Bandy X. Lee M.D., M.Div.

Psychiatry in Society

Coping with an Unstable President

Legal and psychological challenges make this a dangerous moment.

Posted Dec 10, 2018

 James Gilligan
Lee with Lead Author Sheila Markin Nielsen
Source: James Gilligan

Americans are on edge. Our experience with the president is like that with an abusive alcoholic father. We don’t know from one minute to the next if we are going to get the drunken version—that enraged man tweeting out his anger and grievance, calling names, itching for a fight if not war, firing staff, and shouting at the press; or the sober version we see, docilely reading speeches from the teleprompter at a formal event. Lately, the former mental state has become more frequent than the other.

It is exhausting for us all. To the extent that he is under pressure, we are all under pressure. The intensity of the pressure is growing worse because of the many challenges Donald Trump now faces.

Our country has never had a president with this many legal challenges before. We have also never seen a president with this much emotional instability. The combination is terrifying.

Many of the legal challenges are brought on by the president’s own errors of judgment and disregard for the rule of law. The Robert Mueller investigation is coming ever closer to the Oval Office; there are the charges against Michael Cohen, the president’s confidant and “fixer-lawyer”; the newly-elected Democratic House of Representatives has the power to start investigations of him; and evidence of Mr. Trump’s conflicts of interest is mounting as he intersected business dealings with governing, allowing him and his family to get rich from corrupt relationships and self-dealing.

Psychologically, the challenges arise from his tendency for impulsivity, recklessness, paranoid reactions, a profound need to create his own reality, a lack of empathy, and a constant need to burnish his power. He was so pleased by Ronny Jackson, the White House doctor who declared him mentally fit after a 10-minute cognitive screen, that he nominated the Rear Admiral to be Secretary of Veterans Affairs, only for him to be disqualified from continuing in his job. Almost a year later, the false “mental health exam” has yet to be replaced. In terms of dangerousness, he has exhibited verbal aggression, has endorsed and incited violence, and has continually taunted allies and hostile nations alike. He has difficulty coping with criticism or even unflattering news that easily place him in an attack mode. All these characteristics in a president are dangerous.

Our Founders established a country with three co-equal branches of government. A president is not entitled to impose his will on the judicial branch. But the branches of government are not functioning properly, and a man with deeply authoritarian leanings is trying to assert that he is above the law. The investigations into obstruction of justice, collusion with a foreign enemy, and violation of “the emoluments clause” that imminently threaten him. The 25th Amendment was established to deal with a president who is unable to discharge his duties for whatever reason, but it has not been considered for partisan reasons. Nevertheless, the longstanding expert consensus questioning his mental capacity to serve should not be ignored.

Mr. Trump will continue to be on a collision course with our democracy. A democracy by definition is a healthy, relatively nonviolent society where people are allowed to flourish, by comparison to an autocracy. Will our institutions hold up against the intense pressure from this president who assaults the judiciary, the Federal Bureau of Investigation, the Department of Justice, and the press when things do not meet his needs?

Here is where the people come in. The people are the backbone of democracy. We need to be ready to voice our unwillingness to allow Mr. Trump to fire Special Counsel Mueller, or otherwise to bend justice to his will. How do we do that? By having a voice: showing up to rallies and voicing protest if he fires Mr. Mueller or tries to interfere with the investigation into possible criminal activity by his campaign for the presidency. For those with legal expertise, standing up to illegal actions and standing by the rule of law. For those with mental health expertise, pointing out his signs of dangerousness and need for an evaluation. We cannot be silent. Just as silence allows an abuser to continue abusing, our silence is assent when it comes to a dangerous regime.

How do people deal with an out of control, impulsive, erratic parent? One of the ways to do it is to find support in groups or communities of likeminded people who share our concerns and then speak up together. Professions themselves can have power at times like these. The best way to deal with the agitation we are feeling is to have a voice. When we raise our voices together in support of our democracy, the people become a powerful force. With one-half of one branch of government having regained oversight ability, the will of the majority can be powerful. Our efforts to insist that we maintain this democracy, one that sets us apart as a shining, albeit sometimes imperfect, example of government in the world: three co-equal branches of government, an independent press and judiciary, an insistence that the president serves the people and not the other way around, those efforts are crucial as we enter this ever more dangerous time for our country and for ourselves.

These are the reasons why one of us (Nielsen), a former assistant U.S. attorney and former prosecutor, arranged for the other of us (Lee), forensic psychiatrist and violence expert, to meet with a dozen Congress members and their staff a year ago to warn against the dangers of this presidency. Our assessment has not changed but has been confirmed in sometimes frightening ways. Every day, we doubt that things could get any worse, but by our combined evaluation, a lot worse is to come, unless we set proper limits now.

Co-authored with Sheila Markin Nielsen, M.S.W., J.D.

Sheila Markin Nielsen, M.S.W., J.D., is a former assistant U.S. attorney and former prosecutor. She arranged closed-door consultations between members of the National Coalition of Concerned Mental Health Experts and legislators over our concerns in December 2017. She is also author of the Markin Report (