Since late January 2020, mental health experts stated that the U.S. death toll from COVID-19 would be more reflective of President Trump's mental state than of the characteristics of the virus. By March 2020, we issued a "," urging that, without removal of the president, or at least his influence, there would be an unacceptable loss of life. We predicted how the then-president would disastrously mismanage the pandemic, based on a we did in April 2019 when the right information became available. Yet, the now 530,000 U.S. COVID-19 deaths were not prevented, and a recent lays the responsibility squarely on Donald Trump.
We similarly predicted violent events under the Trump presidency, once the massacre of our Kurdish allies of northern Syria, and then the assassination of a top Iranian general. Far before the Jan. 6, 2021, insurrection at the Capitol, we in November 2020: "We are entering perhaps the most dangerous period of this presidency." I wrote in my over the summer of 2020: "We must come to the recognition that he is truly someone who would do anything, no matter how terrible, no matter how destructive, to stay in power." No other president, indeed, has on the nation he had sworn to protect.
Finally, we warned that, without intervention, Donald Trump's mental pathology would spread and potentially . In addition to the proliferation of disinformation-spreading , his ways, and the growth of to buttress his stature, a so far has increased his political influence, threatening to impede other agendas. Just recently, he further entrenched his election lies, targeting lawmakers who voted to impeach or convict him by name and strengthening his stranglehold on the Republican Party, as the of the Conservative Political Action Conference.
Before we can understand how such a , mentally unfit president was not only allowed in office full-term but also continued to be normalized, we must address and correct the interventions of the American Psychiatric Association (APA). Indeed, when the APA for an ethical guideline, "The Goldwater Rule," shortly after Donald Trump's inauguration in 2017, I made the broader prediction that this silencing of the would have dire consequences.
If the president, unlike all other military officers or civilian positions that make life-and-death decisions, did not have to pass a before taking office, and no independent expert could discuss any problems after he took office, even if he posed a danger to the public, then it was a -- the very reason for the First Amendment to the U.S. Constitution. In my view, mental unfitness was the most urgent issue of the Trump presidency, and ceding the profession's authority to power, in the of science and evolving practice, would cripple the public's ability to protect itself. And if unable to hold him accountable for the most urgent area of unfitness, then the nation was unlikely to hold him accountable in any other domain.
This is why I organized an at Yale School of Medicine the very next month, in April 2017, assembling some of the best minds of the field, and later that year published : 37 Psychiatrists and Mental Health Experts Assess a President. Our book became an unprecedented New York Times bestseller of its kind, and we to the public good so as to remove any conflicts of interest. Within three months, the president's mental health was the of national conversation, and Congress members, major news networks, and the public were all aligned. At this time, Donald Trump had yet to consolidate his cult of personality, the media did not have a ban on us, and the public was highly receptive.
This was when the APA and , denouncing us as "armchair psychiatrists" who used "psychiatry as a political tool" for "self-aggrandizing purposes." It even on public figures to attribute to us these motives. Even though we were in keeping with the original "Goldwater Rule" by refraining from diagnosis, in direct contrast to past APA officers -- including one who made a and another who cleared the president of , which is also a diagnosis -- the APA targeted only those whose assessment was disadvantageous to the president.
When the APA enlisted the New York Times to as "psychiatrists ... who should know better," and the New England Journal of Medicine made the extraordinary exception of publishing an by a past APA president at the same time as an original article by a scholar of psychiatric ethics supporting our stance (letters are usually submitted following publication of articles, not invited), the . Within two weeks, inquiries dried up , and the public experienced "a switch turning off." To the end of the Trump presidency, questions : "Where are the psychiatrists? Where are the psychologists?"
soon became , as the since , during a time when scientific organizations that the administration's ideological or political objectives saw deep funding cuts. A high-ranking officer in the APA directly admitted that were behind its decisions. As we have of a past APA officer and enabler of Donald Trump, we need to investigate the APA, correct the misconceptions it promoted, and clarify the profession's duty to public health. I resigned from the APA over thirteen years ago because of its pharmaceutical industry ties, and many other members and officers who resigned from the APA over this issue helped form the , which intends to step in where the APA failed in societal leadership.
The field of medicine recently , Dr. Bernard Lown, closely after the in Dr. Jerrold Post. Both highlighted the psychological cause of most human struggles. Dr. Lown told me shortly before his passing that he believed the greatest threat to humankind was no longer nuclear weapons but extreme individualism and greed, which gave rise to the Trump presidency. As founder of Physicians for Social Responsibility, he inspired my conception of "psychiatrists for societal responsibility."
Our next task should be to understand what happened, to prevent dangerous leadership in the future, and to help heal our .
, is a forensic psychiatrist and violence expert who resigned from the American Psychiatric Association in 2007 because of its financial ties with the pharmaceutical industry. She is now president of the World Mental Health Coalition, which formed in part to step in where the American Psychiatric Association failed in societal leadership.