Media

We need to talk about Donald Trump’s mental health

The increasingly incoherent and volatile president is much easier to understand if we come to terms with one thing

April 11, 2026
Illustration by Prospect. Source: Alamy
Illustration by Prospect. Source: Alamy

The American constitution is creaking at the seams. The founding fathers got many things right, but ultimately their imagination failed them. They could not, in their worst nightmares, conceive of a president who would be simultaneously all-powerful and mentally unwell.

So here we are living in a time captured by WB Yeats’s haunting lines in his poem, “The Second Coming”: 

“Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world.”

The second coming of Trump has been accompanied by the creeping acknowledgement that he might either be mad or senile. And as things fall apart in his mind, so anarchy is loosed upon the rest of the world.

“Mad” and “senile” may not be precise medical terms, but pick your own symptoms. Even his most fervent supporters can no longer hide their disquiet at his impulsivity, malignant narcissism and erratic volatility. All but the wilfully blind recoil from the deranged stream of consciousness that spews from his social media accounts at all times of day and night. 

We can no longer ignore his conspiracy-obsessed mindset and his lack of control. We can see for ourselves his increasing detachment from reality, along with his increasingly frequent delusional claims. We flinch at his emotional volatility, his disregard for democratic norms. We shudder at his disinhibition, blustering menace, vengeful rantings and foul-mouthed posturing. 

None of it is normal, yet it is remarkable how so many people have gone on behaving as though it were. The more craven keep their heads down and pretend not to notice. There are those who feel personally or ideologically obliged to make excuses for him. But, for the rest of us, it is beyond time to speak bluntly about what we see. 

The guy is nuts.

Now, the 25th amendment to the constitution did allow for the possibility that a president might become unfit for office. It worked fine when George W Bush briefly had to hand over power while having a couple of colonoscopies.

But it is inadequate for the crisis we face today since it requires the assent of a bunch of cabinet members and legislators who, until now, have shown themselves to lack the slightest courage or independent instinct. 

Which, of course, is the second thing the founding fathers didn’t foresee. Having just escaped the rule of the mad King George III, they were terrified of creating an elected version of a monarch. So they conceived of Congress not as a partner to the president, but as a rival. 

In theory, it is equipped with formidable powers intended to act as a structural check on presidential ambition. In practice, the 119th Congress has abysmally failed. Invoking the customary metaphor would be unfair to lapdogs. 

The Supreme Court has, at least until recently, been little better. It, too, has nodded along as though ideological loyalty overrode the law itself. As Lord Sumption wrote of its dismal decision to declare Trump to be exempt from prosecution: “If an ex-president is immune from criminal liability for trying to overthrow the constitution and install an unelected intruder in the White House, one is bound to wonder what is left of the constitution.”

In the matter of tariffs, a majority of Supreme Court justices seem to have recovered their bearings. They were duly denounced by Trump as “fools and lapdogs” and a “disgrace to our nation”. He declared his own nominees, Justices Gorsuch and Barrett, “an embarrassment to their families” and speculated that they had been swayed by foreign interests. 

Like a poundshop Tony Soprano, he subsequently visited the Supreme Court in person—the first president ever to have done so—to eyeball the justices as they considered his almost certainly illegal bid to deny birthright citizenship. He was accompanied on this jaunt by Pam Bondi, his joke appointment as attorney general, whom he has since dismissed for being insufficiently efficient in exacting revenge on his perceived enemies.

Much now depends on the final check on power: the fourth estate. Trump has, of course, done his best to diminish, denigrate, control, ridicule, menace, neuter and sue as many journalistic organisations as he can. He now routinely mumbles “fake news” at any reporter who has the temerity to challenge him. His disturbing pick as defence secretary, Pete Hegseth, gave the game away when he suggested that one of Trump’s closest allies would imminently curb CNN from doing its job: “The sooner David Ellison takes over that network, the better."

How would coverage of Trump look different if it started from the premise that the president was mad rather than sane? It’s a complex question for American journalists, who are trained on concepts of neutrality or objectivity that don’t really work when dealing with mental incapacity.

What currently tends to happen is that journalists try to give Trump’s pronouncements a semblance of coherence. They may signal that the president has been guilty of “rambling”—a favourite euphemism—but otherwise will do their best to make the abnormal seem moderately routine. 

It is called sane-washing.

But, objectively, Trump’s recent performances can no longer be “tidied up” in this fashion. If, in the middle of a high-level cabinet meeting about the Iran war, the president spends five minutes talking about his preference for Sharpie pens, that’s hardly a rambling “digression”. It’s a flashing red light. 

Jumping from wartime geopolitics to office supplies is weird. It’s crazy. And yet we are asked to marvel at Trump’s rhetorical mastery. The president has tried to rebrand his tendency toward a non-linear stream of free-associative word salad as “the weave”. But the rest of us don’t have to give him the benefit of the doubt.

An example. Here’s a verbatim section of a 2024 Trump campaign speech, which begins with an attack on Kamala Harris: 

“She destroyed the city of San Francisco, it’s—and I own a big building there—it’s no, I shouldn’t talk about this but that’s OK, I don’t give a damn because this is what I’m doing. I should say it’s the finest city in the world—sell and get the hell out of there, right? But I can’t do that. I don’t care, you know? I lost billions of dollars, billions of dollars. You know, somebody said, ‘What do you think you lost?’ I said, ‘Probably two, three billion. That’s OK, I don’t care.’ They say, ‘You think you’d do it again?’ And that’s the least of it. Nobody. They always say, I don’t know if you know. Lincoln was horribly treated. Uh, Jefferson was pretty horribly. Andrew Jackson they say was the worst of all, that he was treated worse than any other president. I said, ‘Do that study again, because I think there’s nobody close to Trump.’ I even got shot! And who the hell knows where that came from, right?”

This is by no means an unusually unhinged tirade. It’s just that we don’t often see it presented in its raw incoherence. It’s tidied up for us—by people who are then treated with presidential contempt rather than gratitude. 

But now that mere anarchy is being loosed upon the world on an almost hourly basis; it’s time to face reality. There are around 30 weeks before Congress might reassert its power after the midterm elections. The most powerful man in the world does not have the mental capacity to do the job. And we have to stop behaving as though he does.