Should mental-health professionals diagnose Trump as mentally ill?

It’s one thing for us to call Trump a narcissist or a sociopath, but it’s another thing entirely when a group of mental-health professionals argue that Trump should not be allowed to debate—or should be impeached—because he’s sick in the head.

Psychiatrists generally refrain from diagnosing people whom they haven’t examined, adhering to what’s called the “Goldwater Rule”. That rule, put into place by the American Psychiatric Association, came into being in 1973 when a group of over 1000 psychiatrists questioned Barry Goldwater’s fitness for office based on their long-distance diagnosis. Other Presidents, including Clinton, have also been diagnosed as mentally ill by the pros.

After the diagnosing of Trump started in 2016, the APA issued a statement in January, 2018 that reaffirmed the Goldwater Rule:

Today, the American Psychiatric Association (APA) reiterates its continued and unwavering commitment to the ethical principle known as “The Goldwater Rule.” We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable news appearances, books, or in social media. Armchair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.

The ethical principle, in place since 1973, guides physician members of the APA to refrain from publicly issuing professional medical opinions about individuals that they have not personally evaluated in a professional setting or context. Doing otherwise undermines the credibility and integrity of the profession and the physician-patient relationship. Although APA’s ethical guidelines can only be enforced against APA members, we urge all psychiatrists, regardless of membership, to abide by this guidance in respect of our patients and our profession.

A proper psychiatric evaluation requires more than a review of television appearances, tweets, and public comments. Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease. The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.

“The Goldwater Rule embodies these concepts and makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA stands behind this rule.”

I generally agree, for professionals should behave professionally. Doctors don’t diagnose patients without an exam, and psychiatrists are doctors. As an article in the Canadian Medical Association Journal (CMAJ) noted,  

. . . One reason for The Goldwater Rule is the likelihood of error in a diagnosis made at a distance. A proper diagnosis requires much more than “a review of television appearances, tweets, and public comments,” the American Psychiatric Association noted in its statement. “The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.”

You can say we already know enough to agree that Trump is mentally ill, but remember, if you want to assert that in court, the perp has to be examined by mental-heath professionals. Courts won’t accept diagnoses without direct examinations.

Now some mental-health professionals say that there’s a “duty to warn” that overrides the Goldwater Rule, a “duty to warn” about the effect of Trump not just on the well being of America, but on the well being of Americans themselves, making them unstable, liable to suicide, and so on. And so a group of 27 mental-health professionals, including psychiatrists, issued a statement last October warning about Trump. An excerpt from that:

Efforts to bring Duty To Warn into the spotlight have been ongoing since Trump first stepped into the political ring. We are joined by mental health professionals from various field including, but not limited to, psychiatry, psychology, medicine, public health, public policy, and social work; in every field, professionals have been voicing their concern about the president’s instability.

We Are Mandated Reporters
Mental-health professionals are mandated reporters with a duty to warn our patients and the community around us if we feel there is a potential danger.  In this case, we collectively feel there is a duty to warn the public of the threat Donald Trump poses both to our nation and the planet.

It is our duty to notice when an individual is a danger to themselves and/or others.

What about the Goldwater Rule?

“The Goldwater Rule is not absolute. We have a ‘Duty to Warn,’ about a leader who is dangerous to the health and security of our patients.” Mental-health professionals are “sufficiently alarmed that they feel the need to speak up about the mental-health status of the president.”

CMAJ counters:

Last October, when a group of 27 mental health professionals, including psychiatrists, published a book arguing that the current US president’s mental state was a danger to the nation, they said they were honouring another medical principle: the duty to warn. The idea behind “duty to warn” is that if you are in a position to know about a danger and have time to alert others, you should do so. Psychiatrists, for instance, are allowed to break doctor–patient confidentiality if they suspect a patient is about to harm a third party.

But part of that duty rests on having done a proper evaluation, according to Dr. David Goldbloom, a psychiatry professor and senior medical adviser for the Centre for Addiction and Mental Health. “You are intervening to abrogate fundamental civil freedoms,” he said. “You can’t do that from having read an article or watched television.”

Of course, we know that Trump is a danger to the country simply because of his statements and actions, and that seems to me independent of whether he has an official DMC diagnosis by professionals.

But Yale psychiatrist Bandy Xenobia Lee, in an interview with Salon (of course), says that it’s her duty to warn people about Trump’s instability.

Lee has a history of trying to publicize her views that Trump is mentally ill; see the section on this in Wikipedia, which also describes her lobbying Congress. That section says this:

in 2017 [Lee] was editor of The Dangerous Case of Donald Trump, a book of essays alleging that Trump suffers from psychological problems that make him dangerous.

. . . In an interview she also said, “whenever the Goldwater rule is mentioned, we should also refer to the Declaration of Geneva, established by the World Medical Association 25 years earlier, which mandates physicians to speak up if there are humanitarian reasons to do so. This Declaration was created in response to the experience of Nazism.”

And it’s possible that some of this has to do with, yes, inequalities in American society:

Lee then stated in an interview with Salon in May 2017 that Trump suffers from mental health issues that amount to a “state of emergency” and that “our survival as a species may be at stake.” She also discussed her political views, linking what she sees as increasing inequality in the United States to a deterioration in collective mental health.

She continues her efforts in the Salon interview (click to read):

First, she argues that Trump shouldn’t be allowed to debate:

Trump spent most of the debate heckling and interrupting, mixed with some blatant lying. How would you assess his debate performance?

The huge error was in allowing the debate to happen in the first place. “How was his debate performance?” is the wrong question to start. A debate presupposes mental health. We cannot pretend to have one when management of psychological impairment is what is warranted. The majority of the country may be horrified at what he is doing, but we continue to help the disorder in every way possible by treating his behavior as normal. It applies first to the politicians, then to the media and then to pundits who do not come out and honestly say: “This is beyond anything I have seen and beyond what I can understand — can we consult with experts?” And experts, for a psychological matter, would be mental health experts. Perhaps even specialists of personality disorders or sociopathy would be necessary, given the severity.

I’m not sure people treated his behavior as normal; the media was full of people saying that he seemed unhinged. Having someone like Lee weigh in that he’s mentally ill and shouldn’t have been allowed to debate adds little to that; in fact, I thought the debate was salutary in one sense: Americans got to see how unhinged Trump is. If they want to elect him after that, well, they’ll get what they deserve.

One gets the feeling, throughout this interview and in Lee’s other writings, that part of the reason for her crusade goes beyond her view that an unleashed Trump will harm America; it may well also involve her blatant dislike of his politics. In that respect she goes over the top in emphasizing the psychological toll of Trump on America, a toll that presumably should have mandated his impeachment:

The reinterpretation of the “Goldwater rule,” as happened at the onset of this presidency, has been exceedingly harmful, in my view, for silence in the face of grave dangers facilitates conditions for atrocities. Last month, we created a blow-by-blow account of how we exactly foretold the president’s mismanagement of the coronavirus pandemic, based on his psychological makeup. We could not effectively convey this in advance, because the public was led to believe that the “Goldwater rule,” which is a guild rule applying only to 6% of practicing mental health professionals, was universal, or worse yet, some kind of law. But in truth, to change a guideline whose purpose is to protect public health to protect a public figure at the expense of public health violates all core tenets of medical ethics.

Yet Lee has been broaching the Goldwater Rule for a long time (I don’t know how she gets away with this if she’s a member of the APA), and yet nothing has happened to Trump despite her books and her many interviews, all making the same point.

And she may well be right that Trump meets the ever-shifting psychiatric criteria for mental illness. I’m no professional, but Trump’s behavior seems way, way out of line—the tails of the human behavioral distribution. Still, I’m not comfortable with professionals giving a professional opinion by observing Trump the same way we do: scrutinizing his tweets, his press conferences, his debate performance. The man is out of control. But don’t psychiatrists need to talk to a patient before they tell the world he’s nuts? The effect of Trump on people is obvious, and you don’t need to be a mental health professional to see that his Presidency is risky to America. Having Dr. Lee tell us that, in our professional opinion, he’s nuts, adds nothing to our fear of the man.

In fact, if people tried to remove Trump from office, or prevent him from debating, based on Lee’s opinion that Trump is mentally ill, it wouldn’t work. People would just laugh at the attempt, and impeachment on the grounds of mental incapacitation wouldn’t do, either, at least not with a Republican Senate.

I can see where Lee is coming from: she’s a forensic psychiatrist and presumably sees nuances in Trump’s behavior that we don’t see. But we don’t need nuances—we know all we need to know, and if a liberal psychiatrist says Trump is certifiably a bull-goose loony, that will have no effect in swaying his supporters. We already have the means to stop Trump, and we can exercise it in the next four weeks by casting our ballots against him.

Bandy Lee and her book.

h/t: Randy

69 Comments

  1. Mobius
    Posted October 3, 2020 at 12:39 pm | Permalink

    Should mental-health professionals diagnose Trump as mentally ill?

    As much as I may think, personally, that Trump has mental issues, I have to say “No”. Without an actually examination in person I think it violates medical ethics to say otherwise. And, of course, there are then issues of confidentiality involved.

    So, no.

    • A C Harper
      Posted October 3, 2020 at 1:20 pm | Permalink

      Plus, of course if Trump can be remotely diagnosed by mental-health professionals then there is no reason why an equally even-handed (that’s sarcasm) set of mental-health professionals (or gerontologists) shouldn’t remotely diagnose Joe Biden.

  2. Posted October 3, 2020 at 12:41 pm | Permalink

    It’s also not difficult to sway an exam result by answering questions dishonestly. If you have an inkling of where the questions are heading, you’re going to answer them in a way that may minimize your behavioral disorder…if you’re clever enough. You can’t manipulate a blood test or a cancer screening like you can manipulate a behavioral exam.

    • savage
      Posted October 3, 2020 at 1:24 pm | Permalink

      Some forms of diagnosis are very easy to obtain or avoid. For example, to be labeled as mildly autistic (Asperger’s) you just need to answer a few yes/no questions, and in each case it’s quite obvious what the psychologist is looking for.

  3. jezgrove
    Posted October 3, 2020 at 12:43 pm | Permalink

    The Goldwater Rule makes sense, and I see no reason to break it. No (credible) professional diagnosis can be made without an in-person assessment and as PCC(E) rightly notes in the final paragraph: “[W]e know all we need to know, and if a liberal psychiatrist says Trump is certifiably a bull-goose loony, that will have no effect in swaying his supporters. We already have the means to stop Trump, and we can exercise it in the next four weeks by casting our ballots against him.”

    In unrelated news, the timeline of Trump’s Covid-19 diagnosis and his subsequent interactions seems to be unravelling – as does the medical version of how he’s doi healthwise.

    • jezgrove
      Posted October 3, 2020 at 12:44 pm | Permalink

      D’oh – “doing” !

  4. Posted October 3, 2020 at 12:45 pm | Permalink

    One of my best friends is a psychiatrist and she has always said she would not hypothesise on his mental health — or anyone’s — without doing an in-person mental health assessment…

  5. phoffman56
    Posted October 3, 2020 at 12:46 pm | Permalink

    “If they want to elect him after that, well, they’ll get what they deserves.”

    The rest of humanity don’t want that, but they’d get it anyway, wouldn’t they?

    “..the ever-shifting psychiatric criteria for mental illness”

    That hyphenated adjective may be a good reason that what applies to other kinds of doctors maybe shouldn’t to them.

    Hopefully the ‘mental problems’ of Trump are not more of an excuse than of a condemnation of Mass Manslaughterer donald–sorry–Mass Murderer donald now, after the Woodward tape.

    • phoffman56
      Posted October 3, 2020 at 12:56 pm | Permalink

      From WAPO:
      “The jarring contrast between the carefree, cavalier attitude toward the virus on display in a Rose Garden event Saturday and the pernicious awakening that occurred Thursday night resembles a Shakespearean tragedy.”

      A hearse–my kingdom for a hearse!

      • phoffman56
        Posted October 3, 2020 at 12:57 pm | Permalink

        Sorry, meant for reply to jezgrove #3.

        • jezgrove
          Posted October 3, 2020 at 1:50 pm | Permalink

          Thanks! I’ve just seen it now ;o)

  6. BobTerrace
    Posted October 3, 2020 at 12:50 pm | Permalink

    Sub

  7. Ken Kukec
    Posted October 3, 2020 at 12:53 pm | Permalink

    That rule, put into place by the American Psychiatric Association, came into being in 1973 when a group of over 1000 psychiatrists questioned Barry Goldwater’s fitness for office based on their long-distance diagnosis.

    The rule was adopted by the APA in ’73, but the fitness-questioning itself occurred in ’64 when Barry G. ran against LBJ.

  8. Jenny Haniver
    Posted October 3, 2020 at 12:56 pm | Permalink

    “Yet Lee has been broaching the Goldwater Rule for a long time…”

    Lee does repeatedly broach the subject but here I think you mean “breeching the rule.”

    I happen to strongly agree with Lee’s position and there’s much discussion as to whether her and her colleagues are engaging in diagnosis rather than reporting because while diagnoses are derived from clinical observations and interactions, and are subject to strict rules of protocol and privacy, as you note. IMO there’s nothing wrong with drawing informed conclusions from his public actions, writings, reports on him, etc. Those are not formal diagnoses. Indeed, she does skirt the liminal borders between informed opinion and diagnosis, I do agree that she and her colleagues have a “duty to warn” and I’m glad that they’re exercising it. However, I draw the line at not allowing debates or any other political activity that Trump engages in. That goes into policing speech and actions and that’s scary. Lee is a Cassandra and seems to be driven by some internal dynamo that I can’t fathom and that scares me a little but I support her and her colleagues when they opine on video and in writing about Trump’s serious flaws.

    Furthermore, they’ve been almost 100% correct in their prognostications, and that’s due to their expertise not magic.

  9. Jenny Haniver
    Posted October 3, 2020 at 12:57 pm | Permalink

    “Yet Lee has been broaching the Goldwater Rule for a long time…”

    My view is contrarian:

    Lee does repeatedly broach the subject but here I think you mean “breeching the rule.”

    I happen to strongly agree with Lee’s position and there’s much discussion as to whether her and her colleagues are engaging in diagnosis rather than reporting because while diagnoses are derived from clinical observations and interactions, and are subject to strict rules of protocol and privacy, as you note. IMO there’s nothing wrong with drawing informed conclusions from his public actions, writings, reports on him, etc. Those are not formal diagnoses. Indeed, she does skirt the liminal borders between informed opinion and diagnosis, I do agree that she and her colleagues have a “duty to warn” and I’m glad that they’re exercising it. However, I draw the line at not allowing debates or any other political activity that Trump engages in. That goes into policing speech and actions and that’s scary. Lee is a Cassandra and seems to be driven by some internal dynamo that I can’t fathom and that scares me a little but I support her and her colleagues when they opine on video and in writing about Trump’s serious flaws.

    Furthermore, they’ve been almost 100% correct in their prognostications, and that’s due to their expertise not magic.

  10. Ken Kukec
    Posted October 3, 2020 at 1:07 pm | Permalink

    Not sure rational people need psychiatrists to diagnose Donald Trump. What was said of Goldwater in 1964 (in response to his campaign slogan, “In your heart, you know he’s right”) is true in spades of Trump — “In your guts, you know he’s nuts.”

    Ol’ Barry proved himself an elder statesman later in life, but in ’64 he was still playing footsies with the John Birch Society and advocating use of tactical nuclear weapons in Vietnam.

  11. Randall Schenck
    Posted October 3, 2020 at 1:16 pm | Permalink

    Very glad you did a piece on this. I read the book when it first came out in 2017 and have followed the opinions of Brandy Lee since then. I thought they made good sense back then and everything that has happened since reinforces their findings then. We could start by asking the following: What testing requirements are made about candidates for office in the U.S.? None You don’t have to pass any inspections or mental test to be president or Congress far as I know. We ask for much more for many jobs in this country. Airline pilots for one must undergo tests to determine their mental state.

    Beyond all of that, anyone who has paid attention to the actions of Donald Trump over the past four years and not seen big problems with his mental state is simply not looking. I don’t like the idea of giving the most important and powerful job to someone with serious problems such as Trumps. To allow this to occur and the disasters that have followed should be self-evident. We will be paying for this mistake for many years to come and based on many of the comments here, we may not fix anything.

  12. Posted October 3, 2020 at 1:17 pm | Permalink

    Why was Trump given that mental health test? Does anyone know? I’ve wondered if his doctor or other persons with persuasive power saw reason to do so.

  13. Marty
    Posted October 3, 2020 at 1:21 pm | Permalink

    Giving a mental health diagnosis is pretty subjective anyway. At least much more so than providing a physical diagnosis. We can see with our own eyes he doesn’t behave normally, but some psychiatrists might not diagnosis him with anything and others might diagnosis multiple conditions. I think it really adds nothing by having a licensed Doctor making a diagnosis.

    • Randall Schenck
      Posted October 3, 2020 at 1:28 pm | Permalink

      I think Marty, you do not know what you are talking about. Read the book. Try to learn a little of what the professionals know. Particularly do this before you make comments that mean nothing and say nothing. You do follow the same line that many in this country believe. They think mental illness is some kind of illusion – nobody knows. That is why we sell guns to millions of mentally disturbed people all the time. That makes a great combination as well. Happy hunting.

      • Marty
        Posted October 3, 2020 at 1:57 pm | Permalink

        Well I’ve spent a good deal of time going over the medical records of patients that have seen multiple mental health doctors and other mental health providers. What I can tell you without doubt is that a mental health diagnosis is much more subjective than a physical diagnosis. You often see disagreements between treating sources.

      • EdwardM
        Posted October 3, 2020 at 2:00 pm | Permalink

        This is an extremely rude response to a point that is well made; there are many forms of mental illness which diagnosis is subjective. Some are much easier to spot, even for a layman, but some are devilishily hard to pin down, even for professionals. This especially true in as much as many forms of mental illness are present in a spectrum. Trump’s extreme behavior may be an example of the kind of mental illness we can all see, but the fact remains is that YOU are not trained to recognize bona-fide cases.

        You owe Marty an apology.

        • Randall Schenck
          Posted October 3, 2020 at 2:08 pm | Permalink

          Since we are passing out recommendation here I would suggest you read the book too. Maybe I should not say he does not know what he is talking about but it sure looks like it. You are correct, I am not a psychiatrist but the book I refer to showed the findings of 27 of them. They put their profession reps on the line and put it in a book.

    • Jenny Haniver
      Posted October 3, 2020 at 4:09 pm | Permalink

      I don’t really know why people are calling the test Trump was given a “mental health” test. The Montreal Cognitive Assessment Test is was a brief test of cognitive abilities. Mental health and cognitive abilities are not interchangeable terms. And a 10-minute test like that would reveal only the most impaired people. It’s no measure of depression, ADD, OCD, mania, schizophrenia, and personality disorders, which usually fall under the rubric of mental health.

  14. Jon Gallant
    Posted October 3, 2020 at 1:23 pm | Permalink

    Surely we have known for a long time—and Trump’s display of symptoms in the “debate” confirmed—that he is a classic, extreme example of Narcissistic Personality Disorder.
    We don’t need professionals to tell us.

    This is not the first time a Presidential illness has been hidden in plain sight. In
    my childhood, we were told that the revered, recently deceased President Roosevelt had essentially “recovered” from an earlier bout of polio. That is what nearly everyone believed, until 40 years later, when Hugh Gallagher revealed more in his book “FDR’s Splendid Deception”.

    • Randall Schenck
      Posted October 3, 2020 at 1:40 pm | Permalink

      Last time I checked polio was not classified as a mental illness. Your point??

    • EdwardM
      Posted October 3, 2020 at 1:41 pm | Permalink

      You touch on something important here. First, I agree that it is unethical and unprofessional for any medical professional to diagnose someone they have not personally consulted.

      Your comment on Trump being an “extreme example of Narcissistic Personality Disorder” is on point as Trump is only an extreme exemplar of what we see in most politicians. There are some notable exceptions, but it takes some level of deep narcissism to be successful at politics. Narcissists are untroubled by lies which serve themselves and accommodating those is rule number one in a politician’s playbook. That suggests that even we armchair psychiatrists are drawing arbitrary lines on what is and what is not mental illness.

      • Steve Pollard
        Posted October 3, 2020 at 5:09 pm | Permalink

        I agree; and I would only add that, to a non-professional like me, ‘Narcissistic Personality Disorder’ reads as a description, not a diagnosis; and a pretty subjective description at that.

        Unhinged (another subjective judgment) as Trump may be, professional mind-doctors should not diagnose any condition without personally examinating the patient.

    • Posted October 3, 2020 at 2:07 pm | Permalink

      Who’s to say that a President is disqualified if they have a narcissistic personality? I wouldn’t vote for such a presidential candidate but evidently half the country would.

      Assuming we had a professional (or group of them) examine Trump before the GOP primaries. Would he be disqualified from running? I can imagine many would object to that. Could such a diagnosis be used to prevent Trump from seeking a second term? The whole country would explode.

      At most, I could imagine having all candidates for office undergo some kind of personality assessment by a panel of psychiatrists and having it published for all voters to read. (Along with their tax returns, of course.) I would still worry about the politicization of this panel. Imagine a future Trump who manages to load federal psychiatric panels with his sycophants or psychiatrists with particular leanings.

      I think we should leave well enough alone.

    • sugould
      Posted October 4, 2020 at 1:10 pm | Permalink

      Anyone who watched The Apprentice (as I did) would have known he was a vainglorious, self-made celebrity that believed—or wanted us to believe— his own PR, the larger-than-life brilliant tycoon. (Penn Jillette said it best: “Donald Trump just does what he wants, which is mostly pontificating to people who are sucking up to him.”)

      And when it comes to health issues as a concern for fitness in office, Republicans easily embrace a double-standard: Clinton’s possible cold was “evidence” of pneumonia or the plague, making her unfit. But Trump’s pathological lying was always excused as misspeaking, satire, or stress. (Two years of “He’s never had to deal with this before!” transitioned seamlessly into “He’s had so much to deal with!”)

      Now it seems, a third of the country is willing to vote him in as America’s Dictator, King, Savior, or uncouth slob. Just like them!

      So who really has the mental health problem(s)?

  15. savage
    Posted October 3, 2020 at 1:38 pm | Permalink

    The best argument for the Goldwater Rule is that psychologists are too unreliable. I have some confidence that schizophrenia can be reliably diagnosed, but what about things like attachment disorder? It is not even necessary for the existence of a mental health problem to be empirically supported as long as treating it is profitable 😐

    Assuming everyone agrees that someone is awful, there can still be lots of different opinions on what exactly is wrong with him.
    Countless psychological diagnoses have been put forward to explain Hitler’s behavior. Haven’t they been mostly unhelpful?

    Finally, there is a lot of stigma attached to the label of mental illness. Thus I avoid using it unless there is reliable evidence in the hope that doing so might help people in genuine need of mental health treatments.

  16. Historian
    Posted October 3, 2020 at 1:40 pm | Permalink

    I believe security agencies such as the CIA have developed psychological profiles on various world figures. Presumably they employ mental health professionals to accomplish this task without the benefit of in-person psychiatric evaluations. Should they stop doing this because they may get some things wrong? I certainly hope not. This work is done in the name of national security with the intent of anticipating what actions these individuals may take.

    Those mental health professionals who have diagnosed Trump from afar know much more about him from the public record than the CIA psychiatrists know about foreign figures. They probably know a lot more about him than they would have gained from meeting with him in private sessions. Many of them probably anticipated at the start of the pandemic how Trump would react to it. Unfortunately, people such as Lee have gotten relatively little public notice. If the public knew more about Trump’s psychological make-up, perhaps there would have been more resistance to his disastrous so-called leadership. In other words, adherents to the Goldwater rule regarding Trump can, in my view, be held complicit in the death of tens of thousands and the illness of millions.

    People who run for public office should understand that their lives in all their aspects are subject to the minutest scrutiny. This includes their mental health. In regard to Trump’s mental health, I would prefer an evaluation of it to come from trained professionals, not pundits who sense that he’s nuts. So, yes, I think Bandy X. Lee and her small band of mental health professionals are correct that “a duty to warn” is vastly more important to the public interest than the Goldwater Rule.

  17. Ken Kukec
    Posted October 3, 2020 at 1:42 pm | Permalink

    “Trump spent most of the debate heckling and interrupting …”

    I did not recall until brooding upon the debate a few days later having read a Politico piece a couple weeks earlier reporting that Trump’s debate preparation was focusing on a strategy of heckling Biden in the hope of triggering him to start stuttering (a speech impediment Biden had overcome in his youth).

    At long last, sir, is there no bottom to your depravity?

    • Posted October 3, 2020 at 3:53 pm | Permalink

      I hear (radio report) that Biden has taken down his Trump political attack ads. Is this a political maneuver coupled with decent political behaviour, if so, I pronounce Biden sane and fit to rule. 🙄

      • Ken Kukec
        Posted October 3, 2020 at 7:18 pm | Permalink

        Yeah, I understand Biden has pulled all negative ads regarding Trump, too.

        Biden is flawed (as are we all) but he’s an essentially decent fellow. And you don’t need no damned DSM-5 to know the difference between the two, Biden and Trump.

  18. Posted October 3, 2020 at 1:58 pm | Permalink

    Even an examination in person shouldn’t decide political questions. No way is the science of psychiatry advanced enough or objective enough to make such judgements. The whole field has a built-in motivation to overstate their abilities. And what about the politics of the psychiatrists involved? It’s a complete quagmire.

    • Posted October 3, 2020 at 6:29 pm | Permalink

      Yes, a quagmire, like democracy itself. I don’t have much affection for rules that try to neuter the politics of professionals. Lee should feel free to give her evaluation and the public, who still have the actual decision power, should feel free to ignore her. There’s no threat here that psychiatrists will somehow take over the rule of the nation. If this slightly tarnishes the reputation of psychiatry, I’m not sure that’s a problem either.

  19. rickflick
    Posted October 3, 2020 at 2:11 pm | Permalink

    I feel strongly that psychiatric professionals have a duty to speak up in this case. It’s true that medical doctors don’t diagnose patients without an exam because a diagnosis usually requires an array of tests, such as blood tests, MRI, etc. A psychiatric diagnoses is primarily through observing behavior. That is something that can surely be done for DT since we have enough of a sample of a patients behavior. So, I agree with Lee except I’m not sure what Lee means by saying DT should not be allowed to debate. His performance is a way for professionals and voters to further evaluate his mental health. That can’t be a bad thing.
    Vincent Greenwood outlines the DT case in detail in this long essay (posted by someone here some weeks ago).

    https://medium.com/@vgwcct/a-duty-to-differentially-diagnose-the-validity-underpinning-the-diagnosis-of-the-president-371354142a02

    Bottom line – DT is almost certainly a psychopath.

    • Randall Schenck
      Posted October 3, 2020 at 2:33 pm | Permalink

      I think the belief that he should not debate was for a couple of reasons. First that he is not mentally capable of performing in the debate and also he becomes a security risk as this thing is televised all over the world. Many of the statements made by Trump during the debate were so un-presidential it is an embarrassment. Trump gets most of his success in life through intimidation. Intimidate and tell outrageous lies, that is his MO. Is this what should be doing a debate?

      • rickflick
        Posted October 3, 2020 at 2:44 pm | Permalink

        Well, I don’t know if that makes sense. He tweets and talks to the press all the time. How’s a debate going to significantly enlarge the security risk? Embarrassment is not going to increase either. After four years he’s already the laughing stock of the world. No, I think the debate essentially ended his prospects of reelection, and that is what the debates are for, are they not? To show the worth of the candidates. Even if he had not contracted COVID 19, he was doomed after that debate. All the people watching, who do not read his tweets or what much news, have been exposed to the real Donald tRump. I’m sure they were not pleased.

        • Randall Schenck
          Posted October 3, 2020 at 3:13 pm | Permalink

          I cannot agree with that either. What he did during the debate I do not think made any difference to his cult, his base. But this idea that debates are some kind of mandatory thing is just crap. Often we have had presidential elections without debates. They are far from being real debates anyway, they are just TV entertainment. The general consensus on these so-called debates is they do very little to change the vote. The voting is already in progress now before they even debate. All Trump is verses a debate is one big gaslight.

          • GBJames
            Posted October 3, 2020 at 3:51 pm | Permalink

            The cult is not the whole electorate. The fact that they would not be swayed by the debate is irrelevant. There are a handful of Republican types who were in fact swayed by his performance. (To Biden’s benefit.)

  20. GBJames
    Posted October 3, 2020 at 3:48 pm | Permalink

    Sub

  21. KD
    Posted October 3, 2020 at 5:41 pm | Permalink

    Of course, people have strange beliefs without being mentally ill, and people have disturbing beliefs (to others) without being mentally ill, and the reality is that the real distinction is whether you live under a bridge talking to your voices, or whether you live in Beverly Hills making 7 figures as a medium to the stars.

    One may not like Trump, but the reality is that people don’t like Trump because he has been a highly successful politician (in the sense that Hillary Clinton is not) as well as a highly successful business man (in a certain sense, you try and get a bank to write paper in the amount that he has) and people don’t like him or his agenda. Are we really to believe that his NY banker friends missed the fact that he was crazy when they loaned his business hundreds of millions of dollars? I for one have greater confidence in the lending judgments of Wall Street than NYT editorial page writers or NPR’s pop psychologist of the month. Trump is crazy is fine as propaganda but its is dangerous to believe your own B.S.

    The interesting feature of what could be diagnosed as left-wing totalitarianism is the use of the mental health system to punish political dissidents, a tactic honed in the Soviet Union. It is similar to the Communist show trial, you have a fake procedure to carry out political persecutions which everyone is supposed to pretend are not nakedly political acts of repression. Its interesting to see the old Communist power fantasies seeping out of the anti-Trump narratives.

    In right-wing repression, interesting, its more rounding people up in the night and throwing them out of planes and adopting their children. Rather than repression being conducted in the open, and everyone being expected to pretend it is legitimate, repression is done in darkness, and everyone is supposed to pretend its not happening (as the fact that someone’s paternity is not even acknowledged). When people start fantasizing about disappearing Hunter and adopting his love child, we will know we are in serious trouble.

    • KD
      Posted October 3, 2020 at 5:56 pm | Permalink

      The deal is that if psychologists as a profession take on the political role of effectively impeaching Heads of States on the basis of purported mental illness, you do realize that the soldiers as a profession will quickly take on the political role of replacing Heads of States on the basis of purported national security, and having loyal men with guns trumps your doctorate from Harvard when the coup and counter-coup play out.

    • GBJames
      Posted October 3, 2020 at 6:48 pm | Permalink

      ”the reality is that people don’t like Trump because he has been a highly successful politician”

      This statement could not be more wrong.

      • sugould
        Posted October 4, 2020 at 3:45 pm | Permalink

        I’m guessing most successful politicians don’t think it’s wise to infect their most devoted followers with a potentially deadly virus so close to voting.

    • savage
      Posted October 3, 2020 at 11:33 pm | Permalink

      I think people simply don’t like Trump because of his politics. Apart from that, he has been popular throughout his life. He is extroverted, not ugly for his age and does not show a shred of self-doubt. He is (or was?) extremely rich. He also had little difficulties getting invited to parties together with influential politicians and celebrities, who now denounce him as though he was the devil himself.

      • Posted October 4, 2020 at 5:23 am | Permalink

        His wealth is an illusion. What he had he inherited, then he works by parasitising businesses. It is like the case of football clubs taken over by someone with what is essentially money borrowed against the wealth of the club, then loading the club with that debt.

        For goodness sake, he did not even write The Art of the Deal – it was ghost-written
        https://www.cbsnews.com/news/tony-schwartz-trumps-ghostwriter-says-writing-the-art-of-the-deal-is-the-greatest-regret-of-his-life/

        He was brought up in a dysfunctional family, so he is a victim himself in some ways. It is pathetic really…

      • Posted October 4, 2020 at 11:05 am | Permalink

        I don’t know which Donald Trump you’re referring to. He’s always been a lowlife scumbag with extremely poor taste and was always clearly someone who only cared about himself. This was obvious from public every appearance I ever saw. He also complains that the really influential people would never invite him. His whole life has been a struggle to be accepted by the elites. His presidency is largely motivated by getting back at them. Obama, being black and more elite than him, was the last straw.

      • KD
        Posted October 4, 2020 at 11:58 am | Permalink

        As assessment of Trump’s capabilities:

        1.) Branding power. He entered the GOP primary having built a personal brand that would cost probably 2.0 Billion dollars to replicate, if it could be. I bet he has way more name recognition than Bloomberg, even if Bloomberg is significantly superior in the dark arts of capitalism.

        2.) Excellent marketer/campaigner. This got him elected in 2016, and COVID-19, on top of knocking the exuberance out of the economy and forcing people into lockdown miseries, has significantly impaired his ability to campaign.

        3.) Appears to know nothing about how Washington actually works and has no actual experience in government. Mr. Smith goes to Washington is a fictional movie, enough said.

        4.) Incapable of listening to others. Trump suffers from both a lack of knowledge (curable) combine with ignorance (incurable). His lack of knowledge could have been addressed had he gotten serious advisors when he got to Washington and listened to them, but admitting he didn’t know something would place him in a position of vulnerability and aggravate his animating insecurity, so it was not allowed to happen.

        5.) Terrible public sector administrator. Modern corporations function like dictatorships, you can fire and hire people at will. Public administrators function with severe constraints on what they can do, starting with hiring and firing abilities. CEOs make terrible public administrators because managing a public institution is completely different from running a private business, and if you assume the skills are the same you go down in flames.

        6.) Inability to delegate. Having a compulsive need to be the center of attention and a deep seated fear of being shown up by another, Trump is an insecure “C-” who will only delegate to “D” and “F”‘s out of fear of being shown up. While being President + bad public administrator can be overcome by effective delegation, Trump is constitutionally incapable of doing so.

        7.) Irrelevant factors are the goofy things he tweets which are related to marketing to his base. Trump’s political career as a 3rd party candidate and GOP aspirant shows as well as a registered Democrat and a major donor to Democrats shows that he has few, if any, ideological commitments at all (although the buy American stuff is consistent so probably sincere). He will say anything to anyone if he thinks there is an angle in it for him, so if proof of insanity, it would be the insanity of his followers, not his own.

        In conclusion, a good campaigner, a horrible President, but not someone on the brink of psychosis, and only slightly above average in narcissism and psychopathology for Washington.

        • Posted October 4, 2020 at 12:03 pm | Permalink

          Bloomberg the company has revenue of $10B a year and a far better business rating than Trump or any of his businesses could ever reach.

          • KD
            Posted October 4, 2020 at 12:12 pm | Permalink

            Absolutely, Bloomberg runs circles around Trump as a business man, but Trump is better at branding. [Although real estate development is more about finance and conversion plays than an actual business that earns income from operations.]

            • Posted October 4, 2020 at 12:24 pm | Permalink

              He’s not really better at branding. Branding is about establishing value in the minds of consumers. More than half the country thinks Trump’s brand is crap. And, as I noted in another comment, many of us have always thought Trump’s brand was crap. That’s why his branded wine and steaks flopped. I wouldn’t buy anything with the Trump brand as I know he just slaps it on things. It is not a sign of quality.

              • savage
                Posted October 4, 2020 at 12:42 pm | Permalink

                He got some things right about campaigning.

                Calling TV shows while they talked about him on air, which got him free advertising and made him more interesting. Rallies with good turnout. Trump hats. I would also nominate the sticky nicknames he chose for his political opponents (e.g. “low-energy Jeb” or “Pocahontas”), even though I disapprove of them.

              • Posted October 4, 2020 at 12:57 pm | Permalink

                That says more about the deplorables that voted for him than his branding genius. And for those voters that just didn’t know any better (and largely still don’t), it’s a comment on their lack of education and political awareness.

      • sugould
        Posted October 4, 2020 at 3:47 pm | Permalink

        He has been a successful con man, I will give him that.

  22. Bart Enlai
    Posted October 4, 2020 at 2:42 am | Permalink

    See also:

    https://www.nydailynews.com/opinion/ny-oped-the-president-is-a-psychopath-20200924-i4yegtrvjvelzgrqniinn6pvue-story.html

    We should no more hesitate about identifying Trump as a psychopath and malignant narcissist etc than anyone should have hesitated about calling Hitler a megalomaniac.

  23. Posted October 4, 2020 at 3:46 am | Permalink

    This is daft – he is not mentally ill. The US has become a basket case BECAUSE there is too much analysis of people, over-medicalisation, over-prescription of drugs to people who experience what are a normal range of behaviours.

  24. Posted October 4, 2020 at 5:51 am | Permalink

    I have posted this before both on this site and elsewhere.

    A Duty To Differentially Diagnose: The Validity Underpinning The Diagnosis Of The President.

    The article discusses the Goldwater Rule and why it should not apply in this case. It also attempts to diagnose Trump as a psychopath.

    The arguments given against the Goldwater Rule is that there is a duty to inform. I buy that argument because it seems absurd to me that, if anybody has any kind of medical condition that puts the public in danger, the only people qualified to spot the condition have to keep their mouths shut.

    The other argument given is that an in person interview with a psychopath can actually just confuse the issue. Psychopaths are generally good at concealing their condition and even qualified physicians can be taken in. Furthermore, in the case of Trump, there is a huge body of material documenting his behaviour, far more than any non public figure. This means there is plenty of evidence on which to base a diagnosis even without a personal interview. This argument also seems convincing to me, but I’m not a mental health professional, so it may be flawed in ways I do not understand.

    I am also not qualified to say whether the diagnosis given in the article is valid. Again, it seems convincing to me, but I am still not a mental health professional.

    The problem with the Goldwater Rule in this case is that it is used to shut down debate on Trump’s mental health. Conversations usually go along the following lines:

    A: Trump has got NPD.

    B: You are not a qualified doctor. You shouldn’t be making judgements on Trump’s mental health.

    A: Doctor Lee says Trump has NPD.

    B: Doctor Lee is ethically bound by the Goldwater rule and should not be making medical diagnoses of Trump.

    The fact is the diagnoses have been made and, yes, they might have broken one rule but that doesn’t magically mean they are wrong. It might also be considered to be unethical to publish private tax information and yet the NY Times just did it. That also won’t change any of Trump’s supporters’ minds but we don’t see liberal commentators criticising the fact of its publication.

    • Posted October 4, 2020 at 5:53 am | Permalink

      Terribly sorry. The article I linked is the same one that rickflick linked in comment 19.

      • rickflick
        Posted October 4, 2020 at 9:56 am | Permalink

        I obtained the link from someone (you?) who provided it to WEIT a few weeks ago. I believe it’s important enough the be riposted form time to time.

    • rickflick
      Posted October 4, 2020 at 9:54 am | Permalink

      Ah! It was you Jeremy. I couldn’t remember who posted it. Thanks very much. I read it through and I think it’s a thorough analysis. It is convincing that DT is a psychopath which explains all of his behavior. The narcissism, the belligerence, the lack of empathy. Clearly he is unfit for office and should have been removed after impeachment. The GOP should never be allowed to forget their shameful willingness to prop him up.

  25. KD
    Posted October 4, 2020 at 12:09 pm | Permalink

    The bottom line is that impeaching a President is a political action, and the decision to impeach a President is a political decision.

    It is hard to see why psychiatrists would, based on their credentials, be in a better position to make the decision to impeach a President and follow through on it then the body invested with that authority under the Constitution.

    In addition, psychiatrists attempting to do so would create an immediate crisis of legitimacy that a Congressional impeachment action would not create.

    It does work in a place like the Soviet Union because both the profession and any Soviet body would be loyal to the Leader, and any decision would come from the top down.

  26. Brujo Feo
    Posted October 4, 2020 at 4:13 pm | Permalink

    I think that this might be a bit of an overstatement: “Doctors don’t diagnose patients without an exam, and psychiatrists are doctors.”

    First, doctors are sometimes called upon to do just that. I’m thinking of at least two famous cases where doctors several thousand miles away talked strangers through taking out their own appendixes. And of course, one could easily diagnose a green-stick fracture over the phone without ever meeting the patient.

    Further, California has for years dealt with the Tarasoff Rule (https://www.apa.org/monitor/julaug05/jn), which recognizes a duty to warn against dangers posed even by NON-patients. Maybe that isn’t exactly the same as diagnosing someone, but I can live with it.

  27. merilee
    Posted October 4, 2020 at 5:03 pm | Permalink

    Sub


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