Trump is now alone. Here's why that's a bad thing.

“Alone” may have been the most frightening word in the discussion of President Trump’s intemperate reaction to the execution of a search warrant on his attorney’s office and home.

As Mike Barnicle said on Morning Joe, April 10: “The president is alone.”

Very predictably, President Trump has shown the pattern of those who have constructed a narrow circle of friends on whom they are reliant for support and confirmation, and who, when placed under great stress, put excessive pressure on that circle of friends.

Recent patterns among President Trump and his advisors unfortunately resemble predictions from a chapter I published a year ago in The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. President Trump’s oft noted preoccupation with himself “… may initially shape and limit those invited to the narcissistic leader’s social network, with sensitivity to slights and angry reactions to them further eroding that network … The more the individual selects for those who flatter him and avoid confrontation, and the more those who have affronted and been castigated fall away, the narrower and more homogeneous his network becomes … eventually becoming a thin precipice.”

A clear example was the departure of Hope Hicks, widely considered President Trump’s most valued and trusted advisor through his campaign and first year in the presidency. Within the space of 48 hours, she acknowledged telling white lies for the President, received an angry rebuke, and announced her resignation.

The research is clear and overwhelming. Being socially isolated is bad for us – as bad for our health and as lethal as smoking or obesity. Reflecting this, the British government appointed a “minister for loneliness” in January. It is also bad for decision making, especially under stress. That President Trump might have to make awful decisions but do so without trusted advisors or caring and close confidants should frighten us as much as Korean missiles.

Of course the departure of Hicks is but one shrinkage of his close supporters. These also include apparent problems in his marriage, the diminished roles of President Trump’s daughter, Ivanka and Jared Kushner, the loss of long-time confidant and bodyguard Keith Schiller, and this week, the likely removal of President Trump’s trusted personal lawyer, loyal “fixer” and supporter, Michael Cohen. The losses are perhaps reflected in recent choices of replacements, the hawkish Mike Pompeo for Rex Tillerson, and, most notably, John Bolton as National Security Advisor, chosen apparently not because of ideological or strategic agreements, but for a personal swagger that President Trump prizes in others and prides in himself.

In medicine and public health, we have come to recognize that social isolation is serious business. It really is important, as lethal as smoking cigarettes. As a culture, however, we have tended to focus on the individual and discount the social. Right now, the biggest threat to the security of all of us is not whether President Trump is empathic or self-reflective or narcissistic or sociopathic, but that he is no doubt frightened, under enormous pressure, confronted with life-or-death decisions that could affect millions, but would seem to have nobody to whom to turn.

In The Dangerous Case of Donald Trump, 27 mental health professionals wrote of the many ways in which President Trump is dangerous. Exacerbating them all, and an important focus for those with constitutional responsibility vis-a-vis the President’s stability and continued fitness for office, is that he may be truly alone.

This story was originally published April 13, 2018 at 12:00 PM with the headline "Trump is now alone. Here's why that's a bad thing.."