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A Clear Call for a Violence Risk Assessment

No, I am not referring to the British Broadcasting Corporation, although I am referring to a recent, clear-sighted article from the British corporate press.  I am referring to “Bloodbath, Bedlam, and Chaos”—the themes of the article that goes on to say:

Donald Trump has made apocalyptic imagery a defining feature of his presidential election campaign, warning supporters that if he does not win—and avoid criminal prosecution—the U.S. will enter its death throes.

I have continued to warn that unprecedented violence could be looming for our country whether or not Donald Trump is in the White House, Mar-a-Lago, or prison next year.  And it will have been for lack of proper interventions. His influence is now far-reaching, both at home and abroad, not because Trump is particularly talented or clever, but because his sick symptoms have spread unchecked.  A public unfamiliar with pathology took his “power” to be somehow supernaturally endowed, politicians adopted it as a political strategy, and world leaders imitated it as the new avenue for success.

This is why, since his election in 2016, we psychiatric professionals considered it our urgent responsibility to educate the public, as what we are seeing here is not new to psychiatry.  What is new is that such a severely-impaired, dangerously-unfit individual has continued to be empowered. And were such a person—who should not even be a candidate—be allowed to enter the White House again, he is well-primed to use violence to upend the U.S. Constitution and to bring about a novel form of American fascism.

A reader from across the Atlantic has written to me:

Dear Bandy,

I live in the U.K.  Every time you are interviewed and the American public are watching, tell the world multiple times, Trump is evil.

All the Republicans who have sided with Trump have made a massive mistake, as Trump is toxic.  If they had any sense, they would keep well away from him and not want anything to do with him.  Like attracts like, and Trump has attracted many evil people to himself, but other people are just foolish and naive and cannot see the damage Trump is likely to cause in their lives.  Not all Germans who sided with Hitler were evil, many were just foolish and gullible and taken in by him.  If Hitler hadn’t come along, most Germans would have lived a totally decent and good life and not harmed anyone.

Trump is nearly 78 and in 10 years’ time he is going to be too feeble and old to do any more damage, but the people who have sided with him have got to live with their actions and with the fact that they were on the wrong side of history, just like the Germans who sided with Hitler….  Arnold Schwarzenegger, who is Austrian and had a Nazi father, said that after WW2, many of these men were broken and turned to alcohol to help them live with their guilt and foolishness.  Hitler ruined these German lives as well as innumerable others, as he was toxic, too.

History will hold Donald Trump accountable as the man he really is, not the man he says he is….  You are doing a brilliant job.  You are a credit to the psychiatry profession, and you will be recognised for your actions, long after you have died.

Best wishes,

J.H.

The reader has a point—“evil” is the first part of predicting greater dangers in psychiatry.  In my last Newsletter, we discussed unfitness—which, unlike diagnosis, is a matter of public interest, should be performed for the public benefit, and does not require evaluee consent.  There is an examination of similar public interest, and that is assessment of violence risk.  The first part assesses degree of psychopathy—which is, in fact, quite close to evaluating evil.

What is psychopathy?  It is the absence of compassion or conscience.  It may be hard for the average person to imagine a human being without humanity, who fiendishly manipulates others and manifests boundless violence and cruelty.  Because an afflicted person knows right from wrong, it does not qualify one to be “not guilty by reason of insanity.”  It wreaks more havoc on individuals and society than all other psychiatric conditions combined—and yet is seldom detected before massive casualty.

Therefore, it is important to know if Donald Trump exhibits the features of psychopathy, below:

1.  Glibness/superficial charm

2.  Egocentricity/grandiose sense of self-worth

3.  Proneness to boredom/low frustration tolerance

4.  Pathological lying and deception

5.  Conning/lack of sincerity

6.  Lack of remorse or guilt

7.  Lack of affect and emotional depth

8.  Callous/lack of empathy

9.  Parasitic lifestyle

10.  Short-tempered/poor behavioral controls

11.  History of promiscuous sexual relations

12.  History of early behavior problems

13.  Lack of realistic, long-term plans

14.  Impulsivity

15.  Irresponsible behavior

16.  Frequent marital relationships

17.  History of juvenile delinquency

18.  Revocation of conditional release

19.  Failure to accept responsibility for own actions

20.  Many types of offense.

These items are from the well-researched and highly-reliable Hare Psychopathy Checklist–Revised (PCL-R).  To make an actual diagnosis, one needs a doctorate in psychology or psychiatry, forensic training, clinical experience with dangerous individuals, and specific training in administering the PCL-R.  At least one qualified psychologist has publicly made the diagnosis through his “duty to inform.”  Now, we will discuss what else goes into a violence risk assessment in my next Newsletter.

Mental health experts are called upon to do critical assessments for the courts, corporate boards, and governmental bodies.  An assessment of fitness may be requested of an employee, for example, whose fitness is assumed until signs of unfitness appear; if found unfit, the employee is removed from the job.  Similarly, an assessment of violence risk may be requested of a detainee; if found violent (such as after inciting a violent insurrection or after implementing policies that needlessly kill hundreds of thousands of people), the person is removed from the public.  A mental health professional’s duty to inform, warn, and protect—and to continue informing, warning, and protecting in the case of continued danger—means that it is malpractice not to do so. Indeed, one could be held criminally liable for failure to do so.  Other authorities have similar, legally-binding duties.  Donald Trump is currently not president, but even a president is entitled to the psychiatric standard of care.  What was proper to do in 2016—the moment he encouraged his supporters to “knock the crap” out of protesters and promised to pay their legal bills—was to “lock him up” and do a violence risk assessment.  Any professional stating otherwise commits malpractice, and we should not repeat that error now.