A Yale Psychiatrist Evaluates the Mental Health of Trump — and the Nation

Yale University’s Bandy X. Lee has traveled the world helping governments and her fellow health-care professionals understand how poor mental health across society leads inextricably to violence.

Her globetrotting largely ended this past year, however, after Dr. Lee found herself drawn by what struck her as an especially consequential problem at home: the presidency of Donald J. Trump.

Within hours of Mr. Trump’s election, in November 2016, Dr. Lee, an assistant clinical professor of psychiatry, was bombarded with calls and emails from patient groups, political activists, students, and documentary filmmakers seeking her assessment of how violence rates would very likely spike nationwide.

She was so politically inexperienced that she hadn’t even thought to draw the connection. She’s so shy that speaking even to small seminars can leave her nervous. But a year later, Dr. Lee has become convinced of the danger and the need to act.

She first drew headlines in October with the compilation of a top-selling book in which she and 27 other mental-health professionals detail the nature of that danger. And she’s attracted even more attention in recent weeks by briefing lawmakers in Washington on the dire problems that she sees Mr. Trump posing to the country and to humanity.

In doing so, Dr. Lee said, she is speaking for herself, not her university. (A Yale spokesman said the university does not take a position on the president’s mental health.) In an hourlong interview with The Chronicle, Dr. Lee described what has become a somewhat lonely fight on behalf of a profession that’s only starting to understand the real stakes it now faces. The interview has been edited for length and clarity.

Q. Given that you see policies such as the recently enacted tax bill, and the accompanying undermining of the nation’s health-insurance protections, as directly linked to income inequality and greater societal violence, why aren’t more of your professional colleagues getting more involved in helping to shape public policy?

A. That’s probably the direction in which we need to go. The medical profession as a whole is getting more aware of the importance of prevention, but the research is relatively recent. In pursing violence research, my path went from clinical settings, into jails and prisons, and then policy making, and then involved with various governments, precisely because of that lack of awareness, and lack of evidence-based policy-making.

Q. What specifically pushed you to begin looking at the mental health of Mr. Trump?

A. I have not been interested in partisan politics, I considered it so trivial — my concerns always had been to save lives and prevent deaths. And being involved in global health, my research involved things like civil wars, gender-based violence, or mass murders.

It’s interesting how disconnected I was, because my first question to those calling me the morning after the election was, “What does a presidential election have to do with violence?” And then it dawned on me that this presidency is going to have a huge effect, because, until then, I was seeing him more as a symptom than a cause.

And those calling me were right: Hate crimes, deaths due to gun violence, and schoolyard bullying all increased drastically. So it was really that morning after the election, starting at 8 a.m., when my phone was ringing off the hook, that I thought if I devoted most of my life to preventing violence, why would I refrain from being involved in the greatest risk to human safety and survival — in fact the survival of the human species?

Q. How did you begin?

A. After the election, a former colleague from Harvard, Judith Lewis Herman, wrote to President Obama saying that Mr. Trump should undergo a neuropsychiatric evaluation. I thought I should also write letters to members of Congress, and thought I should get co-signers. But my colleagues would always agree with me on the concerns but none would put their names on any documents.

They weren’t so concerned about the Goldwater Rule [which generally discourages psychiatrists from offering public assessments of public figures], but about being targeted, either by a president known to use lawsuits — they thought they might be fighting for their licenses for the rest of their careers — or being targeted by his violent followers, fearing for their own and their families’ safety.

I thought the silence was not a good sign, so I decided to organize a conference on whether we had a duty to warn about a president who might raise mental-health concerns.

Q. Do you also see a need to explore the psychology of the people who elected him?

A. A third of the book is devoted to studying the state of public mental health that led to them electing an impaired person as their president. I’ve noticed that political strategists use psychological maneuvering to position people into voting against their own interests, to supporting policies that actually hurt them, and as a result, they end up with conditions that worsen public health and public mental health, and make them even more vulnerable to manipulation.

Q. What’s an example of such a tactic?

A. Touting racism or religious zeal, scapegoating. When people are deprived, and they can see they are deprived in a wealthy society such as ours, they will feel resentful and angry and begin to grow hatred in ways that would not occur if their life conditions were well-provided-for.

Q. Is the lesson that the opposition — Democrats or others — should work on their own psychological tools? Or will a fight between advanced psychological tools always be won by the more negative force? Is that just the nature of humans?

A. The negative has been used as a political strategy in an unfair and deceptive way. But those who employ it broadly in productive ways include the World Health Organization and the U.S. Centers for Disease Control and Prevention, which use evidence-based policies to improve public health. But we have a Congress that would take away health insurance from tens of millions of people deliberately — it can’t win against that.

Q. Yes, but the reason we have a Congress doing such things is because people are electing them.

A. That’s not human nature — it’s the state of public health, and we’re in a very poor state of public health. That’s why people are manipulated into further disease states rather than healthy states.

Q. That sounds like a grim assessment then, because we may be reaching a critical mass that will continue a cycle of making things worse?

A. That is why it’s no accident that we’ve come to the point where the human species is at the brink of destroying itself, causing its own extinction. That is not a healthy state.

Q. So that’s our future, with no way to pull out?

A. When this happens in an individual, and they’re in a spiral — doing things to themself that bring them further into illness — doctors and hospitals are the things they run away from the most. Such people develop all kinds of conspiracy theories against them. So what you do in that situation, you cannot reason with the person, and so you forcibly hospitalize them.

Q. But you can’t apply that analogy to our country, you can’t forcibly hospitalize our country, and we don’t have anybody on the outside to do that to us.

A. Yes, we could be in a situation where we are doomed. But are there enough healthy elements in us to turn this around. I think there still is, but time is running out, and we’re heading in the wrong direction.

Q. OK, we’re going in the wrong direction, but have we reached a critical mass beyond which this cannot be turned around?

A. We still have a choice, we still can make healthy choices, even though it will be harder and harder to make them. And that is why it’s so critical for us to educate the public and warn them.

Q. But as you said, people resist being “educated,” feeling that represents some form of mind control.

A. Yes, you need to take them out of that bubble of only hearing one side of the story. That is why I am pushing myself out there, to be more in the media, to be talking to the public — something I am immensely uncomfortable doing — because it’s so critical, to our continued survival, and to our turning it around, if there is any chance of that.

Q. If someone could create a structure to evaluate the mental health of our leadership, what should that structure look like?

A. We already have mental-health evaluations — they are very common for many jobs, including all military officers. It’s a great omission that the commander in chief does not have to go through it, and we are seeing the perils of it. We need to educate the public that this is a glaring omission. We are not trying to choose who should be president or not — it’s just a basic measure of minimal capacity. The difficulty now is we have gotten ourselves into a situation where we are talking about our sitting president.

Q. He is going for his annual physical examination next week. Do you have any expectations for that?

A. There is a limited amount that a physical exam can do. I hope that the physician can be astute enough to refer him for a capacity evaluation, and an urgent one, preferably during the same visit.

Q. What has this been costing you professionally or financially?

A. My university and department have been very supportive of me, and profits from the book are going into the service of public mental health. I deduct travel expenses from the revenue from the book, and people have been donating, so I didn’t need to fund-raise.

Q. How about personally? Do you feel any danger?

A. It comes with danger — you’re warning about a dangerous president who has dangerous followers. There’s a reason why I’m the only face out there, even though there are thousands of us. I made the determination I would do this, and that’s fine with me, I’m settled with that fact.

Paul Basken covers university research and its intersection with government policy. He can be found on Twitter @pbasken, or reached by email at paul.basken@chronicle.com.