I'm a forensic psychiatrist at Yale. I took a look at Trump's letter to Nancy Pelosi — and it left me very worried

No healthy human being — not even a Republican who loves Donald Trump — can read his letter to Nancy Pelosi and feel comfortable. The letter is a very obvious demonstration of a troubled state of mind. This occurs in the wake of more than 800 mental health professionals eventually signing onto a petition that the House Judiciary Committee consider mental health aspects.

The assertions Trump makes in the letter should alarm not only those who believe that the president of the United States and the commander of the most powerful military on earth should be mentally sound, but also those who are concerned about such a compromised individual’s influence on society.

Because of the president’s voluminous, unfiltered hourly (or, most recently, quarter-hourly) tweets, responding to real events in real time, psychological professionals like me have an unprecedented window into his mind. I often perform “experiments” of guessing what he must be thinking, then I check against his tweets, and I find myself to be correct every time.

I have used this knowledge to analyze Donald Trump’s tweets as a public service, through Twitter. I analyzed his letter to Nancy Pelosi for the same reason.

I note that I am in keeping with the affirmative obligation of “the Goldwater rule,” an ethical guideline in psychiatry that urges us to meet our responsibility to society by participating in activities that improve the community and better public health. We are charged with educating the public when questions about a public figure arise, without diagnosing. I refrain from commenting on things I do not have enough information for — but when I have information that is critical to protecting public health and safety, I do not withhold it either. In general medical practice, a duty to warn and to protect those who are vulnerable to danger supersedes all other rules.

Reading Trump’s letter to Pelosi without arming oneself with the right interpretation ends up playing into the hands of pathology and helping it. In the most extreme cases, the dynamics contribute to what is called “shared psychosis.” Shared psychosis is a phenomenon that happens commonly in households where a severely ill individual goes untreated: rather than the sick person growing healthy, healthy family members often take on symptoms of the sick person. I have seen some of the most intelligent and otherwise high-functioning persons succumb to the most bizarre delusions from close contact with someone whose mental state is not normal. Shared psychosis can also happen on a national scale, as renowned mental health experts such as Erich Fromm have noted.

The president is quite conscious of his ability to generate this mass hysteria, which is the purpose of his letter. He engenders it unconsciously, through what he refers to as his “gut”. He correctly recognizes that primitive “abilities” strengthen when higher functions are compromised or bypassed.

According to neuroscientists, the unconscious mind accounts for about 98 per cent of mental activity. Delusions form when a person has extreme difficulty tolerating reality and must create an alternative reality to get by. The emotional drive behind this is so strong, it “infects” others more effectively than would conscious lies or strategy. The sheer influence on all those who are exposed, as well as the destructiveness, shows that it is a disease process. Meanwhile, that person also exhausts those who do not adopt his symptoms.

The book I edited — The Dangerous Case of Donald Trump – contained three warnings: that the president was more dangerous than people suspected; that he would grow more dangerous with time; and that ultimately he would become uncontainable. We are entering the “uncontainable” stage, and that's because of shared psychosis.

While attempting to convince the public the exact opposite of the truth through his letter, the president inadvertently gives away his innermost thoughts and fears — and also his own, very clear recognition of reality. With the signs of pathology he reveals, he should submit to a mental health examination or, if he refuses, remove himself from office.

Some are afraid that bringing up mental impairment would exonerate Trump, but mental incapacity to do a job is not the same as incapacity to stand trial or to be criminally responsible. In fact, criminal-mindedness combined with mental incapacity is the most dangerous situation of all.

In order to do its duty to the American people, Congress should resolve, through whatever means at its disposal, this public health emergency.

Bandy X Lee, MD, MDiv., is a forensic psychiatrist at Yale School of Medicine, president of the World Mental Health Coalition, and author