Part XVI. "THIS IS NOT A DRILL": Response to Jeffrey Lieberman

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“We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.” —Elie Wiesel

Yesterday morning, Hawaiians awakened to the horror of imminent extinction from incoming ballistic missiles, with official alerts that “THIS IS NOT A DRILL.” The false alarm was identified after 38 minutes of panic and dread. A day later, Trump himself still has not been heard from on the subject. The president’s shocking absence in the face of what was believed to be certain death for millions of Americans--an event that would most assuredly trigger retaliation that might well spiral worldwide—is yet another illustration of the need for mental health professionals to provide authoritative expertise and professional guidance to help the public and our politicians understand who this president is (and isn’t) and how he is capable (and incapable) of acting.

Since Trump first became a serious candidate for the presidency, growing numbers have expressed dire concern that he can launch missiles on his own authority in under five minutes. In an early August, 2016 article, I expressed the urgent concern that the presidential election was “about apocalypse, not politics.”

We are all aware of Trump’s befuddlement as to why we have a nuclear arsenal if we do not intend to use it. We are all aware of him blurting out his “fire and fury” threats against North Korea, along with his myriad unfiltered tweets attacking “Little Rocket Man,” Kim Jong-Un. He has shamed nuclear-armed Pakistan and India in other tweets. Staggeringly, many Americans continue to see this as strategic “crazy like a fox” behavior despite mounting evidence that it is uncontained “crazy like a crazy” recklessness and disconnection from reality.

And yet a vocal few in the mental health field pontificate on the so-called Goldwater Rule of the American Psychiatric Association, with schizophrenia drug researcher Jeffrey Lieberman as the chief mouthpiece. Goldwater stipulates an ethical violation for striving to help the public understand the extreme emotional instability of the president without interviewing him. Lieberman himself has had to rebut his own ethical questions regarding his treatment of human experimental subjects exposed in a Boston Globe investigation that made author Robert Whitaker a Pulitzer Prize finalist.

In a 1997 publication, Lieberman himself fully acknowledges that he led a study involving 18 people as young as 14, experiencing a first-break psychotic episode typically involving terrifying hallucinations and paranoid delusions. The subjects were withheld from anti-psychotic medication that would have made them better, and instead were injected with methylphenidate (a variation of what is commonly known as meth), making their terrifying symptoms much worse. They were then contained for observation regarding drug effects.

Though no ethical accusations have ever stuck, such shocking behavior appears to violate standards of basic civilized human decency. That has not stopped Mr. Lieberman from claiming the ethical high ground in viciously and smugly attacking Bandy X. Lee, MD, editor of the instant bestseller, The Dangerous Case of Donald Trump (Macmillan, 2017). Many of the co-authors have achieved eminent, if not legendary status (Robert Jay Lifton, MD) in the field of mental health, despite Mr. Lieberman’s slanderous assertion that the book is “tawdry, indulgent, fatuous, tabloid psychiatry” driven by partisan politics. He then goes to the appalling length of comparing our work to Nazi psychiatrists conducting eugenics experiments with humans (how is this different from the schizophrenia human experiments in his own work?) and Soviet psychiatrist subjugatng dissidents.

Although we approach trump’s psychological make-up from a diversity of perspectives, we arrive at the same conclusion that this man poses a clear and present danger to our well-being, including the threat of starting a nuclear war. We assert that the ethical violation consists--not in speaking up--but in remaining silent regarding the erratic leadership of an exceedingly unstable, at times delusional man.

We support the prohibition against thoughtless, gratuitous commentary that the Goldwater Rule originally intended. Mental health professionals should indeed be restrained from careless psychological speculation on the young children of presidents, unstable celebrities, or public figures who pose no danger. But the anachronistic rule itself has no more applicability to Trump than a buggy whip used to get a car moving that has no gas.

Furthermore, psychologist Scott Lilienfeld, et al., in October, 2017, published a remarkable but not yet well-known meta-analysis of the vast scholarly literature on psychological assessment, clinical judgement, cognitive bias, and the questionable validity both of unstructured interviews and informant reports, concluding that the research thoroughly debunks any scientific basis to the claim of higher value in personal interviews:

“…although the Goldwater Rule may have been defensible several decades ago, it is outdated and premised on dubious scientific assumptions. We further contend that there are select cases in which psychological scientists with suitable expertise may harbor a “duty to inform,” allowing them to offer informed opinions concerning public figures’ mental health with appropriate caveats.”

An inane argument has been raised by psychiatrist Allen Frances and mimicked by Mr. Lieberman: bad behavior is not necessarily indicative of emotional instability, just as emotional instability is not necessarily indicative of bad behavior. What’s the point? Eating pretzels is not necessarily indicative of emotional instability and the converse is also true. Sophistry is the term for the use of arguments that sound clever and plausible but are in fact false, often with the intention of tricking or deceiving.

Trump behaves badly and is also exceptionally unstable. Not only are the two not mutually exclusive, they can easily go hand in hand. In point of fact, trump’s psychological make-up, which drives his deplorable behavior, is such that we cannot estimate the depths of just how badly he can behave.

As my colleague Howard Covitz has suggested, red lights at intersections are to be obeyed, even with no other car in sight in the wee hours. All bets are off, however, when we are rushing to save the life of a child who, for example, is in danger of bleeding to death. Even at those times, we must proceed cautiously through the intersection so as not to endanger others, even as we are violating the word--though not the spirit--of the law.

As we can see from yesterday’s 38 minute horror in Hawaii when families were saying good-bye to loved ones knowing that nuclear bombs were coming, the absence of genuine presidential leadership is dangerous and appalling, even when it’s a false alarm, much less a legitimate one.

After he was apprised of the emergency on his golf course, Trump finished his round. The planet may have been saved by his distraction and his dithering, such that he did not push his red button in response to a wrong button pushed by a careless government employee.

Accidents in which missiles are lost, mishandled, or even detonated—so-called "broken arrows”--are far more frequent than we recognize. Similarly, the public is blind to the high frequency of false alarms, such as the terrifying 1979 “Three AM Nightmare Phone Call” taken by Zbigniew Brzezinski, Jimmy Carter’s Secretary of State. The lists of false alarms and “broken arrows” are deeply unnerving.

If you plan on getting a good night’s sleep, neither of these lists is bedtime reading.

What was Trump thinking? What was he doing? Why not so much as a tweet? It is reminiscent of President Bush’s videotaped response, while sitting in an elementary school classroom, to an aide whispering in his ear that the first plane had crashed into the World Trade Center. And yet Bush gathered himself and took the helm.

It is true that Hillary Clinton won Hawaii by her largest state percentage. It is also true that Hawaii’s 9th US Court of Appeals has thwarted trump’s travel ban ambitions. What if the warning was directed at Mar-a-Lago? Or a gathering of his family in NYC? Perhaps it is a good thing that he was distracted by saving par rather than saving the country.

He is proud of his big, powerful red button and continues to ask why he can’t use it?


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