A new article and an old one about Trump's dangerous malignant narcissitic psychopathology prompted this Substack. By Hal M. Brown, MSW (Retired psychotherapist)

Jun 27, 2025

D. Earl Stephens1 wrote a piece in Raw Story+ (the subscription opinion section of the website) today and my comment, below, became my Substack for today. The title is Holy hell! I literally wrote the book on Trump but this has me stunned. Fortunately for those without a subscrption to RawStory+ the same article is on the author’s Substack, Enough Already, here with the title THE MORON - Our pathetic media has learned NOTHING the past decade while covering the stupidest, most dangerous man on the planet .

Stephens is the author of the Toxic Tales book shown below.

The only quibble I have with it is that the title in RawStory+ should read “a book” not “the book.” Except for the group of mental heath experts who contributed to “The Dangerous Case of Donald Trump” nobody can claim they wrote “the” book on Trump. “Dangerous Case” could be considered “the” book since it and a second edition with addtional articles were best sellers.

Below is my comment to the RawStory+ article, including the illustrations I used:

Even before you published your book (shown above), in 2017 John D. Gartner, the clincial psychologist who started the Duty to Warn group, published a book based on Trump's Tweets. Salon has an article about it here: What Donald Trump’s tweets reveal about his mental health.

Trump told us who, and what he was before he was elected the first time. Psychologically he can be viewed as a malignant narcissist who has a sadistic streak as wide as the stripe down a skunk's back. People with this diagnosis depending on the position they hold can just be unpleasant to deal with or the more power they have the more dangerous they become. Since Trump has become the most powerful person in the world the book that laid this out from the point of view of therapists was "The Dangerous Case of Donald Trump" edited by psychiatrist Bandy Lee. Gartner authored one of the chaprters. See Wikipedia page.

This is from Wikipedia:

The authors argue that Trump's mental health affects the mental health of the people of the United States and that he places the country at grave risk of involving it in a war and of undermining democracy itself due to his dangerous pathology. Consequently, the authors claim that Trump's presidency represents an emergency which not only allows but requires psychiatrists in the United States to raise alarms.

Since 2016 as much as eminent mental health professionals like Bandy Lee, James Gilligan, Lance Dodes, John Gartner, Justin Frank, Robert Jay Lifton, Phillip Zimbardo, David Reiss, Steven Buser and others, including not so eminent ones like myself, tried to warn about Trump’s dangerous psychopathology our warnings and reasoning was relegated to progressive venues and media outlets like Salon, The Atlantic, MSNBC , and Daily Kos where I used to post my stories. (I now post in Substack here) In fact, only John Gartner as far as I can tell made it into the mainstream media with an article published in USA Today in May 2017 Donald Trump's Malignant Narcissism is Toxic. (He used the word toxic in the title the way Stephens did in his later book.) It is no solace that the predictions of so many have come true. We (I include myself because I have been one of the therapists writing about this since 2017) tried to warn people. It's possible this had an effect after his first term when he lost to Joe Biden. Obviously we failed in 2024. I venture to say that none of us are surprised at what Trump has done. The only surprise I think most of us would agree on is that he was able to do it this quickly.

Now I am fleshing out this Substack by referencing this article and the comments myself and others made to it.

For those who want to go into more depth about Trump and the role of mental health professionals in warning about him read this article which was published in the website Mad in America in 2020: Muzzled by Psychiatry in a Time of Crisis The Man in the White Coat, The New York Times and The Stifling of the Public Debate about Donald Trump’s Fitness to Serve as President

I forgot about this article until today. Looking at it I was reminded that a comment I posted to it led to a long string of comments and replies. Many are from Steve McCrea, a mental health professional who has made nearly 10,000 comments to article on this website.

I first wrote the following:

Thank you for this behind the scenes account which explains a great deal. As one of the early members of John D. Gartner’s Duty to Warn group I am surprised it is the first that I learned of it. (A video of a Gartner speech was also presented as part of the Yale conference – you can read it here: https://www.dailykos.com/stories/2017/4/23/1655450/-Exclusive-Dr-John-Gartner-s-speech-to-Yale-Duty-to-Warn-Conference-on-Trump-s-mental-unfitness

Both the APA and Dr. Allen Frances did a lot of harm. The latter is the psychiatrist who says that because he wrote the DSM criteria for narcissistic personality disorder he is the only one qualified to say Trump doesn’t fit the definition because he doesn’t suffer or perceive any ill effects. (see https://www.theverge.com/2017/9/2/16239892/allen-frances-twilight-american-sanity-goldwater-rule-trump-personality-disorder).

We should take issue with the argument put forth by Allen Francis because it is a ludicrous one (people with NPD like those with anti-social personality, don’t usually suffer, they make other people suffer). The leaders of the American Psychiatric Associate and their adherence to the Goldwater rule as if it was superglued to the Hippocratic Oath really kept the responsible mental health community from getting the message out that Trump was dangerous, not only because he was an autocrat but also because he was a malignant narcissist with no conscience or empathy and is an exemplar for The Dark Triad, the deadly combination of extreme narcissism, sociopathy, and megalomania.

To find the comment thread my post led to scroll down the comment section until you see what I copied above. I won’t report all of them. They are long and detailed. I will just post my response to this one from Steve McCrea, another mental health professional:

Steve McCrea April 26, 2020 at 10:04 pm

I appreciate both your viewpoint and the civil tone of the discussion. I think the challenge that professionals (and I qualify as one) face here is that concern for safety of the nation can be very legitimate without invoking any kind of “mental illness” as a causal factor. There are plenty of people who are willing to kill other people who have no “mental illness” at all, even by DSM standards. They just think killing people is a good way to solve certain problems. They may even have their own internal “ethics” of when it is and isn’t OK to kill. In some cultures, it may even be required to kill someone if one’s honor is sufficiently undermined.
It is in my view utterly impossible to disentangle “personality disorders” from problems of ethics, morality, and social values. Until and unless there is an objective way to “diagnose” someone with a verifiable “mental illness,” we’re building castles in the air. I’d rather go back to philosophy and ethics to handle this kind of situation. Bringing in “mental illnesses” just adds confusion and controversy.

Here’s my reply:

Steve, I see you live in Portland too, but this is besides the point since what with Covid-19 it may be 1-2 years before we can even consider discussing our different opinions in person.
That being said I think whether done from a distance or not diagnosis has never been precise. When I started working the DSM was nothing more than a little booklet with pages held together by plastic clasps. The the pressure of insurance companies led to the requirement we diagnose. My psychoanalyst friends find making a diagnosis irrelevant for most of their patients. Who when push comes to shove would probably just say they were neurotic or in the most difficult clients perhaps borderline and if they needed a diagnosis would use the code we used in community mental health for years, 309.28.
I think the conceptualization of Trump as a malignant narcissist which was first offered by John Gartner is very useful. As I’m sure everyone reading this knows the personality type never made it into a DSM after it was described by Erich Fromm as a combination of NPD, sociopathic disorder, aggression, and sadism. He described it as a “severe mental sickness” representing “the quintessence of evil”. He characterized the condition as “the most severe pathology and the root of the most vicious destructiveness and inhumanity” (Wikipedia)
No less than the distinguished psychoanalyst Otto Kernberg built on Fromm’s conceptualization. Again from Wikipedia, he noted that “malignant narcissism includes a sadistic element creating, in essence, a sadistic psychopath. In his article, “malignant narcissism” and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984.”
Of course it never became a diagnostic category, but this doesn’t mean the combination of other disorders can’t exist in one person. Add to that the third element of what is called the Dark Triad along with sociopathy and extreme narcissism, megalomania, and the power of the president, and you have an incredibly dangerous psychopathology.
Who better to explain this to the public, and to members of Congress as Bandy Lee has to Democratic members, than mental health experts? Those who understand this have a moral and ethical responsibility to sound the alarm as Bandy Lee who doesn’t outright diagnose but still makes the case for Trump having a psychiatric assessment, and others like those in my first comment have been doing. Should we leave it up to lawyers like George Conway who wrote GEORGE CONWAY SAYS TRUMP IS A ‘MALIGNANT NARCISSIST’: HE’S ‘BOTH MENTALLY DISORDERED AND EVIL’ in Newsweek?
I don’t think so. If you had a client who told you their spouse or partner was abusing a child or threatening to harm someone it would be very clear that even without the legal backing of Tarasoff you would also have a duty to warn – a moral and ethical obligation to use what you know as a psychotherapist to protect someone in danger.
As the book title says, in the dangerous case of Donald Trump because of our being experts in assessing psychopathology in person and , when we have an incredible amount of data from observations, from afar we are the only people with the training and expertise to warn about the most dangerous person in America.

Steve took over replying to numerous comments before I posted my last one in response to Gracie:

Hal Brown,
From the daughter of a narcissist, and a close family member of a 2nd, but infinitely more abnormal and dangerous malignant narcissist, thank you for speaking out and thank you for this very sensible comment.
Those of us from around the world, as well as in the US, who have survived a malignant narcissist up close for years recognised Trump very quickly. Malignant narcissists can “ never be wrong” are hyper vigilant in their application of their psychopathy/sociopathy, devoid of empathy or conscience, delighting in sadistic pleasure, and absolutely are not just abusive, but dangerous, homicidally dangerous, deliberately dangerous.
To leave someone we recognise as an extreme example of this condition in a position of national, international, and most importantly, nuclear power is unconscionable.
To leave them in that position of power when they could be curbed or replaced with a person of the same political party is a dereliction.
To deliberately, consistently, attempt to stop people most qualified to speak on this type of person is unconscionable.
To go further to stop the media from talking about it is staggering and blatantly self-serving in some respect, whether in terms of power, political, or financially.
In years to come, IMHO, there will be a reckoning in the US, and many millions saying “why weren’t we told”.

This is what I wrote:

Gracie,
I am sorry you had these experiences and learned the hard way how toxic these people are.
In my 40 years of practice I saw many people, mostly women, who felt trapped in close relationships with extreme or malignant narcissists. If you do a web search for surviving living with a narcissist you will find numerous articles…
https://duckduckgo.com/?q=how+to+survive+living+with+a+narcissist&t=h_&ia=web
If you search Amazon there are dozens of books with title like “Emotional and Narcissistic Abuse: The Complete Survival Guide to Understanding Narcissism, Escaping the Narcissist in a Toxic Relationship Forever, and Your Road to Recovery”
https://www.amazon.com/s?k=surviving+living+with+a+narcissist&ref=nb_sb_noss
Here’s a very brief therapy primer for treating victims of abusive relationship:
Once a trusting relationship is built, successful therapy with such people has several primary aspects. As therapists we help our clients build their self-esteem and gain insight as to what in their own personality keeps them in such a toxic relationship. But we also educate them as to why their abuser will never change no matter how many times they promise to do so. We essentially diagnose them from A DISTANCE as an extreme narcissist, sometimes combined with sociopaths, who are often master emotional manipulators. We sometimes recommend they read books on the subject.
Americans are married to Trump. Some married him the way women marry abusive men, falling in love with someone who manipulated them. Impeachment should have been a divorce. It didn’t work.

Congratulations to anyone who actually made it to the end of this lengthy Substack and who actually read every word. For thos who skimmed it I hope you got the idea. Put simply, mental health professionals were warning about Trump since 2017 and now everything they anticipated would happen, and worse, has be born out.

(D. Earl Stephens is the author of “Toxic Tales: A Caustic Collection of Donald J. Trump’s Very Important Letters” and finished up a 30-year career in journalism as the Managing Editor of Stars and Stripes. You can find all his work here.)

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