October 1st, 2017

Debate heats up over Trump’s mental health

If he had to do it all over again, John Gartner, Ph.D., would have asked mental health professionals to state their degree when he launched an online petition drive last February collecting their signatures to request that President Donald Trump be removed from office.

So, there’s really no way to tell how many of the more than 62,000 signatures his change.org petition had received by September were from psychologists, psychiatrists and other mental health experts.

“We didn’t even ask people to state their degree for the first 10,000 signatures,” said Gartner, a Baltimore psychologist and founder of Duty to Warn, an organization of mental health professionals and others who planned to hold town hall meetings in 15 U.S. cities on Oct. 14 to wrap up the petition drive.

“It’s a little bit of a mess as far as trying to quantify the actual number. I’m not sure what better method we could have used at this point.”

The petition’s supporters “believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States.”

The petition along with the Oct. 3 release of a book edited by a Yale University psychiatrist titled “The Dangerous Case of Donald Trump” wades into another mess: the question of whether there are civic and ethical justifications to pursue this effort that trump professional neutrality.

The American Psychiatric Association has an ethics guideline found in Section 7.3 of “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry” – but commonly known as “The Goldwater Rule” – that prevents member psychiatrists from giving professional opinions about the mental state of someone they have not personally evaluated.

The ethics principle was adopted in 1973 in response to a Fact magazine story in which nearly 1,200 psychiatrists responding to a survey said they believed Republican presidential nominee Sen. Barry Goldwater was psychologically unfit to assume the presidency. Goldwater later sued the magazine for defamation and won.

On March 16, the 56th day of Trump’s presidency, the association’s Ethics Committee reaffirmed the Goldwater Rule, clarifying that a psychiatrist should not comment on the affect, behavior, speech or other presentation of a public figure without consent or authorization.

While psychiatrists may exercise free speech as any other citizen, the association stated they should not assume a professional role in voicing a critique of the behavior and work of a public figure. Additionally, the association said those who argued that psychiatrists have a duty to warn or protect the public from harm were misinterpreting the limited scope of the Tarasoff doctrine named after the victim of a 1969 murder in California by a stalker who had sought mental health treatment.

The American Psychological Association’s code of ethics has no specific provision concerning psychologists expressing their views of a president’s mental state. It counsels them against diagnosing living individuals who they’ve not personally assessed, said Lindsay Childress-Beatty, acting director of APA’s Ethics Office. There has been no push to change the status quo.

“Our members haven’t expressed a desire to establish a particular rule on this issue,” she said.

As Childress-Beatty notes, the 25th Amendment of the U.S. Constitution already addresses how the determination of whether or not the president is able to continue being the president is made. It states: “Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.”

“APA would say that the question of whether the president is able to discharge the duties and powers of his office, that’s the responsibility of the vice president and these other officials as the 25th Amendment specifies. We would be looking to those officials to do their constitutional responsibilities,” Childress-Beatty said.

Last April, U.S. Rep. Jamie Raskin (D-Md.) introduced a bill to establish an Oversight Commission on Presidential Capacity that would serve as the body to carry out the procedures outlined in the 25th Amendment. The commission would carry out a medical examination of the president to determine if the president is “temporarily or permanently impaired by physical illness or disability, mental illness, mental deficiency, or alcohol or drug use.”

The list of sponsors grew from the original 19 Democrats – including Rep. David Cicilline, (D-R.I.) and Rep. James McGovern (D-Mass.) – to 29 by early September. McGovern’s office did not respond to a request for comment. Cicilline’s office deferred to Raskin’s office. The bill was referred to the Subcommittee on the Constitution and Civil Justice and no further action has been taken.

It seems unlikely the president would willingly submit to a medical examination whose purpose raises some uncomfortable issues. Do mental health professionals really want to single out mental illness as something that can disqualify a person from a job and perpetuate the very stigma they purportedly seek to end?

“It’s important to note that mental disorders, just like with physical disorders, they don’t generally preclude an individual from serving as a public official,” Childress-Beatty said.

Yet Gartner is unapologetic in stating his belief that Trump is psychologically impaired.

“Does a day go by that he doesn’t do something crazy?” Gartner offered. “The probability of our not having nuclear war I think is extremely low at this point.”

Gartner calls Trump “a malignant narcissist,” a term introduced in 1960 by Erich Fromm to explain Hitler. The syndrome has generally been understood as a combination of narcissistic personality disorder, antisocial behavior, paranoid traits and sadism, even if he isn’t keeping an exact count of the behaviors informing his diagnosis.

“To talk about antisocial personality disorder, one of the primary criteria is lying. Do I need to interview Donald Trump to know that he lies? The New York Times, The Washington Post, POLITICO, Time, Newsweek, they’ve all said as a matter of fact that Donald Trump has lied thousands of times in his public statements.”

Gartner added: “We make diagnoses from charts and history and presentation by a resident or reports from family members. We don’t only go on the personal interview. In fact, empirically the personal interview is the least reliable method of establishing the diagnosis because people can lie to you.”

Gartner outlines his thoughts on Trump’s psychological impairments in a chapter in “The Dangerous Case of Donald Trump,” which includes writings by 27 mental health experts who argue they have a civic and ethical duty to warn and protect America from a man they say should not be entrusted with nuclear weapons launch codes.

The forthcoming book is edited by Bandy Lee, M.D., M.Div., assistant clinical professor in law and psychiatry at Yale School of Medicine. She said the book lists potential diagnoses but leaves it up to the reader to judge for themselves the status of Trump’s mental health.

When interviewed in early September, Lee said she was planning to travel to Washington, D.C., to speak about the “medical aspects” of Trump’s ability to lead with “very prominent members” of Congress. “They asked me not to name them,” Lee said.

Lee, who signed Gartner’s petition in February, independently organized a “Duty to Warn” conference at Yale last April after the schools of public health and nursing pulled out as sponsors. “The School of Medicine was supportive to the very end but I was the one who released them because I told them no, politicization was going to be inevitable,” she said.

About two dozen people attended the conference while another 75 listened in remotely, Lee said. “The people were not showing up because they didn’t want to appear in public,” she added.

Lee said she received about a dozen hate mails from members of the public after the conference but also hundreds of favorable messages.

Lee said she approved of Goldwater Rule in its original form but objected to the American Psychiatric Association’s reaffirmation and clarification last March. “It basically functions like a gag rule,” she said. “You cannot say anything.”

“People ask me how did I choose to bring my profession into the political arena, I tell them no, it’s politics that invaded my field,” Lee added. “You never expected someone with signs of mental disability being in the position of the presidency.”

By Janine Weisman

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