THE MANY DANGER SIGNS
Psychiatrists in America today have been told that they have two diametrically opposite professional obligations, and that if they violate either one, they are behaving unethically. The rst says they have an obligation to remain silent about their evaluation of anyone if that person has not given them permission to speak about it publicly. The second says they have an obligation to speak out and inform others if they believe that person may be dangerous to them, even if he has not given them permission to do so. rom both an ethical and a legal standpoint, the second of those two trumps the rst.
The issue here is not whether President Donald Trump is mentally ill. It is whether he is dangerous. Dangerousness is not a psychiatric diagnosis. One does not have to be “mentally ill” in order to be dangerous. Trump may or may not meet the criteria for any of the diagnoses of mental disorders de ned in the Diagnostic and tatistical anual of the American Psychiatric Association, or for many of them, but that is not relevant to the issue we are raising here.
The most reliable data for assessing dangerousness often do not re uire interviewing the individuals about whom we are forming an opinion. The most reliable data may come from the person’s family and friends and, just as important, from police reports, criminal histories, and medical, prison and judicial records, as well as other publicly available information from third parties. In Trump’s case, we also have many public records, tape recordings and videotapes, as well as his own public speeches, interviews and tweets of his numerous threats of violence, incitements to violence and boasts of violence that he himself acknowledges having committed repeatedly and habitually.
ometimes, a person’s dangerousness is so obvious
“Sometimes a person’s dangerousness is so obvious that one does not need professional training in either psychiatry or criminology to recognize it.”
that one does not need professional training in either psychiatry or criminology to recognize it. One does not need to have had 50 years of professional experience in assessing the dangerousness of violent criminals to recognize the dangerousness of a president who: Asks what the point of having thermonuclear weapons is if we cannot use them. or example, host oe carborough reported that Trump had asked a foreign policy adviser three times, “If we have them, why can’t we use them?” Urges our government to use torture or worse against our prisoners of war. Throughout his presidential campaign, Trump repeatedly said “torture works,” and promised to bring back “waterboarding” and to introduce new methods “that go a lot further.” Urged that ve inno ent African-american youths be given the death penalty for a sexual assault years after it had been proved beyond a reasonable doubt to have been committed by someone else.
Boasts about his ability to get away with sexually assaulting women because of his celebrity and power. Trump was recorded saying, of his way of relating to women, that “I just start kissing them. It’s like a magnet…. I don’t even wait. And when you’re a star, they let you do it. You can do anything. rab ’em by the pussy. You can do anything.”
Urges his followers at political rallies to punch protesters in the face and beat them up so badly that they have to be taken out on stretchers. In an editorial, The New York Times has uoted the following remarks by Trump at his rallies: “I’d like to punch him in the face, I’ll tell you”; “I love the old days. You know what they used to do to guys like that when they were in a place like this? They’d be carried out on a stretcher, folks”; “If you see somebody getting ready to throw a tomato, knock the crap out of them, would you? eriously. O ? ust knock the hell... I will pay for the legal fees, I promise you.”
Suggests that his followers could always assassinate his political rival, Hillary Clinton, if she were elected president or, at the very least, throw her in prison.
And so on, in an endless stream of threats of violence, boasts of violence and incitements to violence.
If psychiatrists with decades of experience doing research on violent offenders do not con rm the validity of the conclusion that many non-psychiatrists have reached, that Trump is extremely dangerous—indeed, by far the most dangerous of any president in our lifetimes—then we are not behaving with appropriate professional restraint and discipline.
However, while all psychiatrists, by de nition, have studied mental illness, most have not specialized in studying the causes, conse uences, prediction and prevention of violence. That is why it is so important for those few of us who have done so to warn the potential victims, in the interests of public health, when we identify signs and symptoms that indicate that someone is dangerous to the public health. We need to recognize the earliest signs of danger before they have expanded into a full-scale epidemic of lethal or life-threatening injury. If we are silent about the numerous ways in which Trump has repeatedly threatened violence, incited violence or boasted about his own violence, we are passively supporting and enabling the dangerous and naïve mistake of treating him as if he were a “normal” president or a “normal” political leader. He is not, and it is our duty to say so.
DR. JAMES GILLIGAN is clinical professor of psychiatry and adjunct professor of law at New York University. He is a renowned violence studies expert and has served as director of mental health services for the Massachusetts prisons and prison mental hospital, president of the International Association for Forensic Psychotherapy, and as a consultant to Presi