The superlative Trump can claim: the most insane president of all time

His own staff describe Trump as ‘unfit’, ‘unhinged’, and ‘unprepared’. A cadre of psychiatrists and other mental health professionals have added ‘unwell’. According to them, his mental health has been fading over time, but not just at a gradual pace.

Psychiatrists and neuroscientists who have compared his speech patterns from a few years ago to those of today claim that his vocabulary has diminished greatly. They suggest that the same sort of sentence fragments that form such a strong pattern in his Tweets also appear in his spontaneous speeches. Virtually all his speeches are spontaneous, so there is a mountain of material available to analyse.

An impressive roster of mental health professionals say that this is evidence of escalating neurological degeneration. The most outspoken, Dr Bandy Lee, a Yale University psychiatry professor, told members of Congress last week that an explosion or collapse in his mental condition is just around the corner. She has described the president as a danger to public health because of his instability.

Dr Lee argues that Trump exhibits symptoms of mental illness that she and her colleagues encounter routinely. When they see these signs in a patient, as they have with Trump, they call for urgent action: containment, removal from access to weapons and an urgent evaluation. Trump is not yet a patient, and the authorities have so far refrained from stepping in to force the steps Dr Lee recommends.

Partly, the view of Trump as near the end of his tether may be due to our changing definition of insanity. We often think that behaviour can be characterised as ‘crazy’ when it falls outside societal norms, but those norms change, sometimes quickly. Ronald Reagan, near the end of his life, announced that he suffered from Alzheimer’s. In retrospect, health care professionals could identify specific patterns of behaviour that Reagan exhibited during his second term that are typical of Alzheimer’s patients. Yet, while in office, Reagan stayed within the norms of presidential behaviour. His illness did not distort the judgement or performance of his staff or of those elsewhere in government.

Trump’s case is different, Dr Lee argues. He has infected those around him. ‘Staying in close quarters with a person suffering from mental illness usually induces what is called a ‘shared psychosis’,’ she wrote. Specific traits that are associated with violence include: impulsivity, recklessness, paranoia, a loose grip on reality with a poor understanding of consequences, rage reactions, a lack of empathy, belligerence towards others and a constant need to demonstrate power.

As president, Trump has taken pride in operating outside the norms expected of former occupants of the White House. George W Bush is reported to have remarked after hearing Trump’s inaugural address, ‘That was some weird s**t.’ The rest of Trump’s 12 months in office hasn’t been any less weird.

Does that performance indicate he is crazy? Not yet, at least. In the 20th century, political leaders were thought to be certifiably insane when they unleashed terror, mass murder, and torture on their own people: Hitler, Stalin, Idi Amin, Pol Pot, among others. Not even his fiercest critics suggest that Trump fits that definition of insanity, though he might enjoy imagining himself instilling that much fear in everyone else.

During their 1991 divorce, his first wife said under oath that he raped her when a hair transplant operation caused him pain – though she later stated it was not in ‘a literal or criminal sense’. In the Access Hollywood tape Trump boasted about assaulting women with impunity. He has threatened war with North Korea and Iran. Yet, he hasn’t moved to lock up all Democrats, just Hillary. He seems satisfied with torture by Tweeting so far, though he promised on the campaign trail to bring back waterboarding and other forms of prisoner maltreatment.

Dr Lee worries that Trump’s inclination toward violence – and the psychological traits associated with that inclination – have already infected other members of his team and of his family: impulsivity, recklessness, paranoia, a loose grip on reality with a poor understanding of consequences, rage reactions, a lack of empathy, belligerence towards others and a constant need to demonstrate power.

After a week of critical attention triggered by Wolff’s book and Dr Lee’s visit to Capitol Hill, Trump decided to expel 200,000 Salvadorans who had been granted asylum in the US in 2001. They had arrived as refugees after two massive earthquakes all but destroyed their native country. That should teach the psychiatrists and the press what happens when you question the fitness of the president.

He has exhibited authoritarian impulses, including admiration for strongmen. Putin, Duterte, Saddam Hussein. But even Trump can tell when a leader is insane in this way. He said at a campaign event in Iowa in 2016: ‘If you look at North Korea, this guy, I mean, he’s like a maniac, okay? And you’ve got to give him credit. He goes in, he takes over, and he’s the boss. It’s incredible. He wiped out the uncle. He wiped out this one, that one.’

So Kim Jong Un, Little Rocket Man, may be crazy, but he has made it to the top. And Trump forgives top dogs any excess, including insanity. It is no secret that Trump views himself as a top dog, so he has forgiven himself his own insanity. Or, as he might put it, the president can’t be insane, because he’s president, and anyway, what about Hillary and Bill? The crooks. Trump is a stable genius. He himself said so this past weekend.

Is Trump afflicted with a mental illness in the same way George III was? George was mad, as Alan Bennett’s drama reminded us. Bennett (and many historians who studied George before Bennett did) suggested that he was driven mad by a rare genetic disease, porphyria, and had to be restrained so that he could be treated. Dr Lee has argued that Congress should do just that with Trump.

In fact, recent psychiatric research at the University of London suggests George may have suffered manic depression rather than porphyria. During his manic phases, George was given to writing sentences of as many as 400 words, containing eight different verbs. So he may well have been certifiably insane by current standards, but his illness was probably a relatively common, treatable bi-polar disorder in today’s terminology. He was not driven mad by a rare genetic blood disease. It could have been with him from his teens, but probably not from conception, at least not evident on the surface in his early life.

Our understanding of Trump’s mental state may be subject to the same sort of changing scientific understanding as was the case with King George. Neuroscience and psychiatry have made relatively little progress in the last 40 years. Research on the treatment and prevention of cancer and heart disease have forced down death rates from these diseases dramatically. Deaths from industrial and automotive accidents have declined steadily with additional training, education and use of safety equipment such as seatbelts. But most advanced countries have all but abandoned their efforts in mental health and neurology. Suicide rates and drug-induced psychosis are on the rise, dramatically so in the US.

Research in neuroscience and psychiatry hasn’t yet felt the loving hands of government, much less the ambitions of the pharmaceutical industry, as have treatments for cancer, for instance. Mental health treatment has gone backwards when it has moved at all. Community psychiatric centres have become the rarest of health care facilities. Yet some academics have managed to carry on, and the results of their work offers some intriguing hints about what it is about the brain that makes people behave the way they do. One study released last year established a link for the first time between intestinal bacteria and Parkinson’s disease, an illness characterised by degeneration of certain nerve cells.

Forty years from now, such research may help explain why Donald Trump behaves the way he does today and what treatment is most likely to succeed. In the meantime, Trump is unlikely to be restrained, but diagnosis and treatment are possible as the political winds shift. If a Democratic Congress began to examine his financial records, they may find an entire intestinal system infected with all kinds of exotic bacteria, including Russian forms in his property businesses, mob influences in his casino history and mutated methods of exploiting tax laws to evade paying anything. That he pays little or nothing ‘makes me smart’, he declared during his presidential campaign.

Threatened disclosure or even prosecution over his financial affairs may be the lever the country needs to lift Trump from office through resignation.

A humane society with a well-functioning mental health system might even deal with Trump as a case study, eventually sending his hair off to Madame Tussaud’s and placing his brain in a jar of formaldehyde or at least cryogenically freezing it for later analysis. Unfortunately, few would identify the American health care system as well-functioning, and Trump seeks to cripple the system even further.

What we do know about Trump’s health is not encouraging. Judging from the time of day he usually broadcasts his Tweets, he has poor sleep patterns. His diet is based on Big Macs and artificially sweetened soft drinks. He suffers from high cholesterol, for which he takes a daily dose of statins. He takes no exercise other than an occasional walk around one of his golf courses.

During his campaign Trump dictated a letter for his doctor to sign declaring himself ‘probably the healthiest person ever to run for president’. Even the doctor who signed it later said that he thought it so preposterous that no one would take it seriously. No one did.

Only one superlative about Trump seems to be credible. He may be the most insane American president in history.

• Albert Scardino, a Pulitzer Prize winner, is a freelance commentator on American affairs.