Psychiatrists Are Now Allowed To Talk About Trump's Mental Illness

In her "hot mic" moment with Senator Jack Reed (D-RI) late yesterday afternoon, Maine Senate Republican Susan Collins admitted that Trump is "crazy" and that she's "worried." A prominent psychologist told me this morning that Trump has "many diagnoses, including low IQ with likely some dementia due to neurological involvement and language disorder thrown in. And narcissistic personality disorder, conduct disorder, etc., etc. Quite a conglomeration." Joe Scarborough, looking at Trump, had said it slightly differently on his MSNBC morning show a few hours earlier:

July the 25th... circle it on your calendar. This guy is spinning wildly out of control. He's watching TV. I know... I know you never watch this show, Donald, but whatever show you're watching, it's making you crazy... [I]t's making you act crazy. So you really need to turn to SportsCenter. And you need to stop watching, because these tweets make you look really bad.

No news there. But there is news about Trumpanzee's mental health problems. The executive committee of the American Psychoanalytic Association told its 3,500 members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures-- particularly Señor Trumpanzee. They emphasized that psychiatrists need to use their expertise responsibly today "since Trump’s behavior is so different from anything we’ve seen before" in a commander in chief.

The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, represents the first significant crack in the profession’s decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians’ behavior. It will likely make many of its members feel more comfortable speaking openly about President Trump’s mental health.

The impetus for the email was “belief in the value of psychoanalytic knowledge in explaining human behavior,” said psychoanalytic association past president Dr. Prudence Gourguechon, a psychiatrist in Chicago. “We don’t want to prohibit our members from using their knowledge responsibly.”

...An increasing number of psychologists and psychiatrists have denounced the restriction as a “gag rule” and flouted it, with some arguing they have a “duty to warn” the public about what they see as Trump’s narcissism, impulsivity, poor attention span, paranoia, and other traits that, they believe, impair his ability to lead.

Reporters, pundits, and government officials “have been stumbling around trying to explain Trump’s unusual behavior,” from his seemingly compulsive tweeting to his grandiosity, said Dr. Leonard Glass, a psychiatrist at Harvard Medical School. The rule against psychiatrists offering their analysis of the emotions, thought patterns, and beliefs underlying such behaviors, Glass said, robs the public “of our professional judgment and prevents us from communicating our understanding” of the president’s mental state.

Last week, in an essay in Psychiatric Times, Glass called the prohibition on such communication “an unacceptable infringement on my right and duty” to discuss issues “where the perspective of psychiatrists could be very relevant and enlightening.” He ended the essay by announcing his resignation from the American Psychiatric Association, which adopted the rule in 1973. He had been a member for 41 years.

Called the “Goldwater rule,” the prohibition on offering opinions about the mental state of public figures was adopted after some psychiatrists answered a 1964 survey on whether Sen. Barry Goldwater, the Republican presidential candidate that year, was mentally fit for the Oval Office. The rule states that it is unethical to offer a professional opinion about a public figure’s mental health, including the presence or absence of a disorder, without that person’s consent and without doing a standard examination. In March, the psychiatric association reaffirmed the rule.

The group acted despite growing criticism that the Goldwater rule is outdated and even unethical for preventing psychiatrists from pointing out behaviors that raise questions about a government official’s mental state. No other medical specialty has such a rule; cardiologists are not prohibited from offering their views of an official’s fainting spell, for instance, as long as they make clear that they have not examined the person.

Although opposition to the Goldwater rule has existed for years, it intensified with Trump’s candidacy and then election. In October, a book titled The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President will be published.

“When the book comes out, there will be renewed furor about the Goldwater rule, since it is precisely about what is wrong with him,” said psychiatrist Dr. Lance Dodes, a retired professor at Harvard Medical School who is now in private practice in Los Angeles.

A number of psychologists have spoken to reporters about what Trump’s statements and actions might reveal about his emotional and cognitive state. Although the American Psychological Association “prefers” that its members not offer opinions on the psychology of someone they have not examined, it does not have a Goldwater rule and is not considering implementing one, an official told STAT.

The psychoanalytic association went further. In its July 6 email, it explicitly stated for the first time that the organization does not subscribe to the rule. That position had been implicit for years, but the association’s “leadership has been extremely reluctant to make a statement and publicly challenge the American Psychiatric Association,” said one psychoanalytic association member who asked not to be publicly identified criticizing the other group.

And by the way, Rand Paul's straight ACA repeal bill failed today 55-45, with 7 Republicans crossing the aisle to vote with the Democrats. The Republicans who voted no were Lamar Alexander (TN), Shelley Moore Capito (WV), Susan Collins (ME), Dean Heller (NV), John McCain (AZ), Lisa Murkowski (AK) and Rob Portman (OH).