In Donald Trump, we have a frightening Venn diagram consisting of three circles: the first is extreme present hedonism; the second, narcissism; and the third, bullying behavior.
These three circles overlap in the middle to create an impulsive, immature, incompetent person who, when in the position of ultimate power, easily slides into the role of tyrant, complete with family members sitting at his proverbial “ruling table.”
Like a fledgling dictator, he plants psychological seeds of treachery in sections of our population that reinforce already negative attitudes.
To drive home our point, here are what we consider to be two of Trump’s most dangerous quotes:
• “If she gets to pick her judges, nothing you can do, folks. Although the Second Amendment people—maybe there is, I don’t know” (remark made during a campaign rally in Wilmington, North Carolina, August 9, 2016); and
• “I could stand in the middle of Fifth Avenue, shoot somebody, and I wouldn’t lose any voters” (remark made during a campaign appearance in Sioux City, Iowa, January 23, 2016).
Before Donald Trump, it was unfathomable for American citizens to consciously consider voting for, and then inaugurating, a person as unbalanced as this president.
Admittedly, it’s possible, as Guy Winch points out in his February 2, 2016, Psychology Today article, “Study: Half of All Presidents Suffered from Mental Illness.” According to Winch, many of our previous presidents may have suffered from mental health issues, including depression (Abraham Lincoln), bipolar disorder (Lyndon Johnson), alcoholism (Ulysses S. Grant), Alzheimer’s disease (Ronald Reagan), and transient bouts of extreme present hedonism (John F. Kennedy and Bill Clinton). We have also survived a president who blatantly lied to cover his criminal tracks before he was caught in those lies (Richard Nixon).
In the past, Americans have pulled together and worked to overcome our differences. We moved forward collectively as one great country. Unfortunately, in more recent times, it appears we have become a bipolar nation, with Donald Trump at the helm as his followers cheer him on and others try to resist him.
However, the lack of such tests cannot erase the well-documented behaviors he has displayed for decades and the dangers they pose when embodied in the president of the United States.
In line with the principles of Tarasoff v. Regents of the University of California 17 Cal. 3d 425 (1976), known as the “Tarasoff doctrine,” it is the responsibility of mental health professionals to warn the citizens of the United States and the people of the world of the potentially devastating effects of such an extreme present-hedonistic world leader, one with enormous power at his disposal.
On the whole, mental health professionals have failed in their duty to warn, in a timely manner, not only the public but also government officials about the dangers of President Donald Trump.
Articles and interviews intent on cautioning the masses prior to the election fell on deaf ears, perhaps in part because the media did not afford the concerned mental health professionals appropriate coverage, perhaps because some citizens discount the value of mental health and have thrown a thick blanket of stigma over the profession, or perhaps because we as mental health professionals did not stand united. Whatever the reason, it’s not too late to follow through.
We are not trying to speculate diagnoses from afar, but comparing video interviews of Trump from the 1980s, 1990s, and early 2000s to current video, we find that the differences (significant reduction in the use of essential words; an increase in the use of adjectives such as very, huge, and tremendous; and incomplete, run-on sentences that don’t make sense and that could indicate a loss of train of thought or memory) are conspicuously apparent. Perhaps this is why Trump insists on being surrounded by family members who love and understand him rather than seasoned political advisers, who may note, and then leak, his alarming behavior.
We believe that Donald Trump is the most dangerous man in the world! A powerful leader of a powerful nation who can order missiles fired at another nation because of his (or a family member’s) personal distress at seeing sad scenes of people having been gassed to death.
We shudder to imagine what actions might be taken in broader lethal confrontations with his personal and political enemies. We are gravely concerned about Trump’s abrupt, capricious 180-degree shifts and how these displays of instability have the potential to be unconscionably dangerous to the point of causing catastrophe, and not only for the citizens of the United States.
There are two particularly troubling examples:
1. His repeatedly lavishing praise on FBI director James Comey’s handling of an investigation into Hillary Clinton’s emails and then, in early May 2017, abruptly and abusively firing Comey for the very investigation that garnered such praise, but in this case actually because of Comey’s investigation into the Trump campaign’s ties to Russia; and
2 His stating during the campaign that NATO was obsolete and then, later, unexpectedly stating that NATO was necessary and acceptable.
As is the case with extreme present hedonists, Trump is “chumming” for war, possibly for the most selfish of reasons: to deflect attention away from the Russia investigation.
If another unbalanced world leader takes the bait, Trump will need the formerly “obsolete” and now-essential NATO to back him up.
We as individuals don’t have to follow our nation’s leader down a path headed in the wrong direction, off a cliff and into a pit of past mistakes. We can stand where we are at this moment in history and face forward, into a brighter future that we create. We can start by looking for the good in one another and for the common ground we share.
In the midst of the terrorist attacks on places of worship and cemeteries mentioned earlier, something wonderful emerged from the ashes: a spirit of overwhelming goodness in humanity. In the wake of the attacks, Jews and Muslims united: they held fund-raisers to help each other repair and rebuild; they shared their places of worship so that those burned out of theirs could hold gatherings and services; and they offered loving support to those who’d faced hatred.
By observing ordinary people engaging in acts of everyday heroism and compassion, we have been able to witness the best aspects of humanity. That’s us! That’s the United States of America!
A final suggestion for our governmental leaders: corporations and companies vet their prospective employees. This vetting process frequently includes psychological testing in the form of exams or quizzes to help the employer make more informed hiring decisions and determine if the prospective employee is honest and/or would be a good fit for the company.
These tests are used for positions ranging from department store sales clerk to high-level executive. Isn’t it time that the same be required for candidates for the most important job in the world?
get it at Amazon.com
Our Witness to Malignant Normality
ROBERT JAY LIFTON, M.D.
Concerning malignant normality, we start with an assumption that all societies, at various levels of consciousness, put forward ways of viewing, thinking, and behaving that are considered desirable or “normal.”
Yet, these criteria for normality can be much affected by the political and military currents of a particular era. Such requirements may be fairly benign, but they can also be destructive to the point of evil.
I came to the idea of malignant normality in my study of Nazi doctors. Those assigned to Auschwitz, when taking charge of the selections and the overall killing process, were simply doing what was expected of them. True, some were upset, even horrified, at being given this task. Yet, with a certain amount of counseling—one can call it perverse psychotherapy—offered by more experienced hands, a process that included drinking heavily together and giving assurance of help and support, the great majority could overcome their anxiety sufficiently to carry through their murderous assignment.
This was a process of adaptation to evil that is all too possible to initiate in such a situation. Above all, there was a normalization of evil that enhanced this adaptation and served to present participating doctors with the Auschwitz institution as the existing world to which one must make one’s adjustments.
There is another form of malignant normality, closer to home and more recent. I have in mind the participation in torture by physicians (including psychiatrists), and by psychologists, and other medical and psychological personnel. This reached its most extreme manifestation when two psychologists were revealed to be among architects of the CIA’s torture protocol. More than that, this malignant normality was essentially supported by the American Psychological Association in its defense of the participation of psychologists in the so-called “enhanced interrogation” techniques that spilled over into torture.
I am not equating this American behavior with the Nazi example but, rather, suggesting that malignant normality can take different forms. And nothing does more to sustain malignant normality than its support from a large organization of professionals.
There is still another kind of malignant normality, one brought about by President Trump and his administration. Judith Herman and I, in a letter to the New York Times in March 2017, stressed Trump’s dangerous individual psychological patterns: his creation of his own reality and his inability to manage the inevitable crises that face an American president.
He has also, in various ways, violated our American institutional requirements and threatened the viability of American democracy. Yet, because he is president and operates within the broad contours and interactions of the presidency, there is a tendency to view what he does as simply part of our democratic process—that is, as politically and even ethically normal.
In this way, a dangerous president becomes normalized, and malignant normality comes to dominate our governing (or, one could say, our antigoverning) dynamic.
But that does not mean we are helpless. We remain a society with considerable openness, with institutions that can still be life-enhancing and serve truth. Unlike Nazi doctors, articulate psychological professionals could and did expose the behavior of corrupt colleagues and even a corrupt professional society. Investigative journalists and human rights groups also greatly contributed to that exposure.
As psychological professionals, we are capable of parallel action in confronting the malignant normality of Trump and his administration. To do so we need to combine our sense of outrage with a disciplined use of our professional knowledge and experience.
This brings me to my second theme: that of witnessing professionals, particularly activist witnessing professionals. Most professionals, most of the time, operate within the norms (that is, the criteria for normality) of their particular society. Indeed, professionals often go further, and in their practices may deepen the commitment of people they work with to that normality. This can give solace, but it has its perils.
It is not generally known that during the early Cold War period, a special governmental commission, chaired by a psychiatrist and containing physicians and social scientists, was set up to help the American people achieve the desired psychological capacity to support U.S. stockpiling of nuclear weapons, cope with an anticipated nuclear attack, and overcome the fear of nuclear annihilation. The commission had the task, in short, of helping Americans accept malignant nuclear normality.
There have also been parallel examples in recent history of professionals who have promoted equally dangerous forms of normality in rejecting climate change. But professionals don’t have to serve these forms of malignant normality. We are capable of using our knowledge and technical skills to expose such normality, to bear witness to its malignance—to become witnessing professionals.
When I did my study of Hiroshima survivors back in 1962, I sought to uncover, in the most accurate and scientific way I could, the psychological and bodily experience of people exposed to the atomic bomb. Yet, I was not just a neutral observer. Over time, I came to understand myself as a witnessing professional, committed to making known what an atomic bomb could do to a city, to tell the world something of what had happened in Hiroshima and to its inhabitants. The Hiroshima story could be condensed to “one plane, one bomb, one city.” I came to view this commitment to telling Hiroshima’s story as a form of advocacy research. That meant combining a disciplined professional approach with the ethical requirements of committed witness, combining scholarship with activism.
I believe that some such approach is what we require now, in the Trump era. We need to avoid uncritical acceptance of this new version of malignant normality and, instead, bring our knowledge and experience to exposing it for what it is. This requires us to be disciplined about what we believe we know, while refraining from holding forth on what we do not know. It also requires us to recognize the urgency of the situation in which the most powerful man in the world is also the bearer of profound instability and untruth.
As psychological professionals, we act with ethical passion in our efforts to reveal what is most dangerous and what, in contrast, might be life-affirming in the face of the malignant normality that surrounds us.
Finally, there is the issue of our ethical behavior. We talk a lot about our professional ethics having to do with our responsibility to patients and to the overall standards of our discipline. This concern with professional ethics matters a great deal. But I am suggesting something more, a larger concept of professional ethics that we don’t often discuss: including who we work for and with, and how our work either affirms or questions the directions of the larger society. And, in our present situation, how we deal with the malignant normality that faces us.
This larger ethical model applies to members of other professions who may have their own “duty to warn.” I in no way minimize the significance of professional knowledge and technical skill. But our professions can become overly technicized, and we can be too much like hired guns bringing our firepower to any sponsor of the most egregious view of normality.
We can do better than that. We can take the larger ethical view of the activist witnessing professional. Bandy Lee took that perspective when organizing the Yale conference on professional responsibility, and the participants affirmed it. This does not make us saviors of our threatened society, but it does help us bring our experience and knowledge to bear on what threatens us and what might renew us.
A line from the American poet Theodore Roethke brings eloquence to what I have been trying to say: “In a dark time, the eye begins to see.”
Professions and Politics
JUDITH LEWIS HERMAN, M.D., and
BANDY X. LEE, M.D., M.DIV.
Soon after the presidential election of 2016, alarmed by the apparent mental instability of the president-elect, we both separately circulated letters among some of our professional colleagues, expressing our concern. Most of them declined to sign. A number of people admitted they were afraid of some undefined form of governmental retaliation, so quickly had a climate of fear taken hold.
They asked us if we were not wary of being “targeted,” and advised us to seek legal counsel. This was a lesson to us in how a climate of fear can induce people to censor themselves.
Others who declined to sign our letters of concern cited matters of principle. Psychiatry, we were warned, should stay out of politics; otherwise, the profession could end up being ethically compromised. The example most frequently cited was that of psychiatrists in the Soviet Union who collaborated with the secret police to diagnose dissidents as mentally ill and confine them to prisons that fronted as hospitals (Medvedev and Medvedev 1971).
This was a serious consideration. Indeed, we need not look beyond our own borders for examples of ethics violations committed by professionals who became entangled in politics. We have recently witnessed the disgrace of an entire professional organization, the American Psychological Association, some of whose leadership, in cooperation with officials from the U.S. military, the CIA, and the Bush White House, rewrote its ethical guidelines to give legal cover to a secret government program of coercive interrogation and to excuse military psychologists who designed and implemented methods of torture (Hoffman et al. 2015; Risen 2014).
Among the many lessons that might be learned from this notorious example, one in particular stayed with us. It seemed clear that the government officials responsible for abusive treatment of prisoners went to some lengths to find medical and mental health professionals who would publicly condone their practices. We reasoned that if professional endorsement serves as important cover for human rights abuses, then professional condemnation must also carry weight.
In 2005 the Pentagon organized a trip to the Guantánamo Bay detention camp for a group of prominent ethicists, psychiatrists, and psychologists. Participants toured the facility and met with high-ranking military officers, including the commanding general. They were not allowed to meet or speak with any of the detainees. Dr. Steven Sharfstein, then the president of the American Psychiatric Association, was one of the invited guests on this trip.
Apparently, what he saw and heard failed to convince him that the treatment of detainees fell within the bounds of ethical conduct. “Our position is very direct,” he stated on return. “Psychiatrists should not participate on these [interrogation] teams because it is inappropriate” (Lewis 2005). Under Dr. Sharfstein’s leadership, the American Psychiatric Association took a strong stand against any form of participation in torture and in the “interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere” (American Psychiatric Association 2006).
Contrast this principled stand with the sorry tale of the American Psychological Association. Its involvement in the torture scandal illustrates how important it is for leaders in the professions to stand firm against ethical violations, and to resist succumbing to the argument that exceptional political circumstances, such as “the war on terror,” demand exceptions to basic ethical codes. When there is pressure from power is exactly when one must abide by the norms and rules of our ethics.
Norms and Rules in the Political Sphere
Norms and rules guide professional conduct, set standards, and point to the essential principles of practice. For these reasons, physicians have the Declaration of Geneva (World Medical Association 2006) and the American Medical Association Principles of Medical Ethics (2001), which guide the American Psychiatric Association’s code for psychiatry (American Psychiatric Association 2013).
The former confirms the physician’s dedication to the humanitarian goals of medicine, while the latter defines honorable behavior for the physician. Paramount in both is the health, safety, and survival of the patient. Psychiatrists’ codes of ethics derive directly from these principles. In ordinary practice, the patient’s right to confidentiality is the bedrock of mental health care dating back to the ethical standards of the Hippocratic Oath.
However, even this sacrosanct rule is not absolute. No doubt, the physician’s responsibility is first and foremost to the patient, but it extends “as well as to society” (American Psychiatric Association 2013, p. 2). It is part of professional expectation that the psychiatrist assess the possibility that the patient may harm himself or others. When the patient poses a danger, psychiatrists are not merely allowed but mandated to report, to incapacitate, and to take steps to protect.
If we are mindful of the dangers of politicizing the professions, then certainly we must heed the so-called “Goldwater rule,” or Section 7.3 of the APA code of ethics (American Psychiatric Association 2013, p. 6), which states: “it is unethical for a psychiatrist to offer a professional opinion [on a public figure] unless he or she has conducted an examination and has been granted proper authorization for such a statement.”
This is not divergent from ordinary norms of practice: the clinical approaches that we use to evaluate patients require a full examination. Formulating a credible diagnosis will always be limited when applied to public figures observed outside this intimate frame; in fact, we would go so far as to assert that it is impossible.
The Goldwater rule highlights the boundaries of practice, helps to preserve professional integrity, and protects public figures from defamation. It safeguards the public’s perception of the field of psychiatry as credible and trustworthy. It is reasonable to follow it. But even this respectable rule must be balanced against the other rules and principles of professional practice.
A careful ethical evaluation might ask: Do our ordinary norms of practice stop at the office of the president? If so, why? If the ethics of our practice stipulate that the health of our patient and the safety of the public be paramount, then we should not leave our norms at the door when entering the political sphere. Otherwise, a rule originally conceived to protect our profession from scandal might itself become a source of scandal.
For this very reason, the “reaffirmation” of the Goldwater rule in a separate statement by the American Psychiatric Association (2017) barely two months into the new administration seems questionable to us. The American Psychiatric Association is not immune to the kind of politically pressured acquiescence we have seen with its psychological counterpart. A psychiatrist who disregards the basic procedures of diagnosis and treatment and acts without discretion deserves reprimand. However, the public trust is also 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.
We should pause if professionals are asked to remain silent when they have seen enough evidence to sound an alarm in every other situation. When it comes to dangerousness, should not the president of a democracy, as First Citizen, be subject to the same standards of practice as the rest of the citizenry?
Assessing dangerousness is different from making a diagnosis: it is dependent on the situation, not the person. Signs of likely dangerousness due to mental disorder can become apparent without a full diagnostic interview and can be detected from a distance, and one is expected to err, if at all, on the side of safety when the risk of inaction is too great.
States vary in their instructions. New York, for example, requires that two qualifying professionals agree in order to detain a person who may be in danger of hurting himself or others. Florida and the District of Columbia require only one professional’s opinion. Also, only one person need be in danger of harm by the individual, and the threshold is even lower if the individual has access to weapons (not to5 mention nuclear weapons).
The physician, to whom life-and-death situations are entrusted, is expected to know when it is appropriate to act, and to act responsibly when warranted. It is because of the weight of this responsibility that, rightfully, the physician should refrain from commenting on a public figure except in the rarest instance. Only in an emergency should a physician breach the trust of confidentiality and intervene without consent, and only in an emergency should a physician breach the Goldwater rule.
We believe that such an emergency now exists.
Test for Proper Responsibility
When we circulated our letters of concern, we asked our fellow mental health professionals to get involved in politics not only as citizens (a right most of us still enjoy) but also, specifically, as professionals and as guardians of the special knowledge with which they have been entrusted.
Why do we think this was permissible? It is all too easy to claim, as we did, that an emergency situation requires a departure from our usual practices in the private sphere. How can one judge whether political involvement is in fact justified? We would argue that the key question is whether mental health professionals are engaging in political collusion with state abuses of power or acting in resistance to them.
If we are asked to cooperate with state programs that violate human rights, then any involvement, regardless of the purported justification, can only corrupt, and the only appropriate ethical stance is to refuse participation of any sort.
If, on the other hand, we perceive that state power is being abused by an executive who seems to be mentally unstable, then we may certainly speak out, not only as citizens but also, we would argue, as professionals who are privy to special information and have a responsibility to educate the public. For whatever our wisdom and expertise may be worth, surely we are obligated to share it.
It doesn’t take a psychiatrist to notice that our president is mentally compromised. Members of the press have come up with their own diagnostic nomenclature, calling the president a “mad king” (Dowd 2017), a “nut job” (Collins 2017), and “emotionally unhinged” (Rubin 2017). Conservative columnist George Will (2017) writes that the president has a “disorderly mind.”
By speaking out as mental health professionals, we lend support and dignity to our fellow citizens who are justifiably alarmed by the president’s furious tirades, conspiracy fantasies, aversion to facts, and attraction to violence. We can offer a hand in helping the public understand behaviors that are unusual and alarming but that can all too easily be rationalized and normalized.
An important and relevant question that the public has been asking is this: Is the man simply crazy, or is he crazy like a fox? Is he mentally compromised or simply vile? When he lies, does he know he is lying, or does he believe his own lies? When he makes wild accusations, is he truly paranoid, or is he consciously and cunningly trying to deflect attention from his misdeeds?
We believe that we can help answer these questions by emphasizing that the two propositions are not mutually exclusive. A man can be both evil and mentally compromised—which is a more frightening proposition.
Power not only corrupts but also magnifies existing psychopathologies, even as it creates new ones. Fostered by the flattery of underlings and the chants of crowds, a political leader’s grandiosity may morph into grotesque delusions of grandeur. Sociopathic traits may be amplified as the leader discovers that he can violate the norms of civil society and even commit crimes with impunity. And the leader who rules through fear, lies, and betrayal may become increasingly isolated and paranoid, as the loyalty of even his closest confidants must forever be suspect.
Some would argue that by paying attention to the president’s mental state, we are colluding with him in deflecting attention from that by which he should ultimately be judged: his actions (Frances 2017). Certainly, mental disturbance is not an excuse for tyrannical behavior; nevertheless, it cannot be ignored. In a court of law, even the strongest insanity defense case cannot show that a person is insane all the time.
We submit that by paying attention to the president’s mental state as well as his actions, we are better informed to assess his dangerousness. Delusional levels of grandiosity, impulsivity, and the compulsions of mental impairment, when combined with an authoritarian cult of personality and contempt for the rule of law, are a toxic mix.
There are those who still hold out hope that this president can be prevailed upon to listen to reason and curb his erratic behavior. Our professional experience would suggest otherwise; witness the numerous submissions we have received for this volume while organizing a Yale conference in April 2017 entitled “Does Professional Responsibility Include a Duty to Warn?”
Collectively with our coauthors, we warn that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency.
Our Duty to Warn
BANDY X. LEE, M.D., M.DIV.
Possibly the oddest experience in my career as a psychiatrist has been to find that the only people not allowed to speak about an issue are those who know the most about it. Hence, truth is suppressed. Yet, what if that truth, furthermore, harbored dangers of such magnitude that it could be the key to future human survival? How can I, as a medical and mental health professional, remain a bystander in the face of one of the greatest emergencies of our time, when I have been called to step in everywhere else?
How can we, as trained professionals in this very area, be content to keep silent, against every other principle we practice by, because of a decree handed down from above? I am not speaking of the long-standing “Goldwater rule,” which is discussed in many places throughout this book and is a norm of ordinary practice I happen to agree with. I am rather speaking of its radical expansion, beyond the status we confer to any other rule, barely two months into the very presidency that has made it controversial.
This occurred on March 16, 2017, when our professional organization essentially placed a gag order on all psychiatrists (American Psychiatric Association 2017), and by extension all mental health professionals. I am also speaking of its defect, whereby it does not have a countervailing rule, as does the rest of professional ethics, that directs what to do when the risk of harm from remaining silent outweighs the damage that could result from speaking about a public figure—which, in this case, could even be the greatest possible harm.
Authors in this volume have been asked to respect the Goldwater rule and not to breach it unnecessarily, but I in turn respect their choices wherever their conscience has prompted them to take the professionally and socially radical step to help protect the public. Therefore, it would be accurate to state that, while we respect the rule, we deem it subordinate to the single most important principle that guides our professional conduct: that we hold our responsibility to human life and well-being as paramount.
My reasons for compiling this compendium are the same as my reasons for organizing the Yale conference by the title, “Does Professional Responsibility Include a Duty to Warn?”: the issue merits discussion, not silence, and the public deserves education, not further darkness.
Over the course of preparing the conference, the number of prominent voices in the field coming forth to speak out on the topic astonished me. Soon after the 2016 presidential election, Dr. Herman (coauthor of the Prologue), an old colleague and friend, had written a letter urging President Obama to require that Mr. Trump undergo a neuropsychiatric evaluation before assuming the office of the presidency. Her cosignatories, Drs. Gartrell and Mosbacher (authors of the essay “He’s Got the World in His Hands and His Finger on the Trigger”), helped the letter’s publication in The Huffington Post (Greene, 2016).
I also reached out to Dr. Lifton (author of the Foreword), whose “Mass Violence” meetings at Harvard first acquainted me with Dr. Herman years ago; together, they had sent a letter to the New York Times (Herman and Lifton 2017). His ready consent to speak at my conference sparked all that was to follow.
I encountered others along the way: Dr. Dodes (author of “Sociopathy”), who published a letter in the New York Times with thirty-five signatures (Dodes and Schachter 2017); Ms. Jhueck (author of “A Clinical Case for the Dangerousness of Donald J. Trump”), who cowrote and posted a letter to the head of New York City’s Department of Health and Mental Hygiene with seventy signatures; Dr. Fisher (author of “The Loneliness of Fateful Decisions”), who also expressed concerns in a letter to the New York Times (Fisher 2017); and Dr. Gartner (author of “Donald Trump Is: [A] Bad, [B] Mad, [C] All of the Above”), the initiator of an online petition, now with fifty-five thousand signatures, who cofounded the national coalition, “Duty to Warn,” of (as of this writing) seventeen hundred mental health professionals.
The Yale Conference
On April 20, 2017, Dr. Charles Dike of my division at Yale started the town hall–style meeting by reaffirming the relevance and reasons for the Goldwater rule. As assistant professor in law and psychiatry, former chair of the Ethics Committee of the American Academy of Psychiatry and the Law, chair of the Connecticut Psychiatric Society Ethics Committee, member of the Ethics Committee of the American Psychiatric Association, and Distinguished Fellow of the American Psychiatric Association, he was more than qualified to do so.
It was important that we start with a firm ethical foundation: whatever our conclusion, it could not hold if we were not scrupulous about our ethical grounding. I invited as additional panelists Drs. Lifton, Herman, and Gilligan (the last the author of “The Issue Is Dangerousness, Not Mental Illness”), with the purpose of bringing together the finest minds of psychiatry I could to address the quandary. They are all colleagues I have known for at least fifteen years and highly esteem not only for their eminence in the field but also for their ethics. They were beacons during other dark times.
They abided by the Goldwater rule in that they kept the discussion at the level of dangerousness, without attempting to diagnose. The transcript of the meeting can be found in an online appendix, the link to which is at the end of this book.
The conference was initially meant to be a collaboration between Yale School of Medicine, Yale School of Public Health, and Yale School of Nursing, but when the other schools fell away as the date approached, I released the School of Medicine for what I correctly perceived would be “inevitable politicization.” In case something went wrong, I did not wish to imperil my alma mater and home institution.
Our nation is now living, in extremes, a paradigm that splits along partisan lines, and the quick conclusion will be that the speakers or contributors of this volume “must be Democrats” if they are casting a negative light on a Republican president.
However, there are other paradigms. For the mental health professional, the paradigm we practice by is one of health versus disease. We appeal to science, research, observed phenomena, and clinical skill developed over years of practice in order to promote life and to prevent death. These goals cannot be contained within the purposes of a political party or the campaigns of a candidate. Rather, we are constantly trained to bring medical neutrality—or, if we cannot, to recuse ourselves of the therapeutic situation. It is a glimpse of this perspective that we hope to bring to the reader.
Our meeting gained national and international attention (Milligan 2017; Bulman 2017). While only two dozen physically attended the conference in an atmosphere of fear, about a hundred tuned in online, and hundreds more got in touch with me for recordings or in a show of support. It felt as if we had tapped into a groundswell of a movement among mental health professionals, and also an army of people who wanted to speak about the issue (DeVega 2017).
What was intended as a publication of the proceedings led to this volume (initially so large that we had to reduce it by a third), and five top-tier publishers in the country vied for it.
Authors had to submit their manuscripts within three weeks of the meeting. It was a harrowing time, as the nation’s mood changed from relief as Mr. Trump seemed to settle into his office after the first one hundred days, to a new onslaught of scandals, starting with his firing of FBI director James Comey on May 9, 2017.
Many of the contributors here do not need an introduction, and I am humbled to have the opportunity to present such an assembly of brilliant and principled professionals. A Compendium of Expertise This volume consists of three parts, the first being devoted to describing Mr. Trump, with an understanding that no definitive diagnoses will be possible.
In “Unbridled and Extreme Present Hedonism,” Zimbardo and Sword discuss how the Leader of the Free World has proven himself unfit for duty by his extreme ties to the present moment, without much thought for the consequences of his actions or for the future.
In “Pathological Narcissism and Politics,” Malkin explains that narcissism happens on a scale, and that pathological levels in a leader can spiral into psychosis and imperil the safety of his country through paranoia, impaired judgment, volatile decision making, and behavior called gaslighting.
In “I Wrote The Art of the Deal with Trump,” Schwartz reveals how what he observed during the year he spent with Trump to write that book could have predicted his presidency of “black hole-level” low self-worth, fact-free self-justification, and a compulsion to go to war with the world.
In “Trump’s Trust Deficit Is the Core Problem,” Sheehy highlights the notion that beneath the grandiose behavior of every narcissist lies the pit of fragile self-esteem; more than anything, Trump lacks trust in himself, which may lead him to take drastic actions to prove himself to himself and to the world.
In “Sociopathy,” Dodes shows that someone who cons others, lies, cheats, and manipulates to get what he wants, and who doesn’t care whom he hurts, may be not just repetitively immoral but also severely impaired, as sociopaths lack a central human characteristic, empathy.
In “Donald Trump Is: (A) Bad, (B), Mad, (C) All of the Above,” Gartner emphasizes the complexity of Trump’s presentation, in that he shows signs of being “bad” as well as “mad,” but also with a hypomanic temperament that generates whirlwinds of activity and a constant need for stimulation.
In “Why ‘Crazy Like a Fox’ versus ‘Crazy Like a Crazy’ Really Matters,” Tansey shows that Trump’s nearly outrageous lies may be explained by delusional disorder, about which Tansey invites the reader to make the call; even more frightening are Trump’s attraction to brutal tyrants and also the prospect of nuclear war.
In “Cognitive Impairment, Dementia, and POTUS,” Reiss writes that a current vulnerability in our political system is that it sets no intellectual or cognitive standards for being president, despite the job’s inherently requiring cognitive clarity; this lack of clarity can be even more serious if combined with other psychiatric disorders.
In “Donald J. Trump, Alleged Incapacitated Person,” Herb explains how, as a guardianship attorney (in contrast to a mental health professional), he is required to come to a preliminary conclusion about mental incapacity before filing a petition, which he does in his essay, while reflecting on the Electoral College and the Twenty-Fifth Amendment to the U.S. Constitution.
The second part of the book addresses the dilemmas that mental health professionals face in observing what they do and speaking out when they feel they must.
In “Should Psychiatrists Refrain from Commenting on Trump’s Psychology?” Glass argues against a technicality that would yield a simple yes-or-no answer to the Goldwater rule; instead, he advocates for a conscientious voicing of hazardous patterns, noting that the presence of mental illness is not as relevant as that of reliable functionality.
In “On Seeing What You See and Saying What You Know,” Friedman notes that technological advances that allow assessment and treatment from a distance, especially in underserved areas, have changed the clinician’s comfort level with remote evaluations, even when detecting a totalitarian mind-set or a multidimensional threat to the world.
In “The Issue Is Dangerousness, Not Mental Illness,” Gilligan discusses the ethics of not diagnosing a public figure versus the duty to warn potential victims of danger; when invoking the latter, he emphasizes, what matters is not whether a person is mentally ill but whether he is dangerous, which is possible to assess from a distance.
In “A Clinical Case for the Dangerousness of Donald J. Trump,” Jhueck notes that the United States legally confers mental health professionals and physicians considerable power to detain people against their will if they pose a danger due to likely mental illness—and Trump more than meets the requisite criteria.
In “Health, Risk, and the Duty to Protect the Community,” Covitz offers an ancient reference and two fables to illustrate just how unusual the mental health profession’s response is to a dangerous president, as we do not to speak up in ways that would be unthinkable for our role with other members of society.
In “New Opportunities for Therapy in the Age of Trump,” Doherty claims that the Trump era has ruptured the boundary between the personal and the public, and while clients and therapists are equally distressed, integrating our roles as therapists and citizens might help us better help clients.
The book’s third part speaks to the societal effects Mr. Trump has had, represents, and could cause in the future.
In “Trauma, Time, Truth, and Trump,” Teng points out the irony of seeing, as a trauma therapist, all the signs of traumatization and retraumatization from a peaceful election; she traces the sources of the president’s sudden military actions, his generation of crises, his shaken notions of truth and facts, and his role in reminding patients of an aggressive abuser.
In “Trump Anxiety Disorder,” Panning describes a unique post-election anxiety syndrome that has emerged as a result of the Trump presidency and the task that many therapists face with helping clients manage the stress of trying to “normalize” behavior that they do not feel is normal for a president.
In her essay “In Relationship with an Abusive President,” West illustrates the dynamics of “other blaming” in individuals who have feelings of low self-worth and hence poor shame tolerance, which lead to vindictive anger, lack of accountability, dishonesty, lack of empathy, and attention-seeking, of which Trump is an extreme example.
In “Trump’s Daddy Issues,” Wruble draws on his own personal experiences, especially his relationship with his strong and successful father, to demonstrate what a therapist does routinely: uses self-knowledge as an instrument for evaluating and “knowing” the other, even in this case, where the other is the president and his followers.
In “Birtherism and the Deployment of the Trumpian Mind-Set,” Kessler portrays the broader background from which “birtherism” began and how, by entering into the political fray by championing this fringe sentiment, Trump amplifies and exacerbates a national “symptom” of bigotry and division in ways that are dangerous to the nation’s core principles.
In “Trump and the American Collective Psyche,” Singer draws a connection between Trump’s personal narcissism and the American group psyche, not through a political analysis but through group psychology—the joining of group self-identity with violent, hateful defenses is as much about us as about Trump.
In “Who Goes Trump?” Mika explains how tyrannies are “toxic triangles,” as political scientists call them, necessitating that the tyrant, his supporters, and the society at large bind around narcissism; while the three factors animate for a while, the characteristic oppression, dehumanization, and violence inevitably bring on downfall.
In “The Loneliness of Fateful Decisions,” Fisher recounts the Cuban Missile Crisis and notes how, even though President Kennedy surrounded himself with the “best and the brightest,” they disagreed greatly, leaving him alone to make the decisions—which illustrates how the future of our country and the world hang on a president’s mental clarity.
In “He’s Got the World in His Hands and His Finger on the Trigger,” Gartrell and Mosbacher note how, while military personnel must undergo rigorous evaluations to assess their mental and medical fitness for duty, there is no such requirement for their commander in chief; they propose a nonpartisan panel of neuropsychiatrists for annual screening.
In spite of its title, I would like to emphasize that the main point of this book is not about Mr. Trump. It is about the larger context that has given rise to his presidency, and the greater population that he affects by virtue of his position.
The ascendancy of an individual with such impairments speaks to our general state of health and well-being as a nation, and to how we can respond: we can either improve it or further impair it.
Mental disorder does not distinguish between political parties, and as professionals devoted to promoting mental health, including public mental health, our duty should be clear: to steer patients and the public on a path toward health so that genuine discussions of political choice, unimpeded by emotional compulsion or defense, can occur.
Embracing our “duty to warn,” as our professional training and ethics lead us to do at times of danger, therefore involves not only sounding an alarm but continually educating and engaging in dialogue our fellow human beings, as this compilation aspires to do.
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I watched my president perforate at the Pentagon and all I could think as he held forth about heroism on the 16th anniversary of 9/11 was how did we end up with Humpty Dumpty.
It was Humpty Dumpty, of course, who declared: “When I use a word, it means just what I choose it to mean — neither more nor less.” At least Humpty Dumpty said it without that repetitive thumb-to-stubby-forefinger gesture of our esteemed leader.
Words cascade from that pinched mouth and they mean nothing, because when a man of moral emptiness tries to exhort a nation to moral greatness the only thing communicated is pitiful, almost comical, hypocrisy.
Between a hero and a huckster, between speaking and mouthing, the distance is great. Watching the esteemed leader’s head turning jerkily, like an old electric fan, from teleprompter to teleprompter, I almost felt pity. His is the Age of Indecency
President Trump seems lonely in his evident unfitness. Between him and his wife Melania I imagine what John Lanchester once described as “one of those silences which can only be incubated by at least two decades of attritional intimacy.” Well, they’ve known each other for 19 years.
We’ve had a big fall. For the perpetrators of the attack on America, the biggest success has been the injection of fear into the national psyche. Not even they could imagine how social media could turn fear into contagion and how the politics of fear would help propel a buffoon with feral instincts to the White House.
Looking back over the years since the attack that bright September morning — it was my daughter Adele’s 4th birthday and she had just recovered from an infection so serious I had to hold her little body while doctors performed a spinal tap — I am reminded of lines from Hemingway’s “The Sun Also Rises.”
“How did you go bankrupt?” Bill asked.
“Two ways,” Mike said. “Gradually and then suddenly.”
First, there was the downward glide: the misbegotten war, the soldiers and shoppers, financial implosion, impunity for the mighty, recession, anxiety and polarization. Then Americans, and not only Americans, decided it was better to blow things up than have more of the same. That’s when things precipitated.
The esteemed leader won even though Americans know he makes stuff up and wants a victorious small-to-medium-sized war that will allow him to proclaim American greatness restored. People do crazy things. They invade Russia, for example. Just look at history. Trump might think bombing Iran is his ticket in 2020.
What is all the fear about? It’s the loss of sanctuary. Menace could be anywhere since it came out of a clear blue sky. It’s the loss of victory. There is none to be had. It’s the loss of confidence. America’s power is greater than its ability to use it. It’s the loss of community. Technology is a great connector but also a great isolator. It’s the loss of self-worth. Life in the Facebook age can become an endless invitation to feel inferior or unloved.
All of this has fed a tissue of fear and disquiet easily exploited by the esteemed leader, whose instincts are above all for human weakness.
Hence Muslims and Mexicans and Mullahs and trade manipulators and all the other menaces to America that the leader deploys as needed.
In “The Sun Also Rises,” Hemingway wrote something else: “It is awfully easy to be hard-boiled about everything in the daytime, but at night it is another thing.”
It’s hard to shrug off the darkening skies. The worst of 9/11, almost a generation on, is the feeling that the perpetrators won. They didn’t buckle Western freedom and democracy, but they injured them. They disoriented the West. They sucked some of the promise out of a new century.
The assassins of Abraham Lincoln and Mahatma Gandhi and John F. Kennedy and Martin Luther King took the lives of great men but did not destroy their ideas. Perhaps they reinforced the immortality of those ideas. The assassin of Yitzhak Rabin and the mass murderers of 9/11 dispatched by Osama bin Laden were, however, more successful.
Yigal Amir, Rabin’s killer, uprooted the Oslo seeds of peace by assuring that Israeli Messianic-nationalist religious ideologues got the upper hand over secular pragmatists. They have never relinquished it. Bin Laden sapped America’s confidence, wove fear into the nation’s fabric, and inspired a metastasizing form of jihadi fanaticism that continues to terrorize the West in the crazed pursuit of a restored caliphate.
And Humpty Dumpty wants to build a wall he can sit on to contemplate xenophobia and Islamophobia.
I broke down a couple of days after 9/11 when I saw an image of a woman’s ultrasound stuck on a subway wall at 42nd Street with the words: “Looking for the father of this child.” Perhaps, in retrospect, my sobs were for all the innocence lost that day, the dreams unborn.
Adele was very brave through the spinal tap. Today she’s a brave young woman. They are out there: the brave, the stoical, the imaginative and the decent. Despite everything, they will have their day.
What happens when the people of a great nation gradually realize that their leader may not be, er, quite right in the head?
When Caligula became Roman emperor in A.D. 37, the people rejoiced. “On all sides, you could see nothing but altars and sacrifices, men and women decked in their holiday best and smiling,” according to the first-century writer Philo.
The Senate embraced him, and he was hailed as a breath of fresh air after the dourness, absenteeism and miserliness of his great-uncle, Emperor Tiberius. Caligula was colorful and flamboyant, offering plenty of opportunities for ribald gossip. Caligula had four wives in rapid succession, and he was said to be sleeping with his sister. (Roman historians despised him, so some of the gossip should be treated skeptically.)
He was charming, impetuous and energetic, sleeping only three hours a night, and he displayed a common touch as he constantly engaged with the public. His early months as emperor brimmed with hope.
Initially, Caligula focused on denouncing his predecessor and reversing everything that he had done. Caligula also made popular promises of tax reform so as to reduce the burden on the public. He was full of grandiose pledges of infrastructure projects, such as a scheme to cut through the Isthmus of Corinth.
But, alas, Caligula had no significant government experience, and he proved utterly incompetent at actually getting things done. Meanwhile, his personal extravagance actually increased the need for tax revenue.
Suetonius, the Roman historian, recounted how Caligula’s boats had “sterns set with gems, parti-colored sails, huge spacious baths, colonnades and banquet halls, and even a great variety of vines and fruit trees.”
Romans initially accepted Caligula’s luxurious tastes, perhaps intrigued by them. But Caligula’s lavish spending soon exhausted the surplus he had inherited, and Rome ran out of money.
This led to increasingly desperate, cruel and tyrannical behavior. Caligula reportedly opened a brothel in the imperial palace to make money, and he introduced new taxes. When this wasn’t enough, he began to confiscate estates, antagonizing Roman elites and sometimes killing them.
A coward himself, Caligula was said to delight in the torture of others; rumor had it that he would tell his executioners: “Kill him so that he can feel he is dying.”
Caligula, a narcissist and megalomaniac, became increasingly unhinged. He supposedly rolled around on a huge pile of gold coins, and he engaged in conversations with the moon, which he would invite into his bed. He replaced the heads of some statues of gods with his own head, and he occasionally appeared in public dressed as a god. He was referred to as a god in certain circumstances, and he set up a temple where he could be worshiped.
“Remember that I have the right to do anything to anybody,” he told his grandmother, according to Suetonius.
Caligula had a thing for generals, and he periodically wore the garb of a triumphant military commander. He removed the breastplate of Alexander the Great from his sarcophagus and wore it himself at times.
The Senate, dignified and traditional, watched Caligula with increasing alarm. He scandalized the public by sometimes dressing as a woman, and he aggravated tensions by scathingly denouncing the Senate, relying on sarcasm and insult, and showing utter contempt for it.
One of Caligula’s last allies was his beloved racehorse, Incitatus, who wore a collar of precious stones and lived in a marble stall. Caligula would invite Incitatus to dine with him.
Edward Champlin, a historian of Rome at Princeton University, says that Caligula pursued “a love of pranks that a 4-year-old might disdain” and had a penchant for “blurting out whatever is on his mind” — such as suggesting that Incitatus could become consul. These rash statements rippled through Rome, for leaders of great powers are often taken not just seriously but also literally.
Yet as Caligula wreaked havoc, Rome also had values, institutions and mores that inspired resistance. He offended practically everyone, he couldn’t deliver on his promises, his mental stability was increasingly doubted and he showed he simply had no idea how to govern. Within a few years, he had lost all support, and the Praetorian Guard murdered him in January 41 (not a path I would ever condone).
Caligula was as abominable a ruler as a great nation could have, yet Rome proved resilient.
Likewise, Rome survived Emperor Nero a generation later, even as Nero apparently torched Rome, slaughtered Christians, slept with and then murdered his mother, kicked his pregnant wife to death, castrated and married a man and generally mismanaged the empire.
“If there’s a hero in the story of first-century Rome, it’s Roman institutions and traditional expectations,” reflects Emma Dench, a Harvard scholar of the period. “However battered or modified, they kept the empire alive for future greatness.”
To me, the lesson is that Rome was able to inoculate itself against unstable rulers so that it could recover and rise to new glories. Even the greatest of nations may suffer a catastrophic leader, but the nation can survive the test and protect its resilience — if the public stays true to its values, institutions and traditions. That was true two millennia ago, and remains true today.
My mother recently found piles of my notebooks from when I was a small child that were filled with plans for my future. I was very ambitious. I wrote out what I would do at every age: when I would get married and when I would have kids and when I would open a dance studio.
When I left my small hometown for college, this sort of planning stopped. The experience of going to a radically new place, as college was to me, upended my sense of the world and its possibilities. The same thing happened when I moved to New York after college, and a few years later when I moved to Istanbul. All change is dramatic for provincial people. But the last move was the hardest.
In Turkey the upheaval was far more unsettling: after a while, I began to feel that the entire foundation of my consciousness was a lie.
Who do we become if we don’t become Americans? If we discover that our identity as we understood it had been a myth?
My years as an American abroad in the 21st century were not a joyous romp of self-discovery and romance. Mine were more of a shattering and a shame, and even now, I still don’t know myself.
The politics I heard about as a kid had to do with taxes and immigrants, and not much else. Bill Clinton was not popular in my house.
We were all patriotic, but I can’t even conceive of what else we could have been, because our entire experience was domestic, interior, American. We went to church on Sundays, until church time was usurped by soccer games. I don’t remember a strong sense of civic engagement. Instead I had the feeling that people could take things from you if you didn’t stay vigilant. Our goals remained local: homecoming queen, state champs, a scholarship to Trenton State, barbecues in the backyard. The lone Asian kid in our class studied hard and went to Berkeley; the Indian went to Yale. Black people never came to Wall. The world was white, Christian; the world was us.
We did not study world maps, because international geography, as a subject, had been phased out of many state curriculums long before. There was no sense of the US being one country on a planet of many countries. Even the Soviet Union seemed something more like the Death Star – flying overhead, ready to laser us to smithereens – than a country with people in it.
We were free – at the very least we were that. Everyone else was a chump, because they didn’t even have that obvious thing. Whatever it meant, it was the thing that we had, and no one else did. It was our God-given gift, our superpower.
By the time I got to high school, I knew that communism had gone away, but never learned what communism had actually been (“bad” was enough). Religion, politics, race – they washed over me like troubled things that obviously meant something to someone somewhere, but that had no relationship to me, to Wall, to America. I certainly had no idea that most people in the world felt those connections deeply. History – America’s history, the world’s history – would slip in and out of my consciousness with no resonance whatsoever.
Racism, antisemitism and prejudice, however – those things, on some unconscious level, I must have known. They were expressed in the fear of Asbury Park, which was black; in the resentment of the towns of Marlboro and Deal, which were known as Jewish; in the way Hispanics seemed exotic. Much of the Jersey Shore was segregated as if it were still the 1950s, and so prejudice was expressed through fear of anything outside Wall, anything outside the tiny white world in which we lived. If there was something that saved us from being outwardly racist, it was that in small towns such as Wall, especially for girls, it was important to be nice, or good – this pressure tempered tendencies toward overt cruelty when we were young.
I was a child of the 90s, the decade when, according to America’s foremost intellectuals, “history” had ended, the US was triumphant, the cold war won by a landslide. The historian David Schmitz has written that, by that time, the idea that America won because of “its values and steadfast adherence to the promotion of liberalism and democracy” was dominating “op-ed pages, popular magazines and the bestseller lists”. These ideas were the ambient noise, the elevator music of my most formative years.
I came across a line in a book in which a historian argued that, long ago, during the slavery era, black people and white people had defined their identities in opposition to each other. The revelation to me was not that black people had conceived of their identities in response to ours, but that our white identities had been composed in conscious objection to theirs. I’d had no idea that we had ever had to define our identities at all, because to me, white Americans were born fully formed, completely detached from any sort of complicated past. Even now, I can remember that shiver of recognition that only comes when you learn something that expands, just a tiny bit, your sense of reality. What made me angry was that this revelation was something about who I was. How much more did I not know about myself?
It was because of this text that I picked up the books of James Baldwin, who gave me the sense of meeting someone who knew me better, and with a far more sophisticated critical arsenal than I had myself. There was this line:
But I have always been struck, in America, by an emotional poverty so bottomless, and a terror of human life, of human touch, so deep, that virtually no American appears able to achieve any viable, organic connection between his public stance and his private life.
And this one:
All of the western nations have been caught in a lie, the lie of their pretended humanism; this means that their history has no moral justification, and that the west has no moral authority.
And this one:
White Americans are probably the sickest and certainly the most dangerous people, of any colour, to be found in the world today.
I know why this came as a shock to me then, at the age of 22, and it wasn’t necessarily because he said I was sick, though that was part of it. It was because he kept calling me that thing: “white American”. In my reaction I justified his accusation. I knew I was white, and I knew I was American, but it was not what I understood to be my identity. For me, self-definition was about gender, personality, religion, education, dreams. I only thought about finding myself, becoming myself, discovering myself – and this, I hadn’t known, was the most white American thing of all.
I still did not think about my place in the larger world, or that perhaps an entire history – the history of white Americans – had something to do with who I was. My lack of consciousness allowed me to believe I was innocent, or that white American was not an identity like Muslim or Turk.
Of this indifference, Baldwin wrote: “White children, in the main, and whether they are rich or poor, grow up with a grasp of reality so feeble that they can very accurately be described as deluded.”
Young white Americans of course go through pain, insecurity and heartache. But it is very, very rare that young white Americans come across someone who tells them in harsh, unforgiving terms that they might be merely the easy winners of an ugly game, and indeed that because of their ignorance and misused power, they might be the losers within a greater moral universe.
In 2007, after I had worked for six years as a journalist in New York, I won a writing fellowship that would send me to Turkey for two years. I had applied for it on a whim. No part of me expected to win the thing. Even as my friends wished me congratulations, I detected a look of concern on their faces, as if I was crazy to leave all this, as if 29 was a little too late to be finding myself. I had never even been to Turkey before.
In the weeks before my departure, I spent hours explaining Turkey’s international relevance to my bored loved ones, no doubt deploying the cliche that Istanbul was the bridge between east and west. I told everyone that I chose Turkey because I wanted to learn about the Islamic world. The secret reason I wanted to go was that Baldwin had lived in Istanbul in the 1960s, on and off, for almost a decade. I had seen a documentary about Baldwin that said he felt more comfortable as a black, gay man in Istanbul than in Paris or New York.
When I heard that, it made so little sense to me, sitting in my Brooklyn apartment, that a space opened in the universe. I couldn’t believe that New York could be more illiberal than a place such as Turkey, because I couldn’t conceive of how prejudiced New York and Paris had been in that era; and because I thought that as you went east, life degraded into the past, the opposite of progress. The idea of Baldwin in Turkey somehow placed America’s race problem, and America itself, in a mysterious and tantalising international context. I took a chance that Istanbul might be the place where the secret workings of history would be revealed.
In Turkey and elsewhere, in fact, I would feel an almost physical sensation of intellectual and emotional discomfort, while trying to grasp a reality of which I had no historical or cultural understanding. I would go, as a journalist, to write a story about Turkey or Greece or Egypt or Afghanistan, and inevitably someone would tell me some part of our shared history – theirs with America – of which I knew nothing. If I didn’t know this history, then what kind of story did I plan to tell?
My learning process abroad was threefold: I was learning about foreign countries; I was learning about America’s role in the world; and I was also slowly understanding my own psychology, temperament and prejudices. No matter how well I knew the predatory aspects of capitalism, I still perceived Turkey’s and Greece’s economic advances as progress, a kind of maturation. No matter how deeply I understood the US’s manipulation of Egypt for its own foreign-policy aims, I had never considered – and could not grasp – how American policies really affected the lives of individual Egyptians, beyond engendering resentment and anti-Americanism. No matter how much I believed that no American was well-equipped for nation-building, I thought I could see good intentions on the part of the Americans in Afghanistan. I would never have admitted it, or thought to say it, but looking back, I know that deep in my consciousness I thought that America was at the end of some evolutionary spectrum of civilisation, and everyone else was trying to catch up.
American exceptionalism did not only define the US as a special nation among lesser nations; it also demanded that all Americans believe they, too, were somehow superior to others. How could I, as an American, understand a foreign people, when unconsciously I did not extend the most basic faith to other people that I extended to myself? This was a limitation that was beyond racism, beyond prejudice and beyond ignorance. This was a kind of nationalism so insidious that I had not known to call it nationalism; this was a self-delusion so complete that I could not see where it began and ended, could not root it out, could not destroy it.
In my first few months in Istanbul, I lived a formless kind of existence, days dissolving into the nights. I had no office to go to, no job to keep, and I was 30 years old, an age at which people either choose to grow up or remain stuck in the exploratory, idle phase of late-late youth. Starting all over again in a foreign country – making friends, learning a new language, trying to find your way through a city – meant almost certainly choosing the latter. I spent many nights out until the wee hours – such as the evening I drank beer with a young Turkish man named Emre, who had attended college with a friend of mine from the US.
A friend had told me that Emre was one of the most brilliant people he had ever met. As the evening passed, I was gaining a lot from his analysis of Turkish politics, especially when I asked him whether he voted for Erdoğan’s Justice and Development party (AKP), and he spat back, outraged, “Did you vote for George W Bush?” Until that point I had not realised the two might be equivalent.
Then, three beers in, Emre mentioned that the US had planned the September 11 attacks. I had heard this before. Conspiracy theories were common in Turkey; for example, when the military claimed that the PKK, the Kurdish militant group, had attacked a police station, some Turks believed the military itself had done it; they believed it even in cases where Turkish civilians had died. In other words, the idea was that rightwing forces, such as the military, bombed neutral targets, or even rightwing targets, so they could then blame it on the leftwing groups, such as the PKK. To Turks, bombing one’s own country seemed like a real possibility.
“Come on, you don’t believe that,” I said.
“Why not?” he snapped. “I do.”
“But it’s a conspiracy theory.”
He laughed. “Americans always dismiss these things as conspiracy theories. It’s the rest of the world who have had to deal with your conspiracies.”
I ignored him. “I guess I have faith in American journalism,” I said. “Someone else would have figured this out if it were true.”
He smiled. “I’m sorry, there’s no way they didn’t have something to do with it. And now this war?” he said, referring to the war in Iraq. “It’s impossible that the United States couldn’t stop such a thing, and impossible that the Muslims could pull it off.”
Some weeks later, a bomb went off in the Istanbul neighborhood of Güngören. A second bomb exploded out of a garbage bin nearby after 10pm, killing 17 people and injuring 150. No one knew who did it. All that week, Turks debated: was it al-Qa’ida? The PKK? The DHKP/C, a radical leftist group? Or maybe: the deep state?
The deep state – a system of mafia-like paramilitary organisations operating outside of the law, sometimes at the behest of the official military – was a whole other story. Turks explained that the deep state had been formed during the cold war as a way of countering communism, and then mutated into a force for destroying all threats to the Turkish state. The power that some Turks attributed to this entity sometimes strained credulity. But the point was that Turks had been living for years with the idea that some secret force controlled the fate of their nation.
In fact, elements of the deep state were rumoured to have had ties to the CIA during the cold war, and though that too smacked of a conspiracy theory, this was the reality that Turkish people lived in. The sheer number of international interventions the US launched in those decades is astonishing, especially those during years when American power was considered comparatively innocent. There were the successful assassinations: Patrice Lumumba, prime minister of the Democratic Republic of Congo, in 1961; General Rafael Trujillo of the Dominican Republic, also in 1961; Ngo Dinh Diem, president of South Vietnam, in 1963. There were the unsuccessful assassinations: Castro, Castro, and Castro. There were the much hoped-for assassinations: Nasser, Nasser, Nasser. And, of course, US-sponsored, -supported or -staged regime changes: Iran, Guatemala, Iraq, Congo, Syria, Dominican Republic, South Vietnam, Indonesia, Brazil, Chile, Bolivia, Uruguay and Argentina. The Americans trained or supported secret police forces everywhere from Cambodia to Colombia, the Philippines to Peru, Iran to Vietnam. Many Turks believed that the US at least encouraged the 1971 and 1980 military coups in Turkey, though I could find little about these events in any conventional histories anywhere.
But what I could see was that the effects of such meddling were comparable to those of September 11 – just as huge, life-changing and disruptive to the country and to people’s lives. Perhaps Emre did not believe that September 11 was a straightforward affair of evidence and proof because his experience – his reality – taught him that very rarely were any of these surreally monumental events easily explainable. I did not think Emre’s theory about the attacks was plausible. But I began to wonder whether there was much difference between a foreigner’s paranoia that the Americans planned September 11 and the Americans’ paranoia that the whole world should pay for September 11 with an endless global war on terror.
The next time a Turk told me she believed the US had bombed itself on September 11 (I heard this with some regularity; this time it was from a young student at Istanbul’s Boğaziçi University), I repeated my claim about believing in the integrity of American journalism. She replied, a bit sheepishly, “Well, right, we can’t trust our journalism. We can’t take that for granted.”
The words “take that for granted” gave me pause. Having lived in Turkey for more than a year, witnessing how nationalistic propaganda had inspired people’s views of the world and of themselves, I wondered from where the belief in our objectivity and rigour in journalism came. Why would Americans be objective and everyone else subjective?
I thought that because Turkey had poorly functioning institutions – they didn’t have a reliable justice system, as compared to an American system I believed to be functional – it often felt as if there was no truth. Turks were always sceptical of official histories, and blithely dismissive of the government’s line. But was it rather that the Turks, with their beautiful scepticism, were actually just less nationalistic than me?
American exceptionalism had declared my country unique in the world, the one truly free and modern country, and instead of ever considering that that exceptionalism was no different from any other country’s nationalistic propaganda, I had internalised this belief. Wasn’t that indeed what successful propaganda was supposed to do? I had not questioned the institution of American journalism outside of the standards it set for itself – which, after all, was the only way I would discern its flaws and prejudices; instead, I accepted those standards as the best standards any country could possibly have.
By the end of my first year abroad, I read US newspapers differently. I could see how alienating they were to foreigners, the way articles spoke always from a position of American power, treating foreign countries as if they were America’s misbehaving children. I listened to my compatriots with critical ears: the way our discussion of foreign policy had become infused since September 11 with these officious, official words, bureaucratic corporate military language: collateral damage, imminent threat, freedom, freedom, freedom.
Even so, I was conscious that if I had long ago succumbed to the pathology of American nationalism, I wouldn’t know it – even if I understood the history of injustice in America, even if I was furious about the invasion of Iraq. I was a white American. I still had this fundamental faith in my country in a way that suddenly, in comparison to the Turks, made me feel immature and naive.
I came to notice that a community of activists and intellectuals in Turkey – the liberal ones – were indeed questioning what “Turkishness” meant in new ways. Many of them had been brainwashed in their schools about their own history; about Ataturk, Turkey’s first president; about the supposed evil of the Armenians and the Kurds and the Arabs; about the fragility of their borders and the rapaciousness of all outsiders; and about the historic and eternal goodness of the Turkish republic.
“It is different in the United States,” I once said, not entirely realising what I was saying until the words came out. I had never been called upon to explain this. “We are told it is the greatest country on earth. The thing is, we will never reconsider that narrative the way you are doing just now, because to us, that isn’t propaganda, that is truth. And to us, that isn’t nationalism, it’s patriotism. And the thing is, we will never question any of it because at the same time, all we are being told is how free-thinking we are, that we are free. So we don’t know there is anything wrong in believing our country is the greatest on earth. The whole thing sort of convinces you that a collective consciousness in the world came to that very conclusion.”
“Wow,” a friend once replied. “How strange. That is a very quiet kind of fascism, isn’t it?”
It was a quiet kind of fascism that would mean I would always see Turkey as beneath the country I came from, and also that would mean I believed my uniquely benevolent country to have uniquely benevolent intentions towards the peoples of the world.
During that night of conspiracy theories, Emre had alleged, as foreigners often did, that I was a spy. The information that I was collecting as a journalist, Emre said, was really being used for something else. As an American emissary in the wider world, writing about foreigners, governments, economies partaking in some larger system and scheme of things, I was an agent somehow. Emre lived in the American world as a foreigner, as someone less powerful, as someone for whom one newspaper article could mean war, or one misplaced opinion could mean an intervention by the International Monetary Fund. My attitude, my prejudice, my lack of generosity could be entirely false, inaccurate or damaging, but would be taken for truth by the newspapers and magazines I wrote for, thus shaping perceptions of Turkey for ever.
Years later, an American journalist told me he loved working for a major newspaper because the White House read it, because he could “influence policy”. Emre had told me how likely it was I would screw this up. He was saying to me: first, spy, do no harm.