Why 70,000 Mental Health Professionals Signed a Letter Warning the World About Donald Trump

There has never been a political figure in modern history who has kept psychiatrists, psychologists, and mental health professionals quite so busy — and so publicly vocal — as Donald Trump.

He has been called many things. A genius by his supporters. A menace by his critics. But underneath all the noise, a quieter and more important question persists: what is actually going on inside the mind of this man? What drives him? What explains his behaviour? And why, even after two impeachments, 91 federal charges, and a historic criminal conviction, does he continue to hold a grip on tens of millions of people?

To answer that, we need to go beyond politics and look at the man through a psychological lens.

Under something called the “Goldwater Rule,” the American Psychiatric Association forbids its members from formally diagnosing public figures they have not personally examined. In other words, no psychiatrist can sit down, read a few Trump tweets, and hand him a clinical label. And yet, that is almost exactly what thousands of mental health professionals have attempted to do — in open letters, in books, in documentaries, and in academic papers.

In 2024, over 200 mental health professionals signed an open letter warning the public about what they called Trump’s “malignant narcissism.” The letter argued that based on thousands of hours of public behaviour, statements, and documented actions, Trump displays a consistent pattern that meets the behavioural criteria for serious personality disorders.

A book published in 2019, The Dangerous Case of Donald Trump, brought together 37 psychiatrists and mental health experts who collectively argued that Trump posed a danger to public safety based on observable behaviour. More than 70,000 mental health professionals later signed a petition making similar warnings.

This is not, it should be noted, a political consensus. There are genuine debates within the psychiatric community about whether it is appropriate — or even accurate — to analyse a living public figure this way. Some experts have cautioned that armchair diagnosis, even when well-intentioned, can be more about political opinion than clinical reality.

But the sheer volume and seriousness of these professional voices is impossible to ignore. So let us look at what they are actually saying.

At the core of most analyses is narcissism — not the everyday, casual kind we use to describe someone who takes too many selfies, but a deeper, clinical version known as Narcissistic Personality Disorder (NPD).

The hallmarks of this condition include a grandiose sense of self-importance, an obsessive need for admiration, a lack of empathy for others, and a tendency to react with rage or contempt when criticised.

Trump has displayed all of these, publicly and consistently, for decades.

Consider the grandiosity first.

Trump has referred to himself as “a very stable genius,” “the greatest president God ever created,” and “the chosen one.” He has claimed, at various points, to know more about military strategy than his generals, more about medicine than his doctors, and more about climate science than the scientists. In psychological terms, narcissists tend to divide all of history into two eras — before themselves and after themselves. For Trump, as observers have noted, American history effectively begins with his arrival.

The need for admiration is equally well-documented. Trump is famously sensitive to crowd sizes, poll numbers, and ratings — not as a strategic concern, but as a deeply personal one. When aerial photographs showed that his 2017 inauguration crowd was smaller than Barack Obama’s 2009 crowd, Trump sent a spokesman to the press briefing room to insist — against all visual evidence — that his was “the largest audience ever.” This was not a calculated political lie. It was the response of someone for whom the idea of being second-best was genuinely, psychologically unbearable.

The narcissist’s need for praise is insatiable. The outside world’s continual confirmation of the narcissistic self’s uniqueness is vital. That leads to compulsive testing to reassure oneself that others will approve — and it drives the narcissist to surround himself with sycophants who will not challenge or contradict him.

This explains one of the most distinctive patterns of the Trump presidency: the revolving door of senior staff. Figures like Rex Tillerson (Secretary of State), James Mattis (Defence Secretary), and John Kelly (Chief of Staff) — serious, experienced people — were each eventually pushed out or resigned in frustration. What they had in common was that they disagreed with Trump, sometimes privately, sometimes publicly. And for Trump, disagreement is not a working relationship to be managed. It is a threat to be eliminated.

The lack of empathy is perhaps the most consequential aspect. Over 200 mental health professionals noted in their 2024 letter that Trump watched the violence of January 6th unfold on television for over three hours with what witnesses described as “glee,” replaying his favourite parts “over and over.” This is not the behaviour of a man who simply disagrees with how the election was handled. It is the behaviour of someone who found genuine pleasure in the suffering and chaos he had helped set in motion.

Some psychologists have gone further than standard narcissism and applied a term coined by the late social psychologist Erich Fromm: “malignant narcissism.”

Psychologist John Gartner argues that Trump clearly exhibits four key symptoms of malignant narcissism — the “most destructive” personality type — including paranoia, narcissism, antisocial personality disorder, and sadism. Gartner notes that this particular type of leader appears throughout history, and such figures are almost always “extraordinarily disruptive.” The same label has been historically applied to Hitler, Stalin, and Mussolini.

This is a serious charge, and it deserves unpacking carefully. Comparing any living political figure to Hitler carries enormous weight, and we should be cautious about doing so carelessly. The point being made by these psychologists is not that Trump is equivalent to Hitler in his actions. It is that the psychological profile — the particular combination of traits — shows disturbing similarities.

The sadistic element is the most troubling piece of this puzzle. Sadism, in psychological terms, refers to deriving pleasure from the pain or humiliation of others. It is different from cruelty that is incidental or strategic. It is cruelty enjoyed for its own sake.

Trump’s long record of public humiliation is hard to explain any other way. He has mocked a disabled journalist by physically imitating his tremors at a rally, to the laughter of thousands. He has publicly ridiculed the physical appearances of female political opponents. He has described war hero Senator John McCain — a man who endured years of torture as a prisoner of war — as “not a war hero” because “I like people who weren’t captured.” He has called grieving Gold Star families liars. When a reporter asked about the families of soldiers killed in military operations, he responded by rating his own phone calls to them: “I think I’m better at it than other presidents.”

These are not slips. They are not mistakes made under pressure. They form a consistent pattern, spread across decades, of Trump finding a kind of energy and enjoyment in tearing other people down.

Psychology always asks: where does this come from?

In her 2020 book Too Much and Never Enough, Trump’s niece and clinical psychologist Mary Trump writes that his mother was emotionally self-focused and largely absent, while his father, Fred Trump Sr., lacked warmth and empathy.

Fred Trump was a hard, demanding man who ran a real estate empire and expected his sons to be tough above all else. Vulnerability was not permitted. Failure was not tolerated. Donald, who had an older brother Fred Jr. who struggled with alcoholism and died young, watched what happened when the Trump family deemed you weak. Fred Jr. was written out, marginalised, and effectively discarded. The lesson Donald took from this — consciously or not — was clear: never show weakness. Never admit fault. Never be second.

Psychologists who have studied Trump’s background suggest that his father lacked emotion and empathy, and that this upbringing may have contributed to a fundamental difficulty in forming genuine emotional connections or tolerating the experience of being wrong.

This is not to excuse the behaviour. Understanding where a personality comes from is not the same as pardoning what it does. But it does help explain the particular flavour of Trump’s psychology — the desperate, driven quality of his need to win, to be seen as the biggest and best, to never, ever look small.

Some analysts have pointed to patterns in Trump’s behaviour that suggest something beyond pure narcissism — specifically, the kind of wild swings in energy, grandiosity, and speech that can be associated with bipolar disorder, or at least hypomanic episodes.

Trump is famous for holding rallies late into the night, speaking for hours without notes, jumping from topic to topic, making sweeping and contradictory claims within the same speech, and apparently requiring very little sleep. His social media use — even before he was banned from most platforms — was described by observers as “manic,” often consisting of dozens of posts fired off in the early hours of the morning, full of capitalised words and exclamation marks.

Psychiatrists who have examined Trump’s public record have noted that the list of potential diagnoses includes narcissistic personality disorder, antisocial personality disorder, bipolar disorder, and paranoid personality disorder — though experts caution that some of his behaviour may also reflect a skilled performance artist who knows how to command attention, making definitive conclusions difficult.

This is a fair caution. Trump has always known how to perform. He was a reality television star before he was a politician, and he understands instinctively how to hold an audience. Some of what looks like mania may be craft. Some of it may be something deeper. It is genuinely difficult to separate the two from the outside.

What perhaps no analyst can fully explain is the relationship between Trump and his followers — because understanding Trump in isolation misses something essential about how he operates.

A study published in Clinical Psychological Science found that American voters, regardless of their political leanings, perceived Donald Trump as having traits associated with sadistic and narcissistic personality disorders — with both supporters and detractors rating him as highly disordered, differing only in how much they felt those traits suited a leader.

In other words, his supporters are not blind to who he is. They see the same man. They simply read that man differently — as strength rather than cruelty, as confidence rather than delusion, as straight-talking rather than lying.

Trump’s obvious lies and exaggerations, his narcissism and self-aggrandizement, his put-downs of women or the disabled, are not merely overlooked by his core supporters — they are sometimes actively celebrated.

This tells us something important. A leader with Trump’s psychological profile does not survive and thrive in a vacuum. He requires an audience that reflects him back. And in a country that felt humiliated, overlooked, and hungry for a champion who would break all the rules, Trump became exactly what millions of people wanted to see — a man who said what they were told never to say, who hit back without apology, who made the powerful people squirm.

Whether that makes him a symptom of something larger in American society, or its cause, is a question that will occupy historians for generations.

What is perhaps most striking about Donald Trump, after all the analyses, all the books, all the open letters, is how thoroughly he resists understanding on his own terms.

He does not explain himself. He does not apologise. He does not reflect, at least not in public. He has described his decision-making process as based on “gut feeling” — and this, perhaps, is the most honest thing he has ever said. He operates from impulse, from need, from a moment-to-moment sense of what will give him what he wants.

The narcissist is incapable of critical self-reflection. The only errors ever admitted are tactical ones — things that fell short in failing to bring the outer world into conformity with the demands of the self. Above all, there is the demand to be allowed to do whatever one pleases, without restraint or criticism or punishment.

That description, written by a political analyst trying to understand Trump’s rise, could equally serve as a portrait of a man who, at 78, shows no signs of changing. He does not change because, in his own mind, there is nothing to change. He is already the greatest. He was always going to win. And anyone who says otherwise is simply wrong.

This is what makes him, depending on your perspective, either the most extraordinary or the most dangerous political figure of our time. Possibly both.

Views of the author are personal and do not necessarily represent the website’s views.

Dr. Jaimine Vaishnav is a faculty of geopolitics and world economy and other liberal arts subjects, a researcher with publications in SCI and ABDC journals, and an author of 6 books specializing in informal economies, mass media, and street entrepreneurship. With over a decade of experience as an academic and options trader, he is keen on bridging the grassroots business practices with global economic thought. His work emphasizes resilience, innovation, and human action in everyday human life. He can be contacted on jaiminism@hotmail.co.in for further communication.

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