Since the start of Donald Trump’s campaign, mental health professionals have come out in unprecedented ways to warn against entrusting the U.S. presidency to anyone whose mental aptitude for the Oval Office was more than suspect. In early 2017, I organized an ethics conference at the Yale School of Medicine to clarify our public health obligations. Later, with 27 similarly concerned colleagues, I published the dangerous case of Donald Trump (Macmillan, 2017 and 2019), a New York Times bestseller – suggesting that the concerns of the American people coincided with ours.

When the coronavirus reached our coast, we declared in January 2020 that Donald Trump’s handling of the crisis would result in a large number of unnecessary deaths. Two months later, we issued a “recipe for survival” urging that the president’s removal may be necessary to avoid a national tragedy. We have predicted step by step how Mr. Trump would catastrophically abuse the pandemic, as a key Lancet article recently confirmed.

We also predicted that at some point violent events would occur, such as the massacre of our Kurdish allies and the assassination of a top Iranian general. Well before the violent uprising in the Capitol on January 6, 2021, which disrupted our democratic foundation, we declared that the time after the November elections would be “the most dangerous time of this presidency.”

Finally, we warned that Donald Trump’s destructive psychology would spread without intervention and become unstoppable. The acceleration of right-wing propaganda, lawmakers’ copying of the legislature, and the flourishing of QAnon conspiracy theories continue to threaten the republic.

Despite the advanced scientific and clinical knowledge we have, the public has not been able to protect itself. First, there are no fitness requirements for a US president to take office. In contrast, all other military personnel, law enforcement officers, and other key decision-makers must pass psychological tests before going to work, but no president before putting their finger on the atomic button!

Second, the American Psychiatric Association issued a gag order prohibiting mental health professionals from speaking about what they were observing. This was unusual: for example, legal professionals are not required to personally represent a public figure and obtain consent before disclosing general information that would be useful to the public. But unlike any other field or medical specialty, the APA made this a requirement at the start of Mr Trump’s presidency and essentially banned any expert opinion about his suitability for the office.

Psychiatric knowledge should be shared with the public more often, rather than less, when there are signs of danger in the political arena, especially since the spread of symptoms makes intervention very difficult. The greater contagion of symptoms such as delusions compared to strategic lies is a well-documented phenomenon variably referred to as “shared psychosis”, “folie à deux, plusieurs, ou millions” (insanity among two, several or millions). or “induced delusions”. Psychiatrists who have practiced in prisons or in the public sector, like me, often experience how severely impaired, untreated influential individuals can quickly transfer their symptoms to vulnerable, previously healthy individuals who are emotionally attached to them.

A case in point might be a family I once treated on the outskirts of Boston who believed that aliens were invading their neighborhood from space. The parents both worked and the five children were between 8 and 16 years old. They seemed respectable in public, but privately they were convinced that an alien force had taken over their neighbors and heralded the end of the world. They thought they were the only “healthy” ones left.

The mother, a domineering figure, scourged the only unbelieving member, her 16-year-old daughter. The daughter called the emergency room when her parents started barricading doors and sleeping with knives by their beds. She feared that her paranoia could escalate into an aggressive attack as they mistakenly believed they were under attack. The mother, identified as the “primary” patient with schizophrenia, was taken to the emergency room and hospitalized. Within a few days, the “secondary” family members improved dramatically.

Strong emotional pressure encourages the spread of symptoms, especially from influential people, as I’ve seen several times in my 22-year career in prisons among gang members, co-conspirators, and cell block inmates. This phenomenon is similar to that in Jonestown or other cults that I have previously researched and written about. And I believe it will go on as long as the magic of Mr. Trump remains unbroken with continuous rewards and the lack of a referendum

Because of these dangers, it couldn’t be more important to apply mental fitness standards before a U.S. president takes office – and when that fails, to use mental health professionals to use their experience and skills in identifying hard-to-spot psychiatric ones Diseases can set in.

Would we interview a neurologist or cardiologist who shares relevant knowledge in the same way, for example if a president had a stroke or a heart attack? Would we prevent a legal or constitutional professional from educating the public about the social implications of the misdeeds of a public figure? Of course not. For arguably more dangerous psychiatric conditions that have greater consequences – usurping family, friends and fellow citizens and losing hundreds of thousands of lives – we as a nation have accepted the gagging of experts.

Prevention is always much easier than trying to intervene after the situation has gotten out of hand. Because it is difficult to foresee things that haven’t happened yet, we rely on public education, essentially the exchange of research and scientific evidence pointing out danger and dictating action.

If the public had been informed earlier and had access to the science-based knowledge of mental health professionals, it could have intervened and potentially have significantly reduced suffering and death. In a recent interview with CNN, Dr. Deborah Birx, former member of the Trump Covid Task Force, said numerous deaths would have been averted if the Trump administration had acted earlier. “The first time we have an excuse,” which means the initial increase. “The rest of them could, in my opinion, have been moderated or reduced considerably.”

This also applies to the growing culture of violence, another highly contagious phenomenon.

The fitness test carried out by a body of ours as a public service in April 2019 fully predicted the outcome of the coronavirus pandemic eleven months earlier – but it was ignored without media exposure. It shows the usefulness of fitness screening before someone can take office as important as the U.S. President.

Bandy X. Lee, MD, is an American psychiatrist who specializes in violence prevention programs in prisons and in the community. She is the author of numerous books, all of which deal with violence in the community and in prisons.