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‘A Constitutional Emergency’: Psychiatric Experts Say Congress Must Confront Mentally Unstable Trump
“We recognize the gravity of what we are asking. We ask it because the gravity of the situation demands it."
Apr 14, 2026
A group of four psychiatrists warned congressional leaders on Monday that US President Donald Trump has recently exhibited "every behavioral sign of a personality in acute crisis," presenting a "constitutional emergency" that demands immediate action from lawmakers and members of the administration.
In a letter to the top Republican and Democratic lawmakers in both chambers of Congress, the psychiatrists and Columbia University professor Jeffrey Sachs—who helped organize the letter—pointed to Trump's recent genocidal threats to wipe out Iran's "whole civilization" and bomb the country "back to the stone ages" as examples of rhetoric that has "crossed a threshold."
"President Trump exhibits what forensic mental health experts have, across dozens of independent assessments, identified as the 'Dark Triad' of personality traits: narcissism, Machiavellianism, and psychopathy," the letter states. "Rather than constituting a clinical diagnosis, this trait-based assessment is grounded in behavioral observation and is particularly useful for assessing the level of danger an individual poses in a political leadership position. We do not offer this as a clinical verdict. We offer it as the considered judgment of a substantial body of professional opinion, based on well-researched evidence that is consistent, accumulating, and impossible to dismiss."
The psychiatrists who signed the letter are James Gilligan, clinical professor of psychiatry at New York University; Prudence Gourguechon, former president of the American Psychoanalytic Association and former vice president of the World Mental Health Coalition; Bandy Lee, president of the World Mental Health Coalition and former professor at Yale School of Medicine; and James Merikangas, clinical professor of psychiatry and behavioral science at George Washington University.
The experts' letter came amid growing calls from congressional Democrats for Trump's removal from office, whether through the impeachment process or the pathways offered by the 25th Amendment.
The psychiatrists stop short of demanding Trump's immediate removal. Rather, they urge Congress to reestablish its constitutional authority over war in response to the president's unauthorized assault on Iran; convene "urgent consultations" with top administration officials to prevent Trump from escalating "toward catastrophe"; and "formally initiate consultation" with Vice President JD Vance and Cabinet members "regarding the president’s fitness for office under Section 4 of the 25th Amendment."
"We recognize the gravity of what we are asking. We ask it because the gravity of the situation demands it," the letter states. "A president who publicly threatens to destroy a foreign civilization, who launches a bombing campaign and then imposes a naval blockade without congressional authorization, and who shows every behavioral sign of a personality in acute crisis is not merely a political problem. He is a constitutional emergency. The mechanisms for addressing such an emergency exist. They were placed in the Constitution and its amendments for moments precisely like this one."
The letter was released days after Rep. Jamie Raskin (D-Md.), the top Democrat on the House Judiciary Committee, wrote to White House physician Sean Barbabella requesting an "immediate and comprehensive cognitive and neurological evaluation of President Donald Trump, along with full public disclosure of the findings," in response to his "increasingly volatile, incoherent, and alarming public statements," specifically regarding the war on Iran.
"This is plainly out of the realm of normal politics," Raskin wrote. "When the president of the United States threatens to extinguish a civilization on social media, rants about combat missions with children at the Easter Egg Roll, and drops profane tirades on Easter morning, we have indisputably entered the realm of profound medical difficulty and concern."
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Urgent Warning to Congressional Leaders: Trump is Psychologically Unstable and Dangerous
President Trump exhibits what forensic mental health experts have identified as the “Dark Triad” of personality traits: narcissism, Machiavellianism, and psychopathy. What this represents is a constitutional emergency.
Apr 14, 2026
Editor's note: The following letter was sent to the bipartisan leadership of Congress on Monday, April 13, 2026 in regard to recent rhetoric and actions taken by US President Donald J. Trump.
Senator John Thune
Senate Majority Leader, US Senate
Senator Charles E. Schumer
Senate Minority Leader, US Senate
Representative Mike Johnson
Speaker of the House, USHouse of Representatives
Representative Hakeem Jeffries
House Minority Leader, US House of Representatives
Dear Senate Majority Leader Thune, Senate Minority Leader Schumer, Speaker Johnson, and House Minority Leader Jeffries:
We write to you today with a sense of urgency that we do not use lightly. The behavior and rhetoric of President Donald Trump have crossed a threshold that demands the immediate and bipartisan attention of Congress. This is not a partisan assessment. It is a judgment grounded in observable fact, consistent professional assessment, and the constitutional responsibilities that your offices carry.
President Trump exhibits what forensic mental health experts have, across dozens of independent assessments, identified as the “Dark Triad” of personality traits: narcissism, Machiavellianism, and psychopathy. Rather than constituting a clinical diagnosis, this trait-based assessment is grounded in behavioral observation and is particularly useful for assessing the level of danger an individual poses in a political leadership position. We do not offer this as a clinical verdict. We offer it as the considered judgment of a substantial body of professional opinion, based on well-researched evidence that is consistent, accumulating, and impossible to dismiss.
What makes this more than an academic matter is what predictably happens when this personality structure collides with immovable obstacles. The clinical literature is clear: individuals with Dark Triad profiles, when confronted with situations they cannot control or escape, do not recalibrate. They escalate. The psychological imperative to relieve narcissistic collapse overrides strategic calculation, concern for consequences, and ordinary self-restraint. Rage surges to domination. Impulsivity overrides caution. The urgent need to extinguish psychological pain eclipses every other consideration.
We are watching this dynamic unfold in real time.
The President’s recent public communications have been, by any normal standard of political discourse, alarming. His posts demanding that Iran “open the fuckin’ strait, you crazy bastards” and his threat to bomb Iran “back to the stone ages,” adding that “a whole civilization will die tonight, never to be brought back again,” are not the rhetoric of calculated geopolitical pressure. They are the expressions of a man in profound psychological distress who is reaching for the most extreme retaliatory threats available to him. That these statements were addressed to an adversary in the context of an active military confrontation makes them not merely shocking but profoundly dangerous.
President Trump has now ordered a US naval blockade of Iran — an action that has sent world oil prices soaring and placed the United States in direct opposition to the international community. His ongoing actions carry the potential to trigger a global economic catastrophe, draw in regional and great powers, and ignite a wider conflict with consequences that no one can bound. These orders are being issued without adequate deliberation, without congressional authorization, and in a context in which the President’s judgment is, by every visible measure, severely compromised.
We urge three specific actions.
First, Congress must immediately retake its constitutional authority over war. The bombing of Iran and the initiation of a naval blockade — acts of war under both US and international law — cannot be authorized by presidential fiat. Article I of the Constitution vests in Congress the sole power to declare war and to regulate commerce with foreign nations. The Framers intended Congress to deliberate upon and be accountable for precisely such consequential actions. Congress must assume its constitutional authority now, before further escalation renders the question moot.
Second, congressional leadership — on a bipartisan basis — must convene urgent consultations with senior administration officials, including the Secretary of Defense, the Chairman of the Joint Chiefs, the Secretary of State, and the Director of National Intelligence. The purpose is not routine oversight. It is to create a circuit breaker capable of preventing escalation toward catastrophe, including the potential use of nuclear weapons. Those officials have their own constitutional and statutory obligations. Congress should insist on those obligations and provide a forum in which they can be exercised.
Third, Congress should formally initiate consultation with the Vice President and Cabinet regarding the President’s fitness for office under Section 4 of the Twenty-Fifth Amendment. We do not prejudge the outcome. We are not calling for the President’s immediate removal. We are calling for the process that the Constitution itself provides for this contingency: when a President’s capacity to discharge the duties of office is in question and poses a potential imminent danger to the nation. The Amendment exists because those who drafted it recognized that the question of presidential incapacity would occasionally arise, and that it required a constitutional answer rather than a political improvisation.
He is a constitutional emergency. The mechanisms for addressing such an emergency exist. They were placed in the Constitution and its amendments for moments precisely like this one.
We recognize the gravity of what we are asking. We ask it because the gravity of the situation demands it.
A President who publicly threatens to destroy a foreign civilization, who launches a bombing campaign and then imposes a naval blockade without congressional authorization, and who shows every behavioral sign of a personality in acute crisis is not merely a political problem. He is a constitutional emergency. The mechanisms for addressing such an emergency exist. They were placed in the Constitution and its amendments for moments precisely like this one.
The war with Iran will not wait. The escalation dynamics of this active military confrontation will not wait. The psychological conditions driving the President’s decisions will not improve under pressure — they will worsen.
We urge you to act without delay. The Constitution gives you the tools. Your oath of office assigns you the responsibility.
Respectfully,
James Gilligan, M.D.
Clinical Professor of Psychiatry, New York University School of Medicine
Adjunct Professor of Law, New York University School of Law
Former Faculty of Psychiatry, Harvard Medical School
Former President, International Association of Forensic Psychotherapy
Prudence L. Gourguechon, M.D.
Former President, American Psychoanalytic Association
Former Vice President, World Mental Health Coalition
Bandy X. Lee, M.D., M.Div.
President, World Mental Health Coalition
Co-Founder, Preventing Violence Now
Former Faculty of Social Medicine, Harvard Medical School
Former Faculty of Law and Psychiatry, Yale School of Medicine
James R. Merikangas, M.D.
Clinical Professor of Psychiatry and Behavioral Science, George Washington University
Research Consultant, National Institute of Mental Health
Co-Founder, American Neuropsychiatric Association
Former President, American Academy of Clinical Psychiatrists
Jeffrey D. Sachs, Ph.D.
University Professor, Columbia University
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The Average Taxpayer Shelled Out Over $4,000 for War and Weapons Last Year
Americans want a government that supports them when times are tough—not one that shakes us down for endless wars.
Apr 14, 2026
Well it’s tax season again. Do you know where your tax dollars actually go?
As federal budgeting experts, we get asked about this a lot—often, it’s something people simply have no idea about.
But if you’ve watched the Trump administration launch one war after another, flood the streets of American cities with Immigration and Custom Enforcement agents, and call the very idea of an affordability crisis a “hoax” by their political opponents, you might be getting the general idea.
Around half of Americans are struggling to afford basic necessities. But last year, instead of investing in programs that help people make ends meet, the president and his friends in Congress passed a Big Ugly Bill that cut taxes for the wealthy, slashed health insurance and food assistance for millions of Americans, and added billions in new spending for war and mass deportations.
You spent about 50 days working and paying taxes last year just to feed the war machine—and 23 days working to pay those Pentagon contractors and their millionaire CEOs.
Some of those changes, such as the deepest cuts to health insurance, won’t take effect until 2026 or later. Others are taking effect now and are visible in the war on Iran and the deployment of mass deportation forces in our cities.
These enormous sums for the Pentagon and militarism more broadly—now well over $1 trillion—come with enormous costs to ordinary people. That’s true not just in terms of the opportunity cost for other programs, but also for the drain on our wallets.
In a new report for the Institute for Policy Studies, we broke down last year’s typical tax bill and what each household actually spent, on average, for different programs and priorities in 2025.
We learned, for example, that the average taxpayer paid $4,049 for weapons and war last year—a huge sum in a time of rising costs of living and stagnant wages. That’s far, far more than any other program funded by income tax dollars. Medicaid, the next highest item on our income tax receipt, ran a little under $2,500—and that funds healthcare for 1 in 5 Americans. School lunches and other nutrition programs, by comparison, ran just $124. The Postal Service? $19. (Big programs like Social Security and Medicare have their own dedicated funding streams, and aren’t as significant for your income taxes.)
More than half of the Pentagon’s sum went to private, for-profit military contractors—the top CEOs of which now make over $25 million a year on average. Put another way, you spent about 50 days working and paying taxes last year just to feed the war machine—and 23 days working to pay those Pentagon contractors and their millionaire CEOs.
The war in Iran hadn’t started yet when you were paying taxes last year. But if we use last year’s tax data and set the cost for the war at $35 billion—a line we’re likely on the verge of crossing—the average taxpayer will have paid $130 for the war on Iran. And that becomes a double whammy when you count the many hundreds more at the gas pump, grocery store, or on other expenses made worse because of the conflict.
Polls show that Americans don’t want this war that’s causing so many deaths in Iran and elsewhere at the same time people here in the US are left to struggle. Unfortunately, nobody in this administration asked us.
Meanwhile, programs that actually help people trying to make ends meet—a growing population of us, unfortunately—are getting cut. As more of those cuts take effect—especially to Medicaid—the gap between what we spend on the Pentagon and everything else will only keep growing.
Worse still, Trump and his allies are planning a repeat of last year’s Big Ugly Bill. The president has requested $1.5 trillion for the Pentagon next year—a huge increase from the $1 trillion budget this year. That would make the numbers all the more lopsided.
Nobody loves paying taxes, but we all agree we should get our money’s worth. And in a democracy, our hard-earned tax dollars should go toward programs that actually keep us safe and healthy.
Before plowing more money into the war machine, we need to take a long, hard look at how policymakers are using our money. Americans want a government that supports them when times are tough—not one that shakes us down for endless wars.
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Finding the Right Process to Enable Productive Peace Negotiations in the Iran War
The challenges of structuring a peace process that can overcome 47 years of mutual grievances between the US and Iran were highlighted by the recent talks between the US and Iran in Pakistan.
Apr 14, 2026
Although the international community still knows very little about the highest-level peace talks between the US and Iran in 47 years, facilitated by Shehbaz Sharif, the Prime Minister of Pakistan, some obvious red flags appeared in the morning-after news reports—as JD Vance, Steve Witkoff, and Jared Kushner flew home less than 24 hours after their arrival in Islamabad.
As The New York Times reported: “Vice President JD Vance summed up the failure of 21 hours of negotiations with Iran in one sentence: ‘They have chosen not to accept our terms.’ To Iranian officials, that line reflected their biggest problem with the talks: The United States they argue, had not come to negotiate.” As Javid Zarif (who led the Iranian negotiating team on the Joint Comprehensive Plan of Action, negotiated by the Obama administration to keep Iran from developing a nuclear weapon, but later torn up by President Donald Trump) wrote on X, “No negotiations—at least with Iran—will succeed based on ‘our/your terms.’”
This highlights that, as expected, the talks took the form of a “hard-bargaining” (also called distributive bargaining) approach to negotiation where the parties seek to achieve a zero-sum (win-lose) outcome rather than a positive sum (win-win) outcome. Too often, however, they end up with a lose-lose outcome, as occurred in this situation. In hard bargaining, parties present their positions (i.e., their preferred solution to the issues) as demands—the Iranians offered a 10-point plan; the US, a 15-point plan—both exchanged before the talks began, a tactic that is not recommended by experienced peacemakers.
In the lead-up to the negotiations, it was initially reported that indirect “proximity talks” were planned—where the third-party mediator moves back and forth between the delegations, who are placed in close proximity to one another in nearby, but separate locations. This typically tends to be a much more productive means of negotiation than direct talks, as it represents each party talking to and negotiating with the impartial third-party mediator, rather than the other party, allowing each delegation to avoid the confrontation and aggravation of dealing directly with its adversary. Moreover, it allows the mediator to try out various possibilities for creative solutions by using a “one-text procedure” to develop a text that is controlled by the mediator and continuously adjusted to address each party’s concerns and allow the mediator, over time, to get ever closer to agreement.
Parties need a constructive process to help them engage in meaningful problem solving, especially where there is no trust and they have a long-term hostile relationship.
On the day, however, after brief separate meetings by US and Iranian delegations with the Pakistani prime minister, direct talks were convened. Unlike the common wisdom that it is good to have the parties talking to one another, this kind of negotiation is not helpful to constructive problem solving. Instead, it is likely to break down into confrontational exchanges, whereby each party simply reiterates its positions and demands—and typically issues threats and ultimatums and employs other pressure tactics to try to force the other to concede, causing each to become ever more entrenched in its positions and more resistant to new ideas.
Another problem was the totally unrealistic expectation that was created for the talks—the idea that an agreement settling decades of serious grievances between the US and Iran might be negotiated within a weekend. A much more realistic approach would have been to schedule talks to be held over a much longer time frame or to schedule additional rounds of talks.
The continuous, marathon nature of the talks are also not a good way to structure peacemaking negotiations. The talks began soon after both delegations arrived (the US delegation had traveled for 18 hours) and lasted all afternoon and most of the night. Indeed, such a schedule is not at all conducive to constructive outcomes, as the parties were tired upon arrival and became ever more exhausted and stressed as the talks continued, reducing their ability to listen to and understand the other party’s issues and concerns and to even to consider or create any new, innovative possibilities that could help bridge differences or create trade-offs.
Moreover, such a format offers no time for the delegations to engage in discussions with their own team or reflect on the exchanges that have occurred at the table between the parties. As confirmed by The New York Times, at the end of the talks, “Exhausted and frustrated after 21 hours on the ground, Mr. Vance provided few details, took three questions, and departed.” The Iranians, for their part, are actually known for their “long-winded, relentless approach to deal-making,” which the Iranian Foreign Minister, Abbas Araghchi, has called “market style,” meaning “continuous and tireless bargaining.” This is why it is important to have an experienced mediator who knows how to control the process and who will structure negotiation in a paced manner, over a number of days, with breaks during each day and time to sleep and rest overnight.
It also appeared that Mr. Vance was not plenipotentiary in having full authority to take independent action, since he reportedly broke off negotiations on multiple occasions to phone President Trump, perhaps because, over Easter, Trump said that: “If it doesn’t happen, I’m blaming JD Vance... if it does happen, I’m taking full credit.”
The overriding issue that is often neglected by well-meaning, but unseasoned third parties, as well as by inexperienced delegations, is their total focus on the substance of a negotiation—to the neglect of the process. Although substance is, of course, important, the process of how negotiations are structured is crucial to finding an acceptable outcome that achieves agreement on substance. Parties need a constructive process to help them engage in meaningful problem solving, especially where there is no trust and they have a long-term hostile relationship.
Where the peace process goes from here is uncertain. Trump has already announced that the US will carry out a naval blockade of Iranian ports. It will, of course, help greatly if the ceasefire can be maintained and extended beyond the two weeks, since the longer a cessation of hostilities is in place, the more time there will be for additional meaningful talks to occur. One thing that is certain, however, is that all of those working to promote an end to the war in Iran (Pakistan, Türkiye, Egypt, and other regional partners, as well China, the United Nations, others) have a huge challenge ahead of them in crafting a process that will allow for an integrative approach that will have a chance of resolving this long-standing, intractable conflict.
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