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

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