Donald Trump’s defense of white supremacists who rallied in Charlottesville, Virginia, over the weekend elicited outrage. It’s incidents like this that have prompted a small group of congressional Democrats to propose a committee to evaluate the president’s mental health, STAT reported Wednesday.
The politicians have asked a Yale School of Medicine psychiatrist to help them form an expert panel to assess Trump’s psychological state.
The psychiatrist, Dr. Bandy Lee, told the publication the panel would organize a meeting with multiple mental health professionals in September to analyze the president’s behavior as it pertains to mental illness and review it periodically. It’s unclear if Trump has or will consent to a formal evaluation.
Doing so raises some ethical questions about what it means to convene a panel on someone’s mental health without their consent ― and whether a politician’s privacy can outweigh public safety concerns.
Trump’s mental health
Trump’s mental health has been a matter of ongoing debate throughout his short political career ― specifically, as he has leveled xenophobic remarks against multiple communities and racist attacks on Americans, and was recorded seemingly admitting to sexually assaulting women.
But this blurs the lines between mental illness and racism. While there is some evidence that extreme racism can, in rare cases, be a symptom of a psychotic disorder, in nearly all other cases it’s a product of economic, social and political factors.
Media headlines have speculated about his mental health and diagnosed potential personality disorders and conditions from afar. “Is Donald Trump OK?” asked the Toronto Star. “Donald Trump: Sociopath?” mused The Atlantic.
This has put mental health professionals in a difficult position. Privately and in the media, they have expressed concerns that Trump’s mental state. But last August, the American Psychiatric Association issued a warning to experts to refrain from diagnosing public figures they hadn’t evaluated, including Trump. The APA doubled down on those comments earlier this month, as more mental health experts came forward to discuss the president’s psychological state.
“Engaging in a psychiatric diagnosis requires the consent of the individual and is based on an in-person evaluation,” Rebecca Brendel, a consultant for the APA’s ethics committee, previously told HuffPost. “Rendering an opinion based on observed behavior in the public sphere doesn’t take into account underlying factors that may not be inherently seen.”
Lee agrees with this stance, but feels there’s a distinction between what she views as a duty not to make a diagnosis from afar and calling for an evaluation.
“Ordinarily, confidentiality and consent are considered sacrosanct rules of practice,” she wrote in an email to HuffPost. “But the health professional is nonetheless obligated to break them in times of emergency. In everyday practice, we have an overriding duty to warn and a duty to protect, in addition to numerous other legal provisions and obligations to intervene in cases of potential harm.”
The history of ‘diagnosing’ politicians
The request for psychiatrists to refrain from analyzing a public figure’s mental health in the media isn’t a new one. The APA’s guideline, commonly known as the “Goldwater Rule,” has been in place since the 1970s, when the pattern first emerged with presidential contender Barry Goldwater.
According to the APA, Fact magazine published a survey on Goldwater’s mental state during the 1964 election that included answers from more than 12,000 psychologists on whether they thought he was “psychologically fit” to hold office. Some doctors even went as far as offering an actual diagnosis without ever evaluating Goldwater personally.
There were no set guidelines in place for experts up until that point. Goldwater eventually sued for libel and the case set the standard for psychiatric commentary.
The APA created the Goldwater Rule in the aftermath of the Fact debacle as a way to prevent mental health professionals from making unethical claims about a public figure’s psychological wellbeing. This is because, according to former APA president Maria Oquendo, such claims “could very well have eroded public confidence in psychiatry.”
Lee believes that experts shoudn’t break ordinary psychiatry standards, and is troubled by the APA’s additional guidance, issued in March, around the Goldwater Rule, as it pertains to Trump.
“With my background in violence prevention and public health, this made clear that remaining silent about a dangerous situation was not compatible with my professional integrity,” she wrote in her statement to HuffPost. “What happens next is up to the lawmakers ― this is not my expertise ― but as far as my domain is concerned, my ethical duty is to warn where even one human life is at stake.”
We could all learn from the Goldwater Rule
While the Goldwater Rule is specifically meant for mental health professionals, it would be beneficial if others with public platforms followed suit ― but so many rarely do.
The media has been dissecting the mental health of public figures in its coverage for years, often accompanied by headlines or quips that poke fun at mental illness. And media is even guilty of inaccurate representation when it comes to the rest of the population. A Johns Hopkins University study published last year found that the media disproportionately associates mental illness with violence, when in reality those with a mental health disorder are more likely to be victims of a violent crime.
Politicians, themselves, often evoke psychological health as a method of mud slinging. No one is more guilty of that than Trump, who frequently uses phrases that are offensive to individuals with mental illness. He also appeared to publicly shame former GOP presidential contender Ted Cruz’s wife Heidi Cruz for having depression during their candidacy.
All of these statements have consequences when it comes to mental health stereotypes. And there are more productive ways to talk about mental illness than using it as an insult or as a way to assign blame.
Why these statements are problematic
When it comes down to it, the implication that a problematic president has a mental health issue goes beyond ethics. It could have a lasting effect on those who truly have a mental illness.
Drawing a correlation between Trump’s actions and mental illness alienates the majority of people with a mental health disorder. It implies that their diagnosis is clearly a character flaw and even encourages others to assume that mental illness is dangerous.
“Broad generalizations about a specific group of people, like those with mental illness, are so troubling because they can lead to that group being harshly pre-judged and discriminated against,” Gregory Dalack, chair of the department of psychiatry at the University of Michigan, previously told HuffPost.
Talking about it as such may even discourage those living with a mental health conditions from seeking help or pursuing a certain way of life.
“Someone can have a diagnosis of depression for example, but that doesn’t mean it affects their ability to hold any kind of public responsibility,” Brendel said.
People with mental health disorders live normal and productive lives, and their illness is not a scapegoat for awful behavior in the public eye.
This article has been updated to more accurately reflect Lee’s position on the Goldwater Rule. An earlier version was first published in August 2016.