A therapist's warning: Trump didn't break America — permanent outrage did
After my Wall Street Journal opinion piece, "Is ‘Trump Derangement Syndrome’ Real?" was published, the response was immediate and intense. Some readers thanked me. Many were furious. I was accused of excusing Donald Trump, minimizing harm, and betraying my profession. Some messages were hostile. A few crossed into threats.
What struck me wasn’t the disagreement itself, but how quickly disagreement turned into fury. Simply questioning the idea was enough to set people off. That reaction stayed with me, because it reflected something I had already been seeing in my clinical work.
Over the past decade, one psychological pattern has quietly become dominant in American life. It cuts across education, geography, and socioeconomic status. I would even go so far as to call it the defining pathology of our political era: a state of chronic political anxiety in which outrage becomes habitual and threat becomes the default lens.
In my therapy practices in Manhattan and Washington, D.C., the emotional response surrounding Donald Trump has not cooled with time. It has only hardened. Politics no longer feels like something people debate. It has become part of peoples’ identity, something carried internally long after the news cycle ends.
When I wrote in the Journal that "Trump Derangement Syndrome," or TDS, is not a legitimate psychiatric diagnosis, some assumed I was taking sides. I wasn’t. I was making a clinical distinction. The anxiety, obsessive thinking, disrupted sleep, strained relationships, and constant mental preoccupation that many people experience are real, concerning to me, and deserving of care. People aren’t pretending. They’re suffering. What I was pushing back on was the idea that attaching a political label explains those symptoms or helps people recover from them.
In practice, the pattern is familiar. People describe thoughts they can’t shut off. They check the news compulsively. They lie awake scrolling late into the night even when they know it only makes them more anxious. Some talk about feeling physically agitated, unable to relax. Many admit they can’t stop thinking about Donald Trump, even when they want to.
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Over time, this preoccupation begins to shape daily life. People describe organizing their routines around politics: who they feel comfortable dating, where they socialize, which family gatherings they avoid, even where they choose to vacation. Friendships narrow. Conversations shrink. Politics moves from belief into behavior.
This is not a political position so much as a psychological pattern. I’ve come to think of it as obsessive political preoccupation — not a formal diagnosis, but a description of what happens when a political figure becomes the constant focal point for intrusive thoughts and emotional arousal. The mind stays on alert, scanning for danger even when the threat is abstract or distant.
Part of what sustains this pattern is the need for a villain. A villain offers clarity in a confusing world. It assigns blame. It simplifies complexity. It provides moral certainty without requiring much introspection. When personal life feels uncertain or unsatisfying, political outrage can step in to supply meaning and direction.
Trump did not create this dynamic, but he became its most effective vessel. Long after individual controversies pass, the emotional structure remains intact. The identity holds. The outrage becomes self-sustaining.
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Our culture now rewards emotional intensity over restraint. Outrage is amplified, while reflection is suspect. Calm can look like complacency, and stepping back is often treated as moral failure. In that climate, anxiety doesn’t just persist. It’s encouraged.
The result is a society that struggles to disengage. Politics no longer simply informs opinions. It governs relationships, workplaces, and everyday decisions. Many describe exhaustion from feeling permanently braced for the next outrage.
This is not healthy civic engagement. It is emotional overdrive. A functioning democracy cannot function in a constant state of alarm. When everything feels existential, perspective collapses. People lose the ability to distinguish between genuine danger and emotional habit.
None of this requires abandoning convictions or disengaging from politics altogether. It requires remembering that emotional regulation is not political surrender. Donald Trump will continue to dominate headlines. That much is certain.
The more important question is whether Americans will continue allowing politics to dominate their inner lives. At some point, a society has to decide whether permanent outrage is a way to live.