On 25 March 2025, five Republican senators introduced a Bill to the State of Minnesota proposing to add Trump Derangement Syndrome (TDS) to the state's list of recognised mental illnesses. Their Bill defines TDS as a condition of paranoia, hysteria, intense hostility towards Donald Trump, and aggression towards his supporters.

This is not the first diagnosis of a 'presidential syndrome'. It is, however, the first time a president has pathologised his opponents. In 2003, conservative columnist and psychiatrist Charles Krauthammer, who helped create the Diagnostic and Statistical Manual of Mental Disorders (DSM), judged that the people who claimed George W. Bush had hidden secrets about 9/11 were suffering from 'Bush Derangement Syndrome'.

During Barack Obama’s presidency, the term 'Obama Derangement Syndrome' briefly circulated, based on the mistaken belief that Obama was not born in the USA. Some even suggested that Obama's cheeseburger condiment choice – Dijon mustard, not ketchup – was another sign of 'foreignness'.

Trump Derangement Syndrome is not the first diagnosis of a 'presidential syndrome'. But what differentiates Trump is that he has embraced it – and weaponised it to his advantage

What differentiates Trump is that he and his allies have embraced the TDS label, weaponising it to their advantage. Trump claimed that those who criticised his relationship with Vladimir Putin were suffering from TDS:

Elon Musk then declared that heated Trump-related arguments with his friends revealed they too suffered with the syndrome. Trump 'diagnosed' actor Robert De Niro, Supreme Court Justice Sonia Sotomayor, and several TV hosts with the condition. After calling Trump a fascist, even John Kelly, Trump's former chief of staff, was judged (by Trump) to be suffering from TDS.

And after their dramatic falling-out in June 2025, Trump declared that Musk, too, had fallen prey to TDS.

Political polarisation and elite narrative

The Musk-Trump spat shows how quickly partisan attachments can shift when elites portray former allies as deranged. Between April and June 2025, partisan views of Musk remained largely unchanged. Yet Republicans’ favourable opinions of him dropped sharply after his disagreement with Trump. Clearly, elite conflict quickly reshapes affective attachments.

Scholarship has not yet examined the effects of psychiatric labelling in politics. Decades of work on polarisation, however, point to worrying parallels. We know, for example, that:

• Ideological and affective polarisation is rising dramatically – in the US and elsewhere
• Ingroups are increasingly judging outgroups as irrational, selfish, and less intelligent
• Partisans avoid opponents in social spaces, workplaces and personal relationships
• Partisan rhetoric among elites has increased sharply since the 1990s
• Polarisation among elites drives populist radical right supporters to form hostile judgements of opposition parties
• Political elites often portray opposition supporters as dangerous
• The resulting political polarisation erodes trust in political institutions, and risks inciting violence

In the past, to delegitimise dissent, political actors have applied psychiatric labels to their rivals. And even in established democracies, politicians use pathological language to portray opponents not merely as wrong, but as irrational and dangerous. Moreover, labelling opponents with a mental illness can serve as a way to detain or silence them without formal arrest, effectively stripping them of their political and legal rights.

Politicians use pathological language to portray opponents not merely as wrong, but as irrational and dangerous

A cautionary tale

It is the job of mental health experts to diagnose who is sane, who to lock up, and who to absolve from legal responsibility. When the target of such experts' diagnoses is politicians, the consequences are, of course, political.

During the nomination process for Republican politician Barry Goldwater in 1964, Fact magazine surveyed 12,356 psychiatrists on his fitness for office. Of the 2,417 who responded, 1,189 deemed Goldwater unfit. They described him, variously, as 'emotionally unstable', 'immature', 'cowardly', 'grossly psychotic', 'paranoid', a 'mass murderer', 'amoral and immoral', a 'chronic schizophrenic' and a 'dangerous lunatic'.

Goldwater sued the magazine and won, though the claims still damaged his campaign. In response to the scandal, the American Psychiatric Association introduced the Goldwater rule, which banned mental health experts from evaluating public figures without personal examination.

Yet the rule has not prevented experts publicly speculating about politicians’ mental health; most notably, Donald Trump's. At the same time, no comparable ethical boundary exists to prevent politicians from deploying psychiatric labels to advance their political narratives.

When mental disorders become political weapons

The US is not alone in politicising psychiatry. To silence dissent, authoritarian regimes have long dismissed opponents as mentally deficient:

• In nineteenth-century America, enslaved people who tried to escape were diagnosed with the pseudoscientific conditions 'drapetomania' and 'dysesthesia aethiopica'.
• During the Cold War, the Kremlin locked up Soviet dissidents in psychiatric hospitals claiming it was 'sluggish schizophrenia' causing them to believe communism was insane. Between the 1970s and 1980s, about a third of political prisoners in the USSR were held under this diagnosis.
• For more than 25 years, the Chinese government has condemned protesters from the ultra-conservative Falun Gong religious movement as being 'insane' for opposing communism. Beijing has forcibly committed hundreds of the movement's adherents to mental asylums.
• In 2022, Iranian students rose up to protest the killing of activist Mahsa Amini. Iran's Minister of Education claimed protesters were suffering from what the DSM describes as 'antisocial personality disorder'.
• And in contemporary Russia, scholars report at least 50 cases of forced psychiatric treatment on people protesting against war in Ukraine.

At the time of writing, nobody has yet been institutionalised for TDS, because it isn't a recognised disorder. But, worryingly, as the Minnesota Bill demonstrates, elites in the US continue to exploit the language of psychiatry for political gain. The US leads global psychiatric norms and political trends. Its politicised diagnoses thus carry serious implications.

Why Trump Derangement Syndrome legitimises hostility and aggression

Weaponising psychiatric language to polarise public opinion doesn't merely deepen disagreement; it signals that opponents are irrational, dangerous, or socially and politically defective. It legitimises hostility, dehumanisation and even aggression. When a political leader with enormous influence uses such language, it can normalise the same among citizens, encouraging people to pathologise one another in everyday interactions.

Weaponising psychiatric language to polarise public opinion doesn't merely deepen disagreement; it legitimises dehumanisation

It is essential that people in political life distinguish between pathology and moral or political opposition. Political actors should never respond to dissent as they would to a genuine security threat. And normalising the language of psychiatry has damaging consequences for people genuinely suffering from psychiatric disorders.

If politicians continue – with little evidence – to dismiss their opponents as mentally deficient, this exacerbates division in already polarised societies, and even risks triggering violent conflict.

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