Imagine the situation. In the Oval Office, there is an official diplomatic meeting. A reporter poses the standard question, “Why didn’t Washington warn its allies before striking Iran?” to the Japanese prime minister, who is seated across from the US president. In response, Donald Trump made a joke about Pearl Harbor. Prime Minister Sanae Takaichi was clearly uncomfortable after the comment, which also casually reopened a wound that killed over 2,400 people and violated protocols that both governments had spent decades carefully upholding. A logical impossibility was also included: Trump was born five years after the attack he was alluding to. No one in the room knew exactly what to do with that. You get the impression that this is no longer just a political story as you watch it develop. It’s more bizarre and unnerving than that.
Psychologists and therapists around the country have been saying this for years, but as 2026 approaches, the discussion has become much more urgent and louder. For the better part of ten years, Dr. John Gartner, a psychologist at Johns Hopkins University, has been developing a case that Trump has malignant narcissism, a term that was first used to diagnose Hitler by Holocaust survivor Erich Fromm. Gartner uses this term with an unsettling degree of specificity. Narcissism, antisocial personality disorder, paranoia, grandiosity, and sadism are the elements he names. People usually stop at that last word. Sadism. In a clinical sense, Gartner means to enjoy chaos, humiliation, and devastation. Gartner is obviously aware that making such a serious accusation against a sitting president is not appropriate. Nevertheless, he makes it.
Key Information
| Topic | Trump’s erratic behaviour and its psychological impact on the public |
| Key psychologist | Dr. John Gartner — Johns Hopkins University psychologist; founder of Duty to Warn |
| Diagnosis asserted (unofficial) | “Malignant narcissist” — narcissism, psychopathy, paranoia, grandiosity, sadism |
| Reuters-Ipsos poll (Feb 2026) | 61% of Americans believe Trump has become “erratic with age”; incl. 30% of Republicans |
| “Mentally sharp” perception drop | 54% (Sept 2023) → 45% (2026) believe Trump can handle challenges |
| Duty to Warn organisation | 60,000+ doctors signed on; 27 co-authored a bestselling book on Trump’s psychology |
| The Goldwater Rule | APA 1973 ethical rule — prohibits diagnosing public figures without personal examination |
| Blame deflection pattern | Trump publicly distances himself from failures; subordinates (e.g. Hegseth) absorb blame |
| “Trump Derangement Syndrome” | Political slang — not listed in DSM-5; used to dismiss critics rather than diagnose |
| Academic contributor | Prof. Geoff Beattie, Edge Hill University — published analysis of Trump’s blame psychology |
| Reference / Source | El País English — Trump mental health debate (Mar 2026) |
According to the American Psychiatric Association’s 1973 Goldwater Rule, mental health practitioners are not allowed to diagnose public figures without first conducting a personal examination. The rule’s origins can be traced back to a 1964 magazine cover that made wildly unsupported claims about Barry Goldwater’s psychology. This led to a lawsuit and a sincere examination of professional ethics. Here, Gartner challenges the rule’s applicability. He makes the logical claim that clinical interviews are among the least trustworthy methods of diagnosis, especially when the subject is, in his words, “the biggest documented liar in history.” Over 60,000 medical professionals have joined his organization, Duty to Warn. A best-selling book was co-written by twenty-seven of them. Many people can be written off as alarmists.
What regular Americans are reporting in therapists’ offices may be more instructive than the professional debate. According to a late-February Reuters-Ipsos survey, 61% of Americans, including 30% of Republicans, now think that Trump has become unpredictable as he ages. In 2023, 54% of people thought he was mentally sharp and capable of handling challenges; today, only 45% do. These anxieties are not peripheral. They are commonplace, quietly permeating living rooms, workplaces, and yes, therapy sessions. According to clinicians, political stress has emerged as a recurrent and prominent theme. Perhaps no other president has caused as much psychological distress to others.
Psychologists believe it is particularly important to look at a specific pattern in Trump’s behavior, which is the blame architecture surrounding his outbursts rather than the outbursts themselves. Edge Hill University professor Geoff Beattie has written about Trump’s habit of taking credit for achievements while distancing himself from setbacks, frequently in public and in real time. For example, Defense Secretary Pete Hegseth took full responsibility for the halt in arms deliveries to Ukraine in the middle of 2025. Hegseth handled the international backlash while Trump made a statement that was almost unexpected.
Allowing a loyalist to carry the contentious decision, loudly reversing it, reasserting authority, and emerging with a decisive appearance are mechanics that are consistent enough to imply intention rather than accident. Harry Truman famously said that “the buck stops somewhere,” but it never ends at Trump’s desk.
One could legitimately argue that referring to any of this as “Trump Derangement Syndrome”—a term his supporters use to disparage his detractors—is a form of psychological harm in and of itself. According to Brad Brenner, a licensed psychologist and the founder of the Therapy Group of DC, the label effectively weaponizes the language of mental health to stifle dissent by shifting the conversation away from substance and toward sanity. The DSM-5 does not include it. It’s not a diagnosis. However, it has actual effects on actual people, stigmatizing real political anxiety and making it more difficult for those under stress to get the assistance they may require.
Where this goes is still genuinely unknown. At first, Gartner and his associates banded together with the intention of using Article 4 of the 25th Amendment, which is the constitutional procedure for dismissing a president who is judged incapable of carrying out his duties. That optimism dimmed. Following Biden’s election, the organization fell silent before having a reason to reappear. It’s possible that the public and professional worries about Trump’s mental health turn into one of those persistent background anxieties of American life, existing, unresolved, and causing harm on a low but regular basis. Another possibility is that something changes. For the time being, the therapists continue to accept appointments, and the Oval Office continues to create moments that are difficult to classify.