The President of the United States has a psychiatric disorder that requires his immediate removal from office. Thus far, many psychiatric practitioners have noted President Trump’s erratic, impulsive, paranoid, self-consumed thought patterns, communications, and behaviors and are increasingly alarmed by his altered judgment. He demonstrates an inability to grasp details, and an insistence that his beliefs, no matter how skewed or inconsistent, are what is real and true, despite significant and extensive evidence to the contrary.

Like most psychiatric disorders, tense situations exacerbate symptoms. Being President of the United States means the stakes cannot be higher. The person who holds this office must have the mental capacity and endurance to withstand the pressure, responsibility, publicity and fame that come with this role. Donald J. Trump cannot uphold the duties of this office because he appears to have a Delusional Disorder. In its most heightened state, it grossly impairs judgment, insight, and the capacity to understand ramifications of impulsive actions and communications (crucial for anyone in a position of leadership).

As a New York City native and New York State licensed Clinical Psychologist, I have practiced psychology on the Upper West Side since the late 1990s. Through time I have served in many positions that trained and honed my capacity to diagnose and treat patients with all sorts of psychiatric disorders and impairments. I have done therapy and cognitive evaluations for numerous facilities, including psychiatric hospitals, nursing homes, outpatient facilities, treatment programs, and in private practice. But, most notably, as pertains to the observation that an ever-growing number of clinicians and I recognize, is that Donald J. Trump is unfit to lead. In part, my diagnosis comes from a long, extensive often grueling history of working with active duty New York City firefighters. I have been under the employ of the New York City Fire Department’s Counseling Services Unit since directly after the events of 9/11/2001 and continue to work with members of the FDNY to this day.

Since 9/11 my work has involved the necessity of diagnosing firefighters on the spot when stress overtakes them. When any symptoms manifest that alter their thinking, judgment, or perception of reality, I help to relieve them of their active duty status, as the antidote to their stress reactions and trauma is to be placed in less stressful situations with far less responsibility, such as light duty status, or when symptoms are more severe, they are referred to psychiatric, therapeutic, and rehabilitation facilities. Allowing firefighters to stay on active duty status when their psychiatric health is compromised by stress not only puts their lives in danger, but their coworkers and the public they are assigned to protect. When I, or any clinician elects to take a firefighter “off-line,” it is because allowing them to stay on active duty, even when they insist they are “fine,” is not in anyone’s best interest. Rather, it imperils the lives of those they are assigned to protect. Just because they claim to be fine, since their judgment is altered, they cannot be taken at their word, not when lives are at stake.

Because there is not often the opportunity or luxury of doing one-on-one interviews and evaluations to formulate a diagnosis in the FDNY setting, I have honed my diagnostic skills via direct observations, as when they are called upon to respond to an emergency, or when they are casually sitting in the kitchen at the firehouse interacting with others. Their interactions, behaviors, perceptions and conduct with others enables me to discern when behavior and judgment are impaired. The FDNY Counseling Services Unit trusts me at my word when I inform them that a firefighter is demonstrating impaired judgment. Thus far, every firefighter I have requested be taken off line and provided with treatment has benefitted from the interventions. I have had to request that firefighters be taken off active duty with far less information than what is available in the case of President Trump.

New York City natives in the 1970s, 80s, and 90s could not help but know or know of Donald J. Trump as a member of Manhattan’s society and financial elite. Before most people outside of New York and New Jersey knew he existed, he was part of the consciousness of New Yorkers. News coverage was more selective then, but as a glamorous, glitzy and intriguing skyscraper mogul, his movements, actions, and opinions were well tracked and documented. Being consistently in the spotlight in New York City is no easy task, but Donald Trump knew how to stay relevant, interesting, and exciting, each new business or personal undertaking permeated our local news.

Those of us who listened loyally and diligently to Howard Stern’s (then terrestrial) radio show on K-Rock, 92.3, WXRK, listened to many long conversations between Howard and “The Donald,” a frequent guest on the Stern show or many years. It was a welcoming platform for Mr. Trump, as Howard’s on-air admiration and effusiveness toward Mr. Trump; his financial and sexual conquests, his power, wealth, prestige, societal celebrity and exploits were the topics of their interviews. For Mr. Trump, Howard’s on-air effusive praise and deference to him, encouraged long, intimate conversations between them. To this day, those media settings and platforms are the ones in which Mr. Trump functions most productively. They are admiring, unchallenging settings, and he is in charge of the direction of the conversation, and as such, they are less stressful, so his delusional disorder does not manifest as prominently.

When he is demonstrating the symptoms of delusional disorder, President Trump cannot make reasoned, measured decisions as his view of reality is so painfully distorted. For example, Mr. Tump described the million dollar loan he received from his father as a “small loan.” If he was referring to the loan he received from his father in 1985 to expand his casino empire, that loan was for fourteen million dollars (which equates to approximately thirty-one million now).The discrepancy between his perception of the meaning and value of a dollar in contrast with the average American reflects an alarming lack of awareness about the life struggles of his constituents. Mr. Trump has been able to protect his personal view of wealth within his private world.

With Howard Stern in their many hours of interview footage, as well as with other amiable and unchallenging interviewers or audiences, Mr. Trump can remain intact and can appear to be relatively measured, with a more easy-going demeanor. Mr. Trump has been able to avoid even being aware of the magnitude of his delusional belief system, because he continues to control the focus, content and direction of the conversations and interviews in which he participates. For example, his first address the the joint session of congress as President on Feb 28th, 2017, since dissenters must remain silent, and supporters can cheer, he remained unchallenged in his statements, and so was able to get through the address without showing the extent of his disordered thinking.

In nearly every forum, President Trump’s ability to exercise self-control disintegrates when anyone, especially the press, breaks through his rigorously protected delusional system by challenging him. It is at these times, he makes claims that all news sources (with the exception of the ones that support him) are not only biased, but are the enemy of the people. His outrageous, unfounded claims are not just limited to the body of the press, but against fellow Americans as well, including his most recent claim that President Obama wiretapped Trump Tower. Those kinds of baseless, claims that inflame already tenuous relations between citizens in the country over which he presides are exclusively self-serving, irrational, impulsive, and destructive. His conduct is extremely dangerous to the citizens he has pledged to protect. He does not think twice before hurling accusations to protect his image at the expense of the safety and unity of the country. He has been able to feed and preserve a delusional belief system of this level because he has had the wealth and power to do so. Delusions are fiercely protected by their holders. When President Trump’s delusional belief system is in any way challenged, he lashes out with baseless accusations, fueled by his paranoia and obsession with maintaining his image as invincible in an attempt to nullify the challenges to his authority.

My colleague, Dr. John D. Gartner observed, “We have seen enough of Donald Trump’s behavior now that we can make (this) diagnosis indisputably.” Considering the disordered thinking, altered perceptions, and impaired judgment Mr. Trump manifests, we, as clinicians have a duty to warn the public. Dire situations such as this one demand action. The man in the office of President is mentally unfit to be there and must be removed.

Directly after Mr. Trump’s divorce from his first wife Ivana became front page news, they both attended a charity function where I was volunteering. Since he was a member of Manhattan’s elite, his presence at this fundraiser caused a stir. Many people there watched his conduct while in the same space with his new ex-wife. His behaviors in this social setting were indicative of a person who deemed himself superior to others, he stood apart, entertaining no conversations with women he did not find physically attractive, or men who were not fawning over his power and reassured him of his dominance. Toward the end of the event, I approached him to introduce myself and share some thoughts I had about his most recent interview on Stern. He said, “Why would I want to talk to you? I wouldn’t even let you suck my d*ck. Look at all the beautiful women here. Don’t waste my time.” The event was a charity auction for the designer Missoni, so the audience included many attractive models.

The more access the public has to seeing President Trump in both scripted and unscripted situations, the more obvious it becomes that there is a marked deterioration in Mr. Trump’s cognitive functioning, especially when looking at how much less control he has now over managing how he is perceived by others (a vital responsibility for the person who represents us in the world). In his private empire, he could avoid or squelch people or situations that disturbed how he perceives himself. However, that is far more challenging on a public stage, which explains why it is so difficult for him to be coherent or consistent in any decision he makes or opinion he renders. Too many people can interfere with how he views things, which angers and distracts him. In his private world he can rid himself of anyone who does not adhere to his beliefs. However, that is not as easy on a giant public stage. Thus, he becomes overwhelmed, fixated, reckless, retaliatory and impulsive when he feels personally threatened.

A delusional disorder, when you have the power and funds to make your visions real, becomes more and more intractable and toxic. Mr. Trump went on to create innumerable platforms of reverence and adoration for himself, including buying the Miss Universe Pageant in 1996, further setting the stage for viewing himself as “Mr. Universe” in the process. The fuss made by beautiful women over the man who had the power to judge them and consequently shape their futures is one of the many settings he has been able to create to celebrate his wealth, power, and control. His ability to make or break the careers of his subordinates as he sees fit has aided in building what appears to be a delusional disorder of magnificent proportions, as he holds the highest office in the land.

Building a TV-related empire to go with his real estate empire was Donald Trump’s next goal. In 2004 he created and starred for 14 seasons in the still-running reality TV show, The Apprentice. Each week, contestants were put into sometimes impossibly challenging positions that involved shame and betrayal. He also encouraged the participants to be ruthless and cutthroat toward each other in order to earn the coveted spot as his “apprentice” for one year at a Trump portfolio company. On the show, contestants compete in business-oriented competitions. Ultimately, like so many other forums, only he possessed the power to hire or fire them and banish them from the group of hopefuls, thus changing their lives forever. In the last scene of each show, Mr. Trump sat in the biggest chair at the boardroom table, often flanked by business associates plucked from his own corporation, and/or family members like Ivanka or Donald Jr. At this point, all eyes were trained on him as contestants anxiously awaited his decision on whether they’d be weeded out because they were not “qualified” for the position of his apprentice. Mr. Trump typically delivered scathing commentary about the shortcomings and failures of his cast of would-be entrepreneurs. He did not hold back from publicly abusing and shaming them on camera.

Trump reprised the role of being the center of this self-created universe of worship, day after day, month after month, year after year. It’s enough to make anyone believe they are god, or god-like. Since god is immortal, so is Mr. Trump, to himself. Therefore, he can make reckless decisions because he believes that due to his power, he is invincible, so if US citizens are considered at all, the assumption is what is good for Donald is good for everybody.

In every area of his life, Donald J. Trump has been able to create the outcomes he desires, exclusively from his perspective of how things are or should be. That extremely limited perspective has been most influenced by his self-created world where he forces outcomes and escapes ramifications without having to face consequences or engage with people who have gotten hurt by his actions along the way. In the private sector, Mr. Trump’s conduct and behaviors only indirectly affected the general public. In his role as President, Mr. Trump’s self-oriented decisions directly affect all of us. He now has close to, if not total control of the environment in which he exists, how he is treated, responded to, addressed, and viewed. It is a vicious cycle.

In short, Trump has had the means, resources, and ingenuity to cast himself in god-like roles, where he continues to exist unchallenged amidst his personal team of “yes men” nodding in agreement with whatever decision he makes. Being able to create scenario after scenario where, as he asserted while running for President, “…I alone can fix it,” reflects the results of years of being able to create outcomes that have solidified a dangerously skewed perception of his own power to accomplish whatever he wants, whenever he wants. He believes he can conquer all. Over time these roles drastically intensified, and the responsibility he now holds is potentially life shattering for us. His perception of his invincibility is cemented for him. When it is challenged by anyone who is not beholden to him, he becomes retaliatory so as to reassert his control, regardless of how it imperils others. His perception of himself as invincible and his drive to prove his mastery on the most crucial of world stages directly impacts the lives of the citizens of this country every day. His ability to force outcomes and create circumstances for which he is revered and adored no matter how he conducts himself is a manifestation of a severe delusional disorder, which calls for him to be removed from public office immediately.

“A delusion is a belief that is held with strong conviction despite evidence disproving it that is stronger than evidence supporting it.” – DSM-5 297.1 Delusional Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), Mr. Trump fits the criteria for Delusional Disorder (DSM-5 297.1) of the subtype “Grandiose,” defined as delusions of “power, wealth, importance, relationships to famous people, a special relationship to God or even being a deity” in which “the individual’s way of life becomes progressively overwhelmed by the intensity and intrusiveness of the delusional beliefs.” There are likely other features that manifest privately: erotomanic, jealous, and persecutory delusions, which lend themselves to a diagnosis of Delusional Disorder – of mixed type.

Grandiosity is the most prevalent of President Trump’s delusions. In claiming to know more than the intelligence community whether in regard to Russian hacking, U.S. security, or the ongoing needs of its citizens, Trump has remarked: “I don’t have to be told, you know, I’m, like, a smart person. I don’t have to be told the same thing and the same words every single day for the next eight years,” continuing on that he knew “things that other people don’t know.”

Based on how he speaks of himself and his brand, in his own words, “I comprehend very well, okay? Better than, I think, almost anybody,” he has declared himself to be one of, if not the only person capable of solving the problems of the world. According to him, only he can manage difficult situations and right the injustices of the planet.

When people wonder how has he been able to do accomplish all he has accomplished with this level of psychiatric impairment. The answer is that prior to entering the world stage he is now on, he used his funds and his wherewithal to force the system to adhere to his beliefs about himself and his personal interests in the world. In his private empire, he has always been surrounded by people who have supported his delusional beliefs and justified his interests in creating more power and wealth for himself. At no time has Mr. Trump had to or tried to take into consideration the health and well-being of anyone who he could not directly profit from. That is a perilous situation for the roughly 324 million people who live in the United States.

As President, Mr. Trump is behaving the same way, only the stakes are so much higher. In my clinical opinion, because of his delusional disorder, he believes he knows all, so anyone who challenges his world view will be, and have already been, pushed out of his circle. Sally Yates was fired during the President’s second week in office for questioning the legality of his executive order, as Mr. Trump called for a sweeping ban without regard to logistics or consequence for people entering the United States from Muslim-majority countries where he does not have personal business dealings.

Clinicians have identified Mr. Trump as being Pathologically Narcissistic. Narcissistic Personality Disorder (DSM-V code 301.81). His level of narcissism intensifies his distorted belief system – his delusions about himself and the world. Mr. Trump’s inability to control himself from talking about himself admiringly in so many inappropriate situations, ranging from Twitter outbursts to overstating his inauguration crowd size while standing in front of the CIA’s wall of stars honoring members who have died in the line of duty, are just a few examples of his level of mental illness. His narcissistic personality further pollutes his thinking and further strains his grasp on reality. As such, Donald Trump’s personality disorder exacerbates his delusional beliefs, and vice versa.

President Trump’s distorted thinking, disorganized conduct, and erratic, impulsive behavior, combined with his fixation on his own importance and demonstrated desire to seek revenge directly imperils our safety as citizens of the United States. President Trump must be removed from the line of duty, and brought to a psychiatric hospital or treatment facility where he can receive a psychiatric medication consult. Perhaps time away from the stressors of the Presidency will allow those with proper psychiatric training to manage the symptoms of his disorder and create a proper course of treatment, thus enabling the American public to be relieved of the burden of worry about a problem in which we currently feel we have no recourse.