Should mental health experts speak out about Donald Trump?

by Marc Wilson / 24 January, 2018
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Donald Trump: the “Goldwater rule” gives him some protection. Photo/Getty Images

Psychology professor Marc Wilson assesses whether mental-health experts have an ethical obligation to speak out about the Don.

I’ve been gorging on such news sites as Politico, Slate and the Huffington Post – and as much Fox News as I can stand. And my Stuff app reveals that the wildfires of the Donald Trump Show have reached New Zealand’s shores.

Thanks to Michael Wolff’s book Fire and Fury and claims that White House insiders routinely question their President’s mental status, these sites are afroth with speculation about the 25th Amendment of the US Constitution. This sets out the rules for presidential succession, including Section 4, which says a President can be replaced if the Vice President and Cabinet believe the incumbent is losing it in the belfry department (which is more colourful than saying Potus is “unable to discharge the powers and duties of his office”.) Section 4 has never been implemented for a case of non-physical incapacitation, and the most talked-about instance when it might have been relates to Ronald Reagan, who was diagnosed with Alzheimer’s five years after leaving the White House.

Obviously, it would be a pretty big call for any executive to make, and one assumes it would require solid evidence. Therefore, it’s a little surprising that a number of US mental-health experts have gone on record to express their belief that Trump is losing it. Twenty-seven of them, including Dr Bandy Lee, a faculty member of Yale School of Medicine’s law and psychiatry division, last year published The Dangerous Case of Donald Trump, an edited collection of commentaries that argue the President is a menace.

This is surprising, because of what’s commonly called the “Goldwater rule” – Section 7.3 of the medical ethics relating to psychiatric diagnosis of people who have not been formally assessed by a psychiatrist. It came about after 1964 US presidential candidate Barry Goldwater successfully sued a publisher over an article presenting a poll of psychiatrists indicating the belief that he was unfit to be President.

Essentially, the Goldwater rule says a psychiatrist should avoid making diagnostic claims about someone based on information in the public domain. The arguments include that diagnosis requires consent, actually sitting down with someone to access all relevant information, and avoiding publicly stigmatising the person in question.

There’s some wiggle room, however, in that a psychiatrist may be able to share professional observations of physical or spoken behaviour and mood without making a diagnosis. Psychologists are governed by a different ethical code that makes similar arguments.

I’d be worried if people were carrying on a public discussion about what I could be diagnosed with. But I’m also not the person who apparently has a bigger nuclear button than North Korea’s Kim Jong-un’s. This is part of the argument that’s developing – whether psychiatrists and psychologists have an ethical obligation to speak out to protect the public from the actions of an unhinged button-wielder.

The Psychiatric Association has gone so far as to address these concerns in a 2017 opinion. It says arguments of free speech are redundant, because only professional diagnostic opinions are prohibited, and other situations involving diagnosis without formal assessment – for example, those that can occur in the criminal justice system – provide a precedent in that they still involve someone with authority providing consent.

Importantly, the association also argues that concern for national security or protection of third parties is no justification for ignoring the Goldwater rule because, again, there is no therapeutic relationship as there might be if a clinician was treating a patient who disclosed they were going to hurt someone.

This article was first published in the January 27, 2018 issue of the New Zealand Listener.

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