No matter one’s politics, there can be little doubt among rational people that Donald Trump is the greatest falsifier who ever held the American presidency. One can admire and approve of him in spite of it, and tens of millions of Americans do. But tens of thousands of false and misleading statements that he’s uttered (30,573 during his first term alone, according to the Washington Post Fact Checker database), are easily established and not open to debate.

Over the decades, I’ve done exposés of the business activities of presidential candidates of all stripes—from the Clintons and George W. Bush, to Ross Perot and General Wesley Clark. They’ve all had things to try and hide, of course. But none of them were pathological liars, not by a long shot.

Trump’s fabulism played a starring role in his real estate career, too. In his 1987 book, “The Art of The Deal,” he bragged that he uses “truthful hyperbole” and “exaggeration” to “play to people’s fantasies.” Translation: Lies.

Three decades later, prominent physicist and climate expert Dr. Joseph Romm understandably slammed the press over it during a 2019 conference of mental health experts on ‘The Dangerous Case of Donald Trump’ at Washington’s National Press Club: “…but to this day the media treats him as a president who happens to lie rather than a con man who happens to be president.”

Trump’s disdain for truth veered into performance art long before he entered politics. Case in point: Jonathan Greenberg, a fellow investigative reporter in the early 1980s on the newly-born Forbes 400 Richest People in America list, tells me of the time Trump staged a castigation of his father Fred (who built, owned and controlled the family real estate empire) on the phone in his Manhattan office.

During the (June 1982) interview with Greenberg about Trump’s wealth, the developer’s secretary interupted to say that Fred was calling. Greenberg listened as Trump ordered his father around, directing him on suspiciously large cash transactions. But as the reporter physically inched closer, he discovered that Trump was actually talking to himself to try and impress Forbes that his father relied on him to make all the family’s investment decisions.

“There was nobody on the other end of the phone,” recalls Greenberg. “When he saw me get close enough to hear that nobody was talking to him, Donald said ‘Gotta go, dad, I’m with a reporter,’ and quickly hung up. Then he looked at me and said, ‘I handle all our investments. I went to Wharton, you know.’” [Trump’s campaign press team didn’t respond to a request for comment.]

Two years later, in 1984, Trump posed as his own imaginary PR representative—“John Barron”—on a phone call with Greenberg, who taped the conversation. (Trump has been long enamored with the name Barron, which was given as a first name to one of his sons two decades later.) In calls with tabloid reporters, he masqueraded under another name, “John Miller,” once telling a People magazine reporter in 1991 (she also taped the call): “I’m sort of new here…I’m somebody that he knows and I think somebody that he trusts and likes…Have you met him? He’s a good guy, and he’s not going to hurt anybody.”

In 2016, just months before he was chosen as the GOP candidate for the presidency, Washington Post reporters were 44 minutes into a phone conversation with Trump about his finances when Trump was asked about John Miller. Silence, and then the phone went dead. Confronted as well by NBC about Miller, he said: “It was not me on the phone [in 1991]. And it doesn’t sound like me on the phone.” And yet, under oath in a civil case a year earlier, he had testified that “I believe on occasion I used that name.”

Oh what a tangled [and tiresome!] web he weaves. And yet, this back-and-forth made me hunt for a half-day for an old cassette recording of a brief phone interview I had with an undisguised Donald Trump in 1989 for Time magazine. (Yep, same voice as the fake “John Miller.”)

Magnify this nonsense by tens of thousands of lies, and you get a pretty good idea what mainstream media factcheckers have been up against. Kamala Harris, to be sure, like every Presidential candidate in history, has made some false and/or misleading statements, perhaps more to come—and she’s been caught on them. But Trump is in a Solar System of his own that benefactor Elon Musk can’t seem to reach with his SpaceX rockets.

In a book I recently wrote about Bernie Madoff, who ran history’s biggest and lengthiest financial fraud, I asked if there should be an attempt at analysis and comparison of Madoff and Trump. After all, they are arguably the greatest American fabulists of (for Madoff) the contemporary business world and (for Trump) the political world. Do such personalities know when they lie? Or are they delusional? Or both?

Moreover, do the 2020 presidential election deniers have anything in common with investors (and banks, too) who blindly followed Madoff—given that his returns were too good to be true, and given that there were plenty of red flags? And can denial be contagious and transmissible across huge segments of a society? This is shaky, if not treacherous, ground for a journalist to tread—but to Dr. Bandy X. Lee, a forensic and social psychiatrist, and a faculty member in Harvard’s Program in Psychiatry and the Law, the answer is an emphatic “yes.”

My initial talks with Lee on this subject were conducted in early 2021, three months before Madoff died. Election denialism had started sweeping across the country following the 2020 presidential election, based on lies perpetrated by many but ultimately instigated by the uncontested loser of that election, Trump. In books she has edited or written, Lee argued that Trump’s illness is America’s illness, and laid out critical steps she felt should be taken as a result. In the same way, I wondered, should we see Madoff’s enduring $68 billion Ponzi scheme (I established that it ran for a half-century, back to the early 1960s) as symptomatic of a kind of endemic social affliction that we need to address?

There are plenty of similarities between Madoff and Trump, such as bullying. Ask too many questions to Bernie about his trading strategies and he tossed you off the gravy train—not unlike mainstream media outlets and reporters who Trump rarely speaks to because they are the “enemy of the people.” Bernie spoke gibberish to investors when talking about his strategies. Trump’s speeches at rallies, especially of late, are rambling to the point of being incomprehensible. (He calls it “weaving,” as if he’s creating a new language that only he can understand at this stage.)

In 2017, Lee held a conference on the subject of Trump’s mental health at Yale, where she received her medical degree before spending 17 years as a professor in its School of Medicine and Law. The conference led to a New York Times bestseller she edited called “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.” She penned two subsequent books, including “The Psychology of Trump Contagion.” And in 2019 she hosted the Washington conference mentioned above (covered by C-SPAN) with a panel of mental health professionals. One month ago, a second gathering took place, plus an updated version of the first book—this time with essays by 40 experts.

“This is not a political conference, it is a medical one,” Lee said to kick off the conference.

Lee says she’s received thousands of attacks from Trump supporters on social media (mainly Twitter), email and voicemail, including some death threats. But the Bronx-raised doctor is not deterred, which is music to the ears of law professor Richard Painter—the Chief White House ethics lawyer in the George W. Bush administration—who said at last month’s conference: “We need to hear from Bandy, we need to hear from her colleagues, and we need to hear before it’s too late.”

Last June, Mark Milley, the former Chairman of the Joint Chiefs of Staff under Trump, agreed to pose with Lee’s first book for a photo [see on top] outside Princeton’s School of Public and International Affairs, where he gave a talk reflecting on his life and career. He didn’t mention Trump in his speech. But it was later revealed that Milley called Trump “fascist to the core” and “the most dangerous person to this country,” according to a new book by the Washington Post’s Bob Woodward. (Trump is promising to prosecute and even use the military against political foes if he wins.)

Similarly, Trump’s former White House chief of staff, John F. Kelly, a retired Marine Corps general, secretly bought and used Lee’s book as a “helpful guide to a president he considered a pathological liar” and “to understand the president’s particular psychoses.” according to veteran journalists Peter Baker (of the New York Times) and Susan Glasser (New Yorker)—who interviewed Kelly for a book they recently published. Kelly came to refer to the White House as “Crazytown.”

Like most mental health experts, Dr. Lee says she and her colleagues won’t diagnose people without having treated them directly. That would be a violation of the American Psychiatric Association “Goldwater Rule” dating back to 1973. But words such as dangerous, fascist, and unfit for office are not listed as diagnoses in the industry’s decade-old bible, “The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).” Nor for that matter is pathological liar, sociopath or malignant narcissist.

Every now and then, a prominent psychiatrist takes a swipe at Lee, arguing that she or some of her colleagues cross or skirt too close to the diagnoses line. Lee says it’s not true and that “the overwhelming medical consensus, including renowned legends in the field and actual Goldwater Rule experts, are with us on this.” She says their group, the World Mental Health Coalition (WMHC), formed in 2017, has thousands of mental health professionals as members and is the largest professional organization to address “dangerous leadership due to mental unfitness.” Many who speak out against Trump point to the World Medical Association’s Declaration of Geneva of 1948, which obligates health professionals not to comply with destructive regimes when they go against the humanitarian goals of medicine.

One critic of the group, Dr. Jeffrey Lieberman, a past president of the APA, penned a column in Vice in 2017 about “Trump’s Brain” where he maintained it’s “inappropriate for psychiatrists to opine on public figures that they do not have direct knowledge of or authority to diagnose.”

And yet that seems to be what Lieberman himself once did (or almost did, depending on how one looks at these things.) How so? In the column, he pointed out that a presidential Cabinet can invoke the 25^th Amendment to remove a president deemed incapable of discharging his or her duties. But, astonishingly, there are no guidelines or processes in place to determine the medical criteria. In an attempt to “simulate” what such a process would entail, Lieberman gathered a panel of seven brain-disorders experts who—on the basis of public information about Trump—“ruled out” DSM diagnoses such as bipolar disorder (BD), narcissistic personality disorder (NPD), intermittent explosive disorder (IED), and attention deficit disorder (ADD).

Only one diagnosis—incipient dementia (ID)—struck them as the “most plausible” condition Trump was suffering.

[Notably, his panel of experts used mild words such as intemperate, erratic bombastic, and self-interested behavior to describe the president. But Trump is also a pathological liar, I pointed out to Lieberman. “That’s true,” he replied. And yet his article says nothing about lying and falsifying.]

“I called it a simulation, and that was too clever by half, because it was more than a simulation,” he says, in defense of the panel’s work. “Everyone went through the existing evidence. The only thing is we would never have committed ourselves to is a DSM. We stand by this as an opinion.” He says “the more accurate piece I wrote,” was a New York Times op-ed in 2018, where he stated that Trump could conceivably be just “a jerk” and not mentally ill.

One thing Drs. Lieberman and Lee agree on is how insane it is that candidates for the most powerful position on earth aren’t vetted on their health and mental status in a rigorous and reliable way. “In many corporations, there’s a requirement for a physical or medical exam,” points out Lieberman. “But if you’re a candidate for the presidency, you can just produce a letter—like getting a letter to say the dog ate my homework or not—and then go through a perfunctory annual check-up, which is mostly a check-up from the neck down. Adds Lee: “No one with Donald Trump’s impairments would be hired by a private corporation or by the military, the police, or the government civil service.”

Not to beat this poor horse to death, but on the subject of the APA’s ethics rule against diagnosing-from-a-distance, neuropsychiatry expert Dr. James Merikangas (George Washington University) told the audience at the September conference that forensic psychiatrists are frequently called upon to diagnose people from their death certificates, or their medical records with interviews in prisons and other places where they don’t have all of the lengthy examinations that psychiatrists generally do.

“You could still make a diagnosis and that has been done many times with Donald Trump,” he says. “I am not going to make a new diagnosis of this man. I am going to subscribe to the fact that he is a pathological liar and that he is not very smart and it is very clear, as has been pointed out, that his mental faculties are deteriorating.”

Another speaker, Dr. Stephen Xenakis, a psychiatrist and retired Army Medical Corps officer, said that while he won’t render a specific medical opinion about someone who has not been examined by him, both he and his army medical colleagues were called on frequently to evaluate people for “fitness for duty” and for “dangerousness.” He laid out some examples: “We had to respond to the request by our leaders to say, ‘Should this person have a security clearance? Can this person be put back into the cockpit? Should this surgeon go into the OR? We have what we call the Nuclear Surety Program. Should this person have access to nuclear weapons?’”

In Xenakis’ view, Trump is unfit and dangerous and we can expect serious cognitive “decline” if the 78-year-old is elected next week. “And it needs to be said,” he added. “It was clearly the story that ended up with President Biden deciding not to run anymore…The people who need to understand that—if we’re going to be able to save our country—are those young people sitting on the couch who may not want to vote, who have decided to abdicate their roles and in my view, their responsibilities as citizens, or the swing voters.”

Hitler came up a lot at the conference, largely because Trump promises to enact the “largest-ever deportation” in American history on day one. Last week, his running mate, Sen. JD Vance, said that even Haitian immigrants with legal immigration status are “illegal aliens” who have been unlawfully protected from deportation.

This terrifies mental health experts such as Dr. Henry Friedman, a professor of psychiatry at Tufts and Harvard medical schools who has also been treating patients for more than a half-century. He feels these immigrants are in same position Jews were in during the early years of Nazi Germany when they were deported en masse. “People do not like to think about Hitler and they certainly do not like to think about Trump as analogous or identical, but I actually see it that way,” he told the audience. “I think he really does believe what he says, and I think he believes that with a vengeance.” But many people, particularly Trump supporters, think this is unjustified alarmism and scaremongering.

In Dr. Lee’s view, the former president’s most ardent followers represent a national mental health crisis that cries for a solution. “People are failing to grasp that the most dangerous individuals in history gain popularity through the spread of symptoms, not through rational persuasion, and the symptoms can travel via emotional bonds. At extreme levels, they can result in a shared psychosis, or folie à millions.” In fact, an article by Lee in Scientific American is titled “The ‘Shared Psychosis’ of Donald Trump and His Loyalists.”

Trump’s MAGA supporters reading that that paragraph (no to mention others) will either go nuclear, swear, laugh, wave it off as nonsense, or tweet her some nasties. But if Lee is right about that, do financial fraudsters such as Madoff rise to that same level? Why is it so that so many Ponzi schemes (although not—at least not yet—of Madoff ’s size) continue to proliferate, even as investors are warned time after time that the fantastical returns they are allegedly receiving in such investments are unrealistic. Is the proliferation of predatory fraudsters its own kind of mental health contagion? Or is that taking things too far?

Lee’s take: “Just as Donald Trump is a public health problem more than an individual one, and he represents the dangerous tendencies in our society, so was Bernie Madoff, on a smaller scale.”

Put another way, she believes, sociopathy is more a societal disorder than an individual one, meaning everyone contributes to it in some way, or fails to counter it, even if we never directly had contact with a Trump or Madoff. “Sometimes it takes over such important structures that it can topple institutions or an entire economy,” she warns. “The solution is truly to fix the socioeconomic and cultural conditions that give rise to sociopathic individuals.” That’s a tall order, to say the least, whether one agrees or disagrees with her takes on Madoff or Trump.

Lee thinks it’s safe to say that the two men share (for Madoff, shared) well-sharpened predatory skills. “Predation is usually the goal and the purpose of life for those who are not bound by human attachments, by goals that others find important, or by a conscience,” she explains, adding that while Madoff worked hard to stay out of the public eye, Trump’s financial predations are out in the open—and seem to have no bottom. Lately he’s been hustling everything from Trump bibles ($60), Trump trading cards, silver coins with his face on them ($100), limited-edition gold watches ($499), “Never Surrender” gold high-top shoes ($399), Trump cologne and perfume ($99), hoodies, phone cases, even “Trump Ice” bottled water.

For a presidential candidate, this is unprecedented, tacky, and yet very American. And if his supporters want to buy them, so what? Does this tell us anything about Trump or his souvenir-adorning followers from a psychological standpoint? “It shows the degree to which Donald Trump is willing to exploit disproportionately poor, oppressed and uneducated followers,” says Lee. “He mongers them with fear that the other side will win without their financial sacrifice, cheats them, and promotes a false identity and false sense of ‘belonging’ by wrapping themselves in his paraphernalia.”

Putting aside the junk peddling, how much of Madoff’s and Trump’s bunkum do they themselves (for Madoff, did) believe to be true? “If they tend toward a pathological form of narcissism (as she says Trump certainly does), they believe it all. But if they are people with a conscience, they don’t believe anything—they just put up a facade.”

In the mid-2010s, when I wrote exposés about Trump’s close business ties to a former Russian mobster, I agreed with then-Wall Street Journal editor Gerard Baker that the word “lie” shouldn’t be used by media outlets unless one could establish that the falsehood was intentional—no easy task. Similarly, Gene Foreman, who ran the newsroom at the Philadelphia Inquirer for a quarter century—during which the paper won 18 Pulitzer Prizes—told me he agreed. (Foreman is also the author of “The Ethical Journalist,” a textbook that is considered The Book of Books for sound decision-making.)

In his recent memoir, Marty Baron, executive editor of the Washington Post from 2013 to 2021, writes that “restraint and standards” initially made his newsroom hesitant to use the word “lie.” That’s because the term “suggested we were certain that Trump was certain he knew what he was saying was false,” explains Baron. “And for the most part, we couldn’t be sure. Perhaps he was deluded, which hardly recommended him for the presidency, or, being generous, he could have been grossly uninformed. Or maybe Trump was the ultimate bullshitter.” In his book, Baron cites Trump’s “fantastical thinking that defied verifiable facts” and tweets that were “detached from reality.”

The turning point for the Post was in 2018 when Trump insisted he knew nothing about hush money paid to women who alleged affairs with him. “Not just misleading. Not merely false. A lie,” declared a headline. Trump not only denied making payments, he had lackeys issue denials on his behalf. The word “lie” would appear many times thereafter in the Post, including about Trump’s insistence to this day that he won the 2020 election.

That said, many Trump supporters don’t believe he lies, while many others don’t care that he does because they like his policies. “I would say that the vast majority no longer care what is truth or lies,” says Lee. “What he does is reconstruct priorities, so that eventually his needs are their needs, and this may include detachment from reality. A characteristic of pathology is that supporters will cling to the belief that they are benefitting from his policies, even in the face of contrary evidence and even to the point of destroying themselves. Consider Rudy Giuliani.”

Indeed, the former New York City mayor had his law license permanently revoked last week in the nation’s capital over his role in Trump’s attempt to overturn the results of the 2020 election. Also last week, a federal judge ordered Giuliani to turn over all of his valuable possessions to two Georgia election workers he defamed.

Those assets include his Manhattan penthouse apartment, a 1980 Mercedes-Benz previously owned by actor Lauren Bacall, his collection of 26 watches, and his interest in about $2 million that he says Trump’s 2020 presidential campaign shortchanged him on for his legal work trying to overturn the election. He owes the two election workers $148 million in damages due to his lies, which perhaps explains why he’s peddling his own brand of coffee beans on extreme-right media outlets.)

As for the Post’s Fact Checker team, it could barely keep up with Trump’s falsehoods. The expansive database turned out to be a tremendous burden that reporters did on their spare time during the four years of the Trump administration. The last five months—roughly 10,000 claims—were especially tough on them. So they resolved that for Biden, they would only do the first 100 days—which is what the Trump project started as until reader pressure convinced them to keep going. Hats off to the Post. It was public service journalism at its best. And whoever takes office in January, we must hope the newspaper can find the time and resources to restart the project.

While those Post fact-checkers never used the word “pathological” to describe Trump’s falsehoods (it wasn’t their job to), Dr. Lee believes it’s vital that mental health experts come forward and describe his level of lying as pathological—and to educate people that such levels “cannot be countered through mere fact checking or by simply calling it ‘lies’… The effect of pathological lying, as we have seen, is to inundate public discourse until there is no more recourse—until truth no longer matters, the public is ‘gaslit’ to disorientation, and his audience conditioned to accept fantastical assertions that are no longer tethered to reality.”

On that subject of fantastical gaslighting, several days ago a CNN correspondent spent 24 hours consuming mega-MAGA media for a three-minute video. You’ll find a former Trump White House press secretary (Sean Spicer) pushing a special hemp powder than helps him sleep (“40% off for a limited time”). And Giuliani hawking “Fighting For Justice RUDY organic coffee”—just $29.99 for a two-pound bag; 10% off on your first order). And you’ll learn that “the secret ingredient” in the COVID vaccine has been found.

Aside from such bizarrities, the CNN reporter reveals this overriding theme he found in that media universe: That Trump will absolutely win next week’s election, or else the election will have been stolen. Which of course raises the specter of whether, if Harris wins, there will be Jan 6-style violence again.

Lee saw it coming the first time. She’s an expert on violence, having spent 25 years specializing in treating violent criminals in prisons. She authored a textbook on public health approaches to violence, and initiated reforms at Rikers Island—home to New York City’s main jail complex. “A public health problem has given rise to Donald Trump, but placed in a powerful position, he has become the main threat to public health,” she argues. “I predicted in my 2020 book that his fragile psychology would not be able to tolerate an election loss, that violence would result, and that his ‘presidency’ would not end for his followers.” Veteran journalist Bill Moyers, a White House press secretary under LBJ, called her “the least surprised person in the country.”

For the past week, Dr. Lee, who also earned a masters degree in divinity from Yale, has been in a monastery in the Himalayas—“praying for the nation.” That’s probably not a bad place to be right now.