From an edict handed down last week by the head of the American Psychiatric Association:
“Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as “the Goldwater Rule,” which prohibits psychiatrists from offering opinions on someone they have not personally evaluated. The rule is so named because of its association with an incident that took place during the 1964 presidential election. During that election, Fact magazine published a survey in which they queried some 12,356 psychiatrists on whether candidate Sen. Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency.
While there was no formal policy in place at the time that survey was published, the ethical implications of the Goldwater survey, in which some responding doctors even issued specific diagnoses without ever having examined him personally, became immediately clear. This large, very public ethical misstep by a significant number of psychiatrists violated the spirit of the ethical code that we live by as physicians, and could very well have eroded public confidence in psychiatry… I can understand the desire to get inside the mind of a Presidential candidate. I can also understand how a patient might feel if they saw their doctor offering an uninformed medical opinion on someone they have never examined. A patient who sees that might lose confidence in their doctor, and would likely feel stigmatized by language painting a candidate with a mental disorder (real or perceived) as “unfit” or “unworthy” to assume the Presidency.
Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.”
Naturally, as he is significantly responsible for much that is going haywire in the culture—CNN experts using words like “dick” on the air, a Fox News star and a Wall Street Journal editor calling each other names on Twitter, the New York Times announcing that it no longer is even pretending to follow its own ethics code—this can be partially placed at the feet of Donald Trump, though Ann Althouse’s suspicions that it is really designed to protect Hillary Clinton cannot be discarded.
I agree that professional groups that use their collective weight and credibility to assume greater influence in political matters than their biases and relevant expertise warrant are abusing their positions. I agree that psychiatrists pronouncing public officials mentally unfit for office without the same kind of examination that they would demand with a patient is a dubious practice, ripe for abuse. Still, I wonder if the situation with Trump doesn’t pose a different problem.
Trump is a narcissist. I’m no psychiatric professional, but diagnosing Trump as a narcissist takes no more expertise than diagnosing a guy who dresses as Scarlet O’Hara and talks to himself while he wanders through Times Square with a dead goose strapped to his head as “nuts.” Hal Brown argues at the Daily Kos that reviewing the symptoms of narcissistic personality disorder (NPD) , applying them to Trump and suggesting that having certain of them to the level he does precludes him from being fit to be president isn’t unethical at all. Brown, who is a clinician, cites two typical description of the disorder:
Simply put, narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that’s vulnerable to the slightest criticism. (Mayo Clinic)
Narcissistic Personality Disorder is a disorder that is characterized by a long-standing pattern of grandiosity (either in fantasy or actual behavior), an overwhelming need for admiration, and usually a complete lack of empathy toward others. People with this disorder often believe they are of primary importance in everybody’s life or to anyone they meet. While this pattern of behavior may be appropriate for a king in 16th Century England, it is generally considered inappropriate for most ordinary people today. ( Psych Central )
It doesn’t take Sigmund Freud to read these and immediately think “Trump.” The Goldwater Rule has the perverse result of leaving a diagnosis of the obvious to amateurs (like me) and precluding trained professional from confirming it. Voters who are completely unfamiliar with the disorder need to understand and think about it when someone like Trump is nearing the levers of power. Brown insists that a mental health professional not flagging the problem when they see strong evidence that someone is dangerous may be unethical
.On the other hand, I am troubled where Brown’s way leads. Most professional organizations are dominated by Democrats, which means the members are likely to be biased. Thus there is a greater likelihood that the force of medical expertise will be used as a partisan weapon, though Brown writes as if that isn’t even an issue. Of course it’s an issue. Why, for example, wasn’t there any need to remind members of the American Psychiatric Association about the Goldwater Rule when Barack Obama was first running for President? He is certainly not a poster child for Narcissistic Personality Disorder like Trump, but he display a lot of the traits. Also, though Brown doesn’t acknowledge this either, many U.S. Presidents, good, bad and great, have scored high on the narcissism scale. A psychiatric professional pronouncing Trump or any candidate as a narcissist is likely to be simplified by the news media and the public into a simple “he’s crazy,” with crazy equaling “dangerous.”
It ain’t necessarily so. In a 2013 article in Psychological Science (it costs 35 bucks to download it) psychiatric researchers examined 42 Presidents through George W. Bush, beginning with data compiled by psychologists Steven Rubenzer and Thomas Faschingbauer, who had asked experts on each President to complete personality surveys on the subjects of their expertise. Then, using standard formulas from the research literature on personality, they produced estimates of each president’s narcissism level, and correlated these personality ratings with data from surveys of presidential performance from independent panels of historians. This study concluded that “grandiose narcissism,” characterized by flamboyance, immodesty and dominance, was associated with greater Presidential success. The two highest scores on grandiose narcissism were Lyndon B. Johnson and Theodore Roosevelt., with FDR close behind. The lowest scores were relative White House flops James Madison and Millard Fillmore.
Taking all of this together, I have to conclude that the Goldwater Rule is necessary, even and perhaps especially as it concerns Donald Trump:
1. Amateur diagnoses, like mine, are likely to be taken as opinions only, without the enhancement of special expertise and authority. They help inform the public, but are not so powerful that they mislead.
2. Experience teaches us the professionals can’t be trusted to issue such diagnoses fairly and objectively, and tend to create the mistaken impression that only conservatives and Republicans have mental and emotional problems. Bill Clinton and Eliot Spitzer sure seem like a sociopaths to me, but I haven’t encountered any psychiatric professionals who have been eager to say so.
3. When such a diagnosis becomes another label reducing a complex individual into a stereotype, it impedes rather than assists rational evaluation by the public.
4. Narcissism, as with other mental disorders, isn’t necessarily disabling. It was remarkable how often experts in Ken Burns’ recent documentary “The Roosevelts” described Teddy as “crazy,” while saying that he “managed it” well, in part because he knew he was crazy: mental illness, including depression, ran in his family. I’ll take Crazy Teddy as my President any day. I’ll take Teddy now, dead and all. How I wish we had that option.
5. Trump isn’t unfit because he’s a narcissist. He’s unfit because he’s ignorant, intellectually lazy, not very bright, impulsive, boorish, incoherent, misogynist, dishonest, has the ethics instincts of an 11 year old, and a narcissist.
_________________________
Pointer: Fred
Facts: American Psychiatric Association
Sources: The Daily Kos, New York Times
Ethics Alarms 
And the psychiatrists were so wrong about Goldwater. Perhaps they should have offered opinions about LBJ instead. But considering the fact that this probably influenced a presidential election, the Goldwater Rule remains a good one. Let the voters decide who’s unfit and live with the consequences.
The Goldwater rule is necessary because professionals take their profession seriously. Lawyers don’t pronounce guilt or innocence before the evidence is in; journalists don’t insert their biases into a story; and doctors don’t diagnose people they have not met. If psychiatrists respect their profession, they need the Goldwater Rule.
But, to me, he is the Megalomaniacal Narcissist and she is a Pathological Liar.
-Jut
My 11-year-old and her cohort of Girl Scouts (I am their leader, too), have WAY better ethical instincts even on their worst days. Even when they’re really being jerks. Heck, my 4-year-old is better, and we KNOW how kids that age are.
I would have thought Eisenhower to have escaped the diagnosis, at least by two thirds: dominant, of course; but flamboyance, nah; and immodesty, are you kidding? Al Smith, now, you can see why he didn’t make it:
Seriously, I do agree with your personality execution of Donald Trump. And, most particularly, with the Goldwater Rule. A fairly close relative, long estranged I’m pleased to say, has all the characteristics of grandiose narcissism as described, plus being a champion manipulator. Until recently, he “practiced” in a southern California county without benefit of the Rule. He is, regrettably, a psychiatrist. He is also, tragically, a forensic psychiatrist whom I learned had an arrangement with several judges and lawyers in a southern California county to assess the mental status of clients or defendants in absentia -look, ma! Latin!- working from police reports, trial transcripts and a photograph. Apparently, he could tell a lot from those arrest poses, sort of a long-distance phrenology. He then submitted a few questions to be asked of his “patients” … and presently presented a pro forma -ha! this is easy!- diagnosis and prognosis to the law firm or court without ever having interviewed the person. Since he wasn’t prosecuted, I assume he was asked to leave town rather than risk putting him in front of a jury or, worse yet, a journalist.
The link to the picture of Al Smith in baggy-kneed knickerbockers, high belted around a protruding tummy, dwarfed by Babe Ruth sturdy and confident in the same outfit at his side, like a did not print out. It can be found by searching for the two names together.
Just an FYI, there really is a legitimate field of practice called forensic psychiatry/psychology. Usually, it is employed to attempt to determine the mental state of someone who is deceased, and is, therefore by definition, not available for interview. It normally involves much more than the little bit of information you described, and does involve LOTS of interviews with people who knew the deceased. I have never actually heard of a case of it being used legitimately to diagnose a living, available subject.
Thanks for the full info, DD. I never bothered to look into it. Forensic psychiatry is indeed listed as his specialty. Therefore, given your description, and by what I’ve heard reported, he was not only doing his job badly, he was not doing it at all, and what he wasdoing was not only unethical but illegal. I wonder if it’s harder to get a doctor struck off than a lawyer disbarred.
Sure it is.
In Texas, it’s even easier. Don’t know about other states, as we have Boards of Examiners for most professions (not lawyers, unless the Bar counts).
Psychology is like astrology – it is fun to read but I don’t take it seriously. Oops…have to post this before Nurse Ratched comes back.
Now, now, Rick. Try to stay on your meds this time.
Hey, in looking over articles and blogs about the so-called Goldwater Rule I was pleasantly surprised to find you referenced and discussed what I wrote on the Daily Kos. I am glad you agree with my basic premise. I want to reiterate that I emphasized that among all the characteristics of narcissistic personality disorder I thought Trump’s LACK OF EMPATHY was the most disqualifying. Another trait of narcissists which isn’t listed specifically in the DSM-5 is that they are reluctant to take advice when it means admitting they might be wrong. This would fall under “Regularly shows arrogant, haughty behaviors or attitudes” but when extreme could be dangerous. http://psychcentral.com/disorders/narcissistic-personality-disorder-symptoms
Addressing your criticism I see where I could have expanded my argument to differentiate Trump’s likely NPD from characteristics of NPD in other public figures past and present.
There are other aspects of Trump’s personality which may not rise to the level of giving him a psychiatric diagnosis but still are very troubling, in fact more troubling than his narcissism alone. One is is his impulsivity and another is his being quite will to condone, if not incite violence in others.
There’s an interesting article in the current Scientific American quite relevant to this debate:
“Of Psychopaths and Presidential Candidates
An analysis in the current Scientific American MIND shows where some of this year’s aspirants rank on a standard assessment of psychopathic traits—and the results are interesting, to say the least.”
Excerpt: “The verdict on the candidates: Trump, Clinton and Cruz all scored in the upper quintile in Self-Centered Impulsivity and Coldheartedness. Trump landed in the top 20 percent across the board on psychopathy traits, with a total score that placed him between Idi Amin and Adolf Hitler.”
(Sanders is the Mahatma Gandhi of the group.)
http://blogs.scientificamerican.com/mind-guest-blog/of-psychopaths-and-presidential-candidates/
Thanks, Hal; this is helpful. Yes, I do think expanding the argument to include some other figures would have been helpful. As you know, leaders are a somewhat abnormal group, and narcissism is not an unusual component of the set. Trump seems to be in an entirely different category, however. I think that comparing his narcissism with Obama’s, for example, would have resulted in many readers being less inclined to dismiss your post as politically motivated (I did not interpret it as such.)
Talk about “reluctant to take advice when it means admitting they might be wrong and “regularly shows arrogant, haughty behaviors or attitudes”!
Head over to Huffington Post and check this out:
Conservative Legal Scholars Prefer A Liberal Supreme Court To A President Trump
“The court is important, to be sure ― but not nearly that important,” said retired Temple University Law School Professor David Post, who now writes for the conservative website the Volokh Conspiracy. “With all due respect to my colleagues who might feel differently, this one strikes me as a no-brainer.” The next president might end up only filling a single seat on the court, Post said. “The idea that it makes sense to trade a single justice for all of Trump’s terrible baggage ― his bullying, his ignorance, his appalling tendency to shoot his mouth off without thinking, and all the rest of it ― strikes me as thoroughly preposterous,” he added
http://www.huffingtonpost.com/entry/conservative-legal-scholars-prefer-a-liberal-supreme-court-to-a-president-trump_us_57ade55fe4b069e7e504d4d3?section=&
Being a lawyer he isn’t making a diagnosis but he is without a doubt speaking AS A LAWYER.
I agree with him too, and his logic. But Post has previously shown that his contempt for Trump, which I share, leads him into bias territory, like his freak-out here. This is the problem, Hal—professionals are also human, and when the human part–which is subject to biases and conflicts–represents itself as just professional, and unbiased, the public may be getting deceived. I agree with Post’s conclusion, but based on his other opinions, I don’t trust his method of reaching it.
Perhaps the question on Post is whether he is speaking as a legal scholar or as a staunch conservative (YES, they are human too) who finds Trump dangerous for the reasons given.
After reading this I felt I needed to update my first Daily Kos piece. The comments so far have excoriated me for stigmatizing people with mental illness. I am trying to explain that this isn’t a cut and dry ethical question which lends itself to simple codification.
How can I feel an ethical imperative to share my expertise in diagnosis as applied to Trump when others have said in no uncertain terms that it is unethical to do so?
I’d like readers here to consider adding their comments, obviously whether or not they agree with me.
http://www.dailykos.com/stories/2016/8/13/1559763/-The-Ethics-of-Diagnosing-Trump-Part-Two
Whatever the result, you’re an ethics hero here, Hal. I’m sure you know how rare it is for any opinion piece writer to be objectively self-critical and to reconsider his original piece in any respect. It is a thoroughly professional, honest and exemplary act, and though it is doubtful that as many will follow your example as they should, it is still an important example to see.
I’m impressed and grateful.
Just saying a mere thank you barely expresses how I feel about your words.
Trump isn’t “bright”? I don’t believe he thinks well on his feet, so to speak, but the man has an IQ of 160, and people with high IQs are often socially challenged. Btw, compared to the Clintons, Donald Trump is a saint. (Please read the books “Crisis of Character” and “The First Family Detail” – they’re real eye-openers.)