Reproduced from Source: https://dangerouscase.org/mueller_report/
MENTAL HEALTH ANALYSIS OF THE SPECIAL COUNSEL’S REPORT
ON THE INVESTIGATION INTO RUSSIAN INTERFERENCE IN THE
2016 PRESIDENTIAL ELECTION
EXECUTIVE SUMMARY TO THE REPORT ON THE MUELLER REPORT
We write as authors of The Dangerous Case of Donald Trump, which arose out of our professional response to a medical need. The public-service book predicted much of the course of the current presidency and has received high acclaim among our peers and the public; we have removed conflicts of interest by donating all revenues to the public good.
The Special Counsel’s report provides an uncommon wealth of information regarding the President’s mental capacity, begging for a mental health interpretation. Pursuant to our ongoing, primary
professional responsibility to society to protect public health and wellbeing, and to warn against potential dangers to the public’s safety and security, we have embarked upon this report.
Mental capacity refers to the mental soundness that is necessary to fulfill a task and is a fundamental and necessary component of fitness for duty. It is a functional, not a diagnostic, assessment, focused less on the President’s personal mental health than on his capacity to fulfill the duties of his office as observed by co-workers and close associates. The information in the Special Counsel’s report, deriving from multiple sources under sworn testimony, yields an assessment with uncommonly high confidence.
We found evidence in the report of:
- Compromises in comprehension, or inability to take in critical information and advice;
- Faulty information processing, in the form of mendacity, rigidity, self-occupied notions of
“fairness,” and poor memory; - Interferences to sound decision making, including loss of impulse control, recklessness, and
inability to consider consequences; and - Proneness to placing himself and others in danger, including encouraging, recommending, or
inciting violence on the part of his followers.
Specific examples are in the body of the report.
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In summary, we believe1
that the preponderance of evidence overwhelmingly supports the conclusion that
this President is incapable of making sound, rational, reality-based decisions free of impulsivity,
recklessness, paranoid and other demonstrably false beliefs, with most notably an absorption in selfinterest that precludes the consideration of national interest. These characteristics not only affect the
overall unfitness of this President; they also indicate a profound danger to national and international
security in the nuclear age. Whereas we would still like to see the results of a proper, in-person
evaluation, as stated above, a personal interview does not necessarily yield the most useful information in
a functional assessment. In fact, we believe that we already have enough information to conclude that the
President lacks the mental capacity to discharge the duties of his office, and that his incapacity in these
respects represents a profound risk to public health and safety.
1 What about “the Goldwater rule”? some may ask. The Goldwater rule (Section 7.3 of the American Psychiatric
Association’s code of ethics) has often been misinterpreted, and it is important that we make clear: the Goldwater
rule is a call to action, stipulating that psychiatrists fulfill their primary professional responsibility to society by
participating in activities that improve the community and better public health. Our obligation is not to a public
figure but to society, and the rule states that, when asked about a public figure, we educate the public in general
terms while refraining from diagnosis (or the equivalent). We adhere to the Goldwater rule by refraining from any
diagnosis and, more importantly, uphold its principle by acting for the benefit of society through doing what we can
to protect its health and wellbeing.
p. 3
A REPORT ON THE MUELLER REPORT
MENTAL HEALTH ANALYSIS OF THE SPECIAL COUNSEL’S REPORT
ON THE INVESTIGATION INTO RUSSIAN INTERFERENCE IN THE
2016 PRESIDENTIAL ELECTION
If One is Too Incompetent to Commit a Crime, Despite Trying Hard,
Is One Competent to be President?
An Analysis of Presidential Mental Capacity
Whether the President has the mental capacity to serve in his office is what we, who have been
concerned enough to put our evaluations into the public-service book, The Dangerous Case of
Donald Trump (edited by Bandy X. Lee and published in 2017 and 2019), have been
questioning from the start. While the information in the Special Counsel’s report has been
deemed insufficient for criminal determination, it provides, even in redacted form, a wealth of
relevant information regarding the President’s mental capacity. Not having the mental capacity
to make sound decisions and to refrain from violence, whether by encouraging, recommending,
or inciting it on the part of his followers, whether or not he meets the criteria for being diagnosed
as mentally ill, is dangerous as long as he remains President and constitutes a medical emergency
that health professionals are obligated to respond to.
In medicine, mental capacity is about the mental soundness that is necessary to fulfill a task. For
example, the office of president requires, at the very least, the ability to make sound, rational
decisions based on reality and the ability not to place the nation in grave danger. The final
determination of “competency” is a judicial decision usually made by the courts, while capacity
is a medical assessment that psychiatrists, and especially forensic psychiatrists or other
appropriately trained forensic mental health professionals, contribute to courts as expert
witnesses to aid them in making their legal decisions. Similarly, presidential fitness is a political
decision, but just as the courts routinely rely on physicians’ assessments for fitness for duty,
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political bodies should not be denied access to the same medical and professional information
and expertise that the judicial system benefits from. We therefore offer our analysis as
potentially valuable data, as a part of our professional obligation to protect public health and
safety.
First, it is important for us to clarify that capacity evaluations are about function, in contrast to
diagnostic examinations, which try to define specific illnesses that affect someone’s personal
mental health, so that a proper course of treatment can be prescribed. It is necessary to
underscore, furthermore, that mental illness by itself does not disqualify one from effective
leadership. We do not have the legal authorization to analyze the President’s personal mental
health, whereas we do consider the wealth of public information, now including sworn
testimonies, that throws doubt on the President’s capacity to fulfill the duties of his office to be
central to our primary responsibility to society. Conventionally, a personal interview is usually
required for a diagnostic examination. For a functional examination, by contrast, there are few
tests as informative as observations by the person’s colleagues on his actual performance as to
how he is or is not able to function in his job. Seldom do we have as much detailed information
on a person’s behavior as is contained in the Special Counsel’s report, which has been verified
with the accuracy and expertise of a criminal investigation of the highest order. Therefore, we
can make an appraisal with a level of confidence that far exceeds what we ordinarily have in our
clinical practice.
A capacity evaluation consists of assessing four main components: (a) comprehension, or the
ability to take in information and advice without undue influence from delusions or excessive
emotional need; (b) information processing, or the ability to appreciate and make flexible use of
information and advice; (c) sound decision making, or the ability to weigh different options and
to consider consequences based on rational, reality-based, and reliable thinking without undue
influence from impulsivity, delusions, magical thinking, or fluctuating consistency and selfcontradiction; and (d) the ability to refrain from behavior that places oneself or other people in
danger, such as inciting one’s followers to commit acts of violence, and boasting of one’s own
repeated violence. When it comes to serving in a high governmental office, it also goes without
saying that constantly repeating declarations of demonstrably fallacious untruths despite a
consensus that these violate easily verified, objective, factual reality and that are often followed
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by denying that those statements were made in the first place even when they were made in
public and have been recorded on tape and video, would also be disqualifying.
Documentation of Donald Trump’s Characteristics that Indicate Incapacity
The Special Counsel’s report (henceforth “the Report”) includes many of the observations
previously reported in the press and the media that have pointed out to us the President’s clear
and present dangerousness because of incapacity. What also emerges from the Report, however,
is a broader view of the President’s behavior and psychological state. Not limited to isolated
disclosures, the long and broad view of the Report and its thorough analysis of intentions
document not just instances but patterns of the President’s behavior. These patterns of behavior
lead us to enhanced confidence in our judgments about his psychological state. For example,
forgetting a single name is not documentation of memory impairment; nor is an occasional
thoughtless act proof of lack of empathy or cruelty. Repetitive patterns, however, are what we
can compare to the thousands of patients we have collectively seen and relate to existing patterns
of pathology. Focusing on some of the more alarming patterns of the President’s behavior
revealed in the Report, our concern is not the legal distinctions among collusion, coordination, or
conspiracy, or whether or not a sitting president is indictable, but the cumulative implications
regarding his dangerousness and incapacity.
A. Compromises in Comprehension
Inability to Take in Critical Information. Briefly, the Report outlines how the Russians
systematically and sweepingly attacked America before and during the 2016 election. There
were dozens of connections, meetings, visits, attempts to engage, and phone calls between
Russians and the President’s circle. While the Special Counsel was not able to find the final
legal proof of an actual agreement between Russians and the President, the Report indicates that
some witnesses destroyed evidence, gave false testimony, pleaded the Fifth Amendment, lied,
claimed false privilege, or used encryption applications or programs that did not preserve longterm records. The Report also makes clear that the President knew about, expected, and received
benefit from Russian actions (Vol. I, pp. 4-10). Given the President’s continued refusal to
acknowledge the severity of these attacks, we can see that his comprehension and ability to
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absorb important information from his own intelligence agencies, whatever the reason, is
impaired. If he cannot protect the nation against a hostile force that has attacked us, it also points
to dangerousness. While the Special Counsel concluded that a criminal act (actus reus) could
not be established beyond a reasonable doubt in Volume I, a criminal intent (mens rea) is
extensively well documented in the discussion of the intentions behind many of the President’s
actions in Volume II (as well as actus reus, if not for the Counsel’s decision to abide by the
Department of Justice policy not to indict a sitting president). These factors, combined with the
evidence of mental incapacity, heighten dangerousness.
Inability to Work with Advisors. When the highly-respected White House lawyer, Don
McGahn, failed to meet the President’s demands for obedience to the direction that he tell Acting
Attorney General Rod Rosenstein to fire Special Counsel Robert Mueller, and then demand that
he “put out a statement denying that he had been asked to fire the Special Counsel” (Vol. II, p.
114), he became the object of ridicule (“Lawyers don’t take notes”), saw the impossibility of his
role, refused to perjure himself, headed for the exit, and then provided 30 hours of testimony to
the Mueller investigators.
In a similar manner, his advisors blocked the President from acting impulsively and selfdestructively, hence preventing him from committing a crime. According to one segment of the
Report:
The President’s efforts to influence the investigation were mostly unsuccessful, but that is
largely because the persons who surrounded the President declined to carry out orders or
accede to his requests. Comey did not end the investigation of Flynn, which ultimately
resulted in Flynn’s prosecution and conviction for lying to the FBI. McGahn did not tell
the Acting Attorney General that the Special Counsel must be removed, but was instead
prepared to resign over the President’s order. Lewandowski and Dearborn did not deliver
the President ‘s message to Sessions that he should confine the Russia investigation to
future election meddling only. And McGahn refused to recede from his recollections
about events surrounding the President’s direction to have the Special Counsel removed,
despite the President’s multiple demands that he do so (Vol. II, p. 158).
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These illustrate a president who is: (a) predisposed to rash, short-sighted, and dangerous acts,
without consideration of consequences, motivated by self-protection to the degree that he does
not appear capable of considering national vulnerability; and (b) surrounded only by the most
informal and personal resistance around him to curtail those acts, until the pressure of his
predisposition pushes out the advisors. It is clear that the course of events could have gone either
way if those surrounding the President had yielded to the pressures to fire Mueller, or if they had
spoken directly to Attorney General Jeff Sessions about limiting the scope of the Special Counsel
instead of Rick Dearborn, a senior White House official, pocketing the message. The President’s
investment in a certain “reality” (that the Russian attack was insignificant) and his refusal to
accept critical information or advice hence augment the dangers that our nation faces.
B. Faulty Information Processing
Mendacity. Much has been made of the over 9,000 lies that the Washington Post (March 4,
2019) estimates the President has told since taking office. The Report sheds new light on an
important area of the President’s lying: that to his staff and colleagues. This trend is so obvious
to others, and also so unusual among public servants, that it raises a question of serious mental
pathology: namely, does he actually believe the obvious untruths that he repeatedly utters (in
which case we would need to ask whether he is suffering from delusions), or does he know that
they are untrue but utters them anyway (in which case he is deliberately and consciously lying as
a means of attempting to manipulate others into advancing his financial, political, or
psychological needs and interests, which at high quantities would cause one to ask whether this
is a symptom of an antisocial or psychopathic/sociopathic disorder). Either instance would
constitute faulty information processing. Although the President presented himself as critical of
former National Security Advisor Michael Flynn within a few weeks of his inauguration in
January of 2017 and then orchestrated Flynn’s forced resignation, when Flynn came to his office
after resigning, the President hugged him, told him he was a “good guy” and assured him, “we’ll
take care of you.” After his departure, the President several times directed staff such as White
House Chief of Staff Reince Priebus and Deputy National Security Advisor K. T. McFarland to
reach out to Flynn and let him know he cares about him and to “stay strong” (Vol. II, p. 43-44).
In much the same manner as with Flynn, the Report details the President’s playing both former
Campaign Chairman Paul Manafort and former Attorney-Fixer Michael Cohen to “stay strong.”
p. 8
Cohen was expected by the President to adhere to a “party line” regarding: (a) denying the
President’s continuing active engagement in a possible Trump Tower deal in Moscow well into
the 2016 primary campaigns and during the run-up to the Republican convention; and (b) the
payments to pornographic actress Stormy Daniels. From an email from one of his lawyer’s
reporting on a conversation with attorney Rudolph Guiliani, Cohen was told, “the conversation
was ‘Very Very Positive. You are ‘loved’…. they are in our corner…. Sleep well tonight[], you
have friends in high places’” (Vol. II, p. 147). Similarly, Manafort apparently believed
reassurances that the President would protect him. In “January 2018, Manafort told Gates that he
had talked to the President’s personal counsel and they were ‘going to take care of us’” (Vol. II,
p. 123).
As Cohen began cooperating with the Special Counsel in the Summer of 2018, however, the
President’s comments turned highly critical, asserting that Cohen was lying in order to get a
reduced sentence and publicly playing Cohen, Manafort, and Flynn off against one another.
“The President also said that Cohen was ‘a weak person. And by being weak, unlike other
people that you watch, he is a weak person’” (Vol. II, p. 150).
The criticism of Cohen included what were widely understood to be threats to his family. The
Report describes this:
In the weeks following Cohen’s plea and agreement to provide assistance to this Office,
the President repeatedly implied that Cohen’s family members were guilty of crimes. On
December 3, 2018, after Cohen had filed his sentencing memorandum, the President
tweeted, “‘Michael Cohen asks judge for no Prison Time.’ You mean he can do all of the
TERRIBLE… things having to do with fraud, big loans, Taxis, etc., and not serve a long
prison term? He makes up stories to get a GREAT & ALREADY reduced deal for
himself, and get his wife and father-in-law (who has the money?) off Scott Free…” (Vol.
II, p. 151).
The following month, in January 2019, the Report adds:
In an interview on Fox on January 12, 2019, the President was asked whether he was
worried about Cohen’s testimony and responded: [I]n order to get his sentence reduced,
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[Cohen] says “I have an idea, I’ll ah, tell—I’ll give you some information on the
president.” Well, there is no information. But he should give information maybe on his
father-in-law because that’s the one that people want to look at because where does that
money—that’s the money in the family. And I guess he didn’t want to talk about his
father-in-law, he’s trying to get his sentence reduced. So it’s ah, pretty sad. You know,
it’s weak and it’s very sad to watch a thing like that (Vol. II, p. 152).
Then, “On January 23, 2019, Cohen postponed his congressional testimony, citing threats against
his family” (Vol. II, p. 152).
In its analysis of his actions around Cohen, the Report considers the President’s “intentions” and
points out the basis for “an inference that they were intended at least in part to discourage Cohen
from further cooperation”:
Finally, the President’s statements insinuating that members of Cohen’s family
committed crimes after Cohen began cooperating with the government could be viewed
as an effort to retaliate against Cohen and chill further testimony adverse to the President
by Cohen or others. It is possible that the President [believed the assertions in his tweets
and/or that they] … were not intended to affect Cohen as a witness but rather were part of
a public-relations strategy aimed at discrediting Cohen…. But the President’s suggestion
that Cohen ‘s family members committed crimes happened more than once, including
just before Cohen was sentenced (at the same time as the President stated that Cohen
“should, in my opinion, serve a full and complete sentence”) and again just before Cohen
was scheduled to testify before Congress. The timing of the statements supports an
inference that they were intended at least in part to discourage Cohen from further
cooperation (Vol. II, p. 156).
Others too suffered the President’s mendacity. In his testimony to the Counsel’s office, Reince
Priebus described how he had asked the President to return Jeff Session’s resignation letter while
they were on a trip to the Middle East. The President told Priebus it was in his office in
Washington. Former White House Communications Director Hope Hicks, however, described
the President having shown the letter to senior staff on the same trip (Vol. II, p. 79).
p. 10
When Don McGahn reported that the President had ordered him to contact Rod Rosenstein and
have him fire the Special Counsel, the President denied this account and acted against McGahn.
In a meeting in the Oval Office, the President pressured him to deny the reports. This was the
same meeting in which the President mocked McGahn’s taking notes, comparing him
unfavorably to Roy Cohn (the former lawyer for both Senator Joseph McCarthy and Donald
Trump, who was later disbarred as a lawyer for several violations of the law), who the President
said never took notes. McGahn interpreted this as an attempt to “test his mettle” (Vol. II, p. 117)
and see how committed he was to his memory of what had occurred. The President had also
orchestrated pressure on McGahn by telling White House Staff Secretary Rob Porter “that it
might be necessary to fire McGahn if he did not deny the story, and Porter relayed that statement
to McGahn” (Vol. II, p. 120).
Rigidity. Rigidity is a common feature of a variety of mental health problems. We all have
strengths and weaknesses, but it is the ability to recognize and adjust for them that allows most
healthy individuals to adapt without forming rigid responses. Strong patterns of behavior,
emotional reactions, or cognitive distortions can cause wooden or reflexive reactions to
challenges and limit the flexibility and freedom an individual needs when making choices.
Healthy individuals may react with less reflection or nuance than ordinarily available them, when
they are exposed to an unusually severe degree of stress, but compromised individuals react this
way most of the time, merely “doubling down” when challenged. This tendency can easily
devolve into “attack mode” whenever under stress, causing the individual to act on the first
emotional urge that surfaces, or to view the entire world as against them and thus must always be
on the defensive, which can quickly turn into violence.
A deceptive strategy of ad hominem emphasis on his opponents, as a way of avoiding rational
and evidence-based debates over issues of public policy, together with a combative strategy of
ridiculing his opponents rather than debating about their policy positions, before they have even
had a chance to speak (“hit first and ask questions later,” as in: “low-energy Jeb,” “little Marco,”
“crooked Hillary”) enabled the candidate Trump to distract enough highly-stressed voters from
focusing on the actual policy differences between himself and his opponent, that he was able to
turn a loss in the popular vote into a victory in the Electoral College. He has also shown
predatory skills, being remarkably talented at ridiculing his opponents and brazenly talking down
challenges. He attempts, and sometimes succeeds, at overwhelming his opponents with
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unabashed grandiosity and assurance in his ability to overwhelm opposition not with rational,
evidence-based arguments, but with unsupported, factually untrue assertions that he appears to
make up one day and then deny the next, ad libitum. In psychological terms, this is described as
the most primitive form of cognition, which is called “magical thinking” or “wishful thinking,”
which follows “the pleasure principle” (whatever makes one feel good, or at least less distressed,
and appears to gratify one’s wishes), rather than “the reality principle” (which will often frustrate
or be incompatible with one’s wishes).
Clinical and empirical research shows that this kind of brashness often comes from a reaction
against one’s own vulnerability and an inability to tolerate the reality of human weakness and
uncertainty. The Report, being an investigative document, is likely one of the greatest
challenges to a president who has repeatedly shown an intolerance of investigative reporting,
calling it “fake news” and “the enemy of the people.” In the Special Counsel’s measured but
exhaustive compilation of well-sourced facts and observations, it provides a wall of evidence that
the President has probably never encountered. It cannot be blown through with bluster and an
overwhelming will to deny whatever facts one is uncomfortable acknowledging. It is out there,
carefully compiled, clear, convincing, for all to see. By not reaching a verdict, perhaps
brilliantly, the Report focuses attention on the facts themselves, not on a conclusion that can be
questioned or framed as “angry” or “partisan.” However, being faced with an indisputable
catalogue of facts, and unable to alter his defenses according to the needs of the situation, the
President has already resorted to his customary strategy of lashing out, creating ever greater
present dangers for the nation, as can be seen from his initial reactions of attack and threat
against McGahn, even to the point of accusing his opponents raising the prospect of treason. Our
deepest concern is that when reality smothers his accusations and neutralizes his assaults, that
will be when he resorts to the most dangerous and violent strategies. For example, in discussing
the possibility of his being defeated, about which he said that he had “the police,” “the military,”
and “the bikers for Trump” on his side—implying the threat of a violent coup d’état (with only
what we would call “implausible deniability”) if he were denied victory.
Peculiar Frequent Use of “Unfair”. Given the President’s pride in being tough and hitting
back “ten times harder” than he has been hit, his frequent use of the word “unfair” is striking.
He uses it in a way that implies that anyone who frustrates him, even if they do so because the
law requires them to disobey his orders to break the law, is being “unfair” to him personally. It
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does not seem to occur to him that there are objective laws apart from his personal wishes and
interests. In an interview with the New York Times on July 19, 2017 (Vol. II, p. 93), the
President complained that “Sessions should have never recused himself, and if he was going to
recuse himself, he should have told me before he took the job, and I would have picked
somebody else.” The President described this as “very unfair to the president.” Again, in anger
directed to Sessions following Comey’s failing to state in a May 2017 testimony that the
President was not under investigation, “The President said that the recusal was unfair and that it
was interfering with his ability to govern and undermining his authority with foreign leaders”
(Vol. II, p. 63).
The President dictated to Lewandowski language that the President wanted Sessions to use in
announcing limiting the Special Counsel’s purview to “future elections.” Lewandowski was
to relay this to Sessions. According to Lewandowski’s notes, the President’s dictation included,
“our POTUS … is being treated very unfairly. He shouldn’t have a Special Prosecutor/Counsel
b/c he hasn’t done anything wrong…. He didn’t do anything wrong except he ran the greatest
campaign in American history…. I am going to meet with the Special Prosecutor to explain this
is very unfair and let the Special Prosecutor move forward with investigating election meddling
for future elections” (Vol. II, p. 91).
This pattern represents a degree of immaturity that in an adult is a sign of either regression or
arrested development, neither of which is normal. Cognitively, it shows a lack of abstracting
abilities, in that he cannot conceive of “fairness” occurring outside of fulfilling his desires. This
results in a “whining” lack of tolerance and peevish retaliation, ill-suited and dangerous in a
nuclear-age commander-in-chief.
Poor Memory. After refusing for more than a year to be interviewed by the Special Counsel (p.
C-1), the President finally agreed to respond to questions only in written form. Even with the
help of his lawyers, however, his responses were not able to bring up substantial details that
would be useful for the investigation but mostly state that he “on more than 30 occasions … does
not ‘recall’ or ‘remember’ or have an ‘independent recollection’” (p. C-1). By contrast, he rarely
lacks certainty in his public statements, even with highly questionable content, and touts himself
as having “the world’s greatest memory” or “one of the great memories of all time.” Making
oneself impossible to indict by failure or refusal to recall does not prove innocence or guilt but
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can be valuable data: overall, in his remarkably brief answers (often the questions are longer than
the answers), there is not a single question or part of a question that he answers without some
variation of “I do not recall” or “I do not remember” (pp. C-11 to C-23)—to the point that his
testimony merely demonstrated “inadequacy of the written format” (p. C-1).
Again, the patterns are more informative than individual instances, and the form of his testimony
is significant in terms of: (a) the near absence of content, which indicates an extreme reluctance
or inability to offer information; (b) a written language so starkly removed from the president’s
ordinary manner of parlance, that it reads like “legalese” (or a lawyer’s language, which is a
client’s legal right, but in mental health is a possible indication of high levels of contrivance and
therefore likely unreliability); and (c) with his failure to “recall” substantial information
(regarding Donald Trump Jr.’s Trump Tower meeting, Russian hacking that includes WikiLeaks,
the Trump organization’s Moscow project, and Russian contacts during the campaign and the
transition), there are only two possibilities: either he truly does not remember, or is making a
total fabrication—and either is pathological and highly worrisome with respect to a president’s
capacity to serve, warranting an evaluation.
Avoiding interviews or answers that would make oneself indictable is comparable to a mentally
impaired person avoiding doctors and hospitals at all cost so as not to be diagnosable. Whereas
in criminal justice it is a legal right, in mental health it is valuable information regarding one’s
mental state. A lack of genuine effort with respect to an issue of national security, when the
country was unequivocally and effectively attacked by an enemy nation, is alone a sign of severe
incapacity to fulfill the duties of the presidency.
C. Interferences to Sound Decision Making
Loss of Emotional Control. A number of accounts in the Report indicate the alarming
frequency, intensity, and lack of control of the President’s propensity to angry outbursts. Former
White House Chief Strategist Steve Bannon described the President’s anger upon learning of
Sessions’ recusal, “as mad as I’ve ever seen him,” and he “screamed at McGahn” (Vol. II, p. 51).
In response to Comey’s confidential briefing to congressional leaders on the existence of the
Russia probe in March, 2017, “notes taken by Annie Donaldson, then McGahn’s chief of
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staff, … state, ’POTUS in panic/chaos.’” Others reported that the President was “beside
himself” (Vol. II, p. 54).
Following Comey’s testimony in Congress on May 3, 2017, “McGahn relayed that Comey had
declined to answer questions about whether the President was under investigation,” in spite of
the President’s request to Comey to state that he was not under investigation. “The President
became very upset and directed his anger at Sessions. According to notes written by Sessions’
Chief of Staff Jody Hunt, the President said, ‘This is terrible Jeff. It’s all because you recused.
AG is supposed to be most important appointment…. I can’t do anything” (Vol. II, p. 63).
After Comey’s firing and Rosenstein’s appointment of the Special Counsel, the President again
lashed out at Sessions and demanded his resignation. Hope Hicks described the President as
“extremely upset by the Special Counsel’s appointment. Hicks said that she had only seen the
President like that one other time, when the Access Hollywood tape came out during the
campaign” (Vol. II, p. 79).
In addition to inability to control his anger in dealing with cabinet secretaries, what is striking
about these incidents is the nature of the provocation—threats to self. The President was not
reported as furious that a staff member or cabinet secretary had bungled an important legislative
or foreign policy initiative. What triggered his ire was the threat to him and his stature,
personally. This is most clearly reflected in the President’s widely reported response to hearing
of the appointment of the Special Counsel: “Oh my God. This is terrible. This is the end of my
Presidency. I’m fucked” (Vol. II, p. 78). These statements stand out because of the degree to
which they constitute a virtual admission of guilt—for if they did not support that conclusion,
why would they be “terrible?” Why would he be “fucked,” unless that means “found guilty?”
But in addition to the fact that Mr. Trump’s remarks imply his guilt (for some unnamed offense
or offenses), it is worth noticing also how exclusively self-referential they are. There is no,
“What are we going to do? This will undermine all our plans and policies.” The singular
reaction is perhaps indicative of the extent to which the President is, as with his contrary reaction
to Russia’s attack on the integrity and validity of our process of electing a President, preoccupied
with himself to the point where he does not even consider the good of the nation.
p. 15
Recklessness. The Report describes a number of instances in which the President acted against
the advice of others, including the White House lawyer, McGahn. Following Comey’s March
2017 meeting with congressional leaders at which he disclosed the existence of the Russia probe,
the President twice called Comey directly, notwithstanding guidance from McGahn to avoid
direct contacts with the Department of Justice.
The President initiated several efforts to have him removed or at least to limit his powers. In the
first one, he raised issues about Mueller’s supposed conflicts of interest. These were generally
dismissed by McGahn, Bannon, and others. McGahn told the President that if he wanted to
pursue these, he should do so through his personal attorney since this was not a White House
matter. McGahn also pointed out a number of weaknesses in the President’s arguments and that
advancing them could add evidence of an attempt to obstruct the Special Counsel. In spite of
this, the President’s personal attorney did contact the Special Counsel’s office asserting the
alleged conflicts (Vol. II, p. 83).
Four days later, June 17, 2017, the President called McGahn and directed McGahn to contact
Rosenstein and direct him to fire Mueller. McGahn had no intention of doing so. In a second
call the same evening, the President told McGahn, “‘Call Rod, tell Rod that Mueller has conflicts
and can ‘t be the Special Counsel.’ McGahn recalled the President telling him ‘Mueller has to
go’ and ‘Call me back when you do it.’ McGahn understood the President to be saying that the
Special Counsel had to be removed by Rosenstein” (Vol. II, p. 86). McGahn prepared to resign
including going to his office to remove his belongings. In the end, the immediate situation
seemed to be resolved by McGahn continuing in his position and the President not again
mentioning the direction to call Rosenstein (Vol. II, p. 83-87).
In a parallel sequence of events in June and July, 2017, the President directed Lewandowski to
contact Sessions and have him make a statement that the President dictated to Lewandowski, in
which Sessions would assert that the President had done nothing wrong and that the Special
Counsel’s authority would be limited to “investigating election meddling for future elections”
(Vol. II, p. 91). Scheduling conflicts delayed Lewandowski’s opportunity to meet with Sessions.
A month later, the President asked Lewandowski about progress. Lewandowski asked Rick
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Dearborn, a senior White House official to serve as an intermediary and gave Dearborn a typed
version of the statement the President had dictated for Sessions. Dearborn apparently never
acted on this and the specific request dropped, but was followed by further criticisms of Sessions
by the President (Vol. II, p. 93).
Inability to Consider Consequences. In the above two instances, the President directed actions
to be taken, the dismissal of Mueller as Special Counsel and the limitation of the Special
Counsel’s role by an unrecused Sessions which were only avoided by the passive resistance of
those he directed. The combination of reckless decisions, the consequences of which were
avoided only by staff resistance, false denials, themselves an indicator of guilty intent, and
threatened vengeance against those who kept the recklessness in check and told the truth about it
illustrate a dangerous pattern of impulsive harm doing which, when countered, is only redirected
in more threatened harm. Above all, in a post-Richard Nixon era, knowing that that former
president was forced to resign primarily because his firing of law-enforcement officials who
were facilitating or even just permitting the investigation into his behavior to proceed,
constituted an obstruction of justice, a rational person presumably would have considered the
consequences of such actions. The President himself discovered that the firing of Comey did not
“take the pressure off” but only brought on a new Special Counsel with new investigations into
him that did not work to his advantage.
D. Placing the Nation in Danger
Danger to Self or Others. Tendencies that place oneself or others in danger are also core
components that indicate a lack of capacity to fulfill the duties of his office. There are numerous
reports of the President placing the nation and the world in danger, with empirical studies
documenting an unprecedented rise in hate crimes, schoolyard-type bullying, white supremacist
killings, assaults directly implicating the President, and the extraordinary pipe bomber who sent
sixteen explosives to the President’s most prominent critics, and most recently the mosque
shootings in New Zealand citing “common purpose” with the President. In addition, the
emotional characteristics noted above, including impulsivity, recklessness, and an inability to
consider consequences of his actions, created a particularly dangerous situation in the nuclear
age, where thousands of thermonuclear weapons are under his sole command without an
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adequate set of formal checks or balances. Apart from these, and apart from the outright denial
of Russia’s well-documented attack on the United States’ 2016 elections, including siding with
that enemy nation’s leader over his own intelligence agencies and the attempt to block
investigations into Russia’s attack, there is evidence from the Report that indicate general
evidence of danger.
We know, from the first months of the Trump administration, in response to concerns about his
potential for rash and dangerous acts, there was much talk about the protection provided by key
associates such as Secretary of State Rex Tillerson, Secretary of Defense James Mattis, Reince
Priebus’ replacement as White House Chief of Staff, John Kelley, and Michael Flynn’s
replacement as National Security Advisor, H. R. McMaster. The Report corroborates these
claims and further confirms that the country has been protected against directions to the Assistant
Attorney General to fire the Special Counsel or directions to the Attorney General to announce
that the Special Counsel limit his investigation to future elections, not by forceful assertion of
national interest, but by the passive resistance of those around the President, often in an attempt
to protect the President from himself. Still, the President has ousted these moderating forces
rather than listen to them. Former President Ronald Reagan, who some have suspected of having
suffered from the early stages of dementia while still in office, at least surrounded himself with
capable personnel. The current President seems unable to do this; rather, only a few capable
staff remain in spite of the President. With the President’s apparent symptoms worsening in
plain public view, such as his “tweeting” angry messages over fifty times over the course of
twenty-four hours a few days ago, a departure from his already escalating pattern of “tweets,” the
likelihood of grave danger to national and international security can no longer be overlooked.
Conclusion
The Special Counsel’s report offers an extraordinary level of high-quality information on the
President’s apparent lack of mental capacity: compromises in comprehension (inability to take in
critical information and advice), faulty information processing (mendacity, rigidity, selfoccupied notions of “fairness,” and poor memory), interferences to sound decision making (loss
of impulse control, recklessness, and inability to consider consequences), and proneness to
placing himself and others in danger. Without the limitations on the President’s dangerous
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decision making that the Report reveals on the part of his own surrounding staff, generally
regarded as distinguished and formidable, the national interests of the United States and, indeed,
the world would have been placed at much greater risk by the mental functioning of the current
President. The President has now eliminated most of those staff.
Mental capacity does not relate primarily to a person’s specific psychiatric diagnosis; in other
words, the presence of a mental disorder does not render a person incapable of making rational
and realistic decisions. It is also separate from criminal-mindedness, and is most cases does not
exonerate from criminal wrongdoing (when the act is present). The combination of mental
incapacity and criminal-mindedness, however, creates the most dangerous kind of leadership
possible. Given the clear and pervasive, cumulative patterns we have summarized from the
Special Counsel’s report of the President’s impaired capacity to make responsible decisions free
of impulsivity, recklessness, suspiciousness that leads him to believe that he needs to defend
himself against betrayal or persecution, absorption in self-interest that precludes attention to the
national interest, inability to weigh consequences before taking action, detachment from reality,
creation of chaos and danger, and cognitive and memory difficulties, there is compelling medical
evidence that he lacks the capacity to serve as president.
In the interest of making a reasonable attempt to obtain a personal interview, we make a final
recommendation that the president sit through a formal evaluation by a panel of independent,
nongovernmental body of experts, which the President should be able to agree to if he believes
he is fit to serve. We believe that, given the enormous high-quality data now available, and the
extreme dangers implied in presidential incapacity, it is imperative that the president clarify the
matter of incapacity for the good of the country. However, absent this examination, we believe
that we have enough evidence to come to a conclusion if necessary.
Prepared on the 25th of April, 2019, by:
Bandy X. Lee, M.D., M.Div.
Assistant Clinical Professor in Law and Psychiatry, Yale School of Medicine
Project Group Leader of the Violence Prevention Alliance, World Health Organization
President, World Mental Health Coalition
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Edwin B. Fisher, Ph.D.
Professor in the Department of Health Behavior, Gillings School of Global Public Health,
University of North Carolina-Chapel Hill
Former President, Society of Behavioral Medicine
Leonard L. Glass, M.D., M.P.H.
Associate Clinical Professor of Psychiatry, Harvard Medical School
Senior Attending Psychiatrist, McLean Hospital
Former President, Boston Psychoanalytic Society and Institute
James R. Merikangas, M.D.
Clinical Professor of Psychiatry and Behavioral Science, George Washington University
Research Consultant, National Institute of Mental Health
Co-Founder, American Neuropsychiatric Association
Former President, American Academy of Clinical Psychiatrists
James Gilligan, M.D.
Clinical Professor of Psychiatry and Adjunct Professor of Law, New York University
Consultant to the Violence Prevention Alliance, World Health Organization
Former Director of Mental Health Services, Massachusetts Department of Corrections
Former President, International Association for Forensic Psychotherapy
Disclaimer:
We declare ourselves to be free of conflicts of interest. We receive no support from pharmaceutical
companies or the federal government, and although we each contributed to The Dangerous Case of
Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, this book itself is meant
as a public service, and we are taking no profit from it. We also do not engage in political activism but
are responding to what we see as a public health crisis by putting our skills as expert witnesses to service.
Evidence from the Special Counsel’s report and from elsewhere confirm our assessment and support our
actions as fulfillment of our professional obligation to society, as outlined in our ethical guidelines and
obligated by the law, whereby we are to mandated to report to relevant authorities when we identify clear
danger to the public’s wellbeing. In this case, the authorities are the American people, and hence we are
releasing this report to the public at the same time as to the Chairman of the House Judiciary Committee.
Must check this interview:
https://www.youtube.com/watch?v=ghg4-1rEZzk
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