James Fallows, writing in The Atlantic, has an interesting take on Donald Trump’s interesting week of verbal vomit. He thinks “a flat ban on at-a-distance diagnosis doesn’t really meet the common-sense test.” Of course, he thinks any medical hypothesis would be futile. Although, these last few days have been more unhinged than previously.

But now we’ve had something we didn’t see so clearly during the campaign. These are episodes of what would be called outright lunacy, if they occurred in any other setting: An actually consequential rift with a small but important NATO ally, arising from the idea that the U.S. would “buy Greenland.” Trump’s self-description as “the Chosen One,” and his embrace of a supporter’s description of him as the “second coming of God” and the “King of Israel.” His logorrhea, drift, and fantastical claims in public rallies, and his flashes of belligerence at the slightest challenge in question sessions on the White House lawn. His utter lack of affect or empathy when personally meeting the most recent shooting victims, in Dayton and El Paso. His reduction of any event, whatsoever, into what people are saying about him.

Obviously I have no standing to say what medical pattern we are seeing, and where exactly it might lead. But just from life I know this:

• If an airline learned that a pilot was talking publicly about being “the Chosen One” or “the King of Israel” (or Scotland or whatever), the airline would be looking carefully into whether this person should be in the cockpit.

• If a hospital had a senior surgeon behaving as Trump now does, other doctors and nurses would be talking with administrators and lawyers before giving that surgeon the scalpel again.

• If a public company knew that a CEO was making costly strategic decisions on personal impulse or from personal vanity or slight, and was doing so more and more frequently, the board would be starting to act. (See: Uber, management history of.)

• If a university, museum, or other public institution had a leader who routinely insulted large parts of its constituency—racial or religious minorities, immigrants or international allies, women—the board would be starting to act.

• If the U.S. Navy knew that one of its commanders was routinely lying about important operational details, plus lashing out under criticism, plus talking in “Chosen One” terms, the Navy would not want that person in charge of, say, a nuclear-missile submarine. (See: The Queeg saga in The Caine Mutiny, which would make ideal late-summer reading or viewing for members of the White House staff.)

Yet now such a  person is in charge not of one nuclear-missile submarine but all of them—and the bombers and ICBMs, and diplomatic military agreements, and the countless other ramifications of executive power.

If Donald Trump were in virtually any other position of responsibility, action would already be under way to remove him from that role. The board at a public company would have replaced him outright or arranged a discreet shift out of power. (Of course, he would never have gotten this far in a large public corporation.) The chain-of-command in the Navy or at an airline or in the hospital would at least call a time-out, and check his fitness, before putting him back on the bridge, or in the cockpit, or in the operating room. (Of course, he would never have gotten this far as a military officer, or a pilot, or a doctor.)

This is what keeps me up at night.