Some mental health professionals are calling for an end to professional restrictions on speaking out about the mental health of public figures.
It’s something many Americans have been doing every day since last November’s election.
But now even a few psychologists, psychiatrists, and psychoanalysts are chomping at the bit to make public their thoughts, although most professional societies frown upon them doing so.
What’s all the discussion about?
President Donald Trump’s mental health.
For Americans whose jobs don’t routinely involve delving into people’s psyches, talking about whether the president has dementia, bipolar disorder, or narcissistic personality disorder is not a big deal.
Well, depending on the company you’re in at the time.
But when it comes to talking about public figures, mental health professionals are held to a higher standard.
In this case, the bar was set by the Goldwater Rule, an ethics policy introduced by the American Psychiatric Association (APA) in the early 1970s.
It was named after a debate surrounding Barry Goldwater, the 1964 Republican presidential candidate.
The rule states that it is unethical for a psychiatrist to share a professional opinion on a public figure’s mental health unless “he or she has conducted an examination and has been granted proper authorization for such a statement.”
Some psychiatrists say this ethical guideline amounts to a “gag rule” that prevents them from sharing vital information with the public.
Earlier this year, though, the APA’s Ethics Committee reaffirmed the association’s support for this rule.
But last month, the American Psychoanalytic Association (APsaA) sent an email to its 3,500 members, which, according to StatNews, seemed to open up the way for psychoanalysts to openly comment on the mental health of public figures — even Trump.
APsaA, though, followed up with a statement to clarify that the group’s “leadership did not encourage members to defy the Goldwater Rule.”
The first reason is that the Goldwater Rule applies to psychiatrists, not psychoanalysts.
Secondly, the email stated that APsaA “does not consider political commentary by its individual members an ethical matter,” meaning the group’s ethics guidelines don’t apply to members talking about public figures, just how they practice clinically.
The recent statement also referred to a 2012 APsaA position statement that provided members with guidance on talking about public figures.
This includes being clear that while members can offer possible explanations for a person’s behavior, they can’t “know which if any of these is true about the particular public figure.”
The American Psychological Association has similar ethics guidelines as the other APA Goldwater Rule, advising psychologists to “take precautions” when making public statements about public figures.
“For psychologists in general to comment on the health of anyone they haven’t examined would be highly frowned upon by the American Psychological Association,” said Elaine Ducharme, PhD, a licensed clinical psychologist and public education coordinator for the Connecticut Psychological Association.
Ducharme told Healthline that diagnosing someone you haven’t examined would not only be unethical, but it also doesn’t make sense from a clinical standpoint either.
If a psychologist noticed that someone on the street was yelling at strangers or acting oddly, they could come up with several possible reasons for this behavior.
But without a direct interview — or even an interview over a video chat — these would only be best guesses.
“Diagnosis requires that you are at least having conversations with a person,” said Ducharme.
Even though psychologists can’t talk specifically about a public figure’s mental health — whether it is Trump, or someone who committed suicide — they can still talk in general terms in a way that is useful to the public.
“We have a lot of power and a lot of responsibility in helping people understand mental illness,” said Ducharme.
Although there’s no sign that the Goldwater Rule will go away any time soon, that hasn’t stopped some mental health professionals from speaking out about the current president.
Duty to Warn is a group of mental health professionals with serious concerns about Trump’s mental health.
The group was founded by John Gartner, PhD, a psychologist who taught in the department of psychiatry at Johns Hopkins University Medical School for 28 years, and now practices in Baltimore and New York.
Gartner started a petition earlier this year calling for Trump to be removed from office because he “manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States.”
The petition currently has 59,353 signatures from mental health professionals. A Duty to Warn group on Facebook has 2,714 members.
Jennifer Panning, PsyD, a licensed clinical psychologist in Illinois, signed the petition and is a member of the Facebook group.
“We felt there was enough evidence, including everything from tweets to videotaped behaviors, that warranted us to feel compelled to warn the public,” Panning told Healthline.
The goals of Duty to Warn include educating the public and Congressional representatives about Trump’s behaviors.
Although Gartner wrote that psychiatrists may risk losing their licenses by signing the petition in defiance of the APA’s Goldwater Rule, Panning said the Duty to Warn discussions fall short of diagnosis.
“We know that some of what we’re seeing in the president are more personality disorder issues, not a mental illness,” said Panning. “I think that’s an important distinction to make because we don’t want to stigmatize people with mental illnesses.”
Psychologists have been arguing for a long time about whether personality traits can change over the course of a person’s life.
But in the case of Trump, some think he is what he is — no matter how many times he tries to change.
“[Trump’s] personality patterns are very likely long-standing, unlikely to change and unlikely to respond to treatment,” said Panning.
In her practice Panning has also seen clients whose mental health have been impacted by Trump’s behaviors — like science students worried about Trump’s stance on climate change, or people from other countries concerned about immigration policy changes.
Also affected are people who have experienced gaslighting — an emotionally abusive technique used to make another person, such as a spouse or child, question their reality.
These people have been “particularly upset and impacted by Donald Trump,” said Panning, “in terms of the volatility, the unpredictability and not knowing day to day what was going to happen in the news.”
Panning has written a chapter on “Trump anxiety disorder” for a book to be released in October, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.”
Dr. David Reiss, a San Diego psychiatrist in private practice, also draws a distinction between diagnosing an acute mental disorder — such as depression, anxiety, or paranoia — and speaking about a public figure’s personality traits.
“I agree with [the] Goldwater [rule] that you don’t diagnose an acute disorder without evaluating someone because there could be many different causes for a certain behavior, and you really can’t tell,” Reiss told Healthline.
But identifying personality traits exhibited by someone in the public eye is a different story, especially today when there is so much media coverage available.
“When you have a huge amount of data — press conferences, speeches, rallies, etc. — I think it’s perfectly legitimate to discuss the implications of those behaviors,” said Reiss.
In a recent article for the Huffington Post, Reiss, and colleague Seth Davin Norrholm, PhD, talked about one particular aspect of Trump’s personality — narcissism — as well as the implications of this for Trump’s presidency.
This personality trait gets its name from the ancient Greek legend of Narcissus, the beautiful boy who fell so in love with his own reflection in a pool that he fell into the water and drowned.
Reiss admitted that in the article they come “pretty close to the line” of diagnosing a narcissistic personality.
But he emphasizes that “it’s not really diagnosing it, as much as saying, ‘This is the persona that’s presented to the public and this is the persona that’s acting.’”
Without personally interviewing Trump, Reiss depends upon what he’s been able to glean from the media, Twitter, and other sources.
So could Trump be completely different behind closed doors?
Reiss said it’s possible, but chances are he’s not.
“If he’s not a narcissist, he’s playing a damn good one on TV,” Reiss joked.
This particular personality trait could also explain Trump’s meandering, politicized speech to the Boy Scouts last month.
“Everything he does in public is geared toward building up his own self-esteem,” said Reiss. “He has no sense of his audience. He has no sense of implications. He has no sense of consequences.”
It might also explain Trump’s penchant for lying about matters both large and small.
Like this past week, when he said he received laudatory phone calls from the head of the Boy Scouts and the president of Mexico. The White House recently admitted that both statements were untrue.
As to whether Trump has dementia — which is often mentioned in news stories — Reiss said that “there are surely some indications, but there can be so many different explanations for that. So I make no comment on that.”
A year ago, Dan McAdams wrote a piece for The Atlantic intriguingly called The Mind of Donald Trump.
In it, he created what he calls a “psychological portrait” of Trump.
Using concepts from the fields of personality, developmental, and social psychology, McAdams attempted to understand how Trump’s mind works and the kinds of decisions he might make if he were elected president.
McAdams, a psychology professor at Northwestern University and author of “The Art and Science of Personality Development,” admitted that, at the time, he “thought it was an intellectual exercise. I didn’t think [Trump] would end up in the Oval Office.”
Many of Trump’s personality traits that McAdams discussed in his article — narcissism, extroversion, and disagreeableness — show up again and again in the writings of other psychologists and psychiatrists who were willing to put their views out into the public eye.
Looking back a year later — with Trump six months into his presidency — McAdams said that these big ideas still “remain important, but he would now emphasize other things more.”
One of these is just how important winning is for Trump.
By many standards, the election last November handed Trump the biggest win of his lifetime.
But for Trump — who McAdams said exhibits “sky-high extroversion” — the hunt may be more important than the prize at the end.
“This is why it was so difficult to predict what he would be like in office,” McAdams told Healthline, “because Mr. Trump has always been about winning. He hasn’t been about what you do after you win.”
McAdams said he would place more emphasis on Trump’s hard-nosed leadership style.
“Mr. Trump is as really as close as we’ve had to an authoritarian leader. I didn’t really expect that,” said McAdams. “I didn’t think you would find a man in office who ends up showing so little regard for democratic institutions.”
But there is still one big question left hanging: Will the real Donald Trump please stand up?
In The Atlantic article, McAdams related the story of a man who sat through difficult negotiations with Trump. Afterward, the man’s most striking memory of the meeting wasn’t the hard line Trump took on every little detail, but that Trump was merely an actor playing a part — himself.
When McAdams sat down to write the article, he thought he might, “with no shortage of hubris on my part, be able to find the real Trump behind that mask, to find the life narrative that might drive Trump’s decisions both as a businessman and as president.”
In the end, though, he was forced to conclude that “there is no real Mr. Trump behind the mask,” said McAdams. “He’s always onstage. This is narcissism to the core.”