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Opinion | Bandy X. Lee, Leonard L. Glass, and Edwin B. Fisher

Looking at the Mueller report from a mental health perspective

(Photo illustration by Lesley Becker/Globe Staff; Adobe; Globe file photo)

Concerns about Donald Trump’s fitness for the office of president arose during the campaign and continue to this day. But now, in the Mueller report, we have an abundance of new evidence that sheds light on these concerns. What makes this a unique opportunity is the quality and relevance of the data: They are derived from multiple sources both friendly and opposed to the president, were obtained under oath, and show us how the president conducted himself in the eyes of those who worked directly with him while in office.

While we were concerned enough to put our initial cautions in a public-service book, “The Dangerous Case of Donald Trump,” each additional piece of evidence has substantiated the correctness of that assessment over time. Now, the Mueller report elevates this assessment to new levels. Here is just a small sampling:

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“The president’s efforts to influence the investigation were mostly unsuccessful, but that is largely because the persons who surrounded the President declined to carry out orders.” (Vol. II, p. 158)

The pattern that emerges of the president is one of rash, short-sighted decision-making, without consideration of consequences. He is protected only by actions on the part of former FBI director James Comey, former White House counsel Don McGahn, and former campaign manager Corey Lewandowski, who, in effect, shield the president from himself by refusing or failing to follow his directions. Reckless, impulsive moves that are self-destructive, despite the intention of self-protection, are characteristic of dangerous impairment. They impede Trump’s capacity to prioritize national security.

“The president asked [former chief of staff Reince] Priebus to reach out to [former national security adviser Michael] Flynn and let him know that the president still cared about him.” (Vol. II, p. 43)

“[Former campaign chairman Paul] Manafort told [Manafort’s former business partner Rick] Gates that he had talked to the president’s personal counsel and they were ‘going to take care of us.’ ” (Vol. II, p. 123)

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“[Attorney Robert] Costello told Cohen the conversation was ‘very, very positive . . . you are loved’ . . . you have friends in high places.’ ” (Vol. II, p. 147)

The president reveals that he operates from a different logic than the rule of law, or commonly held principles, in a manner that is manipulative and incompatible with democracy. His seditious manner and encouragement of similar subversion of institutions is closely connected to a view of the world as a threatening place where he must fight for himself and buttress his support. This is a paranoid stance that can quickly turn into violence when a paranoid person is feeling cornered, as corroborated by the president’s later attacks and threats against Cohen when the latter started cooperating with the special counsel. This is a dangerous mindset.

“According to notes written by [Jody] Hunt [chief of staff to then-attorney general Jeff Sessions], when Sessions told the president that a special counsel had been appointed, the president slumped back in his chair and said, ‘Oh my God. This is terrible. This is the end of my presidency. I’m f-----d.’ [Former communications director Hope] Hicks saw the president shortly after Sessions departed and described the president as being extremely upset. . . . [S]he had only seen the president like that one other time, when the ‘Access Hollywood’ tape came out during the campaign.’’ (Vol. II, pp. 78-79)

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These episodes demonstrate not only a lack of control over emotions but preoccupation with threats to the self. There is no room for consideration of national plans or policies, or his own role in bringing about his predicament and how he might change, but instead a singular focus on how he is a victim of circumstance and his familiar whining about unfairness.

This mindset can easily turn into rage reactions; it is commonly found in violent offenders in the criminal justice system, who perpetually consider themselves victims under attack, even as they perpetrate violence against others, often without provocation. In this manner, a “victim mentality” and paranoia are symptoms that carry a high risk of violence.

“We noted, among other things, that the president stated on more than 30 occasions that he ‘does not recall’ or ‘remember’ or have an ‘independent recollection’ of information called for by the questions. Other answers were ‘incomplete or imprecise.’ ” (Vol. II, p. C-1)

This response is from a president who, in public rallies, rarely lacks certainty, no matter how false his assertions and claims that he has “the world’s greatest memory” and “one of the great memories of all time.” His lack of recall is particularly meaningful in the context of his unprecedented mendacity, which alone is dangerous and divisive for the country. Whether he truly does not remember or is totally fabricating, either is pathological and highly dangerous in someone who has command over the largest military in the world and over thousands of nuclear weapons.

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The Mueller report details numerous lies by the president, perhaps most clearly regarding his handling of the disclosure of the meeting at Trump Tower (Vol II, p. 98ff). First he denied knowing about the meeting, then described it as only about adoption, then denied crafting his son’s response, and then, in his formal response to Mueller, conceded that it was he who dictated the press release. Lying per se is not especially remarkable. Coupled with the other characteristics noted here, however, lying becomes a part of a pervasive, compelling, reflexive pattern of distraught gut reactions for handling challenges by misleading, manipulating, and blocking others’ access to the truth. Rather than being seen as bona fide alternatives, challenges are perceived as personal threats and responded to in a dangerous, no-holds-barred manner.

“ ‘Call Rod, tell Rod that Mueller has conflicts and can’t be the special counsel.’ McGahn recalled the president telling him ‘Mueller has to go’ and ‘Call me back when you do it.’ ” (Vol. II, p. 86)

This incident merits singling out not only because of its egregiousness, but also because of its foolishness. In a post-Nixon era, and especially after the experience of firing Comey, a rational, non-impulsive person with reality-based decision-making would hesitate before pursuing this path. Congruent with his reasons for firing Comey, “to take the pressure off,” he apparently believed he could use all the powers at his disposal to have his way, and almost delusionally expected impunity. Such a mindset of false beliefs in freedom from consequences is extremely dangerous when coupled with power and is great cause for alarm in the US presidency.

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As mental health professionals, we are able to offer our understanding of behavior when it reflects profound impairment. The psychological nature of the president’s impairments is thoroughly revealed in the Mueller report. The report has documented the president as willful, enormously self-absorbed, ruthlessly exploitative, threatened, and delusionally heedless of the consequences of his impulsive actions. His dangerousness constitutes a national crisis.


Dr. Bandy X. Lee is a forensic psychiatrist at Yale School of Medicine. Dr. Leonard L. Glass is a psychiatrist at Harvard Medical School. Edwin B. Fisher is a clinical psychologist at the Gillings School of Public Health at the University of North Carolina-Chapel Hill. They are three of five authors of a mental health report on the Mueller report.