TRUE OPINION: Should mental health professionals get publicly involved in debates on whether US President Donald Trump is crazy, psychopathic, or a narcissist? Our new columnist, Tim Kent, explores the ramifications of diagnosing public figures.
A fierce debate has resurfaced regarding the psychological competency of Donald Trump to hold the office of President of the United States. Many mental health clinicians, in particular psychologists and psychiatrists, are insisting they have a public duty of care in raising concerns over Trump’s mental health status in the context of the safety of the country, if not the world. And that they be given unfettered latitude to express their opinions without fear of reprisal.
The American Psychiatric Association (APA) however is arguing that a psychiatrist is prohibited from providing a diagnosis when they have not personally examined the patient/client.
THE GOLDWATER RULE
The Goldwater Rule arose from a legal precedent set all the way back in 1964. The rule is an informal name contained in section 7 of the APA Principles of Medical Ethics which states as follows: it is unethical for psychiatrists to provide a professional opinion pertaining to public figures they have not examined in person, and from which they have not obtained consent to discuss their mental health in public statements. The ruling is named after former presidential candidate Barry Goldwater.
This took place in 1964 when Fact published the article ‘The Unconscious of a Conservative’; a special issue on the mind of Senator Barry Goldwater. The magazine had polled psychiatrists about Goldwater and raised the issue of whether he was fit to hold the office of President of the United States. The article’s conclusion was that Goldwater was paranoid, sexually insecure, suicidal, and “grossly psychotic.” The editor of Fact, Ralph Ginzburg, was ultimately sued for libel / defamation in the case of Goldwater vs Ginzburg which Goldwater won and was subsequently awarded US$75,000 in damages (approximately US$500,000 today).
The rule first appeared in 1973 and states “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 to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
The APA Code of Ethics also supports the Goldwater Rule as is clearly explained by the New York Times letter published on March 11, 2016, from APA President Susan H. McDaniel, PhD, in response to its article, ‘Should Therapists Analyse Presidential Candidates?’
REGARDING DONALD TRUMP
During 2016 and 2017, a number of psychiatrists and clinical psychologists faced heated criticism for violating the Goldwater Rule. The critical mental health professionals had been asserting that Donald Trump displayed an array of personality disturbances that included grandiosity, lack of empathy, and malignant narcissism and given those traits, he has a dangerous mental illness. This is despite the fact they had never personally examined Trump or obtained authorisation for the same.
In defence of the clinicians implicated in this Dr John Gartner, a practising psychologist, stated that: “We have an ethical responsibility to warn the public about Donald Trump’s dangerous mental illness”.
Gartner went on record on a TV show called ‘Waters World’ as stating that he believed Trump suffered from “Malignant Narcissism” which is not a disorder categorised in the Diagnostic and Statistical Manual of Mental Disorders (DSM V) and therefore cannot be counted as a valid disorder.
Other criticisms of Gartner included that he had used his notoriety to promote his upcoming book on Trump. His previous book, In Search of Bill Clinton: A Psychological Biography was published in 2008. His works have been published in the Washington Post, Chicago-Sun Times, Baltimore Sun, Worth, and Talk. Gartner is bound by the same code of ethics as other psychologists, but it is interesting to note that until this time neither the Psychologist Board in Maryland, nor the APA have issued any public remarks related to his actions.
IN THE PSYCHIATRIST’S CHAIR
Some may recall the excellent BBC series ‘In The Psychiatrist’s Chair’ whereby psychiatrist Dr Anthony Clare conducted a series of searching interviews with prominent celebrities and public figures that did consent to the same. One chilling interview conducted in 1991 involved Jimmy Savile that left Clare with deep concerns about the much revered broadcaster.
Whilst Clare could have laid claim to interviewing his subjects face to face, nonetheless they were hardly what you would call formal psychiatric assessments. Perhaps these concerns however, whilst valid, were unlikely to have been acted upon due to Savile’s and Clare’s association with the BBC. Having said that, it could have been argued at the time that given Clare’s qualifications and expertise, he had indeed a legitimate obligation and duty of care to have taken these concerns further.
Below is a transcript of Clare’s impressions from that interview:
“Savile displayed a facade of avoidance and inflated sense of self importance, as well as an almost total emotional vacuity despite a forced affect that was intended to reflect otherwise. Savile went on to boast about suing newspapers regarding his personal life, to keep them at bay, and that if he lost everything he would quickly regain his position in society. He stated hating children and had no interest in charity”
It is difficult to accept given the information/evidence that came to light of Savile’s activities that no one at the BBC and or Savile’s personal staff knew of his propensity to commit grave sex crimes against children. It appeared that a number of people were aware for some years of his sex crimes.
In the interview with Clare, Savile ominously hinted: “I’ve got the freedom to do pretty well anything now including being bored, or being alone or being with people or getting things, I suppose if I didn’t have that I would only see that as a temporary setback because somewhere my inventiveness is such that if I had everything taken away from me now it wouldn’t be long before I got it back again”.
The question here is, given that it is understood now that Savile’s activities appeared to be quite well known for a number of years did Clare and the BBC have a duty of care to advance upon his concerns over Savile? A full transcript of the Savile interview can be found on the link below.
CAN WE DIAGNOSE TRUMP AS MAD OR WORSE?
In the context of Trump being diagnosed at arm’s length, I have a tendency to agree with the ruling that only a personal examination can legitimately assess an individual’s mental state, as such an examination requires attention to detail and a thorough, corroborative information gathering, including a medical assessment. This can only be acquired via a face-to-face interview.
If the consequences are that the individual experienced damage to their career and or reputation based simply upon an armchair appraisal of their mental state, then allowing clinical opinions in this context could open the flood gates for widespread adoption of this practice, and with it, potentially dire ramifications irrespective of the clinical status and expertise of the individual making that diagnosis.
Whatever is thought of Trump’s mental state this approach deviates from just how someone such as Trump managed to occupy the highest office in the country and arguably the world if you take into account the military might of the US. Applicants for law enforcement and the military are routinely subjected to an intense battery of psychological and personality inventories to assess suitability for such positions, yet some applicants still pass through the screening that go on to demonstrate a level of psychopathy that renders them profoundly unsuitable for those positions. Donald Trump and other occupants of the highest office are not mandatorily required to undergo such testing.
As renowned psychologist Martin Seligman once said, sociopaths / psychopaths are as successful as they are allowed to be. Whilst I do not fully concur with Seligman’s seemingly all too simplistic position it nonetheless holds great traction when attempting to explain the rise to prominence of not only Trump, but Jimmy Savile, with the latter enjoying years of untrammeled freedom to engage in horrific sexual offending behaviour, whilst at the same time gaining ever increasing access to vulnerable children in vulnerable settings. The question as to why and how this happened apparently are still being investigated with the BBC at the front and centre of those inquiries.
If it be that clinicians in this context be allowed to issue a living room diagnosis and or clinical opinion in the context of duty of care, then hypothetically why then should it be just confined to political leaders? Finally, I believe that psychology and psychiatry should indeed be given greater traction when involved in forensic and other cases of this nature, in particular parole board hearings that take into account the probability of re-offending in serious cases.
IS TRUMP MENTALLY UNFIT TO BE US PRESIDENT? (VIDEO: VOX)
Sadly, the US health system is almost exclusively market driven and both disciplines have been called upon to provide expert evidence by both the prosecution and defence teams, with the not so surprising, but common, result that there is disagreement from both sides. This state of play has sought to de-legitimise the credibility of the professions.
Another no less significant point to be made is that the diagnosis that Gartner provided is not listed in the DSM, however even if Trump fitted the other diagnostic categories under personality disorders then he still at this stage would not fit the criteria of mental illness.
The DSM indeed in my view levered open a whole suite of other controversies in that it becomes not only difficult to separate the two, but the diagnosis of mental illness elevates the model of sickness and diminished responsibility, as well as a non-existent capacity to determine right from wrong, both of which are not applicable to Trump even from an armchair diagnostician.
Trump’s nefarious activities also were well known in the business/finance sector as was his penchant for pathological lying, sexually inappropriate behaviour and racism long before he assumed office, and this was neither, seriously questioned or intervened upon. Whilst it is beyond the scope of this discussion to highlight all the systemic variables in play that shaped and colluded with the rise of Trump, having said that, the role of media propaganda as well as the failures of the Clinton, Bush and Obama terms, which saw them turn their backs on middle and working class America, and the subsequent voter backlash, are certainly at the top of the tree when embarking on any meaningful analysis.
Lessons need to be learned and that political leaders of his ilk need to be identified and precluded from seizing a public office that carries such profound power as the President of The United States.