Saturday, February 25, 2017


On Diagnosing Trump

A large segment of the Left seems eager to advance the idea that Donald Trump is mentally unfit to be president of the US. I don't respect or admire Donald Trump, I never voted for him, and I never expected him (or Clinton) to be what I would consider a good or successful president.

However, I regard the public attacks on Trump's mental fitness as far more revealing of the depravity of some of his critics than of anything else. The public questioning of Trump's mental health by lay people and professionals who have never examined him in a clinical setting is little more than a scurrilous ad hominem attack in service of an unprincipled attempt to wield a tool of social control for for political purposes.

With respect to social control, people inclined to take seriously the ill-informed, politicized pronouncements of unethical mental health professionals that Trump is "mentally ill" may want to pause to reflect that it was not so long ago that these professions accepted surgical lobotomy and electroconvulsive "therapy" as common, if not routine, "treatments" for "mental illness". Despite a documented history of widespread and selective abuse they are far from rejected even today.

Psychiatry also gave us such enlightening concepts as "drapetomania"—the mysterious illness which caused slaves to try to escape their bondage. The wit who gave us that term was Samuel A. Cartwright, a physician who apprenticed with Benjamin Rush, the "father of American psychiatry". Then there's "The eugenic legacy in psychology and psychiatry". And don't forget that homosexuality was, according to the American Psychiatric Association (APA), also a mental illness until in 1973 (sort of) it wasn't. Finally, readers would do well to reflect on the weaponization of psychiatry in the Soviet Union and its correlates in the US.

Below are some thoughts of others who are concerned with the politicization of mental health by Trump opponents. The first excerpt is from Allen J. Frances who made his first appearance in this blog in 2013. I think Frances overstates the case against Trump and in so doing betrays his political bias nevertheless his main points are well-taken.
Fevered media speculation about Donald Trump's psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president ...
Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump's attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.
His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.
The second excerpt is from a defense in the Journal of the American Academy of Psychiatry and the Law by Redinger et al. last September of the APA's "Goldwater Rule".
... diagnosing public figures via observations culled from the media represents poor diagnostic methodology ... Public figures, especially politicians, intentionally cultivate a public persona that may not accurately reflect their psychological state. Given the risk and potential harm of error, it would be imprudent for any psychiatrist to render an opinion of a public figure's subjective thoughts or motivations, conscious or unconscious, in the absence of a personal and value-free diagnostic interview.

The APA's Goldwater Rule exemplifies a necessary and justifiable professional norm that is intended to temper the potentially imprudent and self-indulgent motivations of psychiatrists to use the cloak of their profession to further a particular political ideology and neutralizes a fallacious appeal to their own authority. Justifications based on freedom of speech, conscientious objection, or the public interest fail to offset the likely harms to the psychiatrist, profession, and public figure.
The final excerpt is by Sera Davidow from the web site of Robert Whitaker, author of the illuminating Mad in America. Davidow underscores the mental health professions as instruments of social control along with the inherent subjectivity of the whole concept of mental illness.
[Trump]'s not 'mentally ill,' because this whole manner of categorization of human beings is just that subjective.

In other words, Trump is not 'mentally ill' because he is not a member of any of society's groups for which tools of control (like our diagnostic system) are most specifically designed. His brand of dangerous is party to some other kind of measure. A different set of standards. And while this tells us something about Trump, it tells us much more about ourselves ...

We need to stop calling Trump 'mentally ill' because it suggests that emotional distress and trauma (and all the rest that often gets wrapped up in and confused with this idea of 'disorder') are somehow scarier and worse than what Trump is actually doing. It's a distraction of the worst kind from what we can actually see and know.

We need to stop calling him 'mentally ill' because it misdirects us away from holding ourselves accountable for his election and the societal ills that led us to this point. We're far better off learning from our mistakes, and figuring out a way to back off of this crumbling ledge.

And we need to stop calling Trump 'mentally ill' because such labels are routinely applied inequitably and in ways that have harmed so many, and this present maelstrom only further encourages that trend. Psychiatric labels tell us little to nothing about how to be with or support one another, and give almost no information about what's actually going on. This is true of both president and neighbor. Friend or lover. Child or parent. Human being.

It certainly tells us nothing about how to get us out of our current bind.
See also: "Friday Feedback: Questioning A Leader's Mental Health" on MedPage Today.

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