Throughout the past four years, there has been chatter about Donald Trump’s mental health and stability, but little political will to make use of the Twenty-fifth Amendment to the Constitution, which allows Congress to deem a President “unable to discharge the powers and duties of his office” and remove him from power. The discussion resurfaced more seriously this month, however, in light of Trump’s hospitalization for COVID-19 and the White House’s lack of transparency around his treatment. The news that he was medicated with the steroid dexamethasone, used for seriously ill COVID-19 patients, also alarmed many because its known side effects include aggression, agitation, and “grandiose delusions”—behaviors that, judging from the President’s Twitter account, at least, he already seemed to exhibit.
On October 9th, House Speaker Nancy Pelosi unveiled a new bill to establish a Commission on Presidential Capacity to Discharge the Powers and Duties of the Office, which would help carry out the Twenty-fifth Amendment process in the event that the President becomes incapable of doing his job. (Sponsored by the Democratic representative and former constitutional-law professor Jamie Raskin, of Maryland, the House bill is similar to one he introduced in 2017.) Announcing the bill only a week after disclosure of the President’s COVID-19 diagnosis and three weeks before the election, Pelosi invoked the Amendment as a “path for preserving stability if a President suffers a crippling physical or mental problem.” She added, “This is not about President Trump. He will face the judgment of the voters, but he shows the need for us to create a process for future Presidents.”
Section four of the Twenty-fifth Amendment provides two distinct avenues for removing a President against his will. In one, the Vice-President joins with a majority of the Cabinet to send Congress a written declaration that the President is unable to serve. In the other, the Vice-President does so along with a majority of “such other body as Congress may by law provide.” The purpose of the House bill is to provide the congressionally appointed body that the Amendment contemplates, by creating a commission of seventeen members to be chosen by both parties, consisting of physicians and former high executive-branch officials. According to the Twenty-fifth Amendment, once Congress receives a declaration of the President’s incapacity, both houses could then decide, by two-thirds votes, to replace him with the Vice-President.
Pelosi’s decision to unveil the bill so close to the election may be, as Republicans have claimed, intended to harm Trump at the polls by drawing more attention to concerns about his health. On October 19th, Senator Kelly Loeffler, a Republican from Georgia, introduced a nonbinding Senate resolution to condemn House Democrats for “politicizing the Twenty-fifth Amendment” and the President’s health “during a global pandemic in order to influence the upcoming November election.”
In truth, it is all too easy, in a fragile democracy, especially in a time of immense crisis and fear, to transform vehement political or moral disapproval of a leader into a conviction that he or she is mentally unsound and therefore dangerous—and should be overthrown through non-electoral means. That is likely why the Twenty-fifth Amendment has been invoked only in temporary and limited ways, and only in cases of physical incapacity. George W. Bush invoked it twice for colonoscopies, each time making Vice-President Dick Cheney the acting President. When Ronald Reagan was shot and in surgery, in 1981, his Administration took steps to install Vice-President George H. W. Bush but soon decided against it. Four years later, Reagan did transfer power to his Vice-President before surgery for colon cancer.
In the realm of mental incapacity, as Richard Nixon faced likely impeachment, his staff feared that his unravelling state might lead him to order a nuclear launch, and his Defense Secretary went so far as to tell the Joint Chiefs not to execute such a military order if it came directly from the President. But Nixon’s Cabinet did not seek to set in motion his removal under the Twenty-fifth Amendment. Reagan’s staff considered invoking the Amendment when his dementia became evident to them, late in his second term, but decided against it. In 2017, Rod Rosenstein, then Trump’s Deputy Attorney General, reportedly suggested that the Cabinet invoke the Twenty-fifth Amendment, shortly after Trump fired the F.B.I. director, James Comey.
The questioning of Trump’s fitness has persisted throughout his Presidency, as members of his party and his close associates fed the narrative of a deteriorating mind. In 2017, then Senator Bob Corker, a Republican from Tennessee who was then the chair of the Foreign Relations Committee, called the White House an “adult day care center”; he went on to say, “I know for a fact that every single day at the White House, it’s a situation of trying to contain him.” In “A Warning,” published in 2019, an anonymous senior Trump official reported: “He stumbles, slurs, gets confused, is easily irritated, and has trouble synthesizing information, not occasionally but with regularity.” Similarly to Corker, the Administration official added that working with Trump was “like showing up at the nursing home at daybreak.” Other senior officials have said that Trump, who is seventy-four, appeared to be suffering from some form of dementia. Trump’s former White House adviser Omarosa Newman stated in her book “Unhinged,” in 2018, that Trump’s “mental decline could not be denied.” Trump’s former White House communications director Anthony Scaramucci said, in 2019, that Trump “has declining mental faculties.”
Others, including Trump’s niece Mary L. Trump, a clinical psychologist, have said that Trump’s behavior shows the symptoms of narcissistic personality disorder. A number of mental-health experts have also suggested that he may suffer from malignant narcissism, a term that was coined by the psychologist Erich Fromm, in 1964, in order to describe Hitler and Stalin. John Gartner, the psychologist who spearheaded the Duty to Warn movement in 2017 and has advocated removing Trump through the Twenty-fifth Amendment, told me that malignant narcissism is a “psychiatric condition that makes you evil,” combining narcissism (which features the extremes of poor self-esteem and distorted self-enlargement), paranoia (which Gartner sees in “the crazy conspiracy theories, sense of victimization, and demonization of minorities”), psychopathy (“lying and exploiting people”), and sadism. The condition is considered dangerous because the combination of aggression, suspiciousness, lack of empathy, and a fragile ego might result in vindictive and destructive acts when the sufferer is wounded. Shortly before Trump’s impeachment trial, in February, more than eight hundred mental-health professionals signed a letter to Congress, warning that “failing to monitor or to understand the psychological aspects” of humiliating Trump “could lead to catastrophic outcomes.”
Trump has repeatedly flipped the conversation about mental deterioration onto his opponent, who many have claimed also shows signs of senility. At a March rally, Trump said, of Biden, “They’re going to put him in a home, and other people are going to be running the country.” Talk of Biden’s mental decline began during the Democratic primary campaign last year, as other candidates observed that Biden garbled sentences, misspoke, and failed to finish trains of thought in some debates. (Biden has spoken about having a lifelong stutter.)
Last spring, Bernie Sanders’s surrogates and supporters promoted the hashtag #WhereIsJoe, implying that Biden’s campaign was keeping him out of sight to hide mental infirmity. Glenn Greenwald, founder of the Intercept and an outspoken Sanders supporter, tweeted that “the steadfast, wilful refusal of Dem political & media elites to address what is increasingly visible to the naked eye — Biden’s serious cognitive decline — is frightening.” Biden, who has said he would not seek a second term as President, released his physician’s report that he is healthy and “fit to successfully execute the duties of the Presidency” but offered nothing specific about his cognitive health.
As a result, the theme of the two septuagenarian presidential candidates’ fitness for office has run through the campaign season. Susan Page, the moderator of the Vice-Presidential debate, even asked both Mike Pence and Senator Kamala Harris about whether they had “had a conversation, or reached an agreement with” their running mates “about safeguards or procedures when it comes to Presidential disability.” Pence and Harris both completely dodged the question.
If a President were, in fact, impaired to a serious degree, it would, of course, be responsible for lawmakers to treat that as a grave threat to national security and to act to insure a stable transition of power to the Vice-President. That is the reason the Twenty-fifth Amendment is in the Constitution in the first place. How we have dealt with Trump thus far, though, has only strengthened the constitutional norm that even widespread and persistent public alarm about a President’s mental fitness does not warrant the use of the Amendment to remove him. More to the point, the bar for mental acuity and stability for Presidents has lowered along with much else in the past four years. As Frank Bruni put it, in the Times, “Please tell me why I should care whether Joe Biden is declining mentally when Donald Trump bottomed out morally long ago.”
Trailing Biden in polls, Trump has continually triggered shock waves around election integrity, claiming election fraud, attacking confidence in the process’s legitimacy, urging his supporters to “go into the polls and watch very carefully,” and, most alarmingly, at times refusing to commit to a peaceful transfer of power. (When pressed by NBC News’s Savannah Guthrie in mid-October, he did commit to a peaceful transfer of power.) If, as seems likely, voters deliver a loss for Trump, the Twenty-fifth Amendment comes into different focus, as an essential support to the democratic electoral process rather than an end run around it. In the event that the President’s mental state leads him to try to circumvent the election result in order to stay in power, having Congress remove him via the Twenty-fifth Amendment as “unable to discharge the powers and duties of his office” would be as legitimate a function of constitutional democracy as can be imagined.
