Hello. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you today for Medscape.
The title of this talk could be "Psychiatry and the Presidency." These are timely issues in the aftermath of the recent presidential election and the assumption of the presidency by Donald Trump.
There has been much discussion about the unconventional conduct of this presidential administration, people's behavior, and so forth. This has invited speculation as to what the underlying motivations might be. Is this an unconventional politician who is shaking things up in Washington? Or is this somebody who is suffering from some kind of mental problem or other reason that would explain this different type of behavior than the Capitol, media, and population generally have experienced?
Psychiatrists have increasingly been asked to comment about this. Unfortunately (in my opinion), some of my colleagues have acceded to these requests and have published commentaries in various sources. The most recent example of this comes from the February 13th edition of the New York Times, where there was a letter to the editor by a group of psychiatrists and/or psychoanalysts from various parts of the country who basically offered opinions about the mental state of President Trump.
The next day, there was also a letter to the editor from another psychiatrist, Allen Frances, who has opined on various topics in the public media in recent years. He explained why this kind of statement of ostensible application of clinical expertise on a public figure with whom none of the letter's authors had any direct experience is inappropriate.
That admonition is well taken and really derives from something called the Goldwater rule, which was named opportunistically because the issue came up in relation to the presidential candidacy of Barry Goldwater in 1964. Basically, it has been codified in the American Psychological Association's code of ethics. It states that it is unethical for a psychiatrist to give a professional opinion about public figures if they have not examined them in person and obtained their consent to discuss it in public statements.
The reason for this is that even though it is tempting to comment or form opinions about the behaviors of public figures—whether they are celebrities, politicians, or other types of media figures—professionally it is inappropriate, because you do not have verified information. It then can be used for all kinds of unjustified purposes, including political purposes that could discredit or undermine people.
For the reasons why this would not be advisable, one only has to look to things that occurred in the Soviet Union back in the day. A totalitarian government was in power when psychiatric diagnoses and confinement to mental institutions were used as political instruments against dissidents. They were given diagnostic labels and, in effect, incarcerated. They had no mental disorder other than having positions that were oppositional to the government.
We have also seen this, unfortunately, in the United States in the 1973 Democratic election. When George McGovern was the presidential nominee, his vice-presidential nominee Thomas Eagleton was campaigning with him. When it was revealed that Eagleton had a history of prior depression and electroconvulsive therapy, he was forced to resign from the campaign and be replaced. This is ridiculous, because if medical history is a factor in an individual's qualification for candidacy, then it should be known. These could be evaluated as whether there are criteria for the public to support or not support the candidate. Mental illnesses should not prima facie be disqualifying criteria or factors.
When Should Mental Health Issues Be Reported?
It is very dangerous, no matter how outrageous behavior may seem, for psychiatrists to engage and be inveigled into making these comments, which serve principally political purposes for individuals who oppose the president or whichever individual in political office, their positions, and their conduct in that office.
I feel there is a more enlightened policy we can use. Just as we are entitled and need to know what the qualifications of an individual are for any political office, and there are various types of information that candidates are requested to reveal (including their financial status and previous tax returns), we obviously have a vested interest in understanding what their medical status is, including medical history and any recurrent illnesses that they have. Part of that should be their mental status and any relevant psychiatric history.
Exactly how this is to be orchestrated? Is there some examination they should be subjected to? Should it just take the form of revealing records from physicians whom they previously consulted? I have not quite thought this through and cannot say. I think the more constructive way to address this increasing interest in candidates' medical and mental status is that there is a process that does ask for that prior and current information.
There are temptations to stray from this course. I get frequent calls from journalists asking me to weigh in on this. I have to repeatedly, if not explicitly, invoke and shield myself with the Goldwater rule, then simply explain the reasons why I will not do so.
I also offer the opinion that if you have objections to an individual's behavior or the way they are conducting themselves in office and you are seeking to cloak this in a form of a diagnosis of a mental disorder, you are doing this without having sufficient information and are also really letting people off the hook. You are excusing the behavior on the basis of a diagnosis as opposed to what you are really upset about, which is their political conduct and motivations for the policies that they are orchestrating while in office. It is really unhelpful in both ways, by being not responsible and also being used to legitimize or to medicalize what essentially is a critique of somebody's performance in political office.
I do not know where this line of discussion in the media is going to go. It is clear that we are in a different period in terms of the way political business is conducted, which is not as usual. I think it is important that mental health professionals and psychiatrists in particular maintain their adherence to their principles and ethics and, in this case, what is called the Goldwater rule.
Thank you for listening. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.