Andrew Harrer/Bloomberg
Is Donald Trump mentally unwell, and if so, should anything be done about it? If you’re psychologist John Gartner, the answer to that question is such a resounding “yes” that the obvious response is an online petition summoning your colleagues to demand Trump’s removal from office.
Gartner, who spent 20 years at Johns Hopkins and now practices privately, has accrued more than 25,000 signatures on his petition, which addresses U.S. Senator Chuck Schumer (D-NY). Whether or not any, all, or most of the signatories are indeed mental health professionals has not been confirmed. The text of the petition, posted at Change.org, is brief:
We, the undersigned mental health professionals (please state your degree), believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And we respectfully request he be removed from office, according to article 3 of the 25th amendment to the Constitution, which states that the president will be replaced if he is “unable to discharge the powers and duties of his office.”
Much of the debate around the public “armchair diagnosis” of someone a mental health professional has never met splits into two broad arguments. First is the stance that relying on a mental illness diagnosis to argue against Trump’s fitness to govern is facile, stigmatizing and inappropriate. It implies that the mental illness per se disqualifies him, rather than his temperament or personal qualities.
After all, many of Trump’s attributes aren’t signposts to mental illness. They certainly may be signposts to an unpleasant personality. Plenty of people who don’t have a diagnosable mental health condition are total jerks. Even if Trump were to have the condition that most people apply to him, which is narcissistic personality disorder (NPD), those with that diagnosis do not by default serve as a beacon to white nationalists or brag about “grabbing women by the pussy.”
The second argument centers on whether or not it’s ethical for a mental health practitioner to make a public diagnosis of a person who is not a client and hasn’t given permission for such revelations.
Gartner’s got a counterpoint for both. About the stigma, this case is special, he told me. We’ve had lots of presidents with mental health issues that “wouldn’t disqualify and might even enhance” their ability to perform their duties, he said. But, he added, the Trump situation is “from a psychiatric point of view the absolute worst-case scenario … if I were to take the DSM (Diagnostic and Statistical Manual of Mental Disorders) and try to create a Frankenstein’s monster of the most dangerous and destructive leader and had freedom to create any combination of diagnosis and symptoms,” Trump would be the result.
That’s because it’s not a single condition at work, according to Gartner. Rather, Trump is something more than a narcissist and shows signs of a quartet of conditions that add up to “malignant narcissism,” which Gartner described as an “old-fashioned term” that was originally devised to characterize Hitler. The quartet, Gartner said, consists of narcissism, paranoia, and anti-social personality disorder, with a dash of sadism thrown in. It is not an official diagnosis, but Gartner said that it’s especially apt in Trump’s situation.
But what about professional ethics? When a mental health professional turns to armchair diagnosis, one phrase that gets tossed around a lot is the “Goldwater Rule.” This rule, Gartner explained, applies only to psychiatrists, not to psychologists like him. It’s the name for a section from the code of ethics of the American Psychiatric Association (APA), not other organizations for other categories of mental health professionals. The rule stems from a time before any of these professionals had the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a guide.
That time was 1964, and a magazine called Fact published a long essay quoting several clinicians’ comments on the mental health of Republican presidential candidate Barry Goldwater. Goldwater didn’t take kindly to having been described as “a frightened person who sees himself as … threatened by the strong virile power around him,” sued the magazine and won a settlement. As a result, the APA cautions that psychiatrists should not offer a professional opinion about a public official whom they have not examined and who has not authorized them to speak about their psychiatric issues. These professionals should confine their comments only to “psychiatric issues in general.”
At the time that Fact exposed Goldwater to this public humiliation, clinicians had no DSM, no book packed with diagnoses and outlining the criteria for each of them. That, Gartner said, is a big distinction between then and now. The DSM, he argued, gives us a set of “simple observable behavioral criteria for every mental disorder.” And he emphatically emphasized the “observable” part.
Each aspect of the quartet of “malignant narcissism,” Gartner said, is part of a diagnosis in the DSM. For all diagnoses, the DSM offers a summary topic sentence, followed by a list of criteria, and a person must meet some minimum number of these criteria to be diagnosed. Gartner had these at his fingertips and walked me through an example of antisocial disorder, which he asserted is the most serious of the quartet that he thinks Trump manifests. As he stepped through each criterion, Gartner cited examples of Trump’s behavior that he has observed—that anyone can have observed, he said—and concluded that with many such examples, Trump does in fact meet the criteria for this disorder.
And Gartner went a step further. “I doubt that interviewing Donald Trump would give them (a professional) a lot of information,” he said. “He runs circles around people, changes topic, never answers questions, I’m not sure that they would get a good deal” more from him. But, he argued, “We have tons of information about his behavior, his words, people who know him well, who have observed his behavior … we have so much information that it is screamingly obvious that he meets these diagnostic criteria.”
The fellow who drafted the NPD criteria, Allen Frances, a professor emeritus at Duke University, has very publicly disagreed with the idea that Donald Trump has NPD. Gartner is not alone in his conclusions about Trump, and a letter signed by 35 mental health professionals and published in the New York Times, echoed his concerns about Trump’s mental state, with the signatories saying that they fear that “too much is at stake to be silent any longer.”
Frances sent a response, also published in the New York Times, one that reflects comments he has already made on Twitter, where he said:
I wrote DSM criteria for Narcissistic Personality Disorder. Trump doesn’t meet them. He’s terrible person classic schmuck-not mentally ill
I reached out to Frances for comment but received no reply. However, in the New York Times, Frances noted that “bad behavior is rarely a sign of mental illness” and said:
Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.
Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).
In an email to me, Gartner offered a riposte regarding what Frances had to say about distress:
There is rumor he is unhappy in the job. He seems constantly enraged at the imaginary evil enemies, lying about him, attacking him, impeding him and committing outrages against him (like rigging his election, even though he won). He doesn’t seem like a happy person does he? No one has ever seen him smile or laugh. Obama, Bush, Clinton all seemed capable of human warmth and sincere moments of happiness. Trump is always at war. Sounds distressing to me.
These back-and-forths may seem like parsing of finer points among professionals while Rome is burning, but the ethics questions matter. Indeed, when the moral compasses of our executive branch and our first amendment institutions point to opposite poles as they do now, leaving the people trapped in between, ethics becomes even more critical. So I asked Gartner about the Goldwater rule: Even if it’s not explicitly mentioned in the ethics guidance for psychologists, does that mean that they can simply ignore it even if the ethical stance it represents is relevant?
Nope, said Gartner, but another ethical rule applies here, and that’s the Tarasoff rule. “Orthodox Jews have 613 commandments,” he began, “and you’re allowed to break any and all to save a life.” The Tarasoff rule is a similar principle for mental health professionals, he said, a “duty to warn that is more important than any other ethical consideration.” The rule, which is the subject of debate, traces to a court case in which a client told his therapist that he intended to kill a specific woman and later did so. In the Tarasoff case, the parents of the murder victim successfully sued the therapist for damages. And it’s not just an ethical principle; in California, for example, state laws reflect this rule explicitly.
Gartner said that the Tarasoff rule applies here. “I would argue that those mental health professionals who don’t speak up are being unethical,” he said. “They are not following the Tarasoff rule, not warning the public about the clear and present danger” Donald Trump poses.
Not all of members of his profession agree with that assessment. Kate Naylor, a licensed marriage and family therapist associate in Austin, Tex., told me that ultimately, “it is unethical to diagnose someone who is not your patient—you lack too much necessary information to make a clear distinction about qualifying behaviors.” About relying on observation of public behaviors, she wrote in an email that “We only know his public persona, and while convincing, there may be much more going on of which we are unaware.”
Naylor said that a formal diagnosis is a “serious matter” that requires “personal interaction, formal and informal assessment and evaluations, personal history taking, and reviewing medical history.” Being that thorough with a public figure who is not a patient is just not possible, she said.
About Tarasoff, Naylor wrote that while duty to warn seems like it could be relevant in this situation, it specifically results from “my patient making a specific threat—putting me in a position to warn the specific intended victim and the proper authorities.” She noted that, as Gartner has done, it’s possible to argue that specific threats and intended victims exist in the situation involving Trump, but that “it’s muddy water. Who exactly would you warn, and how?”
Obviously, Gartner believes that our elected representatives are the ones who need to be warned and asked to take steps. Meanwhile, in the time it took me to write this piece, another 131 people signed his petition in agreement.
I am a journalist and biologist. My book, The Informed Parent, with co-author Tara Haelle, is available now. Read more about me here and find me (too often) on Twitter.
Article source: http://www.forbes.com/sites/emilywillingham/2017/02/19/psychologist-calls-on-colleagues-to-sign-petition-for-trumps-removal/