Should mental health experts speak out about Donald Trump?

by Marc Wilson / 24 January, 2018
RelatedArticlesModule - Trump mental health

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.

Latest

If I were a rich man: A grammarian on the nettlesome subjunctive
98551 2018-11-19 00:00:00Z Diversions

If I were a rich man: A grammarian on the nettleso…

by Ray Prebble

Many people find themselves using one or other of these subjunctive forms without really knowing why.

Read more
As China shuts its gates to our plastics and paper, how can NZ stem the tide?
99059 2018-11-19 00:00:00Z Planet

As China shuts its gates to our plastics and paper…

by Veronika Meduna

Unless we get serious about recycling, there’ll be a tonne of plastic for every three tonnes of fish in the ocean by 2025.

Read more
Heights of contradiction: American and Israeli Jews' complicated relationship
99055 2018-11-18 00:00:00Z World

Heights of contradiction: American and Israeli Jew…

by Todd Pitock

Todd Pitock's travels through Israel reveal the true differences between American and Israeli Jews.

Read more
The Democrat's midterm wins spell the end of Trump's dream run
99105 2018-11-18 00:00:00Z World

The Democrat's midterm wins spell the end of Trump…

by Paul Thomas

Far from being Trump’s near-“complete victory”, the midterms mean opportunities for rigging electoral boundaries have swung back towards the Dems.

Read more
Sally Rooney's Normal People has the makings of a classic
99094 2018-11-18 00:00:00Z Books

Sally Rooney's Normal People has the makings of a …

by Kiran Dass

Normal People is sharply observed portrait of an on-off romance and a book you need to read.

Read more
Why you should avoid 'eating for two' during pregnancy
98747 2018-11-18 00:00:00Z Health

Why you should avoid 'eating for two' during pregn…

by Ruth Nichol

Doubling down on food during pregnancy is out, unless it’s diet quality we’re talking about.

Read more
The long, slow goodbye to Angela Merkel
99173 2018-11-17 00:00:00Z World

The long, slow goodbye to Angela Merkel

by Cathrin Schaer

German Chancellor Angela Merkel plans to leave the job in 2021, but that’s not soon enough for some.

Read more
Silent witness: The forgotten NZ movie star
97576 2018-11-17 00:00:00Z Movies

Silent witness: The forgotten NZ movie star

by Paul Little

One of the earliest and possibly least known NZ movie stars is Eve Balfour, a silent-movie actress, born in Christchurch in 1890.

Read more