The Bulletin of the Atomic Scientists recently moved its Doomsday Clock 30 seconds closer to midnight, citing in part President Trump’s rhetoric on nuclear weapons and minimizing of the science on climate change. According to this panel of experts and their symbolic clock, we are now two minutes from a human made global catastrophe — the closest we have come since the Cold War in 1953.
Renewed investments by China, Russia, India and Pakistan have raised alarms even as North Korea’s nuclear weapons program has advanced. In his State of the Union address, Trump said North Korea’s “reckless pursuit of nuclear missiles could very soon threaten our homeland” and said he is applying “maximum pressure” to head that off. Victor Cha, meanwhile, once Trump’s choice as U.S. ambassador to South Korea, is no longer under consideration — at least in part because he opposes a “bloody nose” strategy of a preventive military strike on North Korea.
We understand too well the awesome power of these weapons and the human temptation to use them in a moment of weakness.
One of us, Dr. Merikangas, graduated from the U.S. Navy Guided Missile School and was a nuclear weapons loading officer. He witnessed our last above-ground test of a special weapon — the 1.4 megaton hydrogen bomb explosion, 250 miles above Johnston Island in the Pacific, that was 100 times more powerful than the atomic bomb dropped in Hiroshima. The other, Dr. Lee, is an expert on the psychological patterns and mindset of individuals who resort to violence to mask extreme feelings of powerlessness, inadequacy and need for approval.
Trump, with the psychological vulnerabilities he displays, in an office that invests enormous power in one individual, may present a situation of unusual risk. Our military ensures that every officer handling nuclear weapons has the mental capacity to do so —but does not take the same precautions regarding the person who can command a strike.
The Department of Defense continuously evaluates and monitors personnel who may cause arming or release of a nuclear weapon. Under the Nuclear Weapon Personnel Reliability Program, “Only those personnel who have demonstrated the highest degree of individual reliability for allegiance, trustworthiness, conduct, behavior, and responsibility shall be allowed to perform duties associated with nuclear weapons, and they shall be continuously evaluated for adherence to PRP standards.”
The president, who has the ultimate responsibility for the use of the most devastating weapons in the history of the world, and who has the sole authority to order the murder of millions of people in an instant, has received only a simple, 10-minute cognitive screen. His doctor did not recommend a mental health screen or any other tests.This, despite evidence that strongly suggests the need to evaluate the neuropsychiatric condition of this 71-year-old man. His speech and behavior on video recordings over time, along with his incessant tweets, provide ample data for concern about deterioration.
The kind of neuropsychiatric evaluation we have been advocating is not subjective. Modern medicine has many ways to assess brain function, starting with a thorough history and interview, followed by a neurological examination that records reflexes, movement, sensation to touch and position, and the function of the organs of special sense, especially the sense of smell. Disorders of speech or sleep-wake rhythms may point to a deteriorating mental state. Definitive objective evidence may also be obtained by performing an MRI scan of the brain to demonstrate atrophy, small strokes, tumors, or other changes of medical significance. A PET scan can show the patterns of regional metabolism that may give diagnostic information.
Psychological function can be similarly tested, using not only a personal interview but any number of standardized tests that can rule out major mental disorders, abnormal personality structure, impaired cognitive function, and quantify the severity of any symptoms. An exam can include the determination of capacity to carry out logical, reality-based decision-making according to the same standards that are applied to every other military officer. Personal data are supplemented with clinical observations, medical records and medication, and collateral information from close intimates. Psychiatric diagnoses are among the most reliable in medicine, and given all the information, a consensus is not difficult to reach.
The American Psychiatric Association has recently issued a statement calling for the end of “armchair psychiatry.” We wholly agree: armchair psychiatry is precisely what we are trying to avoid by alerting lawmakers and the public about the risks of this situation and calling for a thorough, proper and urgently needed evaluation. There has already been a shift in international norms regarding nuclear weapons due to Trump. He has bragged about them, threatened to use them and expressed a desire to increase his stockpile in ways that suggest more psychological than policy-driven motives.
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Although the president has the authority to order a nuclear strike, there are possible safeguards, or at least a chain of command that is required to act, which is not the same as a simple push of a button. During the Cold War there were alerts that missiles were on their way, but cooler heads checked and verified that these were mistakes, and no retaliation was ordered. The recent fiasco in Hawaii is an example of how close we came through human error, but that was an alert, not an actual warning from NORAD to the high command. There is currently a bill and other proposals that suggest it is a good idea to limit the president’s first use of nuclear arms in peacetime. However, none of these are yet official or fail-safe solutions.
There is every reason for commanders in chief to be examined at least as closely as the military personnel under their command. It is unfortunate that routine assessment is not already required, given the awesome responsibility of dealing with weapons that have the capacity to end civilization in an instant. There are procedures in place for those working with the weapons of our nuclear triad. It is time to apply them to the presidents we entrust to decide whether to use them.
Bandy X. Lee is a forensic psychiatrist on the faculty of Yale University School of Medicine and a project group leader for the World Health Organization’s Violence Prevention Alliance. James R. Merikangas is a former Navy weapons officer and a forensic neuropsychiatrist on the faculty of the George Washington University School of Medicine.