"If he had a heart condition, ... I would have expected cardiologists to speak up," Dodes says.

In the thick of the election campaign, Hillary Clinton called Donald Trump unfit to be president. Bernie Sanders called Clinton unfit to be president. Trump called every candidate unfit to be president but him. Now, in a new book, more than two dozen mental health professionals call Trump unfit to be president, saying he is mentally disturbed and a danger to America’s safety.

In an interview with ThinkAdvisor, Dr. Lance M. Dodes, a psychiatrist who co-conceived the New York Times bestseller “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President” (St. Martin’s/Thomas Dunne October 2017), discusses traits of “significant mental derangement” that Trump exhibits and why the book was written. Dodes taught psychiatry at Harvard Medical School and is a former director of the substance abuse treatment unit of Harvard’s McLean Hospital.

The American Psychiatric Association’s Goldwater Rule states that it’s unethical for psychiatrists to give professional opinions about public figures they haven’t examined. But the book’s authors, who are affiliated with, in addition to Harvard, Johns Hopkins University Medical School, Columbia University, Stanford University, Yale and others, say they have an overriding ethical duty to warn America about Trump.

“The public trust is violated if the profession fails in its duty to alert the public when a person who holds the power of life and death over us all shows signs of clear, dangerous mental impairment,” writes Harvard Medical School psychiatry professor Judith Lewis Herman and the book’s editor, Bandy X. Lee, assistant clinical professor in law and psychiatry at Yale School of Medicine.

The experts describe traits Trump has exhibited, based mainly on observing his public conduct and behavior, that are consistent with several psychological disorders, including sociopathy, pathological narcissism, delusional disorder, extreme hedonism and cognitive impairment — all of which are mutually inclusive, or exist simultaneously.

This is, they insist, a toxic amalgam that puts the United States at risk. Consequently, Trump should be ousted from office, Dodes argues in the interview.

He wrote the chapter contending that Trump “undeniably” shows the traits “of a paranoid sociopath — such as impulsiveness, cruelty, lack of guilt and empathy, disregard for the rights of others and loss of reality.” He thus “creates a profound risk of war since heads of other nations will challenge the sociopathic leader, who will experience that as a personal attack leading to rage reactions and impulsive actions to destroy this ‘enemy,’” Dodes writes.

The past February, The New York Times published a letter he and 34 other mental health professionals wrote warning of Trump’s “grave emotional instability … that makes him incapable of serving safely as president.” They said the Goldwater Rule “has resulted in a failure to lend our expertise … at this critical time. We fear that too much is at stake to be silent any longer.”

Others in mental health believe the book’s authors should have stayed out of the discussion about the controversial Mr. Trump. 

“Not only is it unethical and a violation of the law to diagnose or assess someone you have never treated, such as the president, it also feeds the high anxiety that currently exists around the presidency,” says psychotherapist Jonathan Alpert, known as “The Wall Street Therapist” and who is based in New York City. He wrote “Be Fearless: Change Your Life in 28 Days” (Center Street 2012). “If a professional is truly concerned, they’ll do their best to soothe the nation’s anxiety, not fuel it.”

(Related: Wall Street Millennials Are a Strung-out, Rattled Mess: Jonathan Alpert)

ThinkAdvisor recently interviewed Dodes, 70, an addiction specialist who has a private practice in Beverly Hills, California. He was elected a distinguished fellow of the American Academy of Addiction Psychiatry and is author of “The Sober Truth” (Beacon Press 2014). Here are excerpts from our conversation:

THINKADVISOR: Why did you and 26 other mental health professionals write this book?

LANCE DODES: The duty to warn applies. It’s our duty to tell people about Trump. Our nation is facing a crisis because we have the most psychologically ill president — certainly in my lifetime — and he’s a very serious danger to the country. He’s dangerous because he’s ill. If he had a heart condition instead of a psychological condition, I would have expected cardiologists to speak up.

But the American Psychiatric Association’s 1973 Goldwater Rule states that it’s not ethical for psychiatrists to give professional opinions about public figures they haven’t examined.

Not only must that [rule] be overlooked when a dangerous person like Donald Trump is [at issue], it never applies to the kinds of diagnoses we’re talking about.

Why not?

When the rule was promulgated, they were referring to a diagnosis [based on] a person’s inner conflicts and fantasies that are causing them trouble. That has zero to do with making a diagnosis from afar, which you can do. You don’t need an interview with someone to know when they’re lying, cheating, stealing and are delusional, as is the case with Trump.

What’s your overall assessment of him?

He has the most dangerous combination of emotional problems for anyone who could possibly be president. [For one], he’s a sociopath — what the DSM [Diagnostic & Statistical Manual of Mental Disorders] calls “antisocial personality disorder.” He meets every single criterion for it.

What’s an example?

It doesn’t matter to him that he says things that aren’t true or that he contradicts himself. The truth doesn’t matter to Trump because that’s not what he’s about. He’s about enhancing himself moment to moment.

What are the disorders other contributors to the book describe Trump as having?

Malignant narcissism, delusional disorder, extreme hedonism [etc.]. None of these are mutually exclusive. All the labels overlap, and they all point to his dangerousness.

So the objective is having Trump ousted from the presidency?

That’s why we wrote the book. He has to be gotten out of office.

You wrote that if he stays, “He’ll gain more power and less grasp on reality, engender more criticism, producing more paranoia, more lies and more enraged destruction.” That doesn’t sound like a rosy future.

It’s an extraordinarily dangerous future.

Just what threat does Trump pose?

There are two main threats. The risk of war is the most immediate danger. This is not just a person who could take a machine gun and go to the top of a building [and kill] — as horrible as that is — this is a person who has the nuclear codes. So the risk to our country and the world is great.

What might he do?

He’s a great danger for making erratic, sudden decisions in his moments of rage and moments when he loses touch with reality. He’s shown to be prone to both of those. So the danger of his doing something impulsive like that — which he has already done — is enormous.  

How has he shown that?

He launched 59 missiles at Syria [within 72 hours] of seeing an image on the news that he didn’t like — reversing his stated Middle East policy and because he wanted to do something dramatic to show how powerful he is.

What other evidence is there of Trump’s being erratic and making decisions in the moment?

He fired James Comey, the head of the FBI, after hearing him testify in unwanted ways before Congress. He’s had abrupt changes in policy, both domestic and foreign. He’s created international tensions with Mexico, Germany, France and Greece. He’s changed positions rapidly on people he leaned upon for good advice. And then there are his midnight tweets. All of these are impulsive actions.

Please elaborate on your statement that “he loses touch with reality.”

Accusing President Obama of bugging Trump Tower is an example. He loses touch with reality when he’s challenged and enraged. He needs to believe he’s right even if he’s shown to be wrong. This is a very disturbed man.

What’s the other main threat that you say he poses?

Trump is a danger to democracy in the same way that Hitler was a danger to the democracy of the Weimar Republic in Germany or other dictators and tyrants who have taken over previously democratic countries.

Why?

Donald Trump isn’t a man who loves democracy. If you’re a person who cares only about yourself — as he does — who is perfectly willing to trample on others’ rights, to cheat and lie and steal — all true of Trump — that’s incompatible with democracy. But the United States is stronger than the Weimar Republic. I don’t think he’s going to succeed. I think he’s going to fail and won’t be in office long.

Anything else that would indicate he’s a threat to democracy?

Donald Trump has already had a horrible effect on the country. Not only are people in the U.S. terrified by him — like, immigrants who are threatened with being separated from their children — minorities, especially Muslims, have been attacked as a group, just as Hitler did to Jews and Catholics.

How has Trump affected America’s culture?

It’s already been dramatic. There’s been an increase in hate crimes and violence. Racists are emboldened. There’s also his effect on our children: In the past, we’ve benefited from the concept that the U.S. president is a good, just, wise man who will take care of us. That’s no longer true.

Any other evidence you see?

Polls [such as Quinnipiac’s survey in September 2017] now suggest that more than half of Americans think Trump is unfit to be president because of the lies he tells, alone. The free press is being undermined — as every tyrant has tried to do — and the effect is: Maybe it’s OK to make up your own facts. That’s devastating.

Concerning the Russia investigation, do you think Trump is beholden to Russia and is covering up?

Once you accept the idea that this is a person who has no use for democracy or the feelings of other people, why wouldn’t he go to a foreign government to try to get them to help him win the election? It’s unethical and illegal. But what does Donald Trump care about that?

Trump has often been called a con man. You agree?

Yes, he is a con man. But that sounds like he could be just a minor flimflam artist. No. He’s a con man to the depth of his soul. He doesn’t relate to other people the way a normal person does. It’s all about him and where he can get in the world, and it doesn’t matter who he hurts.

Are the tax cuts he’s been promising a fantasy to which Americans cling?

Yes. People still hold out hope. It’s one of the reasons behind the emotional longing for a strong, heroic leader. Politicians have always promised more than they can deliver, but Donald Trump is so ignoring of reality — as in his delusional moments — that he thinks he has the power to create these big changes. 

You and others who wrote the book stress that Trump lacks empathy.

One of the central aspects of sociopathy is a lack of empathy. It’s extremely unclever of Trump to pick a fight with people who have lost their son or husband fighting for our country, as he’s done. In fact, it’s about the stupidest thing you could possibly do. But Trump can’t help it because he has an absence of empathy. Others’ rights don’t matter to him. He’s trampled on people throughout his life, as he did with Trump University [former students alleged him of fraud], failing to pay his employees, his racism and so on.

Is he picking fights — for example, with the NFL, calling for them to fire players refusing to stand for the national anthem — as a way to divert attention from other issues that could damage him far more and make him lose his populist base?

Yes. [But] he becomes delusional at times and says things that are not only untrue but which aren’t in his interest. The NFL is a natural ally of his, but he’s taken them on in way that’s not in his interest.

Why does he do such things?

This is a very disturbed man psychologically who’s in very poor control. He can’t allow things to not be true that he doesn’t want to be true. That’s extraordinarily dangerous for anyone to be but especially for someone who has the power he has as president.

But perhaps what he says and does are calculated efforts to retain his base?

No. He’s not being clever; he’s being extremely stupid.

What do his incendiary statements say about him, like threatening North Korea with “fire and fury like the world has never seen” and that he’d “totally destroy North Korea”?

This goes with his absolute lack of empathy for other human beings: If he unleashed a massive nuclear attack on North Korea, he’d kill much of the population — innocent people. The other aspect of those enraged statements is that he’s out of control. He speaks directly from the place of emptiness in his soul that makes him enraged if things block him.

What about his bullying people by calling them names?

The technical term is “projective identification.” It’s paranoia writ large. If I’m paranoid, I’d say, “You’re trying to hurt me.” But if I say, “You’re the devil,” I’m identifying your entire being as evil. This is a highly effective technique for labeling the entire person, like his calling Hillary Clinton “Crooked Hillary” or Ted Cruz “Lyin’ Ted.” It’s used by small children all the time. If Trump labels someone bad as a whole, then he feels completely justified to destroy them because they’re “evil.”

In view of everything you’ve said — and including his self-described physical mistreatment of “grab[bing]” women — what does Trump’s election as president say about America?

We were always at risk of having a madman Mussolini-like person, like Donald Trump, get control and take over. The Constitution was an attempt, in part, to avoid that. And we did avoid it — until now.

Why did it finally happen?

There are people who long for a strong leader, especially in tough times. That’s how Hitler got elected. He promised to restore Germany to glory and give the people back its economy and power. He promised to do all that — exactly like Donald Trump promised.

Do you think he’ll be impeached?

Either impeached or there’ll be a 25th Amendment [intervention] based on his [mental state]. For the latter, there needs to be people in the Cabinet who are willing to do the right thing. But this group of sycophants is never going to act against him until — and this applies to Congress [impeaching] as well — it’s in their interest.

When do you suppose that might occur?

One or the other will happen as soon as the system reaches a tipping point, where suddenly everything changes because the balance has shifted. Once people in Congress and the Cabinet understand it’s in their personal political interest to act, they will. That will come from pressure by the public — people writing things, like our book, and more rallies.

What will transpire?

It will put more and more pressure on Trump, and he’ll become more and more wild — and, hopefully, instead of having a disaster, the pressure will lead to people finally replacing him.

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