Like most sensible Americans, I am terrified by President Trump. He seems to be, by my inexpert reckoning, a compulsive liar and and malignant narcissist. More and more psychiatrists are speaking out to warn of the dangers of his instability, and my guess is that you could find any number of disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that would easily apply to him. But it would be a mistake—potentially a disastrous one—to go looking for them.1

It’s currently estimated that one in four Americans will suffer from a mental disorder in their lifetime, and those numbers are only increasing. Stress, economic precarity, inequality—all of these factors are contributing to the rise in diagnosed disorders despite pharmaceutical advances and better access to mental health care.2

We blame a lot of things that scare us on mental illness—gun violence, especially—even as we expand the scope of what those illnesses include. The DSM has logged nearly 200 new disorders since its first edition was released in 1952. But the truth is that doctors still know very little about mental illness. Disorders like depression are attributed to “chemical imbalances,” but there is no evidence that such imbalances exist, only that certain chemical formulations seem to mitigate the associated constellation of symptoms. Many drugs were discovered by accident rather than design; Lamotrigine, for instance, was developed to treat epileptic seizures, but doctors noticed it also stabilized patients’ moods. It is now an effective and largely safe drug prescribed to patients with bipolar disorder.3

We also fail, in our public conversations, to distinguish between people who suffer from a mental disorder and people who are actively experiencing a break with reality. Anybody can crack up, with or without a genetic predisposition towards mental distress. In the case of someone like Donald Trump, his privilege has kept him from being checked by reality. He’s surrounded himself with yes-men and children in order to keep anyone who might question his authority or decision-making far outside of his inner circle. It is likely that there is not a single person in his life who says no to him, and that is exactly why his mean and pestilent presence has grown into the strangulating mess it is today.4

Breaking norms the way Trump has done seems insane to us because we did not think it could happen, not because the man himself is unhinged. Trump seems mostly to be just as awful, vain, petty, and pathetic as he always has been. It’s the catastrophic power that this terrible man wields that seems crazy, and that is why we are panicking.5

There is also considerable danger in politicizing mental health. In repressive regimes, mental health is weaponized against the vulnerable. The classic case is Nazi Germany, where mental patients were first forcibly sterilized, and eventually murdered. Psychiatric abuse was used against dissenters in the Soviet Union, where, in 1959, Khrushchev spoke of those who opposed communism as psychologically “not normal.” Many political prisoners were interned in mental hospitals. This practice faded with the dissolution of the USSR, but has made a resurgence in Putin’s Russia: In 2012, members of the dissident band Pussy Riot were found to have “personality disorders” and recommended to be isolated from larger society.6

Malignant narcissism doesn’t disqualify Trump from the presidency. Politicians are often by disposition narcissistic—and if they don’t begin that way, they are susceptible to the inducements towards narcissism encoded in holding office. Trump is cognizant and competent enough to wreck American democracy with every silly thought in his tufted head, whether in heat or in whatever amounts for him as cool consideration. The worse he does, the more important it becomes not to make him an exception. He’s playing the same game as his Republican associates in destructive degovernance, and they will continue to wreak havoc even if he goes down. Trump must be held accountable as an adult citizen responsible for his decisions. He should be impeached on legal grounds, which undoubtedly will snowball the longer he remains in power.7

We must remember how many of us would fail a crude mental-health test, and that great politicians, including Winston Churchill and Abraham Lincoln, would have failed as well. And if you still like the idea of ousting Trump based on his mental health, imagine yourself cheering at his resignation. Now imagine President Pence mandating psychiatric screenings for un-American or antisocial behavior, first for elected officials and judges, then for teachers or prisoners, and then, finally, for you.8