As the president takes to social media for AI meme splurges while his prolonged war with Iran devastates the global economy, Alex Hannaford talks to one of the medical experts sounding the alarm and saying the truth is ‘no longer difficult’ for anyone to see

Just before he hopped on Air Force One for his flight to China to meet President Xi Jinping, Donald Trump posted a couple of memes on his Truth Social account. One was an AI-generated image of Barack Obama, Joe Biden and Nancy Pelosi swimming in the Lincoln Memorial Reflecting Pool, the water full of effluent and rubbish. Above, it read: “Dumacrats Love Sewage”. The other was an AI image of the Democratic governor of Illinois, JB Pritzker, tucking into a giant burger, a slice of greasy pizza and a bucket of fried chicken. “JB is too busy to keep Chicago safe,” it said.

When Donald Trump isn’t sharing delusional AI imagery of those he dislikes, he is pitching himself as the messiah (remember the AI-generated image of himself as Jesus last month?) and, in between raging on social media throughout the night, he’s mixing up his words or even appearing to nod off during televised briefings during the day.

It’s becoming increasingly difficult not to focus on the stony-faced expressions of Cabinet members and aides standing behind Trump as he rambles incoherently through meetings. Who hasn’t watched them and wondered what is happening behind those poker faces as they watch their commander-in-chief lose his thread in real time? This reached fever pitch on Tuesday during his fumbled explanation of the Iran deal, insisting, for instance, that a blockade was holding even as all evidence and intelligence reports confirmed the exact opposite. As retired U.S. Navy Rear Admiral openly remarked, this was all the proof we needed that Trump was finally living with Alice in wonderland.

We can only guess what his inner circle is making of their boss’s increasingly unhinged behaviour. A growing chorus of medical and legal professionals, however, has made their thoughts abundantly clear. In late April, a group of 36 leading US doctors with expertise in mental health had seen enough. Together, they issued a statement calling for Trump’s immediate removal from office for medical reasons.

In it, they said: “... we are compelled to warn of a President of the United States who is increasingly a danger to the public. We do not take our statement, and the responsibility that comes with making it, lightly.” That statement, which includes signatures from two Nobel Prize recipients, was then entered into the official Congressional Record — the archive of American legislative history.

Among those sounding the alarm was Dr Bandy X Lee, a forensic psychiatrist and violence expert who first spoke out about Trump’s mental health soon after his first election in 2016. Lee told The Independent: “I believe it is no longer difficult for even the layperson to see that he is in need of immediate, even hospital-level, care.”

Then, on 11 May, the constitutional lawyer Bruce Fein wrote an open letter to Congress together with lawyer and former presidential candidate Ralph Nader, urging it to enact legislation under the 25th Amendment, which clarifies the transfer of power if a president is incapacitated.

“Every day Mr Trump remains in office is a roll of the dice with the survival of the species,” Fein and Nader wrote. “President Trump might employ nuclear weapons against Iran in a fit of rage … which would not be ignored by China, Russia and Pakistan. Vice President J.D. Vance and principal officers of the executive departments have displayed spinelessness in response to Mr Trump’s dictator-like rants, disqualifying them from fairly appraising his ability to discharge the powers and duties of the White House.”

An analysis of a televised cabinet meeting by The Washington Post revealed that Trump’s eyes were closed for extended periods or he struggled to keep them open on nine separate occasions. The newspaper compared it to another event the previous month when he spent almost 20 minutes visibly struggling to stay awake. In response to pictures from the meeting, the White House responded angrily, it’s Rapid Response account on X posting “He was blinking, you absolute moron.”

Earlier this month, The Daily Beast went even deeper. It published claims that Trump’s late-night and early-morning social media habit meant there were only five days in April when he could have had a full night’s sleep, with a third of his social media output now coming during the night. The outlet said it “must raise questions over at least his physical health, and possibly his mental health, too”.

One documented overnight spree, including the AI-generated image of himself as Jesus and Trump Tower on the Moon, showed posts clustered from 9:49pm. through 4:10am.

Many psychiatrists adhere to the “Goldwater Rule”, which discourages diagnosing public figures without personally examining them, and the doctors added that they did not take their statement lightly. While they admit that Trump was not examined face-to-face and is not a patient of any member of the group, their statement notes “objectively observable signs of serious medical concern”.

While this wasn’t a diagnosis per se, they based their conclusions, they say, on “voluminous evidence from the historical record of the president’s bizarre and impulsive behaviour, rambling digressions, factual confusions, unexplained sudden changes of course in strategic matters, both national and international, and his deeply impaired judgement.”

An accompanying statement concluded that the most worrisome examples were his outbursts of what was termed “extreme, seemingly uncontrollable rage”, such as his multiple threats to destroy Iran. Lee told The Independent that Trump’s grandiose, wishful fantasies and images “are signs of a psychotic spiral … A desperate attempt to counteract the total helplessness one feels when one is losing one’s mind.”

Lee said Trump exhibits delusions of grandeur. “He will not accept limits and his expectations will always exceed reality’s ability to meet them. Hence, we have the perfect setup for a catastrophic, rageful, uncontainable explosion.”

Since the statement was released, she noted in her Substack that Trump has “exhibited even more signs of grandiosity, e.g., posting images of himself on social media shaking hands with God, acting like Jesus and dressing as a pope. And he has continued nocturnal bingeing on social media posts that are filled with accusations of multiple conspiracies against him, as often as 150 times a night.”

While she maintains she is not diagnosing Trump as she would a patient, Lee says she has a positive obligation to improve society and better public health, which includes acting “if anyone is a danger to society — in fact, danger for psychiatric reasons is a mandated duty for which we could be held legally liable for not responding.”

From a psychiatric standpoint, what does a pattern of sleeping four hours or fewer do to executive function, impulse control and the ability to make life-or-death decisions? Lee says that whether caused by anxiety, depression, mania, stress or substances, lack of sleep will worsen any diminished capacity in a person, including executive function, impulse control and critical decision-making.

“We know that he appears to fall asleep during important functions … So, the fateful, life-or-death decisions that are handed to him, or that he takes upon himself despite not being equipped to handle them, imperil our nation and all the globe.”

Lee has spoken about Trump’s propensity for “disinhibition”, the reduced ability to restrain impulses, emotions, aggression and other socially inappropriate behaviour, and “perseveration”, the repetition or persistence of thoughts or actions. Add these together, and “the more he is criticised or disapproved of, the more likely he is to double down, lash out or attack in response, and his inability to hold back or to put aside the issue will keep him spiralling downward in dangerous ways.”

In December, Trump insisted he was “sharper than I was 25 years ago” – before, roughly 15 minutes later, appearing to struggle to keep his eyes open as his Commerce Secretary spoke. Lee says that it’s a rule in psychiatry that the more serious the impairment, the greater the denial that anything is wrong. “In fact,” she says, “lack of insight is one of the symptoms of grave psychiatric illness, especially a psychotic spiral. It brings poor prognosis, because one is less likely to seek help, and the damage is even greater when one cannot tolerate the thought of any defect or failure. This is one of the reasons why it is important to intervene early and to prevent further descent into symptoms.”

As America enters its third month of being in an unsanctioned war with Iran, which has sparked market shocks across the world, many believe the president’s inability to understand what he has unleashed, combined with an incoherence in his messaging, is leading to increasing alarm among those inside the White House, too. There are murmurs from political commentators about growing fears inside the White House regarding Donald Trump’s behaviour, mental state and volatility.

US political commentator Robert Reich, meanwhile, documented a scenario where those closest to the president could finally turn, which he believes has a 30 per cent chance of happening in the next four months.

In this scenario, doing the rounds of smart political dinner parties, he writes: “Trump’s failed war will elevate gas and food prices so high and for so long that much of the Republican base will begin turning against Trump. And Trump’s mental problems will become even more obvious.” Faced with all of this, so the scenario goes, JD Vance promises Marco Rubio that he’ll appoint him vice president if Rubio joins him in seeking to oust Trump under the 25th Amendment. “Rubio agrees.”

It may sound like fantasy politics from staunch critics of the president, but in the face of reality, doing nothing and remaining silent, the medical experts argue, is unethical and unsustainable.

Lee says that, whatever the cause, she believes that Trump poses a grave danger to the nation and to the world for psychiatric reasons. “This is the only criterion we need to implement immediate treatment, including involuntary stabilisation, during which tests can be done to distinguish whether he has dementia, a substance problem, a major mental illness, a dangerous personality disorder, or any combination of these that would produce his presentation.

“Now, with Bruce Fein, we will be urging Congress to appoint itself the ‘other body’ that the 25th Amendment allows and to hold hearings with experts immediately, for the immediate implementation of the president’s removal.”

There is a sharp irony in the fact that many of these medical alarms were once directed at Joe Biden, though a 2025 tell-all book by Jake Tapper and Alex Thompson revealed Biden’s inner circle carried out a campaign of denial and gaslighting around his decline.

For Lee and her co-signatories, their warnings are essentially a black-box recording, documenting what they say is the real-time decline of the current commander-in-chief. Their clinical assessment is now on the record.

The question they have is how so many can listen to these sirens for so long and choose to do nothing.