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Should Psychiatrists Be Allowed To Publicly Analyze Donald Trump’s Sanity?

Cheryl Clark
President Donald Trump and Barry Goldwater shown in these undated photographs.
Should Psychiatrists Be Allowed To Publicly Analyze Donald Trump’s Sanity?
Should Psychiatrists Be Allowed To Publicly Analyze Donald Trump’s Sanity? GUEST:Cheryl Clark, reporter, inewsource

President Trump campaign of the fact that he is not a typical politician and his behavior has borne that out. His habit of tweeting and even threatening opponents are seen by some as part of his eccentric personality. Other see something more troubling. There are psychiatrists who believe he is exhibiting forms of emotional or mental illness but ethically they are prohibited from saying so because of the Goldwater rule. It has been a hot topic of discussion. Joining me is Cheryl Clark. What is the Goldwater rule and how did it start? It is based on Goldwater and he goes back to 1964 when a magazine that was owned by Ralph somehow he got a hold of the American psychiatric Association's membership list and they found that 1000 psychiatrists thought that Barry Goldwater was running for president was mentally unstable and it was published that there was so much outcry from organize psychiatry. It is the oldest group in the country and they were pretty appalled that anybody would do this and they started pushing back on many of their members so it took them a while but in 1973, they establish what became known as a Goldwater rule which says you do not express a diagnostic opinion about a public figure unless that person gives you consent and they are your patient we grow -- patient. That Maxine was sued and it went out of business so you had the admonition by the psychiatric Association and the idea that someone will sue you if you diagnose them without actually seeing them. That is the criteria now before making a diagnosis. That is right. Another point I want to make is what the psychiatrists thought of Barry Goldwater back then he was gender confused, he had schizophrenia, it was all over the map. They could not all be right. So some members now of the American psychiatric Association feel very strongly that they want to be able to diagnose this president based on his public statements and actions. What are some things that you heard from members of the American psychiatric Association. I think they want to be able to speak publicly because media have called upon them to say did you just see what Trump tweeted Westmark what you think about this? Does this indicate instability? They say they are impaired by this policy from speaking out. I want to make sure I emphasize that if they violate the Goldwater rule, they will not lose their ability to practice. They simply risk getting kicked out of the American psychiatric Association. There is some stigma to that. So an argument from people who think that the Goldwater rule should be mitigated or written out of existence is a former profiler for the CIA for 20 years his name is Doctor Joe posts. He said something that was timely about Donald Trump. Something I'm concerned about as a psychiatrist and as a citizen is if that interesting character in charge of North Korea Kim Jong-Un get into a spiral, I'm worried they could play off each other and we can stumble into a problem. You heard with people with imposing views. That was half the panel discussion. A psychiatrist Dr. Paul Appelbaum made a very important point , which is it really doesn't matter whether a psychiatrist start talking about what Donald Trump's mental health status is because no one is going to really pay attention to what they say. He said we are the narcissist here. There are very few unemployed skilled workers in Michigan and the thoughts have been changed. Probably the question here is what purpose does it serve? That question was brought up in a February New York Times piece by retired psychiatrist who lives in Coronado saying what purpose does it serve the public what a psychiatrist is about Donald Trump's mental health was never treated or had anything to do with him? This is Doctor Alan Francis. He was an editor of the manual of mental disorders for the fourth edition. He is no fan of Donald Trump. He says basically whatever is going to happen will happen in a political level not a medical diagnostic one. As you said, the APA has not changed the Goldwater rule so you probably will not be here too much diagnosis from afar. I've been speaking with Cheryl Clark. Thank you. Thank you very much.

It’s no secret Donald Trump is an unusual president, one whose late night tweets, comments and vitriol have prompted some to question his sanity.

All that noise has led clinical psychiatrists to be asked by the news media and others to weigh in on the president’s mental health. Does the nation’s leader have a serious disorder that influences how he presents himself to the public?

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And if so, does the psychiatry community have a responsibility, an obligation, and a moral if not patriotic duty to speak their minds if they fear his words and actions endanger the nation?

The answer for some psychiatrists is a resounding "yes."

They said they’ve watched him long enough to diagnose him with one or more serious mental illnesses such as narcissistic personality disorder, for starters.

Others say, not so fast. Publicly diagnosing the president can get them in a lot of trouble.

That’s because of “The Goldwater Rule,” a policy of the American Psychiatric Association (APA) that says a psychiatrist cannot diagnose without a patient exam and consent lest he or she be found guilty of unethical behavior, face professional rebuke and get themselves kicked out of the association.

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The Goldwater rule dates back more than 50 years and grew out of a 1964 survey on "The Mind of Barry Goldwater," published by Fact magazine, in which nearly 1,200 psychiatrists responded that the Republican presidential candidate was mentally unfit to run the country.

Many offered specific diagnoses based on their observations from afar, through newspapers and TV: Goldwater had schizophrenia, psychosis, persecution complex, paranoia, or was sexually confused, to name a few.

Goldwater won a $75,000 libel case that put Fact out of business, and sanely served several more decades in Congress, but the fact that so many psychiatrists – even APA members – had weighed in, many with their own stark diagnoses of the candidate, caught the APA off guard.

At a recent annual APA meeting in San Diego, the rule was the subject of hot debate. (Spoiler alert: It’s not going anywhere any time soon.)

The discussion was provocative.

Dr. Paul Summergrad, psychiatrist-in-chief at Tufts University in Boston, argued to a roomful of colleagues that it’s not professional for psychiatrists to spout off about public figures they only know through media; the profession must uphold its standards.

Others vehemently and publicly disagreed, some calling the Goldwater Rule a gag rule, a violation of their right to free speech.

Dr. Jerrold Post, a psychiatrist who for 21 years assessed the mental health of political leaders for the Central Intelligence Agency, said that under President Trump’s leadership, the nation is in danger and psychiatrists have a duty to warn the public.

"One of the things I'm generally concerned about – I'm not sure if it's because I'm a psychiatrist, but as a citizen – is if that interesting character in charge over in North Korea, Kim Jong-Un, and that interesting character who happens to be our president at this point, get into a spiral, I really worry they could play off each other and we could stumble into an international war," Post said.

"Is this not a time when it is in fact unethical to be silent, when we were particularly called upon to contribute?" he asked.

One prominent psychiatrist who chaired the task force that published the Diagnostic and Statistical Manual IV in 1994, the so-called bible of mental disorder definitions, told inewsource that the Goldwater Rule is not the issue.

Now retired and living in Coronado, Dr. Allen Frances asked: What good would it do to diagnose Trump?

Frances knows mental disorders and he knows Trump. He wrote the definition of narcissistic personality disorder and is the author of a book, to be published this fall, Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump.

“Anyone with eyes to see and ears to hear can realize that Trump every single day says and does remarkably stupid, self-serving, dishonest, impulsive things. Giving him a diagnosis of narcissistic personality disorder isn’t going to change a thing,” Frances said.

The New York Times published a letter in February from Frances about Trump’s mental health, and since then Frances said he is “even more convinced at the absurd grandiosity of psychiatrists who think they can accurately diagnose someone at a distance, that their diagnosis will add anything to what everyone knows about Trump.”

Dr. Paul Appelbaum, director of the division of Law, Ethics, and Psychiatry at Columbia University, believes the Goldwater rule should be maintained, but he agreed with Frances’ assessment of the narcissism in his own profession.

“There are very few unemployed steelworkers in Michigan whose votes would have been changed by hearing me, as a psychiatrist at an elite university in New York, opining that I thought the candidate they were going to vote for was unbalanced and should not attract their support," he said.

The San Diego Psychiatric Society and Dr. Rodrigo Munoz, a San Diego psychiatrist and former president of the San Diego County Medical Society, also support the APA’s policy on the Goldwater rule, which the APA reaffirmed in March. It’s not a good idea to diagnose people and public figures one has not actually examined, Munoz said.

Love the APA or Leave?

Summergrad, the Boston psychiatrist, noted that if psychiatrists insist on rendering a mental diagnosis of the president, they can simply resign their membership from the APA. “It's not a licensing board type of issue."

Is there anything Trump might do that would prompt the APA to revise the rule?

Appelbaum, from Columbia University, suggested it was not likely. In "every election since Goldwater," he said, mental health professionals including psychiatrists have expressed public concern about the mental stability of a major political candidate. And their comments "align perfectly with the political inclinations" of the speakers.

Dr. Claire Pouncey, a psychiatrist in private practice in Bala Cynwyd, Pa., made the free speech argument, noting that when the Goldwater Rule "tells us we may not speak out about our concerns or passions or fears that we really feel convinced about, it functions as a gag rule and then the Goldwater Rule is in itself unethical," she said. "If I say I'm Claire and I'm a psychiatrist and I think that guy's a whackadoodle, am I speaking colloquially or am I speaking as a psychiatrist?"

She added that if she can get arrested for protesting a healthcare plan without violating the APA's ethical principles, "then why can't I speak publicly about my professional opinion about a public figure's alarming behavior?"