If One is Too Incompetent to Commit a Crime, Despite Trying Hard, Is One Competent to be President?
An Analysis of Presidential Mental Capacity

Whether the President has the mental capacity to serve in his office is what we, who have been concerned enough to put our evaluations into the public-service book, The Dangerous Case of Donald Trump (edited by Bandy X. Lee and published in 2017 and 2019), have been questioning from the start. While the information in the Special Counsel's report has been deemed insufficient for criminal determination, it provides, even in redacted form, a wealth of relevant information regarding the President's mental capacity. Not having the mental capacity to make sound decisions and to refrain from violence, whether by encouraging, recommending, or inciting it on the part of his followers, whether or not he meets the criteria for being diagnosed as mentally ill, is dangerous as long as he remains President and constitutes a medical emergency that health professionals are obligated to respond to.

In medicine, mental capacity is about the mental soundness that is necessary to fulfill a task. For example, the office of president requires, at the very least, the ability to make sound, rational decisions based on reality and the ability not to place the nation in grave danger. The final determination of "competency" is a judicial decision usually made by the courts, while capacity is a medical assessment that psychiatrists, and especially forensic psychiatrists or other appropriately trained forensic mental health professionals, contribute to courts as expert witnesses to aid them in making their legal decisions. Similarly, presidential fitness is a political decision, but just as the courts routinely rely on physicians' assessments for fitness for duty political bodies should not be denied access to the same medical and professional information and expertise that the judicial system benefits from. We therefore offer our analysis as potentially valuable data, as a part of our professional obligation to protect public health and safety.

First, it is important for us to clarify that capacity evaluations are about function, in contrast to diagnostic examinations, which try to define specific illnesses that affect someone's personal mental health, so that a proper course of treatment can be prescribed. It is necessary to underscore, furthermore, that mental illness by itself does not disqualify one from effective leadership. We do not have the legal authorization to analyze the President's personal mental health, whereas we do consider the wealth of public information, now including sworn testimonies, that throws doubt on the President's capacity to fulfill the duties of his office to be central to our primary responsibility to society. Conventionally, a personal interview is usually required for a diagnostic examination. For a functional examination, by contrast, there are few tests as informative as observations by the person's colleagues on his actual performance as to how he is or is not able to function in his job. Seldom do we have as much detailed information on a person's behavior as is contained in the Special Counsel's report, which has been verified with the accuracy and expertise of a criminal investigation of the highest order. Therefore, we can make an appraisal with a level of confidence that far exceeds what we ordinarily have in our clinical practice.

A capacity evaluation consists of assessing four main components:

(a) comprehension, or the ability to take in information and advice without undue influence from delusions or excessive emotional need;

(b) information processing, or the ability to appreciate and make flexible use of information and advice;

(c) sound decision making, or the ability to weigh different options and to consider consequences based on rational, reality-based, and reliable thinking without undue influence from impulsivity, delusions, magical thinking, or fluctuating consistency and self- contradiction; and

(d) the ability to refrain from behavior that places oneself or other people in danger, such as inciting one's followers to commit acts of violence, and boasting of one's own repeated violence.

When it comes to serving in a high governmental office, it also goes without saying that constantly repeating declarations of demonstrably fallacious untruths despite a consensus that these violate easily verified, objective, factual reality and that are often followed by denying that those statements were made in the first place even when they were made in public and have been recorded on tape and video, would also be disqualifying.