At the far end of the spectrum, from healthy confidence to toxic narcissism, lies something entirely different. A condition develops in which a personal hunger for power and a sense of historical, almost religious, mission fuse — the leader cannot tell the difference between what they want and what the world needs. Consumed by this state — what clinicians call megalomania — the head of state not only overestimates their abilities but also turns the world into their personal story, casting themselves as its central, vital character. Nations become props. Other human beings become tools. And crucial aspects of reality — the courts, the economy, the institutions meant to check power — become obstacles to be overcome or dismantled on the path to total control. Laws are ignored. Principles are dissolved.
The defining trait of megalomaniacal hubris is an inability to stop. For an ordinary leader, achievement eventually brings satisfaction; for the megalomaniac, each victory only reveals a larger stage to conquer. Medical science explains why. The body produces hormones and neurotransmitters in response to certain self-perpetuating behaviors. Testosterone is the best-documented correlate of dominance and status-seeking. It is elevated in conquerors, aggressive leaders, and those who actively pursue and win power contests, increasing risk tolerance, reducing fear of social rejection, and sharpening competitive drive. Importantly, it rises after a victory — the “winner effect” — creating a self-reinforcing, addictive cycle of dominance.
Dopamine is linked to the neurochemistry of wanting: reward anticipation, drive, and grandiosity. Some researchers link the narcissist’s pursuit of admiration to an addiction to dopamine and testosterone. Norepinephrine is elevated in aggressive, vigilant, controlling personalities, fueling hyperarousal and rapid, reactive decision-making in domineering leaders. The more the megalomaniac acts out, the more compelled they feel to conquer. They are rewarded by their own body chemistry. This is how power becomes an addiction.
History shows where the addiction leads. Napoleon reconfigured the map of Europe, yet his ego refused to accept a world left unconquered. His invasion of Russia was ended by winter and starvation, and exile followed. The man who had reshaped a continent died on a rock in the ocean, with no world left to control. A second, more insidious path to ruin is the gradual removal of anyone willing to speak the truth. The megalomaniac experiences honest counsel as a personal attack, so one by one the voices of reality are silenced, until only flatterers remain. In the bunker beneath Berlin in 1945, Hitler was still issuing detailed orders to armies that no longer existed, and his generals played along with the charade. His crimes had already killed six million Jews and tens of millions more — human beings erased by the machinery of one man’s delusion.
These dynamics are not safely in the past. We can watch the same neurochemical script — unchecked power, silenced dissent, suppressed facts, ordinary people sacrificed to one person’s sense of destiny — play out now in the actions of President Trump.
Consider the inability to stop. Bound by a two-term limit, he muses publicly that “there are methods” for a third term and insists he is “not joking.” The White House circulates an image of him wearing a golden crown and calls him “the king.” A redesigned U.S. passport superimposes his face over the Declaration of Independence. This is megalomania’s signature: the nation dissolved into one man’s personal story, each win merely revealing the next stage to seize — the winner effect rendered as policy.
Consider the erosion of law. When courts order the release of frozen federal funds, the administration engages in what legal scholars call “legalistic noncompliance,” claiming to obey while quietly defying orders a judge called “clear and unambiguous.” A friendly Supreme Court, meanwhile, has swept away century-old limits on presidential control of once-independent agencies. Obstacles to total power are not negotiated; they are overcome or destroyed.
Consider the silencing of truth-tellers. National security officials are fired after a far-right activist deems them insufficiently loyal. The chairman of the Joint Chiefs is removed. Cabinet secretaries are purged within weeks. Federal workers, even veterans, are culled for suspected disloyalty. One by one, those who might say “this cannot be done” are replaced by those who will only say yes.
We should be clear-eyed about what we are seeing: a malignant narcissist with unchecked power, an addict to whatever makes his body feel strong, and structurally incapable of caring for others — least of all the vulnerable. Politically, we must do everything possible to reestablish limits. That is why the upcoming midterms are so crucial. Our democratic tools include voting, speaking out, nonviolent protest, and ensuring elections are secure.
Psychologically and spiritually, we must remain rooted in our values. We return to our traditions and practices — including connecting with nature — to remember our basic goodness and warmth. We channel our anger into determination. We demonstrate, stay involved, and cry out for justice. But beneath it all, we care. Stubbornly, we return to kindness and rebuild those healing bonds. With wise and just outrage, insisting on a life that honors deep values and meaning, we begin to repair the tattered chords of connection torn by fear and hate and start again.
Radhule Weininger, MD, PhD, is a psychotherapist, meditation teacher, and author based in Santa Barbara.
