Op-Ed: Could Trump have a reality-distorting mental condition?

Eli Merritt
President Donald Trump speaks at a rally Wednesday, Jan. 6, 2021, in Washington. (AP Photo/Jacquelyn Martin)
President Trump speaks at a rally in Washington before pro-Trump insurrectionists stormed the U.S. Capitol on Wednesday. (Associated Press )

In the aftermath of the storming of the U.S. Capitol by a pro-Trump mob, egged on by President Trump, members of the House, the Senate and Trump’s Cabinet are weighing options on how to ensure the safety of the nation and the integrity of our democracy.

There have been calls for his resignation or removal by the 25th Amendment for his being unable to discharge the duties of the office. On Friday afternoon Speaker Nancy Pelosi (D-San Francisco) announced that the House would launch a second impeachment if Trump did not resign “immediately.”

As the gatekeepers of our democracy, they need to inquire about whether Trump is potentially dangerous as the commander in chief — including raising questions about whether he has a reality-distorting mental state.

One such condition is “delusional disorder,” which is unique among psychiatric conditions in that the area of dysfunction can be highly circumscribed. An individual with this disorder often has a single fixed delusion and otherwise functions normally, setting it apart from illnesses such as bipolar disorder and schizophrenia, in which the patient typically experiences broad impairment in social and occupational functioning.

The hallmark of delusional disorder is a non-bizarre fixed false belief, contradicting external reality, which is held by the patient fiercely despite overwhelming evidence to the contrary. There are many subtypes of the disorder, including jealous, somatic, grandiose, persecutory and mixed.

Trump has been fixated for the last two months on the idea that he is the victim of a “stolen election,” despite all evidence that the election was free and fair. He continued to make this claim Wednesday before the mob that invaded the Capitol.

The president is often described as a liar. It is, of course, possible that he is fully cognizant of the fact that he did not win the election, and, in a gambit to hold on to power, he is lying boldly. But I doubt it is that simple.

Trump seems to believe he won. Could he be “captured” (to borrow a term from David A. Kessler’s book "Capture: Unraveling the Mystery of Mental Suffering") by a fixed delusion?

The loss of the November election seems psychically shattering to Trump, and the delusion of a “stolen election” could be one way to deny reality and repress pain. Major loss, it is well known, is the most common trigger of all psychiatric disorders, including delusional disorder. For Trump, the reality of the loss of the election, the White House, Air Force One, and so many other accouterments of office, not to mention Twitter, clearly strikes hard.

According to extensive research, the prognosis for someone with delusional disorder is not good. Some patients recover, but the vast majority do not. Because of the fixed and avoidant nature of the illness, most patients refuse treatment altogether. Those who do seek clinical help sometimes see improvement, but generally, the delusions tend to be recurrent and chronic.

Already, according to a recent report in the Wall Street Journal, advisors to the president are expressing heightened concern. One person close to Trump stated that he is “in a dark place.” Another said, “It’s like watching someone self-destruct in front of your very eyes, and you can’t do anything.”

In light of the deadly events of Jan. 6, the members of the Cabinet and Congress should consider the possibility of a delusional condition as they deliberate about what to do about the threat he poses if he remains in office. The safety of the nation may depend upon it.

Eli Merritt is a psychiatrist and visiting scholar in the Center for Biomedical Ethics and Society at Vanderbilt University.

This story originally appeared in Los Angeles Times.