What ails Donald Trump?

While neither group may wish to admit it, the Trump era may have brought psychiatrists and psychoanalysts closer together

Cohen’s justification — “President Trump has failed the presidential test of moral leadership. No moral president would ever shy away from outright condemning hatred, intolerance and bigotry” — suggests that his effort is, at best, premature. There is no “test of moral leadership” in the Constitution, and failure to condemn bigotry, however reprehensible, wouldn’t seem to rise to the level of the “high crimes and misdemeanors” that the Founding Fathers set as the bar for removal from office.
The US President Donald Trump have made more than a half-dozen false statements. As a student of medical social science, ethics and behavioral science, now I shall try to light on some of the notions and some of the framework conditions which we should take into account as we proceed to discuss the questions raised now a day regarding President Donald Trump.
In the late 19th century, Sigmund Freud’s colleague Wilhelm Fleiss successfully diagnosed an illness in one of Freud’s relatives, without even having met them. Freud was so impressed by Fleiss’s “diagnostic acumen” that he went on to advocate the method in certain circumstances. Freud would write that diagnosing someone without personally examining them was acceptable where the features of certain disorders, such as paranoid schizophrenia (then known as dementia paranoides), made the interview process counterproductive. Here, Freud noted that “a written report or a printed case history can take the place of personal acquaintance with the patient”. Now, a controversial debate about the ethics of diagnostic at a distance or ling-distance diagnosis has arisen in the US. It has come about as commentators have proposed that President Donald Trump suffers from narcissistic personality disorder (NPD) and attention deficit hyperactivity disorder (ADHD), among other conditions.

Sigmund Freud believed diagnosing people without examining them was appropriate in some circumstances. Health professionals have weighed in as well. Psychotherapist and former assistant professor of psychiatry John D. Gartner has been particularly vehement in his assessment of the President. Gartner asserts that Trump suffers from malignant narcissism, a specific manifestation of NPD.  Recently, the American Psychoanalytic Association (APsaP) issued a memo to its more than 3,500 members, advising they were “free to comment about political figures as individuals”, and that the APsaA did not regard “political commentary by its individual members an ethical matter”.

By contrast, the American Psychiatric Association (APA) has long maintained a strict ethical stance on the open discussion of public figures’ mental states. Enshrined in the so-called Goldwater rule, the APA’s prescription cautions psychiatrists against diagnosis at a distance. As former APA President Herbert Sacks put it, psychiatrists should avoid engaging in “psychobabble”, especially when it comes to politicians. He said that, when “reported by the media”, such diagnostic speculation only “undermines psychiatry as a science”. https://cdn.theconversation.com/files/180500/area14mp/file-20170801-22136-8ewtke.jpgThe Goldwater rule is named after former Republican presidential nominee Barry Goldwater, who was defeated in the 1964 election.

What is the Goldwater rule? The Goldwater rule is named after an incident involving Republican presidential nominee Barry Goldwater. Having been defeated in the 1964 US election, Goldwater sued the editor of the short-lived political magazine “Fact” for defamation. Just one month before the election, Fact’s front page had printed a controversial declaration: 1,189 psychiatrists say Goldwater is psychologically unfit to be president!
Fact had conducted a broad but clinically invalid survey, providing questionnaires to more than 12,000 psychiatrists whose details the magazine had obtained from the American Medical Association’s membership list. Of the 2,417 responses it received, some 1,189 psychiatrists asserted Goldwater was unfit for office.

In the feature article, Fact purported to quote many of the psychiatrists it had surveyed, and used their words to suggest that Goldwater was a “megalomaniac, paranoid, and grossly psychotic”, and even suffering from “schizophrenia”. In the trial that followed, Goldwater was awarded some US$75,000 in punitive damages — enough to ensure that Fact never published another issue.

The ruling raised disturbing questions for the APA, threatening not only the reputation of the psychiatric profession, but the future livelihoods of practitioners. In slightly different circumstances, a psychiatrist might face similar civil action, whether “for invasion of privacy of defamation of character”.
In 1973, some four years after the trial, the Goldwater rule was first published in the APA’s professional ethical code. In the most recent 2013 edition, the rule reads as follows: 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.

The rule in dispute: Many academic psychiatrists disagree with the rule. Some have suggested that breaking the Goldwater rule is ethical when it’s necessary to diagnose “mass murderers” from afar, or when “the importance of the diagnosis of an individual … rise[s] to the level of a national threat”. Others have criticized the rule more generally, calling it “an excessive organisational response” to “an inflammatory and embarrassing moment for American psychiatry”. And one psychiatrist has recently described the prescription as “American society’s gag rule”.
In February this year, the New York Times published a letter signed by some 33 psychiatrists who blamed the rule for silencing them at this “critical time”. They wrote that “too much [was] at stake to be silent any longer”, and that Donald Trump’s “emotional instability” had made him “incapable of serving safely as president”. https://cdn.theconversation.com/files/180980/area14mp/file-20170804-27440-1q2uh7l.jpgSome psychologists believe Donald Trump too unstable to be president.

What now for the Goldwater rule? The psychoanalysts may wish to distinguish themselves from psychiatrists on the Goldwater rule, and vice versa, is unsurprising. In countless ways — more than can be named here — psychoanalysts and psychiatrists adopt different views of their roles in the diagnostic process. This is the result of their different training backgrounds, histories, and professional cultures.
Less expected, however, is the growing feeling among psychoanalysts and psychiatrists alike, that today, more than ever, the Goldwater rule should be set aside. While neither group may wish to admit it, the Trump era may have brought psychiatrists and psychoanalysts closer together — at least on this point.

The writer is former Head, Department of Medical Sociology,
Institute of Epidemiology, Disease Control & Research (IEDCR),
E-mail: [email protected]

 

 

What ails Donald Trump?

While neither group may wish to admit it, the Trump era may have brought psychiatrists and psychoanalysts closer together

Cohens justification President Trump has failed the presidential test of moral leadership. No moral president would ever shy away from outright condemning hatred, intolerance and bigotry suggests that his effort is, at best, premature. There is no test of moral leadership in the Constitution, and failure to condemn bigotry, however reprehensible, wouldnt seem to rise to the level of the high crimes and misdemeanors that the Founding Fathers set as the bar for removal from office. The US President Donald Trump have made more than a half-dozen false statements. As a student of medical social science, ethics and behavioral science, now I shall try to light on some of the notions and some of the framework conditions which we should take into account as we proceed to discuss the questions raised now a day regarding President Donald Trump. In the late 19th century, Sigmund Freuds colleague Wilhelm Fleiss successfully diagnosed an illness in one of Freuds relatives, without even having met them. Freud was so impressed by Fleisss diagnostic acumen that he went on to advocate the method in certain circumstances. Freud would write that diagnosing someone without personally examining them was acceptable where the features of certain disorders, such as paranoid schizophrenia (then known as dementia paranoides), made the interview process counterproductive. Here, Freud noted that a written report or a printed case history can take the place of personal acquaintance with the patient. Now, a controversial debate about the ethics of diagnostic at a distance or ling-distance diagnosis has arisen in the US. It has come about as commentators have proposed that President Donald Trump suffers from narcissistic personality disorder (NPD) and attention deficit hyperactivity disorder (ADHD), among other conditions. Sigmund Freud believed diagnosing people without examining them was appropriate in some circumstances. Health professionals have weighed in as well. Psychotherapist and former assistant professor of psychiatry John D. Gartner has been particularly vehement in his assessment of the President. Gartner asserts that Trump suffers from malignant narcissism, a specific manifestation of NPD. Recently, the American Psychoanalytic Association (APsaP) issued a memo to its more than 3,500 members, advising they were free to comment about political figures as individuals, and that the APsaA did not regard political commentary by its individual members an ethical matter. By contrast, the American Psychiatric Association (APA) has long maintained a strict ethical stance on the open discussion of public figures mental states. Enshrined in the so-called Goldwater rule, the APAs prescription cautions psychiatrists against diagnosis at a distance. As former APA President Herbert Sacks put it, psychiatrists should avoid engaging in psychobabble, especially when it comes to politicians. He said that, when reported by the media, such diagnostic speculation only undermines psychiatry as a science. https://cdn.theconversation.com/files/180500/area14mp/file-20170801-22136-8ewtke.jpgThe Goldwater rule is named after former Republican presidential nominee Barry Goldwater, who was defeated in the 1964 election. What is the Goldwater rule? The Goldwater rule is named after an incident involving Republican presidential nominee Barry Goldwater. Having been defeated in the 1964 US election, Goldwater sued the editor of the short-lived political magazine Fact for defamation. Just one month before the election, Facts front page had printed a controversial declaration: 1,189 psychiatrists say Goldwater is psychologically unfit to be president! Fact had conducted a broad but clinically invalid survey, providing questionnaires to more than 12,000 psychiatrists whose details the magazine had obtained from the American Medical Associations membership list. Of the 2,417 responses it received, some 1,189 psychiatrists asserted Goldwater was unfit for office. In the feature article, Fact purported to quote many of the psychiatrists it had surveyed, and used their words to suggest that Goldwater was a megalomaniac, paranoid, and grossly psychotic, and even suffering from schizophrenia. In the trial that followed, Goldwater was awarded some US$75,000 in punitive damages enough to ensure that Fact never published another issue. The ruling raised disturbing questions for the APA, threatening not only the reputation of the psychiatric profession, but the future livelihoods of practitioners. In slightly different circumstances, a psychiatrist might face similar civil action, whether for invasion of privacy of defamation of character. In 1973, some four years after the trial, the Goldwater rule was first published in the APAs professional ethical code. In the most recent 2013 edition, the rule reads as follows: 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. The rule in dispute: Many academic psychiatrists disagree with the rule. Some have suggested that breaking the Goldwater rule is ethical when its necessary to diagnose mass murderers from afar, or when the importance of the diagnosis of an individual rise[s] to the level of a national threat. Others have criticized the rule more generally, calling it an excessive organisational response to an inflammatory and embarrassing moment for American psychiatry. And one psychiatrist has recently described the prescription as American societys gag rule. In February this year, the New York Times published a letter signed by some 33 psychiatrists who blamed the rule for silencing them at this critical time. They wrote that too much [was] at stake to be silent any longer, and that Donald Trumps emotional instability had made him incapable of serving safely as president. https://cdn.theconversation.com/files/180980/area14mp/file-20170804-27440-1q2uh7l.jpgSome psychologists believe Donald Trump too unstable to be president. What now for the Goldwater rule? The psychoanalysts may wish to distinguish themselves from psychiatrists on the Goldwater rule, and vice versa, is unsurprising. In countless ways more than can be named here psychoanalysts and psychiatrists adopt different views of their roles in the diagnostic process. This is the result of their different training backgrounds, histories, and professional cultures. Less expected, however, is the growing feeling among psychoanalysts and psychiatrists alike, that today, more than ever, the Goldwater rule should be set aside. While neither group may wish to admit it, the Trump era may have brought psychiatrists and psychoanalysts closer together at least on this point. The writer is former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR), E-mail: [email protected]