Is Psychoanalyzing Our Politicians Fair Game?

Nassir Ghaemi, MD, MPH

Disclosures

August 15, 2016

In This Article

When the Goldwater Rule Is -- and Isn't -- Helpful

Where the Goldwater rule is needed, I would agree, is to stop rampant speculation that uses psychiatric terms as pejorative epithets, building on the discrimination against mental illnesses that is part of our society. This was the case with Goldwater, when the mostly liberal psychiatric community labeled him as "schizophrenic" at a time, only 2 years after the Cuban Missile Crisis and at the height of the Cold War, when there was much more concern than now about possible nuclear warfare. It is the case with Donald Trump, when psychologists go on television and "diagnose" using metaphors masquerading as science, such as "malignant narcissism."

This is simply Goldwater redux, and deserves condemnation.

The scientific validity of narcissistic personality disorder is not well established on the basis of empirical diagnostic research[2]; because scientific proof of its validity was limited, the personality disorders task force for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), recommended it be deleted. However it was ultimately kept because the APA leadership was reluctant to make a radical change on such a common idea. The term is just a metaphor invented by Freud and is often misused pejoratively, even by clinicians.

This is why we need a Goldwater rule—because, frankly, the psychiatric profession doesn't have its act together on diagnosis, as I've discussed previously in numerous writings. The DSM system is pragmatic, not scientific, which means that it is made up by APA leaders to reflect how they want to see the profession practice. If we like the term "narcissism," we use it—but that doesn't meant it's been proven to have scientific validity, like other medical diagnoses, such as asthma or diabetes.

So we need to stop mental health clinicians—who may be well-meaning in their political views—from engaging in the same discriminatory and stigmatizing language as is the case in the larger culture. That's the positive effect of the Goldwater rule, in my view.

The negative effect is that the Goldwater rule stops any talk whatsoever; it is, in effect, complete censorship.

The problem then is twofold: (1) There are some legitimate scientifically valid psychiatric diagnoses that can and should be understood by the public in relation to public figures; and (2) there may be times of historical emergency where psychiatrists' duties as citizens require public discussion about psychiatric diagnoses in leaders.

First, not all psychiatric diagnoses are limited in their scientific evidence, unlike "narcissism." For instance, the concepts of schizophrenia and manic-depression have been established to be scientifically valid with solid research for over a century. It would not be illegitimate scientifically to apply those concepts to anyone, given adequate documentation, as noted previously.

In addition, there are historical emergencies when psychiatrists' duties as citizens in a democracy would trump the regulations of a professional organization. I will give the most extreme example, not because I think it applies to current candidates, but because I think it makes the conceptual point: Adolf Hitler.

Before Hitler came to power, a prominent psychiatrist in Germany, Karl Wilmanns, diagnosed him as having hysteria during World War I, when he was treated in a psychiatric hospital. At the time, hysteria was a relatively new concept, but later research has supported Wilmanns' observation, with documentation that Hitler was "personally examined" and diagnosed with hysteria by a psychiatrist, Edmund Forster. Forster committed suicide a few days after Hitler came to power in 1933; Wilmanns was fired from his university professorship and never allowed to work again.

In a little known anecdote, around 1940, some German generals who were plotting a coup against Hitler tried to solicit the support of prominent psychiatrists, including the academic professor Dr Karl Bonhoeffer, father of the prominent anti-Nazi activist Dietrich Bonhoeffer. The generals knew that Hitler was mentally unwell, and they wanted the psychiatrists to agree to hospitalize Hitler involuntarily. It is unclear how the process unfolded, but the plan never went into effect.

Would it have broken the Goldwater rule if Dr Karl Bonhoeffer had worked with the generals to hospitalize Hitler against his will? Did Hitler in fact have a psychiatric diagnosis? I have provided evidence that he did, namely manic-depressive illness, which was worsened with daily intravenous amphetamine treatment for his depression.[1]

Even if one thinks that there are psychological limitations to the presidential fitness of Donald Trump, as some do, we are certainly not in the same situation as with Hitler. But the question does come up: When is it acceptable, even necessary, for psychiatrists to be citizens first?

Implications on Historical Interpretation

This brings me to another aspect of the Goldwater rule that is misused: It sometimes is invoked for any public figure, including those who have been dead for decades or even centuries. If applied to all public figures, living and dead, the Goldwater rule would imply that the profession of history is inherently unethical.

History is in many cases about trying to understand the thinking, feeling, and decisions of past leaders. If the Goldwater rule is applied to dead persons, the Pulitzer Prize-winning work[3] of Erik Erikson on Gandhi was unethical—as was the lauded work [4] of John Mack on Lawrence of Arabia; numerous historical works investigating depression, for instance, in the illness leading to the suicide of Ernest Hemingway (not to mention his father); or my own work on political, military, and business leaders.[1]

In other words, the Goldwater rule should be limited to living figures, not all public figures ever in human history.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....