Much has been written by U.S. commentators, pundits, and even mental health professionals about Donald Trump’s mind and psyche during the 2016 campaign for the presidency and his first 20 months in office. Little of it was grounded in applied psychoanalysis, the practice of using psychoanalytical principles to understand the actions, motivations, and limitations of historical figures.

To fill that gap, I wrote “Trump on the Couch,” a task made easier by the revealing historical record on his family and early years and his own published record, from the books he has authored over the years to his more recent, incomparable Twitter output. These sources provide an unprecedented look at how the unconscious patterns Trump developed in childhood influence his words and deeds in adulthood.

A single appearance on “Fox & Friends,” a morning talk show on the Trump-friendly Fox News network, reveals the depth and breadth of the character evaluations and mental illness diagnoses that I made from my analyses.

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It was April 26, 2018, the day that White House physician Dr. Ronny Jackson withdrew as Trump’s surprise nominee for Secretary of Veterans Affairs following allegations of improper professional conduct. From the privacy of his White House retreat, Trump called into the show, and for nearly 30 minutes delivered a rambling monologue, weighing in on topics from Jackson’s announcement to Michael Cohen and Stormy Daniels, James Comey, and Kanye West.

This half-hour revealed how destabilized the president can become and showed many of the disturbing patterns seen elsewhere in Trump’s actions and writing. Three of the most striking were his deep-seated feelings of victimhood, repeating himself, and difficulty answering questions or staying on point. He remarked, for example, that he had made NBC “a fortune.” He then went on to say, “You would think these guys would treat me great” before repeating “I made them a fortune.” And then he said, “They treat me falsely.” His disbelief was palpable.

In most situations, Trump’s impulse is to blame others for the problems he encounters. On “Fox & Friends,” he blamed the Democrats. His tendency to view the “other” as bad, dirty, or destructive was illustrated here by his rants against James Comey, CNN, and Robert Mueller.

A worrisome escalation of Trump’s cognitive limitations was heard in his inability to follow the thread of a conversation, as when he jumped from getting a card for Melania’s birthday to talking about Macron’s wife to talking about Iran — all in a span of three sentences. He said things that just don’t make sense, like there is “a horrible group of deep-seated people” out to get him.

The paranoid portrayal of himself as victim continued in a similar manner. “It’s a witch hunt,” Trump said, “and they know that. … I would give myself an A-plus. Nobody has done what I’ve been able to do and I did it despite the fact that I have a phony cloud over my head that doesn’t exist.”

Also on display was the now-familiar disconnect between Trump’s language, meaning, and the truth, most conspicuously when he contradicted himself while railing against his perceived enemies on “fake news” networks: “I don’t watch them at all. I watched last night.”

What troubled me even more was the acceleration of Trump’s anger, which threatened at times to escape his control and explode into full-throated rage. The same destructive impulses to which he gives free expression from the rally podium sounded out of control when coming from an isolated, disembodied voice over the phone.

Trump on the Couch Cover
Avery/Penguin Random House

The show’s three hosts, Ainsley Earhardt, Brian Kilmeade, and Steve Doocy, kept trying to change the topic in an apparent attempt to distract the president from erupting into full-blown chaos. Without their knowing it, they were unconsciously attempting to serve as the human equivalent of The Wall, the psychic skin that Trump’s disordered personality relies upon to keep him from falling apart entirely. But the “Fox & Friends” hosts’ calm had the opposite effect. After their attempts to contain him continued to fail, they ended the conversation just as he was revving up for another round of invective against Comey, the FBI, and the Clinton Foundation.

Moments before ending the “conversation,” Kilmeade interrupted Trump’s tirade against the “council of seven people” on CNN of which “every one is against me.” Kilmeade suggested, “I’m not your doctor, Mr. President, but I would, I would recommend you watch less of them.”

It’s clear from the transcript of the episode that Trump was incapable that morning of simultaneously appearing on the show and listening closely to what was being said. If Kilmeade had said something comparable to another guest while Trump was watching, it’s easy to imagine what Trump’s take on it would have been: He would have seen the fact that the host was so exasperated by the guest’s volatile mental state that he introduced the notion of how a doctor might address it as a confirmation of the guest’s instability. The tweet would have been “Loser.” Instead, the president didn’t acknowledge the suggestion that he could use a doctor to help him maintain his mental stability.

Questions about Trump’s mental health and the possible need for treatment have been topics for public discussion that predate his presidency, and they will continue after it is over. Much of the initial discussion came from the political left, then expanded into what remains of the center. But if that discussion is now reverberating in the pro-Trump, conservative media echo chamber exemplified by “Fox & Friends,” it has reached an entirely new level. If Fox News is suggesting that the president’s moods could benefit from medical attention, there’s no telling who is next.

The president’s performance on Fox & Friends struck me and many viewers as one of a frighteningly unhinged individual. It supported my conclusions from hundreds of hours of analysis that Trump is mentally unfit in ways that make him psychologically unsuited for the presidency. I would have written the book in all caps if I thought that would have better conveyed the sense of urgency with which it should be read.

The work of assessing the president’s mental health certainly won’t end here. The goal of my analysis was never to diagnose Trump, but to observe, comprehend, and provide some context to help educated readers understand some characteristics of the president’s behavior.

But beware: Simply becoming an educated reader can be seen as an act of defiance against a president who audaciously proclaimed on the campaign trail, “I love the poorly educated.” Education can put one at odds with Trump’s supporters as well: Poorly educated voters returned Trump’s love, awarding him victories in 43 of the nation’s 50 least-educated counties in 2016 (and only 10 of the 50 most educated). Trump’s pathology flourishes when unchallenged by awareness or insight. Information is power, but it is also a responsibility.

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Nothing about studying Trump’s psyche has reduced my concern about his fitness for office. The more I learned and the deeper I looked, my conviction that he is a menace to himself and the American people grew ever stronger. This knowledge has only raised my anxiety, an effect I suspect it will also have on many readers. But anxiety, though unpleasant, is not something we have to run away from. Anxiety is a source of information, and in that respect is a responsibility as well.

The book is not a personal attack on Trump, nor is it a rebuttal to some of his messages, because that would overlook the genuine grievances Trump supporters have with Washington elites in general and the Obama administration in particular. These are real and passionate feelings of dislocation and impotence, to which Trump has given voice.

Instead, the book is a call to action for all Americans, because Trump reminds us of what happens when anxiety is denied or ignored. He is consumed and misled by a lifetime of unprocessed, unacknowledged anxiety, which has no doubt been exacerbated by the power and responsibility of his office. Trump challenges us to avoid making the same mistakes. It’s time we heed that call.

Justin A. Frank, M.D., is a clinical professor of psychiatry at George Washington University Medical Center and author of “Trump on the Couch: Inside the Mind of the President” (Avery/Penguin Random House, September 2018), as well as related books on George W. Bush and Barack Obama.

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  • Reply to Roger W.

    I was hoping to read a response from someone who is not so defensive, or not anti-psychoanalysis; I wanted to be able to continue the dialogue with a more intelligent person who possesses the perspective of a profound group of individuals who spend their entire lives, learning about the human condition of others, whether personally known or not.

    I speak myself for my own profession and the never ending requirements to continue to learn about the human nature and its complexities that require that those of us who are truly responsible, ethical and especially possess the integrity that is always the most significant aspect of the psychoanalytical practitioner; I am especially grateful to read your response to this topic.

    The media who are responsible journalists, are truly experiencing the same sort of response from the readers who don’t have the ability to recognize another’s perspective, about most topics.

    Within the more knowledgeable population, the ability to realize this is a profound experience, especially when the topic of discussion is about an individual who is experiencing so many issues that reflect the individual’s own behaviors and the offering of some credible hypotheses, as to the actions of an individual who is supposed to be the leader of a nation.

    There are no surprises at all with this author’s observations. The fact that STAT is choosing to make this column available is because STAT is about so many different types of topics within the medical field, and includes the mental health practioners too, is why we are reading this column from STAT. They don’t discriminate, what constitutes the reason for their choice, that they publish. I would be rather suspect if they excluded the individuals from the mental health profession. But they have published many different types of mental health issues, including the topic of this column, a person who is experiencing obvious issues with his own psyche. How that is going to effect our own lives is of a great concern for anyone who knows what our country could actually expect from one who has a long history of some rather dubious behavior and more than questionable experiences with the truth, just to begin.

    The truth is about more than politics here, and especially in the current zeitgeist of our entire nation, we need to read more about this topic, like never before. I am grateful for STAT, to recognize the necessity for our recognizing what we must consider, when the topic is about the character of a person and the others who are amongst his “loyal legions,” and why everyone is so adamantly stuck in some sort of way, that they are unable to make the ethical choices for the good of the citizens of our nation.

    I could go on about this topic, but I know that I am not writing anything that has not been read elsewhere, by countless others who are from varying populations already. I wanted to let STAT know that I agree with the decision to have this topic stated in the way it requires, in order to be an authentic statement based upon facts.

    • @Catherine

      Hi, Catherine ~

      It’s not surprising that you wish to shield your fake profession from even more instances of quackery.

      The teenage son of one of my friends landed in a highly-esteemed mental hospital for fighting.
      When I went to visit him, I was astonished to find that all the careful, responsible, highly-educated diagnoses of all the patients needed the exact same treatment! (Group therapy)
      This was amazing. It is so useful that really, you’d almost think that the diagnosis was immaterial.
      It would be like carefully diagnosing pregnancy, polio, giardiasis, and a broken wrist … and then giving them all the same treatment!

      Furthermore, the patients needed the group “therapy” treatment all for the exact same length of time — fortunately, the time for their insurance to run out1
      it was pretty amazing … until I remembered something:

      This fake profession fails the test when challenged in a covert experiment to give a reproducible diagnosis EVEN WHEN THEY SEE THE PATIENT IN PERSON.
      In the experiment, a plant is coached to say he has certain symptoms for entrance to a mental hospital.
      At each hospital, he receives a different diagnosis!

      Wow! It almost seems that the diagnosing psychologist is just MAKING IT UP.
      https://en.wikipedia.org/wiki/Rosenhan_experiment

      The worst case I read about involved the same patient getting a different diagnosis from the SAME QUACK.
      Hahaha.
      Not that it made any difference.
      In your laughable profession, ALL diagnoses require the same treatment.
      http://www.continuingedcourses.net/active/courses/course101.php

      This is more like a religious miracle than it is like science.

      And to compound your fake profession’s inability to make a believable diagnosis even IN PERSON, this risible article purports to diagnose a person they have not ever spoken to — or even laid eyes on!
      That really IS a religious miracle.

      The fact is that your fake profession’s failure of reproducibility even of controlled laboratory experiments — never mind actual diagnosis of people you have never laid eyes on — this failure is a national disgrace.
      https://www.npr.org/sections/health-shots/2018/08/27/642218377/in-psychology-and-other-social-sciences-many-studies-fail-the-reproducibility-te

      You should all be arrested for consumer fraud, and I have no doubt that you WILL all be arrested for it eventually.

      You can’t fool all of the people all of the time.

  • Such arrogance! Apparently, this “healer of the sick” has too much free time on his hands.. it would be more productive if he took some of his self-perceived “psychoanalytic talent” and devoted it to cleaning up the medical profession from its own problems such as the rampant drug and sex addiction among it’s ranks rather than writing political books…heal thyself.

    • @Pamela

      You’re right.

      But here’s something that would be even more productive:
      All psychology is a fake.
      Psychotherapy is the worst of the fake field of Psychology.
      And “psychoanalysis” is the worst of the worst.

      So ti would be even more productive if the author got a job, a real job, maybe manufacturing something useful instead of licking the bottom of the barrel like this.
      What a bottom feeder.
      I suppose he’s desperate for money now that there are no clients for psychoanalysis any more.

      Everyone has smartened up, and that’s why he is driven to make money for his fake diagnosis with fake methods on a client he has never even seen.

      It is reprehensible for STAT to have published this ridiculous hit piece.

  • Too bad some professionals can’t resist using credentials to support their personal/political opinions. Apparently, we are not sufficiently sophisticated to follow anything other than “If I like him, he must be good for the country” and “If I don’t like him, he is obviously bad for the country.” Armed with supporting “facts” (anything published somewhere/sometime) these “best-intentioned” crusaders go “media.” And here we are, not even a year and there’s been enough journalism to fill a Trump library. Perhaps he will be the only President to warrant two separate libraries, one for Trump-deplorables (aka Trump-likers) and one for Trump-haters.
    Isn’t anyone getting weary of this? One or two public psych dissections, reported as “science,” might have been okay, or at least passed unnoticed by the professional discretion police. That would have been understandable since most of them are also Trump-haters and have slacked off on their responsibilities.
    But still? Isn’t anyone getting bored?.
    Far more interesting, at least to me, is why Trump haters can’t let it go? Most prominent in that group are not the “poorly educated,” but the moneyed elitist who inhabit both coasts and figure prominently in media, entertainment, the arts, and even healthcare.
    Peggy Finston MD

    • @Dr Finston ~

      You are 100% correct.

      At first, the Trump Derangement Syndrome was funny, but then it became alarming.

      Now it’s just a bore.

    • That’s correct.
      A college diploma does not mean what it used to mean.

      The basic situation has not changed from the days when college was reserved for the intellectual elite.
      It is still only the top 10% or so of all college graduates who get advanced degrees with solid content.
      —————

      But that 10% is pretty good.
      It’s true that you can’t really say that they carefully studied the textbooks about how to walk on the moon, or how to invent the computer and the internet.
      They really didn’t read those textbooks.
      They wrote them.

  • The really disgusting thing is that our society rewards these psychopaths. Psychiatrists are even lass capable of recognizing these behaviors, than the people they deem “uneducated.”
    If anyone wants a true glimpse into why we have a dangerous psychopath in the highest office in the land, they ought to go see Michael Moore’s Fahrenheit 11/9.

    • @Mavis

      Oh noes!
      ANOTHER unqualified fake diagnosis.

      I wasn’t able to tell who you meant by “psychopath” — the President of the United States, or the psychotherapists.

      These psychotherapists are the people who “testi-lie” In court, sending innocent kids to prison or insane asylums in the morning, and freeing rapists and murderers in the afternoon — all based on absolutely nothing.

      There is no objective reality in their work.
      They are simply making stuff up.

  • Hasn’t “long-distance” psychoanalysis been discredited for a long time?
    Would it be an acceptable technique for a Clinton-hater to use against Hilary?

    And hasn’t Freudianism in general and psychoanalysis in particular been discredited for a long time?
    In Boston, there’s an office over a storefront selling women’s clothes which is the last place in Massachusetts to get a certificate (“suitable for framing”) as a licensed psychotherapist.

    But heigh-ho … whatever … anything for a hit piece.
    Isn’t that right, STAT?

    Oh, and just so you know, I can’t stand Trump. Everything he says is wrong or weird.

    But I still reject this kind of publishing. Shame on you.

  • I’m a college educated “deplorable “. I love ❤️The Donald. I pray God gives him strength to win over jerks like you 😡

  • I am more frightened that you have chosen to diagnose by watching videos and news clips, rather than meeting someone in person and being able to ask questions, etc.
    You are scary! Bet you are a wonderful armchair quarterback, a backseat driver, a prophet and hold “deplorables” like me in your lowest esteem!

    • Sometimes watching video clips & hearing recordings of a leader’s speeches & actions is real evidence of how they are acting & believing at that time.
      Meeting them in person gives them the opportunity to put on the charm for their audience.

    • Skilled professionals the world over make very sophisticated decisions without firsthand experience all the time. I think you could call it an attribute of being an expert: being able to make complex decisions based on what would otherwise be called insufficient data. In the real world, it’s unavoidable.

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