Robert S.Kiefner, MD lives in Concord.

“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.” – Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark.

It’s hard to say when the actual bamboozling began, but let’s say for sake of argument that Donald Trump’s descent down the golden escalator in June of 2015 coincided with our descent as a nation into identity politics, with the threat of freefall into the hellscape of authoritarianism. In 2017, the Yale psychiatrist Bandy Lee, MD compiled the essays of 27 prominent psychiatrists and psychologists as they expressed their concerns about their dangerous and mentally unstable Commander in Chief in the book “The Dangerous Case of Donald Trump, Duty to Warn.”

His flight of ideas, grandiosity and unique brand of malignant narcissism were worrisome enough. Throw in his pattern of remorseless lying, fixed delusions regarding election outcomes, and repeated attacks upon the Constitution which he swore to protect, and you have a cauldron of psychopathology “like the world has never seen,” to borrow his hyperbole.

Psychiatrists and psychologists have been hogtied by “The Goldwater Rule” with respect to offering a clinical diagnosis of Trump without an in-person exam. During the 1964 presidential campaign, 1,189 psychiatrists went on record in “Fact” magazine as stating that Senator Barry Goldwater, for a host of reasons, was not psychologically fit to be president. The candidate then sued the magazine for libel and was awarded $75,000. By far the more damaging outcome of this suit was the 1973 incorporation of the “Goldwater Rule” into the code of ethics for the American Psychiatric Association and the American Psychological Association, an ethics annotation that remains in effect today.

As a mental health professional, to defy this guideline is to potentially put one’s professional licensure at risk. But with the crescendo in right-wing extremism, medical experts and others may be also placing their own lives at risk by speaking out. Sadly, during Trump’s administration and his subsequent efforts to overturn the election, the “Dangerous Case of Donald Trump” has only been amplified. Supporters in the conservative media and Congress seem to readily brush off his outrageous statements and threats against democracy. They figure that he always lies and exaggerates. “We’re only talking “bloodbaths,” so get over it.” Closer to home, our Gov. Sununu and gubernatorial candidate Kelly Ayotte have both been cutesy in their critiques of Trump’s antics, but have stated that they will abandon any values that they may have once possessed to elect Trump, should he be the Republican nominee.

As Trump’s actions and words have become unhinged (not that they were ever hinged), the “duty to warn” has taken on renewed urgency. At risk to their careers and their lives, many have responded to the call. Members of Congress, Trump cabinet members, former White House staffers, senior military officers, State Department officers, and citizens from all walks of life have openly condemned Trump’s antics. Former Chair of the Joint Chiefs of Staff, General Mark Milley, called Trump a threat to the Constitution, democracy, and the military. For his honest, forthright, and patriotic positions, Trump suggested that Milley should be executed. And Trump’s former defense secretary, retired General James Mattis called Trump “dangerous, unfit, and felony stupid” in Bob Woodward’s book “Rage.”

As the Republican Party morphs into an instrument of the former president’s authoritarian ambitions, Trump exerts unprecedented influence upon current congressional sycophants at his beck and call. As the former president uses his criminal indictments to create chaos and raise money, President Biden quietly makes legislative progress. Many good and competent Republicans have fled the ranks (Liz Cheney, Adam Kinzinger, Mike Gallagher, Mitt Romney), discouraged by the institutional dysfunction, poor reelection prospects, and threats to themselves and their families. The emergence of MAGA, while despicable and anti-American, is hardly borne out of stupidity. While the base is consumed by immovable idolatry, there are very real and intentional alliances among white Christian nationalists and entitled billionaires, who are cajoling relationships with the disenfranchised poor and minorities with fear-mongering.

The voters of concern who may well determine the outcome of this election are the disgruntled Democrats and independents, who may feel that the third party candidacies offer an off-ramp for their very real frustrations with the prices of rent, groceries, and gasoline. But it is increasingly clear that third party candidates are largely underwritten with dark money supplied by MAGA supporters, who cater to the collective amnesia surrounding the misery of Trump’s administration. The former president’s promises to torpedo NATO, dismantle the ACA, stomp on labor rights, and continue the campaign against women’s reproductive rights should give pause to his most loyal supporters. While it has been noted that Trump does not appear to be aging as quickly as Biden, it is appropriate to observe that aging might not seem so noticeable when one’s baseline rhetoric is frenetic and haphazard, and in one who is so unencumbered by empathy and compassion.

Past performance is no guarantee of future results, but even cursory examination reassures us that Biden’s presidency and policies outshine Trump. No matter what our background, we should throw cold water on the Goldwater rule, and speak freely, warning all that the Trump and third party candidates pose very real threats to democracy and rule of law. Be bamboozled no more.