Breaking the Goldwater rule
Readers may be familiar with the American Psychiatric Association’s “Goldwater rule” which says it is unethical to offer a professional opinion about the mental health of a public figure without a personal examination of that person and permission from that person. The rule effectively muzzled these professionals and silenced their opinions of Donald Trump before and since his election to the presidency. One can only wonder whether their opinions might have changed the election results.
Now, however, several of these professionals have decided to speak out about Trump, and if you’ve thought he must be deranged, you now have some professionals who publicly agree with you.
The Dangerous Case of Donald Trump (Bandy Lee, MD, ed) is a collection of 27 essays by psychiatrists and mental health experts.
The prologue states:
“Collectively with our coauthors, we warn that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency.”
In his review today, Washington Post writer Carlos Lozada summarizes the opinions in Dangerous Case:
Trump displays signs of “extreme present hedonism,” the tendency to live in the moment without considering consequences, seeking to bolster one’s self-esteem no matter the risk. Or he exhibits “narcissistic personality disorder,” which includes believing you’re better than others, exaggerating your achievements and expecting constant praise. Combine hedonism, narcissism and bullying, and you get “an impulsive, immature, incompetent person who, when in the position of ultimate power, easily slides into the role of the tyrant,” Philip Zimbardo (of the famous Stanford prison experiment) and Rosemary Sword write. Others suggest that Trump shows indications of sociopathy, including lack of empathy, absence of guilt and intentional manipulation. Put it all together and you have “malignant narcissism,” which includes antisocial behavior, paranoid traits, even sadism.
“Mr. Trump’s sociopathic characteristics are undeniable,” retired Harvard psychiatry professor Lance Dodes concludes. “They create a profound danger for America’s democracy and safety. Over time these characteristics will only become worse, either because Mr. Trump will succeed in gaining more power and more grandiosity with less grasp on reality, or because he will engender more criticism producing more paranoia, more lies, and more enraged destruction.” And when the president stands before the U.N. General Assembly and threatens to “totally destroy” an enemy country of 25 million people, enraged destruction seems on point.
The writers emphasize that they are not, technically, diagnosing the president. “Assessing dangerousness is different from making a diagnosis,” Herman and Lee argue. “Signs of likely dangerousness due to mental disorder can become apparent without a full diagnostic interview.”
The APA will have to decide whether these authors have violated the Goldwater rule, and if so, what’s to be done about it. Frankly, I think when professionals see a potentially dangerous person at large in our society (such as a mentally ill person with a gun), they have the right, if not the obligation, to say something. In most states they do have a Duty to Warn, but only if one of their actual patients poses a risk to others. Perhaps the Goldwater rule needs to be reconsidered. Does it, in fact, deny mental health professionals the right to free speech, the right to state their opinions just like everyone else? (After all, a personal opinion about observed behavior is not a professional diagnosis based on personal interviews and clinical analysis.)
Meanwhile, I applaud the authors for speaking out, if a bit late. And I await Trump’s inevitable tweet about this.