Can therapists diagnose Trump as mentally ill, and warn people about his potential to promote violence, without examining him?

June 13, 2023 • 9:00 am

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.

Bandy Lee (from her Twitter account)

h/t: Fred

59 thoughts on “Can therapists diagnose Trump as mentally ill, and warn people about his potential to promote violence, without examining him?

  1. Calling someone who’s a narcissist mentally ill is an insult to those of us who have actual mental illnesses. Narcissism is a behavioral problem, not a mental illness. & saying that he has a mental illness LETS HIM OFF THE HOOK. That’s utter BS.

    1. Quick google search: Narcissistic personality disorder (NPD) is 1 of the 10 clinically recognized personality disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition (DSM-5)

    2. See below; I said “narcissistic personality disorder,” which is not the same thing as narcissicm. I would suggest that you retract your claim that I insulted you.

      From the Mayo Clinic:

      Narcissistic personality disorder is a mental health condition in which people have an unreasonably high sense of their own importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others. But behind this mask of extreme confidence, they are not sure of their self-worth and are easily upset by the slightest criticism.

      1. It’s obviously true that personality disorders are in the DSM, but most physicians would not classify them as mental illnesses. An illness is something you acquire and probably can be treated. A personality disorder is a personality type or trait that is severe enough to interfere with functioning and cause problems in certain aspects of life, and it is not considered as something that can be treated like an illness can. Same for mental handicap—yes, it’s a mental/neurological/cognitive problem, but we don’t think of it as an illness to be treated.
        The OP makes the error of thinking a personality disorder is a chosen behaviour: it is not. People with personality disorders can learn to a limited extent to recognise their inbuilt behaviours and try to avoid them, but not very well. They have no more choice about their condition than those with mental illnesses have.

  2. Wow, I never thought of this. Donald Trump is facing a long string of indictments for various. This could be a blanket defense. He was driven mad by the twin demons of Rep/Dem aiding the vanishing of Original America. He screamed warnings from 1600 Pennsylvania Avenue, and the sound went into the void.

    Innocent by reason of insanity.

    1. As good determinists we know he could not have done otherwise. To “blame” him would not make sense. To prevent him from doing further harm does make sense.

      1. Some day determinists who hold this maxim should be asked to indicate whence comes the moral judgment of “harm.” Most likely they would not say “moral code comes from God.”

      2. Also, insanity is a LEGAL defense, not a medical/psychiatric term, and it is affirmative defense, in my understanding, with the burden of proof shifted to the defense if they claim it…and it’s a very high bar to clear. But I think it’s moot. It’s hard to imagine Trump ever willfully claiming himself to be insane or out of control of his own actions, or not to know whether his actions are right or wrong.

        1. RE: “or out of control of his own actions, or not to know whether his actions are right or wrong.” Well spotted, putting in some of the crucial legal criteria for an insanity defense.

  3. “She helped draft the United Nations chapter on “Violence Against Children,”

    What is her record on calling out from the rooftops against The Woke as they advocate the violation of children?

      1. I judge that the harm done to children by Woke is a world-emergency. It is on her CV to be active in preventing violence against children. It is relevant that she is psychologizing “X” out of the blue, yet not demonstrating her warrior credentials against Woke. (My apologies if she is — I’m only going by the listed foci cited here.)

  4. Performing a medical diagnosis without examination of the patient and relevant tests is not only unethical but not scientific or rational.
    Providing a personal opinion regarding a human being is subjected to personal, historical, cultural, racial & political bias.
    That is why we have an intellect and rational analysis, so that can process the data w others & reach knowledge of a complex reality.
    Whereas we are entitled to our opinions, we must act w Justice, compassion & judgement as we develop action plans.

    1. I can certainly see that without formal examination, a psychiatrist can have an opinion about someone, but one without as much confidence as a diagnosis made by proper and full assessment. Yet people have opinions, and express them. Any psychiatrist expressing an opinion about Trump is probably going to be close to the mark because there is a huge public body of evidence about his reactions to situations which tells us a great deal. I wouldn’t worry much about betting all I have on them being right if a formal mental state examination were to be conducted.

  5. I found this the other day, which gave pause to my staunch Free Speech position :

    “An exotic case of practicing psychology without a license”

    By Marc W. Pearce, JD, PhD, University of Nebraska-Lincoln
    December 2013, Vol 44, No. 11

    “… it is unlawful for anyone who is not a licensed psychologist to hold herself out to be a psychologist.”

    … so…

    I don’t know.

  6. I have no strong opinion on whether psychologists should be allowed to give diagnoses (formal or informal) on people they haven’t formally examined.
    I am, however, convinced that everyone should learn how to recognize the signs of “dark triad” personalities (Machiavellian, narcissist, sociopath) and to avoid giving these people any power. (IMO, Trump’s whole history and persona screams “narcissist”. So does Elon Musk’s. Putin is probably more of a Machiavellian, with some narcissism thrown in.) Can you imagine how much better the world would be if none of its most influencial people were megalomaniacal assholes without a conscience? (And how much better off many people would be if they could avoid getting tangled up in personal relations with predators and abusers?)

    1. The only President I can think of in modern history (I don’t know about those before) who is unlikely to have had at least some markers of being a “Machiavellian, narcissist, [or] sociopath” is Jimmy Carter. People don’t usually rise to the level of the highest office in the world without being willing to do some pretty nasty stuff solely for personal gain. I would make the same assessment of Carter based on this rule alone, if his life after his presidency didn’t show him to be such a humble man who only wished to work for the benefit of all humanity, lived an extremely humble life financially, and never engaged in any activity that involved any sort of self-aggrandizement whatsoever. Carter never benefited from the fact that he was President (he only used it to help the least fortunate), but all others have.

      1. “People don’t usually rise to the level of the highest office in the world without being willing to do some pretty nasty stuff solely for personal gain.”
        That may be true. But it would indicate that the mechanisms by which people rise to power are at least partly broken.

      2. Carter was much more on an egotist than a lot of his supporters care to acknowledge, at least when he was an active public servant. He was a very high-IQ guy (nuclear engineer & all that) who served on nuke subs in the Navy. He was also brought up in that deeply Calvinist Southern Baptist tradition. It doesn’t exactly encourage a lot of introspection or humility.

    2. Unfortunately, it is the very fact that they are “megalomaniacal assholes without a conscience” that, in part, helped them gain the power and noteriety they have. I am not saying that theirs is the only way to power and influence, but it is a tried and true way.

  7. There’s a selection effect. Lots of people just go around predicting bad outcomes and eventually one comes out right and they are able to say “I told you so” and seem prophetic.

    And as out-of-left-field predictions go, this one wasn’t that hard.

  8. I always read your morning post – it’s the way I start my day. Thank you!
    For a different, detailed, informed perspective about the narcissistic personality, DJT, and the state of ‘things’ – I recommend you read my book. To respond in a few words is not helpful – it misses the context and nuance.

  9. “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.'”

    Being right about one thing (Trump’s propensity to promote violence) does not absolve someone from breaking a rule, especially when that rule doesn’t apply to that specific claim, but to her wider claim that he suffers from mental illness generally.

    “…is the Goldwater rule a good one? I’d say ‘yes,’ given the dangers of chilling public discourse by giving quasi-professional medical opinions.”

    I would also say it’s a good rule, but for different reasons than your own. Mental health professionals should not be weaponizing mental health diagnoses, especially when they haven’t examined a patient. This can obviously be used to destroy political and social opponents. Patients should not fear getting help because they may have present or future aspirations to become government officials.

    The fact that I want to see Trump destroyed is immaterial. We don’t start breaking rules just because we want to see the banned behavior used against someone we hate. The whole point of rules (like the First Amendment) is to afford all cases the same uniform treatment. If a rule is only used to protect the people we already like, it’s not a rule at all. It’s like saying that “all people are equal in the eyes of The Party,” when it’s really just the people with whom the Party has no quarrel.

    Furthermore, even if Lee did examine Trump, wouldn’t HIPAA privacy rules preclude her from publicly exposing her diagnosis? This came up when Trump contracted COVID, and the unanimous verdict from experts seemed to be that even the President is protected by HIPAA:

    From the link above, people may pounce on the quote, “…the law does allow for disclosure if it ‘is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public,’ to say that someone who examined Trump can disclose mental health issues that may put the public at risk. This appears to be largely related to contagious diseases. Furthermore, if one reads the relevant HIPAA sections, it doesn’t appear that disclosure would be allowed unless very specific conditions of a legal battle or administrative tribunal were met. In other words, even if Lee was a random citizen who once treated Trump for mental illness, it doesn’t seem like she can just willy-nilly disclose her findings, no matter her personal feelings about the diagnosis.

    1. ” This appears to be largely related to contagious diseases.” Doesn’t the Jan. 6 affray demonstrate that, whatever Trump has, it sure is contagious?

      1. Haha touché. But, as we’ve seen over all of political history, that is often the nature of both ideologies and cults of personality.

  10. I remember reading the book when it came out back in 2017. It proved to be perfectly true and there were many in the book who provided input on Donald Trump. I also agreed with Brady Lee that duty was more important than any outdated Goldwater Rule. The unlimited hours on television and internet platforms probably give more detail on Trump’s mental state than many hours in the chair with a psychiatrist. We also have available, Mary Trump (Psychologist) and niece of Trump who has provided many interviews on television concerning this guy and a book or two. I believe one of her books — Too Much Is Never Enough sold nearly a million books on the first day. The more important question might be how so many people still follow this guy?

    1. If duty demands breaking the law or violating medical ethics, then do so. Just don’t expect to escape consequences because your heart was in the right place.

      That said, I don’t see why Yale should have fired her. If she had lost her Connecticut license to practice medicine in the state, then the university would have to figure out what to do. The university appointments of most physicians are contingent on their holding valid licences so they can generate clinical income to pay their salaries. Ditto her appointments on the medical staff at Yale’s teaching hospitals would be absolutely contingent. But firing her while she can still see patients for them seems heavy-handed to me, especially since there is no evidence of a complaint with the licensing authorities.

    2. ” I also agreed with Brady Lee that duty was more important than any outdated Goldwater Rule.”

      So if a Gerontologist decided that President Biden was too frail and cognitively challenged to perform the role of President then he or she should ignore the Goldwater Rule too, and speak out?

  11. 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.

    I think that such personal opinions, even if rendered by a licensed mental health professional, are plainly protected by the First Amendment’s Free Speech Clause.

    There are few people in public life today more thin-skinned than The Dersh. He’s always been a shameless self-promoter, but at one time he was one of the most outstanding law professors and keenest legal analysts this nation has produced. Then, a few years back, like Col. Kurtz, he went up the Nung River past the Do Lung bridge into his own private mental Cambodia, and, after that, “his ideas … his methods … became … unsound.” 🙂

    1. “I think that such personal opinions, even if rendered by a licensed mental health professional, are plainly protected by the First Amendment’s Free Speech Clause.”

      That isn’t really the question though, is it? The question is whether the Goldwater Rule was broken and, if so, if it’s a good rule in the first place (I leave the question of whether she should have been dismissed from Yale to others, as I have no significant opinion on the issue). Her comments are clearly protected by the First Amendment, but professional associations are free to have their own rules, and for good reason.

      1. I think a state licensing board’s sanctioning a member for expressing a personal opinion would violate the First Amendment.

        Whether a licensed mental health professional’s public statements constitute personal opinions or a professional diagnosis for purposes of the “Goldwater rule” is a question of fact to be decided after notice and hearing. Even if the professional’s statement is deemed a prohibited “diagnosis” under the Goldwater rule, I think any statement on such grave matters of public concern would carry First Amendment implications, at least as regards any sanction imposed on the professional by either a state licensing board or a state university (which, obviously, Yale is not for purposes of analyzing the case under consideration).

        1. I don’t understand. What “notice and hearing”? I’m not suggesting someone like Lee should have her license revoked. As has already been noted below, the APA has no real power. What it seems this post is discussing is whether we, as a society, should consider it ethical for medical professionals to make public diagnoses of individuals without examining them, and/or to make public the results of prior examinations if said examinations did occur, and under what circumstances (if any). See my post above for some reasons why I believe doctors should not do such things (especially the one about people who need help not seeking it for fear of any treatment being weaponized against them in the future).

          Ms. Lee certainly will not lose her license or even face a hearing. But breaking certain ” best practices” rules can sometimes result in some professional repercussions, like the loss of a professorship.

          1. Ken is right, I think. The whole point of licensing is to ensure that doctors practise ethically. If someone thinks that a doctor has crossed the line, the right route is to the licensing authority. The authority has wide discretion as to penalty, sometimes just a caution without an actual finding of wrongdoing, (and a warning to other doctors), sometimes a recorded reprimand, sometimes a fine, sometimes a licence suspension. A lot depends on the doctor ‘s willingness to admit she did something considered unethical. Only in cases of sex with a patient would permanent revocation be imposed for a first offence. The licensing authority governs all doctors, not just those with professorships and its view is that miscreant doctors should be considered corrigible except in grave transgressions.

          2. I think there’s a fundamental misunderstanding here, though I’m not sure why. I never brought up any sort of punishment that I think Lee should suffer. I only brought up the question of whether the “Goldwater Rule” is a good idea and whether it was broken in this case. I even said that I give no opinion on the apparent repercussions suffered by Ms. Lee. I am clearly attempting a philosophical and ethical discussion, not a legal one or one about being a certified practitioner, professor, or anything else.

          3. OK, I see that, CC. It’s just that you can’t say “ethics” and “doctors” in the same sentence without invoking the risk of professional sanctions, because doctors are legally compelled to act ethically. Since the Goldwater rule is an ethical principle applicable only to doctors, as soon as you discuss it you are necessarily raising the consequences that doctors might face for transgression, which non-physicians would not. We clinicians can’t really separate in our minds the philosophical from the regulatory in medical ethics. Even if that’s not on the point you were making.

  12. Of course, the APA isn’t a regulatory agency nor does it have any actual legal authority over anyone, though it makes recommendations and gives guidance to legislators and regulators, of course, and many, if not all, of them will follow its recommendations and make laws that go along with them. It’s a private organization, a corporation, and it only has direct “authority” over its members. It also accredits PhD programs, and many states (such as Florida) require professionals to have earned a so-accredited degree to receive a license to practice as a psychologist in the state. But the APA can’t take back your degree or anything of the sort or remove your right to practice except via state legislatures, unless I’m very mistaken. In this, it’s much like the AMA and other, similar organizations. That doesn’t mean I think it’s recommendations or rules are frivolous or should be flouted, but as far as sanctions, I think the only ones available to it are to cancel someone’s membership and publicly denounce their behavior.

    1. You are correct! They can try to set standards (many of which I might disagree with, like that on “gender-affirming care” for children), but they have no true authority revoke a license like, say, a state’s medical board or bar association. Of course, the organization itself can publicly denounce someone in its profession, and members of the profession can end up being scrutinized, denounced, and sometimes even sanctioned by their colleagues and others for not following the “rules” set out by organizations like the APA, but there is no obligation for any such behavior.

  13. A doctor should no more make a claim about Trump’s health without examining him than he should about Biden’s health without examining him.

    1. I wonder, what would be the chances that Trump would agree to be examined by any legitimate Dr. I remember the last MD Dr. that we heard from said he had the body of a 20 year old or something similar to that. And then there are several of his lawyers who are no longer in business.

        1. Yes and what did you hear from any of them? Only much later did we hear any reality of just how sick he was with covid

          1. First, your original statement was this: “I wonder, what would be the chances that Trump would agree to be examined by any legitimate Dr. I remember the last MD Dr. that we heard from said he had the body of a 20 year old or something similar to that.” Regardless of the following, my answer was to your initial query.

            As to your followup questions: it appears the White House physician immediately addressed the public upon Trump’s admission to Walter Reed Hospital for treatment of COVID-19. He confirmed that Trump had the infection. He disclosed very little beyond that.

  14. The APA is not a licensing or disciplinary body. Its opinions, like those of all professional societies, represent a sort of best-practices compendium. Psychiatrists, as physicians, are licensed to practice by self-regulating bodies set up under enabling legislation in the states, provinces, or countries in which they operate. To practice medicine, a person must have a licence granted by the self-regulator, (called a College in Canadian provinces and territories but they are not academic institutions.)

    A complaint that a doctor (including a psychiatrist) has committed professional misconduct could be adjudicated only by (in Canada) the College(s) where the doctor is licensed and similar rules apply at state licensing Boards afaik. As Jerry says, it is generally considered professional misconduct to offer a diagnosis or any other regulated medical act to a person who is not your patient. Not only could this lead the College to suspend your licence but the Courts might deem that you had created a doctor-patient relationship and are now liable for any medical consequences of that ill-considered diagnosis, such as failure to arrange treatment and follow-up!

    Responsibility for acting on allegations of professional misconduct rests with the College who has licensed the doctor, usually by investigating a complaint brought to it by a patient, a member of the public, or a Crown agent such as a public health officer or even the police. Doctors are sometimes surprised to learn that Colleges will investigate and discipline behaviour that has nothing to do with their treatment of any named patient.

    So if a psychiatrist offers a gratuitous mental health diagnosis to Mr. Trump, the avenue for him, or for anyone else, is to complain to the state(s) the psychiatrist is licensed in. The licensing authority will be obligated to investigate unless the complaint is clearly vexatious or frivolous. As with all proceedings, the verdict depends on all the facts of the case, determined by preponderance of evidence. The Goldwater rule would certainly be cited but the only opinion that counts is the licensing tribunal.

  15. Long ago, I was privileged to be on the committee for Republican candidate Richard A.C. Greene, who ran for Commissioner of Public Land on a platform that called for ceding eastern Washington to Idaho, and, if they refused, invading to force them to take it. We also called for replacing the University of Washington by a wilderness area, and we characterized our candidate as a Warren Harding Republican. Using my status as a geneticist, I publicly asserted that our opponent’s chromosomes showed he was just too good for the job. The University neglected to discipline me for this exercise. However, a newspaper did express doubt that either our candidate or I actually existed. I replied publicly by confessing that I had long suffered from the same doubt.

  16. As an MD who interned in medicine and psychiatry, I interpreted his TV behavior in 2015 (at my first encounter) as indicating something extremely strange that I had not seen before in political figures. That so many voted for him was baffling.

    It suggested correction was needed at a much earlier educational level. Instead of the classical “3 Rs” at nursery school (reading, ‘riting and ‘rithmatic), we first need REASONING, RESPECT and RACIAL BIOLOGY. The old teachings, such as the Wizard of Oz, and Father Christmas, etc., have not sufficed.

  17. I think that she violated the Goldwater Rule, because she did not follow the specific protocol for making a diagnosis. I just now looked into that (albeit pretty superficially), and a brief synopsis of how a diagnosis is made is that the patient is subjected to in-depth interviews, where they answer a series of questions that are aimed at revealing their attitudes and opinions. People close to the person are also interviewed, and their stories are taken into account. Accounts of the longer term behavior of the person are also learned. This data is used to eliminate or fail to eliminate this or that mental state, until a ‘surviving’ mental state is left, and that is offered as a preliminary diagnosis. If this is wrong, please tell me.
    A concern about the accuracy of this protocol is that the patient knows what is being done, and they could guard against giving deviant kinds of answers or reactions.
    The Goldwater Rule was made pre-internet, and now we have public figures who are laid bare to display their unguarded behavior to all of us, 24/7. So although I do think she violated the rule on technical grounds, I wonder if the data on Trump is somehow better than what you’d get following the standard protocol for making a diagnosis.

  18. The Goldwater rule is wise. Regardless of how much you hate trump or think him a threat, you are only engaging in bad politics if you make medical statements about him which neither you nor anyone else have proven — and it is bad politics because it contributes to the sense, widespread in America, that he is being unfairly persecuted; that your political side is biased; that that side is arrogant, presumptuous, dismissively supercilious; and much else. Just as the theory of the luminiferous ether can be shown to be false without attacking it for imaginary theoretical problems, there is enough provably bad about Trump that it is totally unnecessary to make unverified statements about his mental health. He can be shown to be unfit for office because he is in fact unfit for office. Putting all this aside, a diagnosis of narcissistic personality disorder isn’t, in any case, the great blow that it is made out to be; we all know, and even our political enemies know, that we are all a little bit narcissistic and that throughout history a large number of politicians have been not just narcissistic but supreme narcissists while being effective leaders or tyrants. So the charge is feeble, and there is more than a slight air of desperation to it. It won’t work.

    1. For me, thinking that Trump is a vindictive and dangerous man makes it easier to hate him. But concluding that he is mentally ill due to not being socialized while growing up makes me feel sorry for him and to maybe hate him less.

  19. “[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?””

    I think she’s right on target with this. Even if we replace psychological impairment with something like ethically depraved, it is still right on target. The point being that there has always been, since before Trump ran for office, more than enough evidence in the public record that Trump was (is) unfit to be trusted with any public office. This is not merely differences in political views. Trump is abnormally unfit as made clear by his countless appearances in the media and social media. He brags about grabbing pussies without asking. He makes fun of disabled people like a 5 year old while giving speeches. I could go on, but what’s the point. You either already know and agree, you know but are OK with it, or you deny reality. And really, those by themselves are enough. Aren’t they?

    And the real point for me is that the politicians, and media, and the pundits that treated him as if his behaviors were not beyond the pale, as if it were just business as usual. That’s the real problem with our society. There are always Trumps, but it’s not healthy society that allows a Trump to become their leader.

    1. To our lovely host: Sorry for being all over this thread. Mental healthcare issues are very important to me, and my number one concern is people not getting help they need for fear of future disclosures, or hiding their issues for fear of public “diagnosis.” There are a lot of people in a lot of mental pain in this world, many of them don’t get the help they need because of stigmatization, fear of disclosure, and myriad other reasons, and things like the Goldwater Rule will make some people more comfortable in getting that help. That alone is reason enough for me to defend it.

      To Darrelle:
      I agree with literally everything you said! All Lee had to do was replace her diagnosis of Trump’s mental health with a statement that, in her personal opinion, he is an unhinged and violent person who will destroy this country.

      What we want to avoid is what happened to Goldwater: having a survey sent to nearly 2,500 psychologists and psychiatrists, with over 1,000 agreeing that Goldwater was mentally ill, so those numbers could be published to ostensibly demonstrate that Goldwater was indeed mentally ill. As with Trump, all that needed to be said about Goldwater was that his public statements showed him to be a clearly unhinged and belligerent man who would almost certainly plunge the world into nuclear war.

      In order to avoid things like that survey, it’s not enough to say something like “you can’t sign a petition or mark a box on a survey about someone’s possible mental health.” You need a hard and fast rule that applies to all individuals in the profession. That’s what the Goldwater Rule does.

      I expect to see a sharp increase in the Republicans and right-wing media putting up their own psychologists who will say that Biden is suffering from severe dementia. Hell, I won’t be surprised if some outlet sends out a survey just like the one used against Goldwater, just to see how many professionals they can get to say that Biden has dementia or is otherwise unfit to be President. But I will have nothing but contempt for the professionals who make such statements and reply in the affirmative to such declarations, and I think the worst offenders should possibly suffer sanctions from either their employers or medical boards should their statements be sufficiently concrete (I’m not sure if Lee’s statements were sufficiently concrete to evoke any such responses, but I haven’t claimed otherwise in this thread. I’ve only debated the merits of the Goldwatwr Rule and whether she technically broke it).

      1. In my first comment I purposely did not engage with Jerry’s direct questions because truthfully I’m not sure what to think. What I mean is, I don’t know enough about the many aspects of this issue to warrant having confidence in any position.

        I’m not sure the Goldwater Rule is a good rule to have. I think maybe so, but I’m not sure. For one doubt, considering the extreme case of Trump, there is a MFT of data on Trump’s behavior available in the public record. It seems plausible to me that this data set is significantly better than the data set a psychiatrist could develop via normal clinical practice. Not only is there much more data, it’s been gathered “in the wild” rather than in conditions in which the subject knows they are being evaluated. Of course, that doesn’t mean the general case could be quite different.

        And of course that only speaks to the issue of how accurate informal diagnoses might be. The other question is even if such diagnoses are just as likely to be accurate as those made in a proper clinical setting, is it OK to state them publicly without the subject’s consent? In general I’d say that is a bad thing. Bad enough to have rules against it? Probably. Rules backed by the ability to punish, like laws as opposed to merely statements of professional ethics? Maybe. Or would existing more general laws be enough to cover it, maybe defamation or similar? Don’t know.

        And then there’s edge cases, like Trump. Maybe both the Goldwater rule and Lee breaking the rule in this particular case are both ethically OK. The WMA Declaration of Geneva was inspired by much worse than what happened to Barry Goldwater.

  20. Just wanted to point out that the 2004 book ‘Bush On The Couch’ psychoanalyzed our previous worst President, based upon his public behavior. The author argued that such analyses of world leaders were commonly done by the CIA and other intelligence services.

    Reading that book I concluded as we all do now – one malignant personality is hardly surprising – the real problem is with the fact that millions of voters were attracted to that person as a leader.

    1. Yeah. But this real problem is kind of like the real problem of the existence of murder — nothing conceivable, at least in the foreseeable future, is going to overcome it. Such attractions have been a staple of politics since the beginning of history and even before. And they will persist. The best we can do is be mature ourselves politically and thereby spread mature politics: a task that each of us, in all likelihood, will at best contribute to only a little bit. That seems to be the brutal reality.

  21. perhaps it should be mandatory that government leaders have compulsory psych evaluations to determine their ability to do their job.

  22. I wonder, if the Goldwater Rule or some variation of it had been around circa 1938, would it have been “unethical” for a trained therapist to publicly state that Adolf Hitler had serious psychological maladies and was likely to start a horrific war? Many national leaders throughout history have had major psychological issues that led to hundreds of thousands, even millions of deaths. And none would have willingly undergone a thorough analysis by any sort of therapist. But what good would it have done if they had been properly evaluated? It certainly would not have stopped the carnage brought about by Hitler, Stalin, Pol Pot, etc., etc. Worse are the unhinged followers who help propel the looneys to power and wage war against any perceived threats to their idol’s power. How can sane people halt the march to power of a madman who has millions of equally mad people marching with him? Lee’s ethical violations pale considerably when compared to the monstroug violations committed by tRump and his most rabid followers.

  23. If the Goldwater Rule has no teeth other than being considered unethical by some of one’s colleagues, then it’s outdated, and has no teeth worth mentioning. Even though polarization in modern America may be overblown, it’s stronger now than it was back in the Goldwater era.

    Instead of adding teeth to the rule, I say discard it. The American public is already accustomed to the necessity of applying another rule: consider the source. The credible media (if there are any left) could find out, with a modest effort, whether any given psychiatrist was a political hack/tivist, or is stepping into the psychiatry-meets-politics waters for the first time.

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