‘Vermin’

Dehumanization is the First Step to Violence and Genocide

When Donald Trump was elected in 2016, I dropped everything in my highly rewarding, nearly two-decade career, because there was suddenly, in my view, a psychiatric emergency.  This is how doctors are trained: when we see an emergency, we cannot simply walk away, even if we are not on duty or if the person in danger is not our patient.  In this situation, the “patient” was my nation.

Also in an emergency, we do not consider if the person before us is of one political faction or another, or what other categories might apply.  Superseding anything is the fact that the person is human, and this allows for the medical neutrality that is integral to our profession.  The Hippocratic oath also deeply ingrains that our own advantages do not take precedence, either: ethical guidelines have long warned that doing the right thing in medicine may entail self-sacrifice.

Coming from three generations of doctors in my own family, these values are unequivocal in me.  This is how I came to mobilize everything I could to hold a conference with my colleagues in early 2017 and then to put our medical consensus into the public-service book, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.  It became an unprecedented New York Times bestseller of its kind and Washington Post’s “most courageous book of the year,” 2017.  Within three months, we were the number one topic of national conversation, which I took as an organic hunger for our experience and point of view.

Our sudden blackout from the media was not organic. It shocked me when the American Psychiatric Association (APA) intervened in the opposite way everyone expected, essentially stopping independent professionals in our tracks.  It declared that not only its members (without disclosing that, despite its name, it is a private trade association dependent on the pharmaceutical industry) but all mental health professionals had no societal duty; those who spoke up did so “unethically”, despite its own ethics code stating in the very preamble that psychiatrists have a responsibility to patients as well as to society.

The APA’s vociferous public campaigns (whoever has not heard of “the Goldwater rule” now, when before Donald Trump not even psychiatrists knew about it?) were directly responsible for truncating the most viable and appropriate intervention early in the Trump presidency: the Twenty-Fifth Amendment.  Or at least this is what was foremost on the mind of many U.S. Congress members—among numerous other officials outside of Congress, it turns out—who explicitly relied on our public education and actively consulted with us.  This is how I came to meet with over fifty lawmakers, while lecturing alongside the original drafter of the Amendment, John Feerick, who emphasized that its implementation was meant to be “driven by the data,” which psychiatrists provided.

What I, and no doubt the public, did not recognize was that the APA would be so corrupt as to align with power over the principles of the profession it claimed to represent.  This is now a familiar pattern in many institutions.  Universities are becoming the first to stifle free thought; the Supreme Court the first to rescind rights; and governments the first to place their own constituents under deprivation and danger.  The APA was merely the first to act in this way, since mental health matters were of foremost importance in the Trump era.

Hence, Donald Trump’s escalation to calling his opponents “vermin” is a natural consequence of his uncontained psychological dangers.  It is, of course, part of a familiar dehumanization process that precedes massacres and genocide, but this manifestation is the end product of a long, predictable process.  Even before this rhetoric, Trump has been “entraining” his followers into a mindset that allows for his total control, that insulates them from outside influences or information sources, and that conditions them to accept his adversaries as their own, so that he has a ready-made personal army at his disposal.  This is how street gang members are convinced to kill police officers, and child soldier recruits to sacrifice their own family members.

This is why, since my first book, The Dangerous Case of Donald Trump, I have tried to warn that what we were facing was an existential public health threat, not just an eccentric individual.  Adolf Hitler or Josef Stalin became who they were not because they had an extraordinary psychological structure, but because their nations extraordinarily handed to them power that they could not handle.

Hitler was called a “seismograph of crowds.”  Trump is similar, for this is actually a symptom to ensure his psychic survival—except, being pathological, it ultimately brings about his self-destruction.  Mental health professionals could have offered the same understanding of psychological dynamics for therapeutic purposes, but this is what the APA hindered, rendering the population maximally vulnerable.

I have seen approximately a thousand individuals with Trump’s personality structure in my 25-year career of specializing in evaluating and treating violent offenders.  A strong democracy successfully contains such individuals in jails and prisons—or does not produce them in the first place.  As the U.S. increasingly becomes a power-driven society that tolerates oppression, it fails to detect these personalities but rewards them, perhaps even elevates and makes use of their ability to hypnotize crowds—but has no idea of the dangers and violence we are unleashing by doing so.

As Donald Trump is leading in the polls and has even surpassed Joe Biden, the question we need to ask ourselves is, When will we finally act?  I have described the dynamics of this unhealthy leader-follower bonding as “narcissistic symbiosis,” which progresses to a “shared psychosis.”  This does not mean that each individual Trump follower will be psychotic, but as a collective they will act as if psychotic, heedless of the relentless path to collective destruction.  The question we may ask ourselves at this juncture is, do we wish to follow him on this inevitable course, or can we mobilize the healthy drive in ourselves to recognize an uncomfortable reality and to take the proper precautions?  It will be an uphill battle, since, much like climate destruction, we have chosen in the early stages to deflect and deny, instead of intelligently responding.  But it is a call now that we can no longer ignore.