No Position Change About Speculating on Trump's Mental Health

Alicia Ault

July 27, 2017

Contrary to a recent news report, the American Psychoanalytic Association (APsaA) is still urging its members to exercise caution when discussing the mental health of President Donald Trump or other public figures.

The online publication Stat reported that the APsaA had emailed its members to tell them they should not feel bound by the American Psychiatric Association's (APA's) "Goldwater Rule." The rule, instituted by the APA in 1973, prohibits its members from offering opinions on someone they have not personally evaluated.

The letter that the APsaA emailed noted that the APA's rule applies only to that organization's membership. Contrary to the Stat news report, "Our leadership did not encourage members to defy the 'Goldwater Rule,' " said the APsaA in a statement posted on its website after the Stat story ran.

The APsaA did note that "members of APsaA are free to comment about political figures as individuals," but said that its ethics policy urges restraint in those discussions.

The APA said it is not budging from its current position. "The American Psychiatric Association stands firmly behind the Goldwater Rule," said Rebecca Weintraub Brendel MD, JD, consultant to the APA's Ethics Committee, when asked to comment by Medscape Medical News.

"The rule represents sound psychiatric ethics, preserves the integrity of the profession, and respects the patients that our members serve," said Dr Brendel, who is also assistant professor of psychiatry, Harvard Medical School, Boston, Massachusetts.

Misguided Policy?

But at least one APA member has been publicly outspoken in his belief that the organization's policy is misguided and does a disservice to individuals with mental illness. "The Goldwater Rule is caused by stigma and worsens it," said Nassir Ghaemi, MD, professor of psychiatry at Tufts University School of Medicine and Harvard Medical School, told Medscape Medical News.

Refusing to discuss a politician's mental health — including whether he or she has a psychiatric condition — stigmatizes the person and the illness, said Dr Ghaemi.

Psychiatric illnesses are neither all bad nor all good, he said. Winston Churchill and Abraham Lincoln — both of whom experienced severe depressive episodes — may have been great leaders in times of crisis because of their conditions, said Dr Ghaemi, who is also the author of A First-Rate Madness, a book that explores the link between mental illness and political leadership.

Mental health professionals have a history of wrestling with whether to publicly speculate about politicians' mental health status. In the early 1960s, the issue came to a head when thousands of psychiatrists weighed in via a public poll on the mental health status of Republican presidential hopeful Barry Goldwater. The poll results indicated the majority of respondents believed he was not psychologically fit to be president.

The debate began anew in 2016 during President Trump's candidacy. Dr Ghaemi said that historically and currently, liberals have been overrepresented among psychiatrists. This has in part driven the desire to speak out about candidates' mental health.

The APA and the APsaA positions have been rooted in a desire to keep mental health professionals from using their scientific standing to sway politics, he said.

Indeed, the APsaA's email to its members noted that its executive councillors in late June endorsed the policy that the APsaA as an organization would speak to sociopolitical issues only, not about specific political figures.

"The unique atmosphere of this year's election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible," said APA President Maria Oquendo, MD, PhD, during the run-up to the 2016 election.

A patient who saw their psychiatrist offering an "uninformed medical opinion on someone they have never examined...might lose confidence in their doctor and would likely feel stigmatized by language painting a candidate with a mental disorder (real or perceived) as 'unfit' or 'unworthy' to assume the presidency," said Dr Oquendo.

Manic Traits

However, Dr Ghaemi believes there is often enough information available to make a reasonable diagnosis without conducting a direct examination. He also does not agree that it is acceptable to overlook the mental fitness of a candidate for the presidency, especially at a time when mental health organizations have called for parity in policies and reimbursement for physical healthcare and mental health care.

President Trump has been loath to release much personal information, including tax filings and medical records. Dr Ghaemi said that that is all the more reason that outside organizations should be a part of the discussion.

"It makes sense in a democracy that people should have more information, not less information, about their leaders," said Dr Ghaemi. "The only thing that's stopping us is this negative attitude that's being promoted by the APA," he said.

Dr Ghaemi has said publically that he believes President Trump has manic traits — such as little need for sleep, high energy, extreme self-confidence, and distractibility — that could indicate a hyperthymic temperament.

That is a scientifically validated concept, as opposed to much of the talk of the president's narcissism, which Dr Ghaemi said is a personality trait, not a disease.

Any public discussions by psychiatrists should be coming from an evidence-based standpoint, he said.

But there should be discussion. "Censorship is not helpful," he said.

Dr Ghaemi has disclosed no relevant financial relationships.

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