AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman. Last month, Pentagon leaders told a Senate panel they would ignore any unlawful order by President Donald Trump to launch a nuclear strike. The testimony came as part of the first congressional hearings in more than 40 years on the president’s authority to start a nuclear war. This is Connecticut Democrat Chris Murphy.

SEN. CHRIS MURPHY: We are concerned that the president of the United States is so unstable, is so volatile, has a decision-making process that is so quixotic, that he might order a nuclear weapon strike that is wildly out of step with U.S. national security interests.

AMY GOODMAN: Well, for more, we’re joined by someone who’s led a discussion of mental health professionals who are deeply concerned about President Trump’s psychological instability. Dr. Bandy Lee is a forensic psychiatrist on the faculty of Yale School of Medicine, an internationally recognized expert on violence. She organized the “Duty to Warn” conference at Yale and edited the book The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. The book became a best-seller the instant it was published in October, sold out, resupplied, sold out again. Dr. Bandy Lee is with us to talk about the issues raised by these 27 psychiatrists and mental health experts. Of course, it’s now many, many more, not just people who participated in this book.

What are your deepest concerns about President Trump? And have you had concerns about, oh, presidents you agree with and disagree with, mental health concerns, before?

DR. BANDY LEE: Well, it’s actually historically unprecedented that so many mental health professionals have come forth with their concerns, under any president, of any party. So it really is the first time that this many mental health professionals are coming together in a coalition. We even have a website now, DangerousCase.org, where the public and lawmakers can discourse with us. There are thousands of us at this point.

AMY GOODMAN: So talk about—lay out what your concerns are as a psychiatrist.

DR. BANDY LEE: So, our concerns are that someone with this level of mental instability and impairment has this much power, in the office of the presidency—basically, the power to start a devastating war, to launch nuclear missiles, without any inhibition. You saw from the hearings that there is very little inhibition in place right now. Within five minutes of the commander-in-chief’s orders, nuclear missiles could be launched without question. And—

AMY GOODMAN: And how does that relate to his mental fitness?

DR. BANDY LEE: And, of course, his decision-making capacity, having such levels of impulsivity, having a loose grip on reality and being so fragile in his ability to cope with ordinary stresses, such as basic criticisms or unflattering news, will tend to unravel, especially in times of heightened stress, such as under the special counsel’s investigations.

AMY GOODMAN: Just last week, Tony Schwartz, author of—well, co-author of Trump’s book, The Art of the Deal, told MSNBC’s Ari Melber that the president’s inner circle is worried about his mental state.

TONY SCHWARTZ: I know that two different people from the White House, or at least saying they were from the White House, and that turned out to be a White House number, have called somebody I know in the last several weeks to say, “We are deeply concerned about his mental health.” That’s—

ARI MELBER: Wait a minute. You’re saying you have knowledge of people calling from a White House line raising that question. Why would they do that? How do you know that?

TONY SCHWARTZ: I know that because I know the person that they called. And this is a person who I absolutely trust, who has great integrity.

AMY GOODMAN: So, that was Tony Schwartz, who I think ghostwrote the book The Art of the Deal, very close to Trump for a period of time. What are your thoughts about what he said?

DR. BANDY LEE: Well, as you know, he has a chapter in the book, even though he’s not counted among the 27 experts. We do have three others who have been included for their special insight, their special experience with Mr. Trump. And we included him because he has special insight into these matters. And I would agree with his assessment. We speak often. We share our observations. And we’re both deeply concerned.

AMY GOODMAN: The chapter that Tony Schwartz wrote in your book, “I wrote The Art of the Deal with Donald Trump. His self-sabotage is rooted in his past.” Explain his point here.

DR. BANDY LEE: Well, there’s actually a lot that’s outlined. It’s a reprint of an article that he wrote, I believe for The New Yorker. He outlines very much his interactions and experiences with the president. And he describes, most markedly, this emptiness, this—what he calls a black hole level of self-esteem or self-worth that is missing, whereby he can have all the admiration of the world, all of the successes, and he will—his thirst will never be quenched, because of that intense need. And that is what we’re seeing, over and over.

And what is most concerning for us is that his way of coping with this critical sense of need at every moment, so much, to the point where he cannot think of the past or the future or consequences, his main urgency is to quench the need at the moment. And the way he does this is by burnishing his power, by going to belligerent language or affirming conflicts and others’ sense of the world as a threatening place where you have to be violent.

AMY GOODMAN: This is Republican Senator Lindsey Graham of South Carolina speaking about, well, then-candidate Donald Trump. This was back in 2016.

SEN. LINDSEY GRAHAM: I’m not going to try to get into the mind of Donald Trump, because I don’t think there’s a whole lot of space there. I think he’s a kook. I think he’s crazy. I think he’s unfit for office.

AMY GOODMAN: So that was Graham in 2016. But Senator Graham sounded different last month, when he spoke to CNN.

SEN. LINDSEY GRAHAM: You know, what concerns me about the American press is this endless, endless attempt to label the guy as some kind of kook, not fit to be president.

AMY GOODMAN: So, that is Senator Graham now. What about what he’s saying?

DR. BANDY LEE: I think the laypersons, the public or lawmakers, would be prone to underestimating the dangers of this president, because most people are used to seeing individuals who are healthy. It’s only professionals who see those who are impaired, day in and day out. And so, the natural tendency will be to interpret what they’re seeing in terms of a normal range, a normal variation of human choices, decision making and behavior. What we are—what we feel pressed to do is to warn about the situation where someone is not acting within normal range, where one is normalizing what is in fact a malignancy in one’s interpretation of reality.

AMY GOODMAN: On Wednesday, the House voted not to impeach President Trump. The vote failed 364 to 58, with all Republicans voting against the measure. The Democratic leadership also came out against the impeachment vote. The measure was introduced by Congressmember Al Green of Houston, who said on the House floor, “Donald John Trump, by causing such harm to the society of the United States, is unfit to be president and warrants impeachment, trial and removal from office.” And then, in April, Maryland Congressmember Jamie Raskin introduced a bill that would create a commission to determine if the president is mentally or physically unfit for office. This is Congressman Raskin, also professor of constitutional law, explaining how the bill is based on the 25th Amendment.

REP. JAMIE RASKIN: Section 4 of the 25th Amendment says that the vice president of the United States can act with a majority of the Cabinet to determine that there’s a presidential incapacity, or the vice president can act with a majority of any body to be set up—and Congress never set up the body that’s called for in the 25th Amendment. So this is us essentially following through on our constitutional obligation to set up a body in the event of a presidential disability. And that’s something that would be determined by the body, but, of course, only with the vice president of the United States. So, we’re talking about a body that is nonpartisan, that’s independent and that acts with the vice president, who, of course, is reporting directly to the president. So it would be in the most extreme cases where there’s a consensus that’s developed the president is incapable of discharging the duties of office.

AMY GOODMAN: So, that is Congressman Jamie Raskin. You just came from Capitol Hill, where you’re talking to—

DR. BANDY LEE: Yes.

AMY GOODMAN: —Democratic and Republican congressmembers. What about this?

DR. BANDY LEE: Senator—or Representative Raskin was one of the members that I got to meet, but, unfortunately, he was called to vote, so we didn’t get to talk much. He definitely wishes to follow up. And we, among ourselves, have also been advocating for an expert panel, that would be separate and independent and appointed by the National Academy of Medicine, so, in fact, we could work on figuring out what the solution might be for us to be able to form an independent panel that can give recommendations that he could receive through a commission.

AMY GOODMAN: Let me ask you about this unusual article I just read that’s sort of going all over the internet, “Could Trump’s Hair Drug Threaten His Physical and Mental Health?” And it said—this is from months ago—”This week, President Trump’s doctor disclosed that the president takes finasteride, a drug marketed as Propecia, to treat male pattern baldness. While it is tempting to make jokes about Trump’s hair, and even the sexual side effects that accompany the drug, it also has many disturbing side effects that neither the president—nor any other man—should risk.

“In the 19 years since Propecia was approved to treat hair loss from male pattern baldness, side effects have been so concerning that the term post-finasteride syndrome (PFS) has been coined and hundreds of lawsuits have been brought. In addition to its sexual side effects, the drug’s effects on cognition, mood and mental states have been documented in the scientific literature.

“A 2013 study in Journal of Sexual Medicine noted 'changes related to the urogenital system in terms of semen quality and decreased ejaculate volume, reduction in penis size, penile curvature or reduced sensation, fewer spontaneous erections, decreased testicular size, testicular pain, and prostatitis.' [unquote] Many subjects also noted a 'disconnection between the mental and physical aspects of sexual function,' and changes in mental abilities, sleeping patterns, and/or depressive symptoms.”

Do you think this is relevant?

DR. BANDY LEE: Most definitely. Mental function is not separate from physical function, and many medications have profound effects on the mind’s capacity. And so, this is one of the reasons why an evaluation would be so critical, because mental impairment can be just as debilitating as physical impairment, and the both are connected. So, to have all the medical records, as well as to be able to get a list of medications and to do a medical exam, would be essential to doing a mental health exam.

AMY GOODMAN: I wanted to go back to this issue of “duty to warn” and the conference that you put on—

DR. BANDY LEE: Yes.

AMY GOODMAN: —where you had an auditorium at Yale University of something like 500 seats, and maybe 20 people showed up. Since then, you’ve had death threats. Talk about how this movement has grown, and, again, where this whole concept of “duty to warn” comes from, why psychiatrists should be weighing in here. A lot of people have to be scratching their heads and saying, “You haven’t had a sit-down discussion with Donald Trump. You haven’t personally analyzed him. You know, stay in your wheelhouse. This is not your business. You are trying to classify as a mental illness, perhaps, hatred, meanness, bigotry. This is not your right.”

DR. BANDY LEE: Well, actually, we deal with all those things in psychiatry. I am a forensic psychiatrist, which means I work at the interface of psychiatry and the law. So, legal cases, criminal cases, civil cases, I often deal with them. And what we do is distinguish between that which is mental impairment versus that which is criminal responsibility or intended choices. And oftentimes the distinction can be blurred for the public, especially when the impairment looks like someone’s intended choices or even look like a brilliant strategy, when in fact it follows a pattern of pathology and drives toward damage and destruction for oneself as well as others. And those are the times when I feel that it does enter into our domain.

AMY GOODMAN: So, explain “duty to warn.” You’re sitting in your office. You have a patient. They say, “I’m going to go out and kill,” and they name the person. What’s your responsibility there? And how does that relate to the president?

DR. BANDY LEE: So that was the Tarasoff case, where an individual was sitting with a counselor and expressed a desire, thoughts of harm. And the counselor respected confidentiality, did not warn the potential victim. And then, afterward, he went out and killed the person, Miss Tarasoff.

Since then, court cases have been added to expand the rule, so not only do you have a duty to warn the potential victim; because this is a danger and a case of—it’s an emergency, you have to break confidentiality or do what you need to do to protect safety. Safety comes first. When safety and survival are concerned, it doesn’t matter if the person, the victim, is not your patient. It doesn’t matter if the source of information does not come from the patient.

And also, there is a part in medical ethics that says, in an emergency, the physician does not have a choice not to take the person as a patient. So that would mean, if you were walking in the street and someone were having a heart attack, you do have to treat the person as if it were your patient—without consent, without need for confidentiality. The psychiatric equivalent would be someone acting erratically in a public place, say, in an airport or the subway. You have to intervene, especially if law enforcement or security would not be able to recognize the level of danger here, because they may not recognize the signs of mental impairment. Sometimes impairment can look like they are acting normally and making decisions out of conscious choice, especially because they themselves will insist that this is their own decision making and will have very little insight, meaning recognizing that something is wrong with them. So this is especially when it becomes important.

When danger is concerned, what you can get from an individual interview is limited. What is more important are others’ reports, observation of behavior. And, in fact, with this president, we have far more information than we often have with our own patients. We see his reactions to situation in real time, over extended time. And to declare dangerousness, you don’t need all the information. You just need enough information to alarm you.

AMY GOODMAN: And, Dr. Bandy Lee, how do you assess—you know, President Trump, the Access Hollywood tape comes out. You know, he acknowledges it. And then, what, however many months later, he says, “Oh, this is all fake.”

DR. BANDY LEE: Yes.

AMY GOODMAN: So, how does this fit in to the analysis of a psychiatrist like you?

DR. BANDY LEE: So, whereas we would not make a diagnosis without all the information—in fact, it would be irresponsible to do so. And I believe that we basically cannot, until we do a full assessment. But, of course, we have many running hyphotheses in our head, what we call differential diagnoses. And so, we have some hyphotheses as to what might be going on with the president. What we—things that we predicted seven months ago, when we put the book together, have mostly come true.

AMY GOODMAN: Like?

DR. BANDY LEE: That he was worse than he appeared in public, that he would get worse, that he would not be containable, and that—I think around this time people were expecting he would pivot and become more presidential—that all of this would not happen, and in fact his impairment is more deep-seated and would follow a certain course. In other words, with increasing pressures, with evolution of his presidency, that he would grow worse.

AMY GOODMAN: Let’s go to Robert Jay Lifton, who contributed to your volume. In October, he was on Democracy Now! and talked about the debate over whether Donald Trump understands and can responsibly manage the most destructive nuclear arsenal on Earth.

ROBERT JAY LIFTON: Well, any restriction on the president—any president, but especially Trump—on his capacity to initiate a nuclear war, any restriction on that is profoundly desirable. It’s a strange world, to say the least, when the generals are there to restrain the civilian. The generals aren’t, on the whole, known for their military restraint. There are exceptions. With the Vietnam War, as you know, it was initiated by civilians, “the best and the brightest,” as it was called. The military was at first a little reluctant, then entered it and became corrupted by it, and created what I came to call atrocity-producing situations. That could happen here, too, with the generals, who are ostensibly restrainers, allowing him, being unable to prevent him from initiating some form of war, being themselves drawn in and then corrupted by it. That’s a really dangerous sequence. Anything that holds that back or in check is desirable.

AMY GOODMAN: So that’s Dr. Robert Jay Lifton, the world-renowned psychiatrist who wrote about Nazi doctors, who wrote about the nuclear bombing of Hiroshima and Nagasaki and the Hiroshima survivors. He wrote a piece in The Dangerous Case of Donald Trump. Your final comments, Dr. Bandy Lee?

DR. BANDY LEE: So, violence is an end product of a long process. And we have seen this process evolving, in the mind of Mr. Trump, but also in his public responses, his effects on the public. And I would agree with Dr. Lifton that we cannot place the greatest dangers to our existential continuation.

AMY GOODMAN: And your final comment in summarizing the message you have, the whole “duty to warn” movement that you’re a part of, where it’s headed now?

DR. BANDY LEE: Well, we’re pushing for an evaluation. We’re warning about dangerousness. We’re actually trying our best to educate the public so that people will be aware, they will be affirmed in what they are seeing, they will be educated on the depths of what they are seeing, and also that there is a way of dealing with the situation, handling it.

AMY GOODMAN: Dr. Bandy Lee, we want to thank you for being with us, forensic psychiatrist on the faculty of Yale School of Medicine, internationally recognized expert on violence, editor of the best-selling book, just recently published, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.

This is Democracy Now! To see Part 1 of our discussion, go to democracynow.org. I’m Amy Goodman. Thanks for joining us.