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Monday, May 25, 2020

It is not in the national interest to have a crazy president – at any time, but especially in a crisis

There’s Still Time To Stop Him
We Can Prevent a ‘Darkest Winter,’ Or We Can Remain Hostages to Trump’s Worsening Mental Condition
By Dr. Bandy X. Lee

The One-Percenters Convincing Themselves Trump Isn't CrazyRick Bright publicly underscored that if we accept a president’s wishful narrative over medical expertise “2020 could be the darkest winter in modern history.”

Mental health experts have been trying to inform the public that not even a nuclear winter could be ruled out.

Dr. Bright, a top government virologist, in testimony before the U.S. House of Representatives last week described the very consequences we anticipated.

Bright testified the totally disastrous handling of the pandemic led to a level of death and tragedy and an unprecedented economic collapse that did not have to be.

From our perspective, this is the natural consequence of having a mentally impaired president. Like a cascade, psychological disturbance in the high office progresses into social, cultural and geopolitical dangers.

In the context of a pandemic, they manifest as a dangerous inability to contain the pandemic and to lead a coordinated response abroad as our country traditionally reacted.

Benjamin Franklin’s axiom that “an ounce of prevention is worth a pound of cure” is apt. In this Mental Health Awareness month, focus on the severe stresses of the pandemic and its serious mental health consequences might have been prudent. But even greater prevention is necessary and should not be neglected.

What is prevention? It is not letting problems get out of hand before beginning to think of doing something. Most problems are the product of a long process. The better we understand the process, the earlier we can intervene.

Stages of Prevention

There are three levels of prevention:

Primary prevention, or intervening before any problem occurs

Secondary prevention, or intervening immediately when there are signs of a problem

Tertiary prevention, or intervening in a problem that has started so that it does not grow worse

One of the major achievements of modern medicine is that we have learned to intervene early based on scientific evidence. Fully half of human beings are thought to be alive today because of improvements in prevention.

Another way of visualizing this is the upstream-downstream model. In the imagery of a swiftly flowing river, we can picture preventive measures and health promotion happening upstream and disease and illness occurring downstream.

Intervening early at the upstream level allows for the greatest possible reduction of disease and suffering for whole populations at the downstream level. Public health is sometimes called the art of preventing disease and promoting health, as it is responsible for the health and safety of populations.

Dr. Bright is a medical professional trained in infectious disease, while I am trained in mental disease. 

My colleagues and I felt our own obligation to speak up early in 2017 when the societal ramifications of not ignoring mental health expertise became clear. Now the national consequences of not heeding pandemic expertise are becoming clear.

I have been invited to meet privately with at least 50 members of the U.S. Congress. But neither any of my colleagues nor I have been able to appear before any Congressional committee, despite the efforts of our many advocates inside and outside of Congress.

CDC’s Role

Prevention is central to the work of the U.S. Centers for Disease Control and Prevention. It has played a major, pioneering role in violence prevention and creating recommendations with the World Health Organization. The CDC helped 133 nations to lower global homicide rates by 16% over 12 years.

Likewise, Americans hardly remember malaria, tuberculosis, polio and autoimmune deficiency syndrome, or AIDS, being endemic in the United States. That is thanks to the CDC’s work in public health promotion.

Most of my violence prevention efforts have been through public health, which involves collaborating with other disciplines and across sectors at the societal level. My teaching activities at Yale Law School, like my clinical work, progressed from helping students to represent clients who were traumatized to proposing a course on preventing trauma and violence through therapeutic uses of the law and policy.

Donald Trump’s response to the pandemic was predictable through the evidence we document in The Dangerous Case of Donald Trump.

We could see it ahead of time from the high-quality, abundant reports by close associates under sworn testimony in Special Counsel Robert Mueller’s report.

Unsurprisingly, defunding, dismantling and disabling the CDC, and a dubious choice for its head, rendered CDC hardly able to function in a crisis.

Retaliation for Speaking Out

Another consequence of mental impairment in the presidency is that truth-tellers are subject to severe retaliation. We see this under dangerous regimes.

Dr. Bright had to file a whistleblower complaint after being removed from his role for trying to push science before politics. He is still risking his pension, his health and his life in a heroic effort to prevent greater disaster.

Intimidation and muzzling also have befallen other key medical persons who do not subscribe to the preferred narrative, such as Dr. Anthony Fauci. The president has also ordered censorship and withholding of important CDC guidelines from the public while prohibiting the CDC from holding its own press conferences.

Our experience is no different. The American Psychiatric Association, on behalf of the Trump administration, has used its influence and reputation to discredit and silence any mental health professional who would speak up. It is an important story that has been reported.

We possibly have the greatest concentration of top scientists who would make us a world leader against a pandemic. Instead we are COVID-19s epicenter. We may have the largest number of world-renowned mental health experts that should have prepared us for a mentally impaired president. But we have become his hostages.

Consequences of having a mentally compromised president are growing ever more dire. A crisis will not disappear by wishing it away. Critical decisions are being taken in the wrong direction every day as the situation worsens and public approval of Trump falls.

It is not too late to halt the next cascade by choosing prevention.