What, beyond a team of university psychologists, could explain the mechanism of Donald Trump’s mind? In the early 1990s, two journalists thought they’d figured it out, claiming Trump was fighting his overwhelming fear of being fat with a steady stream of amphetamine-like diet pills.

Two decades ago, Donald Trump wasn’t a fascist lightning rod, hick idol, reality star, or political entity. He was just a high-profile rich schmuck and evergreen victim of Spy magazine, which used him as a peg for a February 1992 feature on Dr. Joseph Greenberg, whom they alleged was prescribing powerful stimulants to anyone with a checkbook. Stimulants, Spy’s John Connolly speculated, that might explain how Donald Trump maintains his infinite, inexhaustible arrogance:

Have you ever wondered why Donald Trump has acted so erratically at times, full of manic energy, paranoid, garrulous? Well, he was a patient of Dr. Greenberg’s from 1982 to 1985…Dr. Greenberg diagnosed both of the Trump brothers as suffering from a “metabolic imbalance.”

According to Spy, Dr. Greenberg believed the cure for “metabolic imbalance” (not an actual medical disorder) was Tenuate Dospan, a diet drug similar to dexedrine with known side effects that include “confusions” and “hallucinations,” according to the NIH. It also gives you an amphetamine-like buzz. This is all probably why it’s only supposed to be prescribed on a short-term basis, as opposed to the multiple-monthlong regimens Dr. Greenberg allegedly dosed out, according to Spy:

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Dr. Greenberg’s program included no set caloric limit, and Tenuate was prescribed or five months. The long-term use of Tenuate can, according to the medical literature, lead to psychosis—delusions of grandeur, say, like the belief that by simply putting your name on real estate properties, you will double their value.

Or, say, like running for president without a platform beyond “look at that yonder Muslim, what’s he up to?” Most juicily, Connolly included what purports to be the Trump brothers’ medical charts, “indicating many, many visits” to Greenberg. Over email, Connolly told me that the image was in fact a direct photocopy of the Trump brothers’ medical records, and not merely a reproduction from information or an illustration:

Donald Trump’s medical record from the office of Dr. Greenberg, as published by Spy in 1992

It’s unclear how such a document was obtained (though notably the article was written four years before HIPAA established stricter standards of patient privacy).

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In the controversial 1993 Trump biography Lost Tycoon, author Harry Hurt attributed a steady stream diet pill habit to “Donald’s mood swings” and “his fits of distemper.” Per Hurt:

On April 19th, 1982, during the period between his license hearing before the Casino Control Commission and the groundbreaking on the Trump Plaza site in Atlantic City, Donald paid a visit to the midtown Manhattan office of Dr. Joseph Greenberg. According to the doctor’s records, Donald had been recommended by his friend Charles Goldstein, an attorney involved in the Penn Central deals. The ostensible purpose of Donald’s visit was to seek assistance in losing weight. He had gone to the right place. Dr. Greenberg was an endocrinologist who specialized in providing patients with drugs to control obesity...

Donald was so delighted with the results that he started recommending Dr. Greenberg’s treatments to his brother Robert, various friends, and celebrity acquaintances such as Diana Ross. The diet drugs, which he took in pill form, not only curbed his appetite but gave him a feeling of euphoria and unlimited energy. The medical literature warned that some potentially dangerous side effects could result from long-term usage; they included anxiety, insomnia, and delusions of grandeur. According to several Trump Organization insiders, Donald exhibited all these ominous symptoms of diet drug usage, and then some.

“The first thing I would do when I got to the office in the morning,” recalled one former vice-president, “was to go see Norma Foerderer and ask her, ‘Is this a Dr. Greenberg day?’ If she said yes, I would do everything I could to stay out of Donald’s way.”

Greenberg’s chemical notoriety was wide enough to grab the attention of Mike Wallace and 60 Minutes, who included his practice in a 1976 segment on amphetamine abuse:

WALLACE: You eventually came to Dr. Joseph Greenberg?
WOMAN: Right, in Great Neck.
WALLACE: And what did he do for you?
WOMAN: I was taking eighty pills a day.
WALLACE: Under his direction?
WOMAN: Under his direction.
WALLACE: Eighty pills?
WOMAN: Eighty pills a day. 8-0.
WALLACE: And how many of those were amphetamines or amphetamine related or amphetamine substitutes?
WOMAN: I would say between four and six a day were amphetamine-type drugs. I had a very, very strange experience, and this is perhaps why I finally left him: I could not determine where I ended and where you began.
WALLACE: What?
WOMAN: I could not determine where I ended and where you began for two years after that time. I walked around holding my hands because I did not know that they were attached to my body.

Greenberg later sued CBS and settled out of court. He has since passed away, and was thus unavailable for comment.

If Trump suffers from body dysmorphia (or even run-of-the-mill self-loathing of the flesh), it would explain more than just possible side effects from treatment: the man is obsessed with physical appearances. Recall the letter Trump’s physician, Dr. Jacob Bornstein, issued to the public, describing his body in boasting terms usually reserved for show dogs or Triple Crown steeds: “Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency,” adding that “over the past twelve months, he has lost at least fifteen pounds.” Dr. Bornstein did not return a request for comment on Trump’s use of Tenuate Dospan.

Fat cells provide a moral framework in Trumpian politics, a means of assessing virtue or whether you’re a sad mess. In an interview with People, Trump wielded this campaign weight as both a sign of his dominance and the general shittiness of his opponents:

“I have lost weight because my events are so exciting. When I’m done I don’t want to eat,” he says. “But I could see how it could go the other way for some people. That’s only because their events are boring.”

If Donald Trump hates you, he will talk about your physique. The relative fitness of your body is often what separates the Losers from the Great. When fellow racist and GOP debate moderator Megyn Kelly famously pointed out Trump’s history of calling “women you don’t like fat pigs, dogs, slobs and disgusting animals.” he countered only (and incorrectly) that he’d only ever pilloried the weight of Rosie O’Donnell. Some might chalk this all up to mere obnoxiousness, that Trump is nothing more than a big rich bully.

Which he is, of course. But what we don’t often consider the possibility that Trump equates fatness with badness because he hates himself, that he feels compelled to both drink only Diet Coke at lunch and make fun of fat people who drink Diet Coke. It’d be one thing to support a plain old bigoted bastard—a longstanding American tradition—but quite another to elect someone who so strongly hates the way he looks in the mirror that he’d consult a total quack. We’ve trusted plenty of imbeciles with the nuclear codes before, but are we prepared to hand them to a fundamentally unstable narcissist?

Trump spokesperson Katrina Pierson did not return a request for comment.

Illustration by Jim Cooke