US POLITICIANS as diametrically opposed as independent socialist Bernie Sanders and right-wing Republican Ted Cruz have called Donald Trump “pathological.” So have medical practitioners and now, so has a judge.

Cruz declared Trump “a pathological liar,” during the Texas senator’s failed 2016 bid for the Republican presidential nomination. Sanders, a senator from Vermont, said the US could not “continue having a pathological liar in the White House,” after the US House of Representatives, then controlled by the Democrats, impeached Trump in December 2019.

Recently a New York Supreme Court judge echoed those views when he handed Trump $355 million in penalties, after finding Trump, his sons and associates guilty last September of committing fraud in building the Trump New York real estate empire. Trump’s two sons Don Jnr and Eric were each ordered to pay $4m for their part in the scheme.

In handing out the penalties, Judge Arthur Engoron noted that Trump and his sons “are incapable of admitting the error of their ways” and said “their complete lack of contrition and remorse borders on pathological.”

So is Trump actually pathological? To Cruz, the answer seems to be one of political expediency. He endorsed Trump four months after dropping out of the 2016 presidential race, although his decision apparently required “prayer and searching my own conscience.” By 2018, Trump was embracing Cruz on stage and gushing “nobody has helped me more.” Cruz endorsed Trump again in 2024.

In the medical community, however, the consensus is more unwavering. Within days of Trump’s January 2017 inauguration, a petition was launched — eventually signed by more than 70,000 mental health professionals — declaring that Trump “manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States.” It urged his immediate removal from office. 

Forensic psychiatrist and president of the World Mental Health Coalition, Brandy X Lee, in a January 2021 interview with Scientific American shortly after the Capitol insurrection, concluded that Trump’s “emotional fragility, manifested in extreme intolerance of realities that do not fit his wishful view of the world, predisposes him to psychotic spirals.”

The World Mental Health Coalition had put out a statement on January 9 2021, echoing the earlier call for Trump’s immediate removal from office. (His term officially ended on January 20 of that year.)

But there’s even a peer-reviewed study examining whether you have to be pathological just to want to vote for Donald Trump. In Dimensions of pathological narcissism and intention to vote for Donald Trump, published by the National Library of Medicine in April 2021, the authors found that “self-centred antagonism and indifference to others were the aspects of narcissism driving intended Trump voting.”

However, the researchers concluded that Trump’s style of bombastic insults may not constitute a winning strategy. “When considered along with the fact that Trump lost the election, findings suggest that appealing to the darker aspects of personality may not be the most effective way to win elections,” they wrote. 

“A platform rooted in animosity towards others can generate a substantial amount of angry enthusiasm (as was clear during the election and its immediate aftermath), but may not be one that is convincing to the majority of people, at least not in a country as diverse as the US.”

In November, we will find out who is right.

Linda Pentz Gunter is a writer based in Takoma Park, Maryland.