Recent days have raised an arresting possibility: Trump himself appears to be suffering from Trump Derangement Syndrome.

This isn’t really surprising. A practitioner of germ warfare would need to wear an airtight suit to avoid being infected by the virus intended for his or her enemies. Unless Trump has been very careful in the lab, it’s not hard to imagine that his various experiments in conspiracy theory, self-mythologizing, insult, grandiosity and fact denial might be seeping into his own consciousness. At a minimum, there are plainly a lot of people living in his head, and it’s hard to believe he is collecting rent from all of them.

When it comes to discussions of Trump’s mental health, there are always two questions. One relates to measurement. He’s been saying wild stuff for a long time. Is any particular new statement really more daffy than things he has said before? The other question relates to motive. He says things all the time that sound bonkers, or at least would sound that way from any other politician. But, at least some of the time, he is doing so because such behavior is the essence of his brand as an anti-establishment political disrupter. Trump’s efforts to sound like he may really be losing his mind may be evidence of his rationality.

But this binary framing—yes, he is nuts; no, it’s just an act—could be a false choice. In the pathology of TDS, living in the agitated psychic state required to make his performance convincing may over time lead to the performance no longer being a performance at all. Trump has gaslit himself.

At a minimum, his words lately follow a logic that is opaque even to many supporters. Take, as an example that is no longer much of an anomaly, his discursive interview last week with Rush Limbaugh. In the closing days of a presidential campaign in which he is running behind, Trump used the time to keep talking about his 2016 opponent (“She deleted 33,000 emails, she should be in jail for that”); LeBron James (“He’s a hater”) and the NBA (“I can’t watch it … I just don’t have any interest in it anymore”); New York Times reporter Maggie Haberman (“I haven’t seen her, I haven’t spoken to her, in a year and a half”); and the alleged anti-Trump drift of Fox News in recent years, perhaps due to the fact that former Republican House Speaker Paul Ryan is on the board (“You watch this Fox—it’s a whole different ballgame.”) Even accepting that Trump is following a strategy of mobilizing the committed, rather than persuading the one or two Americans who are genuinely torn between Biden and Trump, do these comments advance his self-interest?

In other recent moves, Trump has thrown barbs at his attorney general for not indicting Joe Biden, Barack Obama and others for their role in a “TREASONOUS PLOT” ; claimed that Kamala Harris is a “monster” and a “communist”; asserted that he is “a perfect physical specimen”; retweeted a QAnon-linked account that posted a conspiracy that Osama bin Laden is still living; and at a Johnstown, Pa., rally pleaded: “Suburban women, will you please like me? Please. Please. I saved your damn neighborhood, OK?”

At this late date, many people sniff and sip these remarks as though they are new vintages at a wine tasting (“full-bodied with overtones of smoke; more tannins than usual”) but no one finds them especially shocking. Supporters, no less than foes, accept that Trump just isn’t a normal politician. But we are so used to discussing him clinically (“a disrupter,” in a generous mood; “unbalanced,” in a censorious mood) that neither side typically pauses to ponder that even a non-normal politician must still somehow—even if way deep down—be a normal person.

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