The news that President George H.W. Bush has died is especially poignant at a time when a starkly different kind of president is at the helm of our national politics and foreign policy.  Recall that is was George Bush, our 41st president, who presided over the end of a Cold War we now seldom invoke except as ancient history.

In Helsinki last summer, when our 45 president came face-to-face with Vlad the Putin, architect of the new cold war in progress, he blinked and the world wobbled on its axis. The spectacle of an American president siding with Russia against our own intelligence agencies over Russian meddling in our elections was unimaginable until it actually happened.  (Trump's exact words: "President Putin says it's not Russia.  I don't see any reason why it would be.")  Trump's weird love affair with Putin raises a number of potentially damning questions of a kind that, depending on the answers, make his impeachment an urgent imperative.

Did the Russians quietly recruit a flamboyant real estate tycoon a glaring personality disorder starting in the 1980s, plying him with flattery, prospective business deals, and sex?  Did Vladimir Putin seek to renew this relationship when Donald Trump became a TV reality show celebrity positioning himself to run for president? Did the Kremlin have a hand in putting Donald Trump in the White House?  Is the US President guilty of collusion with Russia?

These and related questions dominated the 24-hour news cycle during most of the 45th President’s first year in office.  Behind the headlines loomed two linked questions, one political, the other medical.  The first involves the one of the most intractable problems facing modern medicine, namely a range of mental disorders severe enough to pose a threat to the afflicted individual and (or) others.   The second—the political question—arises from the fact that the damage a mentally deficient, morally defective, or emotionally unstable individual can do to others depends in large measure on the wealth, power, status, and position of the psychologically impaired individual.

This cold war with Russia is clearly different and not in a good way. This time around, it’s Western-style democracies that are at a systemic disadvantage.  Governments in the West hold real elections and do not censor the press or silence critics.  That difference create a strategic asymmetry that favors dictatorships like Russia and North Korea.  But there is another major difference that makes greatly accentuates the effect of this asymmetry:  Donald Trump has all but taken the US out of the game.  Why?  Is it only for personal gain?  Is he being blackmailed.  Or is there a deeper explanation, a kind of “deep state” that is entirely internal to his psyche?

Halfway through his first term in office, Donald Trump’s bizarre behavior has made his unfitness for the nation’s highest office absolutely clear to the vast majority of people everywhere.  The even more troubling question is whether this behavior shows signs of progressive deterioration, whether it has become so bizarre as to belong to the realm of psychopathology—in particular, whether it fits the pattern of a condition known as narcissistic personality disorder.  The Mayo Clinic describes this disorder as "a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. But behind this mask of extreme confidence lies a fragile self-esteem that's vulnerable to the slightest criticism."¹

People with this mental disorder “may be generally unhappy and disappointed when they're not given the special favors or admiration they believe they deserve…and others may not enjoy being around them”.   They typically: (1) expect to be recognized as superior even without achievements that warrant it; (2) exaggerate achievements and talent; (3) are preoccupied with fantasies about success, power, brilliance, beauty; (4) become impatient or angry when they don't receive special treatment; (5) react with rage or contempt and try to belittle the other person to make themselves appear superior; (6) Have difficulty regulating emotions and behavior.

These signs and symptoms are all readily observable from afar in President Trump’s public behavior, all on display daily on Twitter and in his public appearances and press conferences.  Whether or not his private behavior fits more than a dozen other symptoms of this personality disorder is impossible for any outside observer to know.  But even a cursory reading of Bob Woodward’s Fearwill confirm that an unhappy or disappointed Donald Trump is no fun to be around.  And not a few of his original inner circle in the White House are in fact no longer around either by choice or because he famously takes pleasure in firing people.

And then there’s the constant stream of lies.  It’s true that prevaricating, dissembling, and cherry-picking facts are common practices in high-stakes politics, but this President does not simply tell an occasional lie, does not simply distort the truth when he’s cornered. No, this President makes a habit of lying.  He lies all the time.  Gratuitously. Extravagantly.  Flamboyantly.

There’s a serious question as to whether Trump has any relationship whatsoever to the truth.  This kind of dishonesty is pathologicaland people in its thrall are always a problem sooner or later and they are sometimes dangerous.  A pathological president who can pardon convicted criminals or start a nuclear war poses a clear and present danger to the nation and the world.

This President’s impaired ability to relate to others, to reason or think logically, and to act rationally would be bad enough if the consequences were confined to domestic politics.  But that is clearly not the case.  The role of president is to be America’s chief diplomatic and foreign-policy decision-maker, as well as the Commander-in-Chief of US Armed Forces. Presidents are the architect of US relations with the outside world.  Obviously, when a president is inexperienced in international relations and incapable of strategic thinking, that is a problem.  But when the ruler of a rival state is adept, cunning, and committed to a policy of divided-and-conquer—leveraging AI and social media to exploit a kind of systemic asymmetry in the process—that is a crisis waiting to happen.

Vladimir Putin did his best to make it happen two years ago.  He did his best to catapult a literally crazy candidate into the Oval Office using cyber weapons and social media.  To his followers and acolytes, Putin looks like a genius.  But Putin had no clue what he had wrought.  No clue just how irrational and reckless a crazy man in the White House can be. And what peril it represents for Russia and the world.