I’ve written twice about this subject: the controversies involving Yale clinical and forensic psychiatrist Bandy X. Lee (no longer at Yale). Lee has been accused of violating the Goldwater rule, which involves giving professional psychiatric opinions about public figures you haven’t examined—in this case Donald Trump. The article below from Mother Jones magazine describes her travails around “diagnosing” Trump and warning of his potential to incite violence. As I wrote in November of 2020:
I agree that Donald Trump is mentally ill, but I’m not a professional, and thus am not bound by the strictures of professional associations to avoid diagnosing someone you haven’t personally examined. And those strictures exist most prominently in the American Psychiatric Association’s (APA’s) “Goldwater rule“, created after a number of psychiatrists pronounced Barry Goldwater unfit for office in 1964. Here’s the rule from the APA’s “Principles of Medical Ethics,” and this rule is still in force:
On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
There doesn’t seem to be a penalty for psychiatrists who flout this rule, however, as psychiatrists who have diagnosed Trump as ill, or even lobbied Congress to proceed with the Trump Dump, have suffered no penalties.
In general I tend to agree with the Goldwater Rule, even if it’s nonbinding and the APA levies no penalties for flouting it (other people, as you’ll see, can punish violators). Yes, I think Trump is mentally ill, afflicted with narcissistic personality disorder, but I still think, as I did three years ago, that giving a professional diagnosis, whether you be a doctor or a psychiatrist (who are doctors), is pretty close to slander, and has far more potentially deleterious consequences than a statement by average Joes like me. “Professional” statements can be used for impeachment, removal from office, and so on. That said, I don’t see a problem with professionals warning the public about the dangers of someone based on their past behavior, without giving them a professional diagnosis. That’s what Lee claims to have done, and she was fired for it.
But in the past, Lee, who never examined Trump, appears to have come pretty close to diagnosing him. In a debate in Salon, Lee not only pronounced Trump to be mentally ill, but then went on to say the Goldwater Rule is itself harmful. Wikipedia notes this:
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.
And she discusses the 2020 debate with Biden.
[Salon]: Trump spent most of the debate heckling and interrupting, mixed with some blatant lying. How would you assess his debate performance?
[Lee]: 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.
To me that comes close to giving a professional opinion, but it’s not 100% clear cut. She does say that he has a mental health disorder, and to me that’s a professional opinion. (After all, one psychiatrist said that “he may just be a jerk.”) There is, of course, a continuum between jerks and the mentally ill, and where to draw the line is unclear.
Bandy went on to organize a conference of mental-health professionals in April, 2017, that resulted in a collection of essays by various therapists, The Dangerous Case of Donald Trump, a book that became a bestseller. (Note: I haven’t read it.)
Mother Jones reports on the fallout, and on Bandy’s firing from Yale (click on screenshot):
Bandy certainly has the expertise to warn people about potential violence, and that’s what she continued to say about Trump after her book came out: the man has the behavior that tends to lead to violence among his followers, something instantiated in January of 2021. She has studied criminal gangs and their leaders, and sees their behavior mirrored in Trump’s. She also notes that these leaders lose their influence when they are put in jail. (Bandy also argues that since 1900, violence tends to spike whenever there’s a Republican President.)
At any rate, Bandy continued her warnings about Trump’s likelihood to inspire violence, which of course came true. And she continued to be criticized by the APA. She appears to have been skirting the Goldwater rule, saying that she didn’t violate it, yet also asserting that the rule doesn’t really apply when there’s another rule that overrides it. This is from her Wikipedia bio:
Lee says that when meeting with lawmakers, she was adhering to the American Psychiatric Association’s guideline, which precedes the Goldwater rule, and which urges psychiatrists “to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.” 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 from the Mother Jones article:
According to Lee, Trump’s extreme dangerousness puts him in a completely different category from previous Republican presidents, who merely endorsed a set of harsh economic policies that are associated with increased violence. In contrast to past presidents with likely personality disorders, she believes, Trump has a psychological profile that is common among violent offenders. “There is typically a developmental arrest caused by early trauma or abandonment,” Lee says. “As adults, they still act like children in the playground; convinced that might makes right, they often can’t stop bullying others. “Trump’s mother, Lee points out, became chronically ill when he turned two, and his father was cruel and emotionally unavailable, repeatedly urging his son to be “a killer.”
. . . Despite the scolding directed her way by influential psychiatrists, Lee contends that she has never broken the Goldwater Rule, which, as she wrote in 2017, “is the norm of ordinary practice I happen to agree with.” In The Dangerous Case of Donald Trump, she and her co-authors challenged Trump’s fitness to serve based on his behavior rather than on a diagnosis per se. “The issue that we are raising is not whether Trump is mentally ill,” Gilligan writes in his chapter. “It is whether he is dangerous.” As proof of the psychological peril at hand, the authors point to Trump’s angry tirades and verbal abuse of subordinates, his admiration of authoritarian leaders, conspiratorial fantasies, aversion to facts, and attraction to violence.
You can see the conflict here. In the first paragraph, Lee implies that Trump has a personality disorder, and has a psychological profile—connected with childhood abandonment—that leads to bullying and promoting violence. That sounds very much like a claim derived from professional psychiatric experience. Yet in the second paragraph she says she’s never broken the Goldwater Rule: she was just warning people about Trump’s propensities given his behavior. But this is a distinction without a difference: that warning comes from professional experience. (Of course, people like us could also make such prognostications without penalty, but a prediction derived from professional experience comes awfully close to violating the Goldwater rule.)
Well, does it matter? Lee turned out to be right, of course, and Trump was impeached (unsuccessfully) as Democratic members of Congress, like Nancy Pelosi, called him “unhinged.” And then there was January 6, and other calls from Trump for his supporters to beat up people.
In the meantime, Lee was fired from teaching at Yale after 17 years following a Twitter kerfuffle with Alan Dershowitz (she said Dershowitz “had taken on ‘Trump’s symptoms by contagion'”, which again skirts the Goldwater rule). Dershowitz complained to Yale about this “violation,” and Yale dumped Lee. She’s now suing the University and, as she’s become un-hireable in universities, got a degree from Yale Divinity School. She’s now a visiting professor at Union Theological Seminary, where she’ll start a violence prevention institute.
So, if Lee turned out to be right, did she still violate the Goldwater rule? This is a close call, but on balance, and based on the fact that her opinions and warning were derived from her professional expertise, I’d say “yes”.
But two questions remain. First, is the Goldwater rule a good one? I’d say “yes,” given the dangers of chilling public discourse by giving quasi-professional medical opinions. It’s for the same reason that administrators of the University of Chicago don’t make pronouncements on public issues, even when speaking for themselves. It’s because even in private speech, their words carry an imprimatur of authority, and that could chill speech in the University. In some cases violations of the Goldwater rule are clear; if Bandy had diagnosed Trump from afar with narcissistic personality disorder, she would be in violation of the APA’s rule—even though she wasn’t a member of the APA.
But there are no professional sanctions that come with violating the rule.
This leads to the third question: should Bandy have been fired by Yale, even if her predictions about Trump were right? Here I say “no.” She was fired because Dershowitz complained to Yale about her violations of the Goldwater rule. But even if she violated it, Yale didn’t have an obligation to let Bandy go. And given that she claims, with some justification, that she warned about Trump based on his behavior, not a clinical diagnosis, I don’t think she should have been dumped. After all, Yale derailed the career of an accompanlished psychiatrist. Note how Wikipedia begins her bio:
Bandy Xenobia Lee is an American psychiatrist whose scholarly work includes the writing of a comprehensive textbook on violence. She is a specialist in public health approaches to violence prevention who consulted with the World Health Organization and initiated reforms at New York’s Rikers Island Correctional Facility. She helped draft the United Nations chapter on “Violence Against Children,” leads a project group for the World Health Organization’s Violence Prevention Alliance, and has contributed to prison reform in the United States and around the world. She taught at Yale School of Medicine and Yale Law School from 2003 through 2020.
That is positive accomplishment, which to me argues against her firing.
And had she been wrong about Trump’s incitement of violence, I still don’t think she should have been fired. And, as I said, there is some justification for what she did even if she did break the Goldwater rule. After all, she didn’t give a formal diagnosis just to criticize the man: she did it to warn people about what he was capable of doing. (Remember, psychiatrists are allowed to break rules about professional confidence if they think their patients are likely to commit crimes of violence.)
As I said, I haven’t read all of Lee’s writings. But based on what I have read, and on the description in Mother Jones, which of course does lean way Left, I think Lee was acting according to both her training and her conscience. Although her warnings didn’t have any effect in impeaching Trump or preventing the insurrection he promoted, she didn’t deserve to have her career forced off the rails by Yale.