Dr. Lance Dodes on Trump's courtroom antics: "Decompensate to the point of gross paranoid psychosis"

"The decompensation consists of exposing an inability to see reality"

By Chauncey DeVega

Senior Writer

Published November 7, 2023 6:00AM (EST)

Former US President Donald Trump prepares to testify during his trial at New York State Supreme Court in New York, on November 6, 2023. (JABIN BOTSFORD/POOL/AFP via Getty Images)
Former US President Donald Trump prepares to testify during his trial at New York State Supreme Court in New York, on November 6, 2023. (JABIN BOTSFORD/POOL/AFP via Getty Images)

Testifying in court is stressful, even under the best of circumstances. Testifying when you are the defendant and your future and freedom are being decided by the court, is even more anxiety-producing. For a person like Donald Trump, someone who is mentally unwell, the stress and pressure caused by a courtroom is likely cataclysmic.

The fact that he is being held accountable for his obviously criminal behavior by people whom he deems to be beneath him as a rich white man appears to be especially maddening for the ex-president. As the pressure of accountability grows, in these last few weeks and days Trump has defied the court’s gag orders and fines by continuing to threaten court officials, witnesses, and his other “enemies." He has been disruptive, being so bold and contemptuous of the proceedings that he even went so far as to storm out of the courtroom while chased down by his Secret Service detail. He also let out a deluge of posts on Truth Social in apparent response to the civil trial and his children being forced to testify, where he raged and appeared to be having a tantrum.

"There is an often-neglected component of narcissism that ends up directed against the narcissist himself. Don’t forget that Narcissus drowned after he became weak because he was unable to look away from his reflection in the water."

On Monday, Trump “testified” in the New York civil trial. As predicted, Trump claimed he is a victim of “persecution” and that he is being unfairly targeted. He attacked the judge, the attorney general, the prosecutors, and the legal system more generally. At one point, Trump was so out of control that the judge admonished his attorneys, telling them to control their client because if they could not, he would be removed from the stand. In all, Trump behaved like he was at a political rally and the court was a theater for him to perform in. Salon's Tatyana Tandanpolie summarized Trump's outlandish and dangerous behavior as follows:

Legal experts, though unsurprised by Trump's courtroom conduct, seemed floored by what the former president was getting away with on the stand.

"Already sparks are flying in all directions in trumps testimony – Trump surly w/ AG, Kise criticizing questioning, and judge striking Trump responses without being asked," former U.S. Attorney Harry Litman wrote on X, formerly Twitter. "Going to be a really crazy day and Trump likely to blow his cool on multiple occasions."

"Donald Trump forgetting that this is a bench trial not a jury trial," wrote MSNBC legal analyst Katie Phang.

"Yet another reminder of why Trump will never testify at his criminal trials," national security lawyer Bradley Moss tweeted, pointing to Engoron's requests for Trump's comments to be tamped down.

"If the Trump lawyers are having these many issues in a civil trial, imagine how they’re going to handle a criminal one," Moss added

"Mind you, this is Engoron extending to Trump the ability to smear the presiding judge in a way other individuals could not do without fear of being held in contempt," he said in another tweet, referring to when Engoron told Trump he could attack him. 

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Trump’s claims that he is a “victim” who is being unfairly prosecuted because of a “witch hunt” are of course not true.

I asked several leading mental health experts and one of Trump’s biographers for their expert insights and observations about his state of mind and resulting behavior these last few weeks and what may come next as the corrupt ex-president’s legal troubles escalate.

These interviews have been lightly edited for clarity and length

Dr. Lance Dodes is a former clinical professor of psychiatry at Harvard Medical School and a training and supervising analyst emeritus at the Boston Psychoanalytic Society and Institute:

Donald Trump’s severe narcissistic, antisocial (sociopathic) character disorder means he cannot tolerate or even acknowledge losses or defeats. Instead, he lashes out with less and less grasp of reality, insisting more and more that he is personally great, a saintlike martyr and anyone who dares to hold him accountable for his lies or his crimes is evil. His lengthy history, however, shows the opposite, that he is simply a sociopath, interested only in his personal gains in power and wealth despite the harm to others.

Those who have concluded that he is decompensating are correct, though it would be more precise to say that the decompensation consists of exposing an inability to see reality and violent self-interest that has always been who he is. As many have predicted, as pressure on him continues to rise, his claims of greatness, his inability to accept legal constraints or punishments, and his destructive impulses toward all who have limited him, will increase. Ultimately, he may decompensate to the point of gross paranoid psychosis with even more obvious incitement to riots and civil war rather than accept the reality that he has been finally held accountable.

Dr. Justin Frank is a former clinical professor of psychiatry at the George Washington University Medical Center and the author of "Trump on the Couch: Inside the Mind of the President":

There is an often-neglected component of narcissism that ends up directed against the narcissist himself. Don’t forget that Narcissus drowned after he became weak because he was unable to look away from his reflection in the water. Trump’s power is weakening for the same reason. He is unable to look away from fantasies of his own great beauty - his reflection in the lake - long enough to keep himself from weakness before he fell in and died. While specifics are different, the myth persists. Now I think Trump can’t look away from his paranoid anxiety, including his impending dementia, and will drown in jail.

He is willing to go to jail because it is a continuation of the psychotic part of his narcissism - he is so special and powerful and compelling that others will keep looking at him, while he doesn’t realize that few people are as narcissistic as he is. It will be the next part of his downfall because of that very myth, now projecting his own eyes of his greatness onto his followers, but not Into Them.

As for his kids, pathological narcissists see kids as extensions of themselves. So, if they stop functioning as extensions when they turn on him, he will cut them loose. His not showing up for their testimony is a case in point. It will be interesting to see if he will show up for Ivanka’s on Wednesday.

All of this is about assumptions of undying love like his undying self-love.

Trump is so secure in being loved that he is unable to think clearly. What this means is that he assumes that people love him so much he can still shoot someone on Fifth Avenue, and he can still lie to federal agents, and they will love him still as he goes to jail. That is not true, because, following the myth of narcissus to its end, he is nearing the level of complete self-destruction.

Dr. Mark Goulston is a prominent psychiatrist and former FBI hostage negotiation trainer:

Trump alternates between being a malignant, malicious narcissist and a sociopath. From his narcissist side, he is all about control and power and the two things that trigger his rage and reckless abandon are when he is feeling out of control and powerless. When that happens, he is like a mortally wounded animal, which can be the most vicious and dangerous animal of all.

"As for 'decompensation," this requires that Trump is a somewhat normal person living in a state that allows for a decline into this condition. He's never been typical in this way."

From the sociopath side, the more he has to hide, the more he has to fear. He has gotten away with so many hidden things for so long, that he has been able to manage the fear of them being exposed. But now where so many hidden things from so many directions are coming at him, the fear and paranoia he is experiencing is more than he can manage. Hiding things effectively was for a much younger, sociopathically agile Trump.

I believe he could be pushed over the edge to truly outrageous behavior that even some of his base would see as too extreme, if someone came forth with the threat of exposure of things, without specifically naming them, that go back to his college years, his teens and before (because this is a lifelong pattern of behavior). That would make his imagination and paranoia go so wild as to cause him to become completely unhinged.

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Finally, Trump is also a gambler and is banking on the fact that all the judges are afraid to lock him up because if that happens, they're afraid they'll trigger the kind of retaliatory rage and violence that we're seeing now against Israel and Jews. In spite of that belief, we're also seeing how that gamble is becoming less likely to pay off.

Michael D'Antonio is the author of the biography, "Never Enough: Donald Trump and the Pursuit of Success":

Although many in the press indulge in the assumption that Trump is filled with anxiety and fear (I've speculated about this in the past) I now favor the idea that he is enraged but not afraid. Anger and disgust for the opposition make up his emotional set point and I suspect this hasn't changed. He may also feel a bit of confidence based on his lifelong success in avoiding accountability. He likely believes that he can hide behind claims of ignorance or defiant arguments against prosecutors and that with his coaching his attorneys will succeed in limiting the damage.

Given the possibility of appeals, which would at least delay his comeuppance, I wouldn't say that the prosecutions are causing him to “lose his sh*t”. This doesn't mean he isn't raging at those around him. The thing about this is — he has always raged against those around him. Those who are loyal understand that these outbursts are generally about him letting off steam and may even believe that when they occur, they are followed by a return to expert scheming. As for "decompensation"...this requires that Trump is a somewhat normal person living in a state that allows for a decline into this condition. He's never been typical in this way. However, should he ever reach the end of the line with a conviction, he may finally be reduced to such a condition.

I doubt that Trump fears being betrayed by his children. They are too well-trained and so firm in their devotion that they would do anything, including commit perjury, to protect him. (He does feel that Michael Cohen has done him dirty, of course.) As he claims martyr status Trump is aligning himself with the experience of many of his followers who consider themselves to be victims of a society that had rigged the game against them. (This is why they believe Trump's election fraud claims.) The forces arrayed against them include the government, Hollywood, the coastal elites, and, more recently, big business. (Hence Josh Hawley's appearance at a United Auto Workers union picket line.

Is Trump willing to go to jail for MAGA? I doubt that this sentiment is sincere. He declares it as part of his effort to portray himself as a victim and a hero to what began as a slogan and became a movement devoted to disruption. I can imagine 'round-the-clock vigils and even riots outside wherever he could be incarcerated, which would affirm his belief that he has followers who will never abandon him.

As a rule, it is wise to consider Trump as a man constantly painting a self-portrait. (In real life he expects to be carved into Mt. Rushmore.) I think he believes he is too good for this world, and that if we don't recognize this now, we will someday.

By Chauncey DeVega

Chauncey DeVega is a senior politics writer for Salon. His essays can also be found at He also hosts a weekly podcast, The Chauncey DeVega Show. Chauncey can be followed on Twitter and Facebook.

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Crime Democracy Crisis Donald Trump Fraud Interview Lance Dodds Law Mental Health New York Tish James