What evidence have 'duty to warn' psychiatrists presented publicly about Trump's behavior since 2017?
Executive summary
A loose coalition of psychiatrists and psychologists—often calling themselves “duty to warn” or led by figures like Bandy Lee and John Gartner—have publicly pointed to patterns in Donald Trump’s publicly observable behavior since 2017 as evidence he poses a danger: grandiosity and narcissistic traits, impulsivity and poor attention, paranoia and provocative rhetoric, and a pattern of statements they argue encourage violence and weaken democratic norms [1] [2] [3]. Their evidence is almost entirely observational and documentary—books, conferences, open letters, media interviews, petitions to Congress and public ads—rather than clinical examinations, a fact central to the ethical dispute with mainstream psychiatry [4] [5] [6].
1. Public behaviors and statements presented as the core “evidence”
Duty-to-warn clinicians base their warnings on publicly observed speech and conduct—presidential addresses, tweets, interviews, insults, threats about military or nuclear force, and rhetoric around political opponents—which they interpret as symptomatic of narcissism, paranoia, impulsivity and dangerousness; these observable behaviors are the explicit evidentiary foundation of The Dangerous Case of Donald Trump and related public statements [1] [4] [7].
2. Organized products: a book, conferences, petitions, and ads
The group’s work crystallized in the 2017 book The Dangerous Case of Donald Trump, which gathered essays from dozens of psychiatrists arguing that Trump’s behavior constituted a “clear and present danger,” and it grew out of an April 2017 Yale conference titled “A Duty to Warn” and later formal petitions and congressional submissions urging lawmakers to consider psychological factors in impeachment and oversight [1] [4] [8] [9].
3. Specific claims and psychological labels used publicly
Prominent members publicly labeled Trump’s behavior with diagnostic language—narcissistic personality disorder, malignant narcissism, antisocial and paranoid traits—while some authors framed the case less as a formal diagnosis than as the articulation of risk: that his brittle self-worth, grandiosity, impulsivity, and alleged callousness increase the risk of harmful decisions and political violence [6] [9] [2].
4. Use of legal analogies and the “duty to warn” justification
Advocates often invoke Tarasoff-style obligations and civic duty as the moral-legal rationale for speaking out, arguing that observable conduct and public harm justify warning the populace even without a clinical exam; critics within psychiatry say Tarasoff is being stretched and that the Goldwater Rule forbids professional diagnostic statements about public figures not personally examined [3] [7] [9].
5. Political advocacy, media strategy, and contested motives
The movement has deployed mainstream media, academic fora, congressional letters and even paid ads to influence public opinion and policy, an approach praised by supporters as public-health advocacy and criticized by detractors as politicized or a breach of professional ethics; opponents include leaders of the American Psychiatric Association who publicly rebuked such actions as irresponsible or a violation of the Goldwater Rule [3] [10] [5].
6. Strengths and limitations of the evidence they present
Strengths: the critics point to a large, persistent public record of statements and conduct available for independent review and to reports of psychological harm among some clinicians’ patients who experienced trauma in response to the presidency [4] [3]. Limitations: none of the sources show private clinical examinations or direct diagnostic testing of Trump—indeed the debate hinges on whether observational, behavioral evidence suffices for professional warning—so the “evidence” is interpretive and contested within psychiatry [4] [11].
7. How mainstream psychiatry and other experts have responded
Mainstream psychiatric authorities have split: some groups and individual clinicians argue the Goldwater Rule should be relaxed in exceptional public-safety circumstances and have resigned or pushed for change, while the APA and many ethicists insist diagnoses without examination are unethical and that Tarasoff does not plainly authorize public diagnostic assertions about a sitting president [2] [10] [7].