Pasquale S. Toscano //
Madness is therefore defined to be a vehement dotage, or raving without a fever, far more violent than melancholy, full of anger and clamour, horrible looks, actions, gestures, troubling the patients with far greater vehemency both of body and mind, without all fear and sorrow, with such impetuous force and boldness that sometimes three or four men cannot hold them.Robert Burton, The Anatomy of Melancholy (1621)
Well, sadly, the person who’s running the executive branch is a deranged, unhinged, dangerous president of the United States, and it will be a number of days until we can be protected from him, but he has done something so serious that there should be prosecution against him.Nancy Pelosi to Lesley Stahl, 60 Minutes (2021)
For my mother the therapist, in whose home the stigma of mental illness never held sway.
I. Deranged, Unhinged, Dangerous
The language of disability has long sounded a convenient strain that even progressives rewrite in their acridest compositions. This is particularly true of the rhetoric of “mental illness.” For too often the facile “crazy” or “raving mad” can perfectly cap an evening of gossip about that friend’s, or family member’s, behavior. The same goes for discussions of treasonous actions, though of course with higher stakes.
Case in point: the escalating, asyndetic “deranged, unhinged, dangerous,” a nearly-Homeric epithet for Donald Trump, coined by the honorable representative from California, Nancy Pelosi.
He may be “deranged.” He certainly is dangerous. I would have voted for impeachment.
But asyndeton is a tricky figure (itself a sort of “defective” speech wrote George Puttenham in 1589). Words crescendo with stertorous haste until the series’ final term illuminates everything that came before—and here, the rays of satisfying, righteous equivalency glimmer severely.
Deranged, unhinged, dangerous: shortly after the violent attack on the Capitol by Trump supporters on January 6, 2021, this triangulation seemed enough to cripple—another of those words!—American democracy, but the juxtaposition is nothing new. Dangerous leaders have always been mad—at least eventually. And mad people have long been deemed dangerous. Michel Foucault was the harbinger of this truth in 1965: Paris’s Hôpital général was “an instance of order, of the monarchical and bourgeois order being organized” in seventeenth-century France (40). Into what then has our Speaker stumbled? And why does it matter? Donald Trump, for all his bombast, has not leapt into our lives like Sin from Milton’s Satan. Neither have the discourses we now use to describe our disdain for him—Pelosi’s, psychiatrists’, democrats’, mine—we, whose desperation has left only enervation in its march to the sea.
But we cannot be so fatigued as to ignore how madness, shame, and politics have found themselves forever in a fractious throuple, at least in certain parts of the world—and how to perpetuate this status quo is to perpetrate dangerously stigmatizing narratives about mental alterity. My goal in this essay is therefore not to spotlight the many instances of supposedly-crazy leaders turning out to be just what their countries needed, though I will mention a few case studies. But to obsess over the history of the Speaker’s three words—deranged, unhinged, dangerous—their mutually-informing denotations, connotations, and various, historicized configurations, not only to understand why it is that we gladly accept their imbrication still today, but also to insist that we organize our repudiations of Donald Trump in ways that do not rely upon a bedrock of disabling assumptions about incapacity and impairment.
II. Dangerous, Unhinged, Deranged
There’s a reason Pelosi’s formulation captured headlines, and liberal larynxes, the world over. Many of us are already primed to conflate the three words, especially in the form of dangerous—i.e., impious or nefarious—(and thus eventually) unhinged, deranged. This version seems vestigial, atavistic, even primeval. But it is all the more perilous precisely for its apparent obsolescence.
In passages still interpreted almost literally by some, the Old Testament is clear about disability when, in say, Deuteronomy, it warns unheeding Hebrews, “[t]he Lord shall smite thee with madness, and blindness, and astonishment with heart” (28.28). Nebuchadnezzar of Babylon discovered this the hard way, “driven from men,” forced to “eat grass as oxen,” his body “wet with the dew of heaven, till his hairs were grown like eagles’ feathers, and his nails like birds’ claws,” but when he finally looked up to Heaven, “reason returned” (Daniel 4.33-6).
Similar stories emerge from other cultural frameworks, such as those from the ancient Mediterranean: Sophocles raises to dazzling tragic heights Ajax’s mental breakdown—which involved slaughtering sheep mistaken for soldiers—as punishment from Athena, while in his declining ages of humankind sequence, Ovid foregrounds the nefarious Lycaon, who served Jupiter roasted flesh of a lately-killed hostage. The punishment simply realized what was latent in the act itself: his inhumanity. So the monarch is reduced to scampering into fields, “howl[ing] his heart out, trying in vain to speak,” and developing a “lust for slaughter” (Melville 8). “Madness borrow[s] its face from the mask of the beast,” as Foucault tells us (72)—and then the two become one. It’s no mistake that 1500 years later—in the captivating, obsessive, and maddening work that perhaps remains the best one ever written about atypical psychology—Robert Burton chooses to begin his clinical first partition with lycanthropia, or wolf-madness.
To her credit, of course, Pelosi does not propound a causative link between Trump’s threat to democracy and his madness qua punishment (if madness it is), but her comment depends upon the legibility of a link between them, if not this one—the idea that the terms deranged, unhinged, and dangerous fit together in some way, and that to join them one after the other, is a signal of reason itself. Stahl doesn’t object. Why should we?
III. Deranged and unhinged and dangerous
To approach an answer, we should briefly consider each term individually.
Unhinged is the older of the two synonyms for something like crazy, and as a transitive verb has meant “[t]o unsettle, unbalance, or disorder (the mind, brain, etc.)” (OED 2a) as early as the more literal, to take a door off its hinge; by the turn of the eighteenth century, its past participle was used as an adjective.
Deranged comes into the language another hundred years later to mean essentially the same thing, “Disordered in mind; insane” (OED 1), as in the title of John Perceval’s stupefying Narrative of the Treatment Received by a Gentleman, During a State of Mental Derangement (1838).
All of these descriptors occupy a larger semantic field under the banner of madness, outdated as a clinical moniker, but which very much survives in the vernacular and continues to be associated with DSM-style clinical diagnoses—schizophrenia, depression (once, something like melancholia), OCD; the list goes on, and is ever expanding (Porter 217).
At least since early modernity, throughout Europe and the places it colonized, anyone with any of these conditions might have been considered disconcertingly “distracted”—defined alongside but ultimately differentiated from “idiots,” or the intellectually-disabled, and in practice all but indistinguishable from those who posed the biggest problems to a newfound interest in consistent work ethic (including the “lazy,” vagabonds, and beggars). Many of them ended up in one of the sixteenth century’s houses of correction (like London’s Bridewell, on which cutting-edge new scholarship is being done), the seventeenth century’s workhouses, and finally, by the turn of the eighteenth century, a growing number of asylums wildly differing in quality (and often with frighteningly little government, or medical, oversight), where straightjackets, shackles, and uncleared human excrement could be found in abundant supply, and through which members of the public-turned-spectators could often traipse for a small fee.
Dangerous now claims its place in the equation. Even if the so-called “Great Confinement” is not as synchronously widespread as Foucault would have us believe we cannot ignore the fact that certainly by the fin de siècle of the 1700s more “distracted”—unhinged and deranged—people were being committed because they were dangerous. But dangerous how—or to what? Foucault’s answer—and that of many disability theorists working in his wake—is to centralized political power and the sociocultural norms (e.g., order, an aversion to scandal) required to maintain it.
An alternative is to themselves and to others, the sort of caveat therapists rattle off when they explain the circumstances in which they can violate doctor-patient confidentiality. This possibility has long been presented as probability even in brief discussions of the insane, such as when pioneer of the biography John Aubrey reports that Thomas More once hurled his dog into a river to escape the threatening presence of a roving Tom o’Bedlam (or nondescript mad person, thus associated with England’s notorious psychiatric hospital St. Mary Bethlehem). I’ll leave it to professionals to clarify just how likely mentally-ill individuals are to turn dangerous in the first place, but spoiler-alert, it’s less frequently than we’re primed to believe.
And yet, we cannot allow this horrifying history of policing able-mindedness (cf. Price 268); or reports of horrendous treatment even in the best institutions (Perceval recounts being handled “as if I were a piece of furniture, an image of wood, incapable of desire or will as well as judgement” [Porter 160]); or psychiatry’s obviously checkered history (e.g., antebellum physician Samuel Cartwright diagnosed slaves who tried to escape with the confabulated drapetomania [Nielsen 57]) to obscure the fact that the severity of certain experiences of nonnormative psychology and psychosomatic embodiment is not simply manufactured by social forces (even if the norm is).
In his landmark memoir of depression, for instance, Pulitzer Prize-winner William Styron explained that checking himself into the hospital was the first step to securing a reprieve from disabling depression. There is no doubt about the fact that he would have killed himself otherwise—though he’s quick to criticize several of its medical personnel. (And I should add that the lives of countless others, including mine, have been infinitely improved by psychiatric drugs like SSRIs.) In this case, the formulation deranged, unhinged, and (therefore) dangerous is correct.
IV. Dangerous: unhinged, deranged
So now we have to ask ourselves: is this the kind of danger that Pelosi suggested Donald Trump posed, to himself and to others—and was her assessment motivated by something more than a preference for able-mindedness? On the one hand, the answers to both questions must be a resounding yes. People died in the Capitol riot, and the former president’s culpability is unmistakable, even to members of his own party (though perhaps too few). In 2017, an array of 27 mental health professionals who contributed to The Dangerous Case of Donald Trump largely predicted as much in their explorations of the president’s “individual psychological patterns: his creation of his own reality and his inability to manage the inevitable crises that face an American president” (xvi).
On the other hand, however, these yeses aren’t quite right, or don’t tell the full story.
The truth is that anyone living with psychological disability is dangerous to American democracy regardless of whether they encourage awful acts of domestic terrorism or exhibit “narcissistic personality disorder” (NPD) or flaunt the various kinds of sociopathy to which the writers of Dangerous Case consistently return—but on the basis of their aberrant bodymind alone. This is because what unites most, if not all, of the terms of the semantic field of madness is a lack of reason. An absence of rationality, albeit to varying degrees. Think of this the next time you say someone is out of his mind.
Naturally, this is a problem anywhere people are expected to govern themselves, or to make informed decisions about who should do so. Madness–or for that matter, “idiocy”–is in other words rendered dangerous “by a democratic republic’s need for a competent voting citizenry” (Nielsen 51). There is a long intellectual history at work here: most of the political theorists of ideas such as liberty, freedom, and republicanism that underpinned America’s “founding”–from Greco-Roman antiquity to the Renaissance to the Enlightenment–had grappled with the importance of reason to a well-ordered state. And many of them–e.g., Plato, Aristotle, a score of English humanists–had also conceived of tyranny and madness (and gender) as densely imbricated (a trend Rebecca Bushnell brilliantly examines).
Which is all to say, it’s after the Revolution that confinement truly takes hold in the United States–after this war that cognitive and psychological disabilities become thoroughly menacing as limit cases to humanity’s potential for popular sovereignty. According to John Locke, for instance, “if through defects that may happen out of the ordinary course of Nature, any one comes not to such a degree of Reason, wherin he might be supposed capable of knowing the Law … he is never capable of being a Free man,” and “so Lunaticks and Ideots are never set free from the Government of their Parents” (Two Treatises 2.60). Political theorist Nancy J. Hirschmann helpfully summarizes the philosopher’s gist: “freedom has an intimate relationship to reason; hence, … Locke describes lack of freedom not on its own terms but rather by talking about reason” (180).
So too Milton—though with an important twist. Perhaps seventeenth-century Europe’s most famous (or notorious, depending upon one’s political persuasion) disabled man, the poet/polemicist is often a great iconoclast of ableist images—and I’m convinced he includes an early account of an accommodation request in Samson Agonistes (1116-8)—but his virtuosic opposition to censorship nonetheless privileges a normative bodymind: “when God gave him reason, he gave him freedom to choose, for reason is but choosing; he had bin else a meer artificiall Adam, such an Adam as he is in the motions.” The process involves chaos—stunningly, liberatingly so (cf. Smith 6-7)—yet the need for the mind to triumph over the passions is clear, all the more so in English’s greatest long poem, Paradise Lost.
These are the men America’s “founders” were reading—and it shows. In Federalist 2, for instance, John Jay writes that “many, indeed, were deceived and deluded” by the pamphlets spreading misinformation about the Congress of 1774, “but the great majority of the people reasoned and decided judiciously; and happy they are in reflecting that they did so.”
In order to maintain a healthy body politic, individual bodies must be sane and clean and healthy. We might epitomize this idea as dangerous: unhinged, deranged. Here, the colon is key, an obvious equal sign promising to introduce an elaboration of the category just given. Dangerous citizens in a democracy necessarily include those who are unhinged and deranged.
This seems to make sense until we question whether thinking qua reasoning as it has just been defined is what we want most from a citizen and, even more so, a leader to begin with–“reasoning” as an unerring, privileged modality of making decisions and governing, engaging and interacting with the world. These are certainly important queries, but they cannot be answered fully here.
Nor can we address whether there should be such a thing as the Twenty-Fifth Amendment in the first place–psycho-somatic prerequisites for the presidency and an acknowledgement that certain embodied realities are incompatible with the nation’s highest office. All three are similarly beyond my purview at the moment.
But temporarily tabling these concerns is only possible because they require the kind of nuance in which Pelosi’s—and let’s face it, our—formulation has little interest. Her implication is not that some deranged people are unfit—eugenics, anyone?—for office. But that to be deranged and unhinged is to be dangerous, as if these terms are clear, stable, objective (and as if disability as an identity category isn’t surprisingly fluid or capacious in the first place). This narrative has a history, and importantly, a history of not holding water. The examples of Abraham Lincoln (as Joshua Wolf Shenk has shown us), Franklin Delano Roosevelt, John F. Kennedy, and Winston Churchill (as Nassir Ghaemi brilliantly elucidates) all gainsay the formulation as Pelosi framed it. And though we might take issues with certain aspects of their legacies or lionization—Churchill on colonialism, JFK on the Bay of Pigs Invasion, and so on—many experts agree that their derangement, their madness, their craziness (as Lincoln’s friends branded him, the distinction between this and melancholy being nugatory then, as it often remains today) played essential roles in the parts that we still consider laudable.
V. Dangerous—(and) deranged, unhinged
What we are left with—if we wish to reject the allure of ableism despite its rhetorical power—is a kinder and more tenable alternative: we had a dangerous–(and) deranged, unhinged president. (Never mind that deranged and unhinged carry the same negative baggage concerning psychological impairment that lame does for its mobility counterpart.) The dash (and conjunction) makes all the difference in the world, allowing the possibility of–but not taking as a given–some connection, while at the same time leaving, even insisting upon, room for disjunction and difference.
How does this align with what the medical experts have to say?
Not well. Already, there are a number of open controversies about The Dangerous Case: its contributors defied the Goldwater Rule to start with, and leave little room for the possibility of psychological disability as an epistemology or at least in part a social construction. But at the volume’s best, its contributors are at pains to emphasize that the issue is not “mental illness” per se but dangerousness (and for this section, I’ve reversed the order of Pelosi’s series to reflect as much)—that Donald Trump is mentally ill in much the same way as other horrendous, callous, despotic leaders, Hitler being foremost on everyone’s minds. Fair enough.
And yet, the unfathomably unanticipated travesty of Dangerous Case is that its mental-health professionals have lent a lamina of authority to other uses of the rhetoric of disability devoid of the nuance that characterizes Case at its occasional best. (I say occasional because often, its experts distil entire arguments into facile refrains like Donald Trump is not crazy like a fox but crazy like a crazy .) Circulated by respected news outlets, these other discourses are all the more dangerous because they’re attractive to liberals like me, even while redrawing the boundaries of madness and sanity to fit our current needs without so much as a passing thought about the fact that this was exactly the kind of activity that allowed for the Great Confinement.
Just this past week, in fact, a Washington Post op-ed by Jennifer Rubin—a longtime, but now enlightened, conservative—ran with the headline, “Sane Republicans need to leave the GOP.” The pith is obvious enough, but far more insidious is the way the rhetoric of insanity is used to subtend her point, infusing it with emotion and the shame of stigma for those recalcitrant voters who refuse to cast aside their elephant pins. “Sane Republicans,” she tells us, “have no reasonable hope to rescue their party.” Those who have coopted it are so “nutty” not even Fox News can satiate their lust for “crazier ‘news’ outlets.” What’s more, a “rational approach to government … is irrelevant to the MAGA crowd.” This should sound familiar.
The irony is that I happen to agree with Rubin’s basic arguments (already having sent them to reasonable Republicans in my family). And I happen to agree with Speaker Pelosi (whom, in fact, I respect a great deal, regardless of a growing number of progressives’ disillusionment). I happen to find Donald Trump a vile, would-be autocrat, whose welcome-home to Mar-a-Lago eerily evokes the beginning of Shakespeare’s Julius Caesar.
Which is what makes the argument I’ve made here so hard, so painful, so anathema: how much easier would it be to decry the entire lot of Trump and his supporters as a cabal so crazy, demented, irrational as to be irreconcilable with American democracy? But we on the left, those of us who purport to care about the oppressed and marginalized (like Indigenous individuals, queer folks, women, and people of color who often bear the brunt of ableism in the United States), must hold ourselves to a higher standard to do better, be better, think better. Not normatively, but against able-bodiedness and -mindedness. And, as I’ve argued before, that means activating other standards for condemning the dangerous, deceitful demagogue Donald Trump. If for no other reason than because Trump himself has time and again shown his own ableist colors, his insistence on able-mindedness at all costs.
Pelosi seems to suspect as much when she adds that the then-president “has done something so serious that there should be prosecution against him.” Serious according to what? Until we can devise better standards, our laws, democracy, Constitution. If we make the case that Donald Trump has breached these, as terrifically flawed (and already ableist) as they may be, what more do we gain from calling him crazy? Nothing but the gut punch, the affective cherry on top, the rhetorical piece de resistance so that even if all other arguments fail, we can at last appeal to those final bases for uniting a divided country.
Danger, derision, disability.
Cover Image: Interior of Bedlam, William Hogarth, 1763 (Wikimedia Commons). Description: wealthy tourists–one of whom fans herself–watch the inmates of Bedlam Hospital. One plays the violin, another looks through a small periscope, while still another appears physically unwell.
 Price (2013) offers a particularly brilliant discussion on the issue of naming. Hereafter, I defer to her usage of “mental disability,” along with related terms from mental alterity and difference to psychiatric or psychological disability, though none of these signify in exactly the same way.
Rebecca W. Bushnell, Tragedies of Tyrants: Political Thought and Theater in the English Renaissance (Ithaca: Cornell Univ. Press, 1990).
Robert Carroll and Stephen Prickett, The Bible: Authorized King James Version (Oxford: Oxford Univ. Press, 1997).
Michel Foucault, trans. Richard Howard, Madness & Civilization: A History of Insanity in the Age of Reason (New York: Vintage, 1988).
Nassir Ghaemi, A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness (New York: Penguin, 2011).
Nancy J. Hirschmann, “Freedom and (Dis)Ability in Early Modern Political Thought,” Recovering Disability in Early Modern England, ed. Allison P. Hobgood and David Houston Wood (Columbus: Ohio State Univ. Press, 2013), pp. 167-86.
Bandy X. Lee, ed., The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President (New York: St. Martin’s Press, 2017).
A.D. Melville, Ovid, Metamorphoses (Oxford: Oxford Univ. Press, 1986).
Kim E. Nielsen, A Disability History of the United States (New York: Beacon Press, 2012).
OED Online (Oxford: Oxford Univ. Press, Dec. 2020).
Roy Porter, Madness: A Brief History (Oxford: Oxford Univ. Press, 2002).
Margaret Price, “Defining Mental Disability,” in The Disability Studies Reader, 4th ed., ed. Lennard J. Davis (New York: Routledge, 2013), pp. 298-307.
Margaret Price, “The Bodymind Problem and the Possibilities of Pain,” Hypatia 30.1 (Winter 2015): 268-84.
Wayne A. Rebhorn and Frank Whigham, George Puttenham, The Art of English Poesy: A Critical Edition (Ithaca: Cornell Univ. Press, 2007).
Joshua Wolf Shenk, Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness (Boston: Houghton Mifflin, 2005).
Nigel Smith, Is Milton Better than Shakespeare? (Cambridge: Harvard Univ. Press, 2008).
William Styron, Darkness Visible (New York: Vintage, 1992).