Trump Sleep disorder (TSD)

By Darius Zoroufy, M.D.

January 3, 2019

My patient Lindsey

Recently, Lindsey* returned to see me in sleep medicine clinic.  A few years ago, I’d helped Lindsey work on sleep hygiene to resolve her insomnia. I had not seen her since 2015. When I asked her how her sleep had been, she reluctantly admitted that her sleep deteriorated immediately after November 8, 2016.  She recalled watching “in shock” all night as the election returns were reported.  For the weeks that followed the election, she stayed up every night watching the post-election reporting in disbelief.  For Lindsey, it was unfathomable that our nation could elect Donald Trump as President of the United States.  After the election she found herself overwhelmed by anxiety and too uneasy to go to sleep.  Since then she has been staying up through the night reading reports and watching the news, unable to rest. 

Lindsey is an example of a syndrome that I see frequently in my practice.  They are not people who are frustrated that his opponent did not win, nor are they having trouble accepting a political defeat. In fact, many of these patients describe themselves as conservatives, often having voted Republican before the 2016 election. They find that feelings of insecurity, horror, and vulnerability leave them unable to sleep. I call this Trump Sleep Disorder. 

For more than a century people within the United States and citizens of other nations saw the American President as the most powerful, influential leader in the world. The President has always shown that he believes, as Thomas Jefferson wrote in the very first document of our nation, that all people have “certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness”.  When President Woodrow Wilson asked Congress for a declaration of war against Germany, he said “It is a fearful thing to lead this great peaceful people into war… But the right is more precious than peace, and we shall fight for the things which we have always carried nearest our hearts — for democracy, for the right of those who submit to authority to have a voice in their own governments, for the rights and liberties of small nations, for a universal dominion of right by such a concert of free peoples as shall bring peace and safety to all nations and make the world itself at last free.” FDR taught us that “the only thing we have to fear is fear itself”.  Kennedy’s short Presidency included “ask not what your country can do for you, ask what you can do for your country” and inspiried the nation to invest in space exploration. President Nixon, for all his faults, opened a relationship with communist China. President Reagan spoke with calm strength during his 8 years in office with statements like “Peace is not the absence of conflict, it is the ability to handle conflict by peaceful means.”  President Obama inspired a nation in the freefall of a recession with “Yes we can.” 

Why was the election of Donald Trump different?

Those of us who have voted in a few election cycles recognize that our candidate does not always win, and we accept that as part of democracy.  Until the election of Trump, candidates differed in their political philosophies.  For example, we can debate Reagan economic policy and Clinton economic policy. Yet in the past we remained confident that our President was respected as the leader of the free world. The actions of our President had not been a matter that interfered with my patients’ sleep. 

Trump’s Presidency has been different. 

The election of Donald Trump has created instability in political and trade relationships around the world. Many polls have shown that Trump supporters remain loyal to him regardless of scandals, untruthful statements, and abdication of world leadership because they believe in his nationalist philosophy. But among those who do not support him, many feel overwhelmed by feelings of insecurity, horror, and vulnerability and their sleep has been significantly disturbed. 

Insecurity

The election of Donald Trump has left many feeling insecure.  His decision-making sometimes seems haphazard and impulsive, as if based purely on his mood at the time, rather than on rational deliberation. For example, removing the United States from the Paris Climate Accord and the Iran Nuclear Deal seemed to serve no purpose other than to undo important American accomplishments completed during the Obama administration.  Other times, decisions seem to serve Trump’s personal agenda of self-promotion. For example, he orchestrated a prolonged and costly government shutdown to force American taxpayers to pay for a border wall of undefined construction (concrete or steel slats?) and minimal effectiveness since most illegal immigrants enter the U.S. legally. Much like Nazi architecture was intended to promote nationalist political grandiosity, the border wall’s purpose would serve as a physical, architectural monument to Trump himself and his nationalist agenda.  The demand for border wall funding occurred despite his repeated proclamations that Mexico would pay for it.  

Insecurity also results from concerns regarding the degree to which Trump owes allegiance to Russia for their assistance in his election. There is overwhelming evidence that Russia interfered in the 2016 U.S. Presidential election. The office of the special counsel Robert Mueller continues to investigate the degree to which Russia collaborated with the Trump 2016 election campaign.  The 36 indictments and guilty pleas so far begin to show a picture of how the Russian government used resources to work with corrupt members of Trump’s inner circle.  Still unknown is the degree to which Trump himself was involved.  He denies involvement the way a child with crumbs on his face denies taking cookies out of the cookie jar:  even though we did not see him commit the act, it is implausible that he did not do it. 

With regards to policy, many of his opinions and decisions appear to be directed and dismantling the work completed during prior administrations.  From NAFTA to the Clean Air Act and Clean Water Act to the Paris Climate Accord to the Iran Nuclear Deal to the Affordable Care Act, he is harshly critical of the earlier accomplishments of Presidents, cabinet departments, and Congress.  He provides limited rationale for his opinions and refuses to provide explanations other than vague superlatives of what he has planned.  When stable and effective policy is torn apart and replaced with little more than vague promises, many people are left feeling insecure about the future.  They find it difficult to sleep when they are preoccupied by questions like:

·       If we start trade wars with our allies, will we adversely affect the foundation of our alliances?

·       Will our environment be polluted when regulations governing pollution are removed?

·       Are we yielding our position of leadership when we withdraw from important multilateral geopolitical and climate agreements?

·       What will Trump dismantle next?

An impulsive, self-aggrandizing President who may owe allegiance to a foreign power leaves many feeling insecure and unable to sleep. 

Horror

White supremacy, racism, anti-immigrant policies

Trump’s anti-immigrant racism started with his speech announcing his candidacy for President in the 2016 election accusing Mexican immigrants of bringing drugs and crime and labelling them as rapists.  He and his spokespeople have continued to disparage immigrants of Hispanic, Arabic, and African origin, blaming these immigrants for problems in American society, alienating many in our country.  He has also defended white supremacists and their violent actions.  Although he and his spokespeople deny that Trump is a racist, white supremacists see Trump and his policies as aligned with their goals. This toxic environment has led to an increasing number of hate crimes and increasing examples of white people demonstrating racial intolerance in public (often called out in social media).  Although some in this country appear to be content with the repression of non-white people, many find this overt racist hostility to be horrifying and reminiscent of the repression that occurred before the civil rights era of the 1960’s.  Lindsey herself is a member of an ethnic group that Trump has called out as causing society’s problems, and she wonders when she might be attacked on the street for how she looks.  She finds it hard to sleep as she wonders whether her church is going to be location of a white supremacist mass shooting. 

 

Vulnerability

Misogyny, sexism, normalization of sexual assault

Trump has a lifelong history of making sexist and misogynist statements.  In her book Down Girl:  The Logic of Misogyny Cornell philosophy professor Kate Manne differentiates between sexism and misogyny.  Sexism is an ideology that women have different capacities than men and are therefore better suited to some roles and less well suited for others.  For example, the “glass ceiling” metaphor represents the sexist ideology that women are naturally more nurturing but less resilient and decisive than men, so she is better suited to raise children and less well suited to lead a company.  Misogyny, however, expresses hostility toward women who step outside the roles set forth in the sexist ideology as a means of enforcing the patriarchal status quo or an individual’s status. 

Trump’s expressions of misogyny have spanned throughout his life but none were as publicly jarring as the Access Hollywood tape in which he bragged about using his fame as an excuse to physically assault women.  This recording demonstrates that the President would be willing to use his status to grab women without their consent, supporting the fear that women can be helpless against men, when they use their power to force women to comply to their sexual whims. 

When Trump picked Brett Kavanaugh to replace Supreme Court Justice Anthony Kennedy, few outside of the news cycle and those involved in politics were interested.  However, it was revealed that Judge Kavanaugh had attempted to rape Dr. Christine Blasey Ford when they were in high school.  After Dr. Ford publicly recounted the details of the assault, Brett Kavanaugh denied the allegations, arguing that the allegations were politically motivated to take away his career advancement.  In other words, Kavanaugh argued that he could not have committed these acts, because he is too prominent and his career is too important. 

Many women saw the confirmation of Brett Kavanaugh to the U.S. Supreme Court as the ultimate example of how sexual assaults are not as important as the positions of prominent, powerful men.  Trump’s unwavering support of Kavanaugh showed that the most powerful man in the country does not consider the sexual assault of a teenaged girl to be as important as politics or the career aspirations of important men. 

 

Trump Sleep Disorder

Lindsey and many other women have found it is difficult to feel relaxed and safe enough to go to sleep since Donald Trump was elected.  They feel insecure living in a country led by an impulsive, self-promoting President who has unclear allegiance to a foreign country.  They feel overwhelmed by feelings of horror when they see the cruel racism of children pulled away from their parents and kept in cages or when the President himself defends white supremacists.  Perhaps most disturbing is the feeling of vulnerability that results from a President who regularly uses misogyny to attack political foes and who has repeatedly shown that he believes men of power should not be held accountable for sexual assault. 

Working with Lindsey has been difficult.  How do I reassure her that the country will endure and that she is safe when I have no way of knowing that it is true?  I cannot tell her that society will heal when men use Trump’s statements as their excuse to assault women.  How would I reassure a child that there is no monster under the bed when I can hear it growling? 

My advice was that Lindsey needed to take a news and social media break for 2 weeks.  After those 2 weeks she must turn off all handheld electronics and stop watching the news for at least 2 hours before bedtime.  I gave her specific sleep hygiene and relaxation advice.  I also prescribed a short course of a sleeping pill to try to help her get back on track.  I asked her to give me an update on how she was doing after the holiday season.  I hope she is finally getting some sleep. 

 

As Trump says, we’ll see what happens.