I would have hoped that any sensible American citizen would by now have been sufficiently scared by Donald Trump’s morbid flights of fancy, high school playground style bullying, outlandish threats and bluffs, unrealistic and unsavory promises to crush enemies and enrich workers, to put aside all their concerns about alternative candidates and refuse any temptation to cast a masochistic vote for Trump.

Yet such confidence seems sadly unjustified in this election and points up the vulnerability of the institutional arrangements governing qualifications to be an American president. Far more important than the constitutional requirement of an American birthplace, or even than physical health, is the mental condition of a candidate. Clearly, we cannot trust voters to pass this judgment, even if they were so inclined, as the Trump saga confirms. With Trump’s over the top narcissism and wild bipolar swings of sentiment, it seems painfully obvious that he is mentally unfit for the presidency, and this is frightening considering the embedded capacities of any occupant of the Oval Office to initiate war and use nuclear weapons, as well as inflict less spectacular harms as might result from unraveling the world economy, scrapping the Paris Climate Change Agreement and Nuclear Agreement with Iran, and irresponsibly ending old alliances and entering into new ones.

It must be acknowledged that Hilary Clinton is also multiply deficient as a presidential candidate, but not nearly in ways so scary and in forms far less likely to involve blind dives from the high board of flights of fancy into waterless pools. I dearly wish she was closer to Sanders in outlook, commitment, and character, but she can at least be counted on to do some decent and constructive things to enhance the quality of governance and life at home. She will surely push hard to implement the climate change agreement and probably will abide the Iran agreement despite Israel’s continuing efforts to undermine all that was achieved. Above all, she is not Trump!

It is not that Clinton deserves our vote, especially taking into account her hawkish regime-changing approach to foreign policy in the Middle East, but maybe, just maybe, she learned a thing or two from her support of the Iraq and Libyan disasters, and even if she hasn’t, she still earns my vote by the lamentable logic of ‘the lesser of evils.’ At the same time, I would not criticize those who weighed the pros and cons differently than I do, voting for a third party nominee that seemed the best available candidate regardless of their prospects of winning in November. There is much to be said in favor of voting for someone who is a good enough candidate that a vote of support would be something other than one more iteration of the lesser of evils. It is one of the few ways that an ordinary citizen has to register a vote of no confidence in a system that can do no better than provide citizens over and over again with nothing more congenial than a choice among evils. Unlike football, winning isn’t everything in politics, although most of our politicians approach their challenge with a zero-sum mentality. It is damaging to democracies when the cynical among us call the tune with their belief that casting a principled, yet losing, vote is a wasted vote, or worse, almost a crime against reason! Remember the liberal fury directed at Ralph Nader and his 90,000 or so supporters in Florida that allowed George W. Bush, with a major assist from the U.S. Supreme Court, to win the 2000 election.

In the end, Americans, whether or not they realize it, have a responsibility to the world that citizens of other countries possess to a far lesser degree. If Trump were to become the next American president it would imperil the world, and likely cause grave dislocations in many international settings that could cause massive suffering along with possibly disastrous unintended consequences. Even our most ‘rational’ recent presidents have caused havoc in foreign societies. Our militarized government rests on three principal pillars of influence: the Pentagon, Wall Street, and Israel. These constraining forces can push even the most decent and intelligent of presidents in militarist directions as Barack Obama found out.

The United States as a liberal democratic global state, projecting its power throughout the whole of the planet, should ideally extend its electoral franchise globally. As things stand, and will indefinitely remain so, the United States and its people insist on the absolute prerogatives of territorial sovereignty while denying comparable autonomy to many other nominally sovereign states. Given this uncontested reality, there is as much likelihood of Americans agreeing to extend the vote in its national elections to foreign societies throughout the world as there is of the ISIS leadership waking up one morning to announce adherence hereafter to the pacifist precepts of Gandhiism.

What is a distant second best option, yet far better than nothing, is for as many Americans as possible to be at least aware of their custodial role for the peoples of the world. With such awareness would come the duty to vote responsibly with respect to the wellbeing of others, including taking into consideration impacts on a sustainable human future. Again, predicting that a substantial number of American voters might be willing to behave like world citizens is a bet no oddsmaker in Vegas would be foolish enough to take.

Obviously, mere awareness is not nearly enough to secure the wellbeing of either the country or the world. The realities of technology and complex interdependence are such that the current world order has no capacity to absorb and localize serious mistakes of judgment made by the United States Government. The most minimal elements of political sanity at this stage of history mandates the adoption of a constitutional requirement that candidates for the presidency be certified as to their mental health, and not only by a psychiatrist of their choice. A professional politically neutral mechanism should be established to select a panel of qualified psychiatrists that would then be entrusted with certifying the mental health of aspiring candidates for the presidency and vice presidency.

At present, there is some relevance accorded to physical health with much attention accorded to the disclosure of medical records and indications of physical ailments that might interfere with the discharge of the formidable burdens associated with being president. When Hilary Clinton was found to be suffering from a mild case of pneumonia earlier this month a media frenzy ensued that examined the issue of her health from every conceivable angle. Such a preoccupation highlights by comparison the neglect of the far more serious, and possibly more difficult to detect, presence of serious mental disabilities of a kind that could produce the worst sorts of governmental decisions and policies. The mental disorders of an aspiring presidential candidate are far more threatening to the security of the country and the world than are physical ailments, which although also potentially dangerous to the person, are far less likely to cause catastrophic damage or twist decisions in sinister directions.

Admittedly, certifying mental health is an awkward process that needs to be handled with great sensitivity, and even then could misfire, or be wrongly interpreted by the public. At the same time, this forthcoming election amply demonstrates that business as usual, with eyes and ears closed to issues of mental disability is no longer an acceptable approach to the selection of American leaders in the 21^st century. Too much is at stake.

Despite this, there persists a strong taboo surrounding mental health. Raising questions about the mental condition of a candidate for public office is still widely perceived as hitting below the belt. And what is worse, some mental disorders perversely give rise to enthusiastic support among the citizenry. In this regard what makes Trump seem a high risk candidate because of his mental health is what may yet get him elected! This is a thought to ponder. The memory of Hitler and Mussolini reminds us that pathological mental imbalances can be a source of public charisma and political popularity. The Trump candidacy is certainly not the first time that a demagogue’s manifest mental disorders are a principal explanation of his passionate populist support, but it could be the last time!

Richard Falk

Richard Anderson Falk (born November 13, 1930) is an American professor emeritus of international law at Princeton University, and Euro-Mediterranean Human Rights Monitor's Chairman of the Board of Trustees. He is the author or coauthor of over 20 books and the editor or coeditor of another 20 volumes. In 2008, the United Nations Human Rights Council (UNHRC) appointed Falk to a six-year term as a United Nations Special Rapporteur on the situation of human rights in the Palestinian territories occupied since 1967. Since 2005 he chairs the Board of the Nuclear Age Peace Foundation.