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Friday, September 9, 2022

The Trump Contagion

There’s no vaccination, only incarceration

By Dr. Bandy X. Lee

The phenomenon of contagion is what mental health experts have warned against since their 2017 monograph, The Dangerous Case of Donald Trump. They stated that, if his presidency were not intervened with swiftly and properly, his symptoms — his pathology, criminality, and violence — would spread and become uncontainable. 

In March 2020, the first month of the SARS-CoV-2 pandemic in the United States, they issued a “Prescription for Survival,” to highlight how his removal, or at least removal of his influence, was mandatory for survival. 

They noted that the more important, underlying pandemic to gain control over was “the mental health pandemic,” or his compromise of the nation’s collective mental health. The latter was the more infectious, since it required only emotional bonds, not physical exposure, to take hold and was responsible for vastly exacerbating the former.

Poor mental health also contributes to denial, and therefore those who are the most affected are the least likely to admit that anything is wrong. Bioterrorism is frightening, but psychological warfare even more so, for it hijacks the very mind that is capable of protecting itselfOver 1 million deaths later, we are still having trouble holding the primary culprit for mass death accountable, or even in naming him.

As a social psychiatrist, my focus has been on ecology, and on Donald Trump as a public health phenomenon. Contagion of mental symptoms is common in public hospital and prison settings, where there are high concentrations of untreated, severe mental disturbances. 

Severe symptoms can spread among family members, criminal co-conspirators, gangs, and other tight-knit groups. A colleague and collaborator at the World Health Organization, Dr. Gary Slutkin, knows that violence is better described as an infectious disease whose spread we can interrupt. International terrorism and suicide are contagious. 

Effective prevention, therefore, requires population-level interventions and application of psychiatric principles to systems, institutions, and cultures. The course I last designed for the students of Yale Law School was of translating law into social policies that further societal health.

Three conditions are necessary for the spread of mental symptoms:

1. Severe pathology in an influential figure

The transmission of mental symptoms has been given different names: induced delusional disorder; shared psychosis; folie à deux, trois, quatre,…, or millions — depending on the number affected — or mass hysteria when affecting a whole population. All describe the same phenomenon, but none are satisfactory. 

The latest, induced delusional disorder, focuses on the most commonly transmitted symptom, delusions, but does not cover other possible symptoms, such as mood. Shared psychosis captures the syndrome-like severity, but is a misnomer because it often does not involve actual psychosis. Folie à deux, or “madness in two,” is perhaps the most preferred but a foreign phrase. 

Finally, “mass hysteria” describes well the frenzied irrationality that captures crowds, but often does not actually involve symptoms of “hysteria”, or the contemporary term, “histrionics”. The important feature is that mental symptoms are not confined to the person but are psychosocial. They take hold and spread across interpersonal connections, just as they initially take over one portion, and then eventually the whole mind of an individual; this is how inner, and then outer, conflicts arise.

Severe psychopathology in an influential figure, therefore, transmits to others or a group, until the exposed persons or groups come to feel, think, and behave as if they had the same disorder as the primary person. Unlike normal social dynamics, where enthusiasm, common purpose, or even outrage can be “infectious” but individuals retain their uniqueness, the spread of pathology is especially efficient and deleterious, taking over the entire personalities of those involved.

Transmission happens more readily in vulnerable persons, but those who succumb are not necessarily of unsound mind to start. Even bizarre beliefs, such as the primary person being God-ordained, can take hold in ordinarily rational persons. Delusions are more infectious than strategic lies or simple misinformation, because the primary person is driven to fuel them through emotional pressures on others to believe and to affirm the false beliefs. 

For example, when an influential figure must hold the belief that a serious viral pandemic is a “hoax”, orchestrated by enemies to bring down one’s presidency, or that a reelection that one has lost is in fact “stolen”, the underlying emotional process is difficult to correct with “mere” evidence or presentation of facts.

2. Group members with high emotional investment

Another condition for the spread of mental disease is emotional investment. Folie à deux describes shared madness within a pair, but here the focus is on folie à groupe, or the spread of mental symptoms in a group. The group can be a household (folie à famille), a prison dormitory or cell-block, a religious or other highly emotionally-bonded group, a community, or a nation (folie à millions). 

Members may have high emotional investment in the primary person because of family relations, gang affiliation, cultic programming, or societal identity. Pathology in the primary individual create the ideal conditions for transmission: a compulsion to “tweet”, a desire to deny reality and to denigrate the press, intolerance of uncertainty, pressures of conformity, and an insatiable need for adulation finding a “forum” in addiction-inducing, hypnotic rallies.

Induced delusions are like primary delusions, wherein resistance is too great for evidence or truth to gain traction. Those who try to maintain their grounding in reality experience stress, anxiety, ostracism, and exhaustion and may eventually submit. When it originates in disease, it is no longer a simple culture but a “cultural disorder.”

3. An environment that fosters contagion

Conditions of isolation, either physically or through filtered information, especially when they “immunize” against alternative viewpoints through phrases such as “fake news,” combined with constant, high levels of exposure to the symptomatic primary individual, form the ideal environment for shared delusions.

The cult-like quality of the leader-follower arrangement between Donald Trump and his supporters. alarmed my colleagues in the mental health profession enough to write entire volumes. Existing arrangements of “viral” social media, profit-driven news programs that rely on ratings, and rallies that reinforce herd mentality and conformity, all contribute to the spread of symptoms.


How is the recognition of shared psychosis, or folie à groupe, helpful? We know from the scientific literature that, when contact with the inducing individual is removed, the shared symptoms usually subside just as dramatically as they have appeared. We can prevent epidemics from occurring in the first place by screening candidates for mental impairment before they take influential positions. Once they are in power, there must be an effective means of removing them if they are found to be unfit. Further, we can armor ourselves by promoting public mental health and education about mental disease. Additionally, we must remove environmental “toxins” that include propagandabrainwashing, and the social engineering that social media generate.

In the current situation in the United States, for the current mental health pandemic we face, there is one thing to do: indict Donald Trump. Take him into custody. Remove him from exposure to the public. Indict his co-conspirators, too.

Doing so carries dangers — indeed, great dangers — but only by the measure that we have waited to intervene. Psychic epidemics, like viral epidemics, are exponential in growth, and by not intervening, we have allowed an entire culture to become engulfed in criminality and pathology. While difficult, we must stem the Trump epidemic before it grows even worse, and the time to act is now. 

Bandy X. Lee: Forensic psychiatrist, violence expert, president of the World Mental Health Coalition (, and editor of "The Dangerous Case of Donald Trump.”