records, has a family history of Alzheimer’s in a first degree relative, and that his children have yet to allow him alone with anyone but themselves. It is widely known that he has yet to demonstrate sufficient knowledge of any of the major issues facing America or the world, and that he immediately becomes defensive and accusatory when confronted with the expectation that he should if he wants to be president. As Hillary Clinton so aptly stated, he’s easily baited and temperamentally unfit. If Donald Trump were a patient in the ER, I would be expected to intervene.
And yet, we as a nation stand paralyzed and in awe of a slow moving train wreck in progress. I can’t help but be reminded of the numerous families that remain apprehensive and reluctant to agree to proactive measures, even in the face of the crisis that has befallen them. Despite the reality that no one’s gotten any sleep or peace, and their loved one is on a rampage destined for destruction, they hesitate to act and often inadvertently prolong everyone’s suffering in the process. They contain the dysfunction for as long as they can, rather than face hard truths about their new reality. As such, these families are a microcosm of America in the aftermath of Election 2016.
How do we reconcile the fact that 52 percent of voters over age 45 selected Donald Trump at a time when the aging Baby Boomer cohort will become more heavily reliant upon the Social Security and Medicare that the Republican party is determined to privatize and destroy? Why aren’t they able to practice self care in their own best interest, and why are we as a nation standing idly by while they endanger us all? Lady Liberty is ailing, yet we allow her to languish. At what point do we take the keys away from people who continually drive us into a ditch in the interest of individual and public safety? It is no coincidence that half of Fox News viewers are 68 or older, or that they’ve fallen prey to fake news propagated in service of the Republican party, as evidenced by their disastrous decision on November 8. As a nation, we’ve allowed our parents and grandparents to be exploited by political forces that use their votes to inflict harm upon the social safety net, and the general welfare. We continue to allow ourselves to be lead astray by deferring to the political will of people who lack sufficient insight and judgment to choose progress over propaganda.
Yet again, our country and the world have been entrusted to a man who hasn’t demonstrated the mental and behavioral stability to keep himself, let alone the rest of us safe. After eight years of steady, even-handed leadership from a president often labeled too “professorial,” “calm,” and “aloof,” it’s a wonder we haven’t yet drawn a connection between his stability and our prosperity.
It’s also a wonder that people who claimed to be suffering from severe anxiety just voluntarily committed themselves to strife at the hands of Instability-in-Chief, and we aren’t yet treating it like the emergency it is.