5 Feb, 17 | by Iain Brassington
It doesn’t take too much time on the internet to find people talking with some measure of incredulity about Donald Trump. Some of this talk takes the tone of horrified fascination; some of it is mocking (and is accompanied by correspondingly mocking images); and some people are wondering aloud about his mental health. In this last category, there’s a couple of sub-categories: sometimes, people are not really talking in earnest; sometimes, though, they are. What if the forty-fifth President of the United States of America has some kind of mental illness, or some kind of personality disorder? What if this affects his ability to make decisions, or increases the chance that he’ll make irrational, impulsive, and potentially dangerous decisions?
This does raise questions about the proper conduct of the medical profession – particularly, the psychiatric profession. Would it be permissible for a professional to speak publicly about the putative mental health of the current holder of the most important political office in the world? Or would such action simply be speculation, and unhelpful, and generally infra dig? More particularly, while the plebs might say all kinds of things about Trump, is there something special about speaking, if not exactly ex cathedra, then at least with the authority of someone who has working knowledge of cathedrae and what it’s like to sit on one?
As far as the American Psychiatric Association is concerned, the answer is fairly clear. §7.3 of its Code of Ethics, which you can get here, says that
[o]n occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
This rule is nicknamed the “Goldwater Rule”, after Barry Goldwater, the Senator who sued successfully for damages after a magazine polled psychiatrists on the question of whether or not he was fit to be President. Following the rule would appear to rule out making any statement about whether a President has a mental illness, a personality disorder, or anything else that might appear within the pages of the DSM.
Over on the BMJ‘s blog, Trish Greenhalgh has been wondering about what a doctor may or may not do in cases like this:
I have retweeted cartoons that mock Trump, because I view satire and parody as legitimate weapons in the effort to call our leaders to account.
But as a doctor, should I go further? Should I point out the formal diagnostic criteria for a particular mental illness, cognitive condition, or particular personality disorder and select relevant examples from material available in the public domain to assess whether he appears to meet those criteria?
Her post is long, but it does generate an answer:
I believe that on rare occasions it may be ethically justified to offer clinically-informed speculation, so long as any such statement is clearly flagged as such. […] I believe that there is no absolute bar to a doctor suggesting that in his or her clinical opinion, it would be in the public interest for a particular public figure to undergo “occupational health” checks to assess their fitness to hold a particular office.
Her phrasing is such as to leave no bet unhedged – she’s careful not to say that she’s talking about anyone in particular; but, beneath that, the message is clear: it might be justifiable to depart from the Goldwater Rule to some extent in certain hypothetical circumstances.
My post in response will also be long – in fact, it’s going to spread out over two posts. I think she’s plausibly correct; but the way she gets there is not persuasive.