“We've had some real zeros in the White House before,” Taibbi writes, “but we've never had a chief executive who barked at the moon or saw ghosts — at least, not one who was so public about it.”
Journalists aren’t the only ones calling Trump crazy. In July, the American Psychoanalytic Association sent an email to its 3,500 members reminding them that they are not bound by the so-called Goldwater Rule, which says that it’s unethical for psychiatrists to offer a medical opinion about a patient they have not directly examined. This email was widely picked up by the press, viewed by some as a professional health organization finally coming to its senses about Trump.
Meanwhile, psychologist John Gartner started a petition on Change.org for “mental health professionals” (with no method to determine if their status as mental health professionals extended beyond self-appointment on the internet) to declare Trump mentally unfit to be president. So far, it’s received more than 60,000 signatures.
As much as I wish Trump weren’t president, slapping him with lazy e-diagnoses is not the way to get there. This obsession with his mental state is not only irrelevant to the current political situation, but endangers the acceptance and treatment of people with mental illness.
This isn’t a new debate. Back in 1964, Fact Magazine sent a survey to 12,356 psychiatrists about Barry Goldwater, the Republican running for president. Their responses led to the provocative cover story: “Fact: 1,189 Psychiatrists Say Barry Goldwater Is Psychologically Unfit to Be President!”
To say the survey was unscientific is an understatement, but even worse than the shoddy methodology were the 38 pages of comments the magazine published from the responding psychiatrists. Although some comments stated objections to the idea of such a survey, many more made unfounded personal attacks. One psychiatrist diagnosed Goldwater as a “dangerous lunatic” (not a real medical condition). Others said he had a paranoid personality due to “his anality and latent homosexuality,” and that his mental problems derived from “the fact his father was a Jew while his mother was a Protestant.”
The rule says it’s unethical to offer a medical opinion about a patient you have not examined or received permission from to discuss.
Today these comments read like a Reddit thread containing particularly virulent hate. Even in 1964, many medical professionals were embarrassed by them. Both the American Medical Association and the American Psychiatric Association (or APA, a large organization not to be confused with the American Psychoanalytic Association that sent the July email) condemned the Fact survey, and Goldwater brought a libel suit against the magazine and its publisher, eventually winning $75,000 (well over $500,000 in 2017 dollars) in punitive damages.
Nearly a decade later, the APA formally addressed the problem with section 7.3 of its Principles of Medical Ethics. Known as the Goldwater Rule, it’s a set of guidelines for how psychiatrists should talk to the media. The rule says it’s unethical to offer a medical opinion about a patient you have not examined or received permission from to discuss. Although the APA said that it’s OK to discuss mental health conditions generally, offering specific diagnoses is verboten.
Now, in the face of Trump’s erratic behavior, a growing number of psychologists and psychiatrists are violating the rule, as loudly as they can.
In February, 35 psychiatrists published a letter in the New York Times stating that in their professional medical opinion, Donald Trump was mentally unfit to be president. That, along with concerns from many other psychiatrists — including Jerrold Post, founder of the CIA's program for psychologically profiling world leaders, who wants to ditch the rule — launched a months-long debate among mental health professionals. Another critic of the rule, psychiatrist John Zinner, publicly declared that Trump has narcissistic personality disorder and poses an “existential threat” to the world.
(A psychiatrist who feels it is his responsibility to save the world from nuclear apocalypse? As tempted as I am to name what psychiatric illness that sounds like, I won’t because I’m not a medical professional qualified to make diagnoses.)
There are many, many reasons why it’s futile to diagnose Donald Trump. The first is practical: The former reality TV star was, is, and always will be an incredibly effective performer — whether on The Apprentice, at a rally, or on his Twitter feed. Without actually speaking to him in person, there’s no way to distinguish the entertainer from his true self.
But but but, his critics say, if we could definitively prove that Donald Trump is “mentally ill,” then we can 25th Amendment him right out of the White House!
This, too, is problematic. Should having a mental illness preclude someone from being president of the United States? I would answer that by pointing to yet another Republican politician: Abraham Lincoln. Although historical diagnoses are notoriously problematic, Lincoln himself was straightforward about self-diagnosing “melancholy” and articulating its manifestation — which today we’d call clinical depression.
These rules set pretty basic standards for how to have intelligent conversations involving people who have been horrendously marginalized, and continue to be so.
None of this hand-wringing about Trump is likely to get him booted from power. But it does increase the already significant cultural stigma that goes hand in hand with having a mental illness. And as someone with a chronic illness (Bipolar 1, Code 296.46 in the 2013 DSM-5) that requires lifelong care, I’m not just worried about added stigma, I’m terrified that the participation of medical professionals in this debate will seriously harm how mental illness is defined and treated.
In 2013, back when Trump was just a B-list celebrity with a grudge against Obama, the Associated Press added an entry in its stylebook for mental illness. The guidelines required that journalists question the relevance of mental illness to every story, and if it is relevant enough to include, to ask, “Who is an authoritative source for a person’s illness, diagnosis and treatment?” These rules set pretty basic standards for how to have intelligent conversations involving people who have been horrendously marginalized, and continue to be so.
And yet I now see mainstream journalists breaking these rules all the time. Which brings me back to Matt Taibbi’s disappointing story in Rolling Stone.
The part of the story that most upset me is Taibbi’s reference to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5, a technical classification of psychiatric disorders.
“Everyone with half a brain and a recent copy of the DSM (the Diagnostic and Statistical Manual of Mental Disorders, used by shrinks everywhere) knew the diagnosis on Trump the instant he joined the race,” Taibbi writes. “Trump fits the clinical definition of a narcissistic personality so completely that it will be a shock if future psychiatrists don't rename the disorder after him.”
The DSM is a book that, though flawed, is the best thing that people with mental illness — that’s roughly 1 in 5 Americans — have to getting a name, validation, and treatment for our conditions. To cite it sloppily in an effort to dethrone Donald Trump? I’ve got to stand up and say no. It’s taking the very words that were created to help people, and turning those words into weapons.
As for the shrinks who think it’s appropriate to ignore the standards that the Goldwater Rule set forth: I can’t help but wonder if they’ve stopped to consider the damage that they are doing to their own profession, and the harm that they are inflicting on the very people that they have committed to help. ●
Alexandra Mendez-Diez is a freelance writer. She’s several years into that apocryphal novel of many a Brooklyn writer, but one time the US State Department gave her a significant chunk of money to work on it, and service to her country is as good motivation as she can find to get the book done.