Let’s pretend you’re a psychiatric intake clinician at Bellevue or some other large hospital. A patient presents with the following symptoms:

1. He strongly believes that he is in direct contact with God. He speaks to God daily and, when pressed, professes that God on occasion speaks to him.

2. In his position as chief elected official of a large nation, he believes it is his duty to spread the beliefs of that nation throughout the world, especially what he perceives as freedom and liberty. So important is this end, that he believes virtually any means are justified in achieving it. Even torture.

3. He alienates virtually the entire world by invading two nations on false pretenses and then rewards the people who assisted him with "Medals of Freedom." But God speaks to him, so he knows it’s not only OK to do this, it is THE RIGHT THING to do.

4. He ignores increasingly massive evidence of human-caused climate change and asserts, on the basis of advice from a handful of "scientists" of dubious reputation that attacks on his environmental policies are purely partisan.

5. Domestically, he speaks strongly about equal opportunity for all and says his on-going program of tax cuts that benefit only the rich are in fact a powerful incentive for the poor to work harder and become rich so that they can enjoy these benefits. He ignores the increasing spread between the very rich and the poor in his nation because his rich and powerful friends, along with God, assure him that it is OK.

6. When a major catastrophe strikes, wiping out a large, unique city along with 90,000 square miles around it, he attends a fund-raiser for his party in California and then plays golf. When, five days later, he finally visits the devastated area he jokes, as unrescued, mostly poor people continue to die, about the good times he had when as a young man he visited the now-lost city.

7. He has stood for national office twice and, one way or another, won. When the delusional nature of his beliefs are pointed out to him, he cites the results of these elections, in which many millions of people, knowing precisely what he believed, voted for him.

Following the intake interview and incarceration, and after the usual battery of diagnostic tests—which reveal a powerful consistency in maintaining the huge disjunct between his beliefs and reality, you diagnose extreme, possibly untreatable delusions of grandeur. You prescribe a regimen of powerful psychoactive drugs and intense daily therapy.

After six months with no change, you conclude that you are faced with a case unprecedented in the annals of mental health.

Partly through chance, partly through inheritance, partly through family connections, partly through expedient support by rich and powerful associates, this person has convinced a large percentage of the population of his nation that he is not only sane but that his beliefs are IN FACT ABSOLUTELY CORRECT.

You, gasping at the horror of it, realize that, in addition to your diagnosis of him as a dangerously unbalanced individual, must also conclude that his nation—of which you happen to be a citizen—is itself suffering from a wholesale delusional disorder.