Dear Mr A,
Thank you for attending the Trump Derangement Syndrome specialist clinic at Borough County Hospital on 26 January 2026. It was a pleasure to meet you and to discuss the symptoms you have been experiencing. You reported episodes of extreme and almost uncontrollable anger, fits of vituperative outburst, and a pronounced tendency to catastrophise potential scenarios. You indicated that these symptoms began earlier in January, following reports of the President’s threats to either purchase or invade Greenland, and were subsequently exacerbated by his remarks dismissing NATO, and in particular British troops’ achievements in Afghanistan, over the past weekend.
You informed me that the onset of these symptoms came as a complete surprise to you, given your previous resistance to the Syndrome and its effects. You reported a longstanding right-of-centre political orientation with libertarian leanings, which had led you to assume a degree of immunity. You noted that your wife, children, and several members of your wider social circle — especially long-standing contacts from your university arts course — have experienced acute episodes in the past. You had therefore regarded yourself as comparatively resistant — and indicated that you had, in private, supported a number of the measures implemented by the President since his election, including several that have acted as significant triggers for others in your immediate environment.
One notable feature of your presentation was that you had previously followed recommended guidance in not taking all presidential statements at face value, applying — as per NHS advice — “large pinches of salt” alongside the President’s public rhetoric. You reported that you had generally recognised the more extravagant elements of what the President refers to as his “weave” style as exaggerations, intended to disorientate interlocutors rather than to signal literal intent. This pattern altered in mid-January, when you interpreted at face value the President’s remarks concerning the possible invasion of the sovereign territory of a NATO ally. This shift was followed by episodes of marked verbal agitation, including shouting at television news coverage (I recommend abstaining from the BBC as a therapeutic aid) and the production of extended, emotionally charged posts on social media.
I explained that this presentation was symptomatic of a typical outbreak of Trump Derangement Syndrome (TDS), a condition which short-circuits the patient’s capacity to apply proportionate analysis to presidential utterances. I asked whether you genuinely believed that the President would have authorised a direct military incursion by US forces into the sovereign territory of a close ally. You replied, with some evident uncertainty, that you were not sure, that it was difficult to know, and that in any case there was the precedent of Venezuela. This final response was diagnostically significant, as it demonstrated the category confusion that constitutes a core indicator of TDS.
We agreed that the seizure of the Venezuelan president had, in fact, taken place. I explained that this action occurred under conditions that differ categorically from those of a sovereign allied state: the target was diplomatically isolated, militarily weak, and outside any binding alliances. It took place in a context of implicit regional consent, significantly lowering the political and strategic costs involved. However, because this episode represented a clear breach of expectations, you reported a growing willingness to believe that the President would escalate further, extending even to military action against an ally. At this point, the effects of TDS were evident in a reduced capacity to distinguish between actions.
This was followed by the President’s speech at Davos, after which you showed me examples of posts you had made across several social media platforms, asserting that the President was, to use your own word, “insane.” You described experiencing shock, vertigo, and physical agitation — “reeling” was the term we eventually agreed upon. However, within a matter of hours, these symptoms subsided and were replaced by feelings of embarrassment and deflation, as the President and representatives of NATO reached an agreement and the prospect of the United States purchasing, never mind annexing, Greenland came to appear implausible. You reported feeling foolish for having regarded this as a realistic possibility and indicated that you had deleted a number of your more extreme social media posts, principally those in which a hypothetical invasion of Greenland became a wider global catastrophe.
You then described attempting to spend what you had hoped would be a quiet weekend with your wife and youngest daughter in the countryside. However, while driving to Somerset, a radio bulletin alerted you to remarks in which the President questioned the role of British troops in Afghanistan. You reported that this caused a brief but alarming loss of composure at the wheel. You expressed to me, in emphatic terms, that this particular incident represented a final breach, and that you now regarded yourself as his sworn opponent “forever.” A review of your social media activity following your arrival suggests that this position was communicated with sufficient force to make the future granting of a US entry visa during the remainder of the 47th Presidency highly unlikely.
By the time of our consultation, a subsequent telephone call between the President and the British Prime Minister had already produced a renewed sense of deflation. We discussed your resulting emotional confusion. On the basis of our consultation, and following a review of your recent social media activity, I am able to confirm a diagnosis of TDS.
Under no circumstances should you allow yourself to react when the President is more outrageous than on previous occasions
I would like to explain briefly the current understanding of this condition. Episodes are commonly precipitated by the patient’s expectation that there exists some stable ceiling to the President’s utterances. When the anticipated ceiling is repeatedly shown not to exist, expectations are destabilised, triggering an initial acute episode. In your case, the suggestion that Greenland might be invaded proved sufficient to overwhelm what had previously appeared to be a robust level of resistance.
Once established, the condition tends to recur. Each subsequent outrage is experienced as unprecedented and intolerable, despite clear evidence of prior escalation. The absence of any upper limit to provocation flummoxes judgement, producing recurrent shock rather than adjustment over time. You may still feel that the President will not, or cannot, go further than he already has; I advise strongly that you be vaccinated against any such assumption.
With regard to management, I will ask your GP to issue the following prescription. First, under no circumstances should you allow yourself to react when the President is more outrageous than on previous occasions; he will be. You will be issued with a recording intended to guide you through the visualisation of a ceiling to provocation, before guiding you, calmly, through the recognition that no such ceiling exists. Each time the President articulates a new extremity, pause, breathe, and do nothing. Maintain an attitude of watchful waiting for a period of up to three weeks. When the situation inevitably levels out, note that you have once again merely observed the President getting a deal.
You are advised not to attempt to infer his endgame; this is not information he is likely ever to disclose
In The Art of the Deal, the future President observes that he aims high, applies sustained pressure, and is often prepared to settle for less than his opening gambit while still achieving a satisfactory outcome. You are advised not to attempt to infer his endgame; this is not information he is likely ever to disclose. It may also be useful to recall the advice traditionally attributed to the Chinese strategist Sun Tzu in The Art of War, which notes the strategic value of unsettling an opponent. Whether or not such principles are being applied deliberately, their effects are readily amplified by contemporary media, allowing agitation to spread well beyond the immediate participants. In these circumstances, it is advisable to disengage where possible and to prioritise activities conducive to emotional regulation, including the enjoyment of quiet weekends in the countryside. Safe driving!
Yours sincerely,
Dr Y
Senior Consultant, Behavioural Medicine
Borough County Hospital
