Tuesday, August 23, 2016

Something to Know - 23 August

Mike Luckovich

The swirl of current campaign blather includes opinions and expressions of doubts about the medical suitability of either Trump or Clinton.   Frankly, to me the best story in the LA Times this morning is about the temperament issue and the ability to be able to launch a nuclear attack by the president with no one to second guess the act. That is a compelling reason to deny Trump.  In the meantime, snack on this good op-ed:

No diagnosis needed for Trump
By Matthew Goldenberg

   BECAUSE OF Donald Trump's unusual public conduct, legions of armchair analysts have wondered aloud about his mental health. A former dean of Harvard Medical School tweeted that Trump "defines" narcissistic personality disorder. New York Times columnist David Brooks has said the GOP nominee "appears haunted by multiple personality disorders." Entrepreneur Mark Cuban was cruder, calling Trump "batshit crazy." Trump's coauthor for "The Art of the Deal," Tony Schwartz, labeled him a "sociopath." Washington Post columnist Kathleen Parker found Trump's behavior reminiscent of a brain injury.
   As a psychiatrist, I have frequently encountered questions about Trump's mental status in my daily life. A new neighbor asked me what I thought of him. A medical student wondered, would I diagnose him with a mental illness? On a recent phone call, my mother was more specific: "Is he a narcissist or what?!"
   I'm not supposed to answer that question. To underline that point, the American Psychiatric Assn. issued a statement this month reminding its physician members, myself included, to avoid psychoanalyzing the presidential candidates.
   That ethical standard has been in place for decades. In 1964, thousands of psychiatrists, in response to a magazine survey, openly questioned then-GOP nominee Barry Goldwater's fitness for White House duty. Several psychiatrists offered specific diagnoses. The fact that so many psychiatrists were willing to casually diagnose a person they'd never met embarrassed the profession and led to the codification of the so-called Goldwater Rule — no professional opinions on people we have not personally examined.
   So when folks ask me to speculate about Trump's mental health, I have an easy out — I cite the Goldwater Rule. But increasingly, not engaging in these discussions seems both disingenuous and itself ethically dubious. For one thing, the void left by thoughtful professionals is filled with speculations by commentators, many of whom lack the expertise to appropriately apply diagnostic labels. Moreover, remaining quiet about the election feels like an abdication of moral responsibility.
   Like many Americans, I have been personally appalled by much of Trump's indecorous behavior as a candidate. He comes across as cantankerous, vain, impulsive, demeaning and ill-informed. I understand why people have raised questions about his mental health. It can be tempting to describe his behavior in familiar psychopathological terms. But there are several reasons why we should resist using a psychiatric framework to describe Trump.
   For starters, we don't have access to critical information. I haven't interviewed, diagnosed or treated Trump. I know only his public persona. It's certainly possible that much of what I see in that persona is an act, a representation not of his true self but rather a character he has embodied in order to win votes or enhance his fame or riches.
   Nor am I aware that Trump has been significantly troubled by psychological distress or impaired by any condition (a criterion for the diagnosis of any mental disorder). He is, after all, functioning well enough to be one of two people nominated by a major party to be the next president of the United States.
   Furthermore, casually and pejoratively tossing around psychiatric labels to describe unusual or distasteful behavior is stigmatizing to those who are suffering with mental disorders. Calling Trump, say, a narcissist, does not adequately explain his toxic behavior or exemplify the condition. I know and treat plenty of people with narcissism, and none of them publicly incite violence or malign entire ethnic groups.
   Perhaps the most important reason to skip a psychiatric assessment of Trump is that it just isn't necessary. You don't have to be a psychiatrist to know that there's something seriously wrong with the candidate. The lessons I learned in preschool, kindergarten and elementary school — not in medical school, residency and years of psychiatric practice — are what tell me that Trump is unfit for the job. My core values as an American — not my professional training — are what make me concerned about a Trump presidency.
   Trump should never be president, but not because he may or may not have a mental disorder. He shouldn't be president because he disparages women, denigrates Mexicans and Muslims and mocks the disabled. He shouldn't be president because he demonizes the media and impugns those who challenge him. He shouldn't be president because he insinuates that his rivals might be assassinated and advocates the commission of war crimes. He shouldn't be president because he rejects science and demonstrates a remarkable lack of knowledge or interest when it comes to foreign and domestic policy.
   As a psychiatrist, I don't have a public opinion on Trump. As a citizen, I certainly do.

   MATTHEW GOLDENBERG is an assistant professor of psychiatry at Yale University School of  Medicine.


Donald Trump and the National Rifle Association  aid and abet violence.

- An American Story

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