Politics & Policy

President Trump and the Dangers of Armchair Psychiatry

President Trump at Palm Beach International Airport, January 1, 2018. (Reuters photo: Jonathan Ernst)
Medical professionals should stop attempting to diagnose the mental health of politicians from afar.

Back in 2006, when George W. Bush was still president, Duke University Medical Center professor of psychiatry Dr. Jonathan Davidson published a study that reviewed biographical sources for the first 37 presidents (from 1776 to 1974), and expert psychiatrists concluded that half suffered from mental illness, 27 percent while still in office. Twenty-four percent met the diagnostic criteria for depression at some point in their lives, including most famously Abraham Lincoln and Calvin Coolidge. Richard Nixon was treated for many years for stress by psychiatrist and internist Dr. Arnold Hutschnecker. Nixon was severely depressed after leaving office. The psychiatrist who treated Nixon after Watergate has confirmed this to me. “Who wouldn’t be?” he said.

The key to all these cases was either a physician making an in-person assessment and coming up with a diagnostic impression and treatment plan or at least the president or those close to him recognizing the problem. What makes the current pundit-media attack on President Trump’s mental health most disturbing is that those leading the charge are either non-psychiatrists, or else have never examined the president, such as psychiatrist Dr. Bandy Lee of Yale, who traveled to Washington last month to brief twelve Democratic and one Republican lawmakers on President Trump’s supposed mental instability.

Dr. Lee’s claims come across as partisan meanness, and they undermine the integrity of the medical profession at a time when we are already spending too little actual face time with our patients. Philadelphia psychiatrist Dr. Claire Pouncey, writing in the prestigious New England Journal of Medicine, supported the actions of Dr. Lee, along with the book of essays she published, The Dangerous Case of Donald Trump. But Dr. Jeffrey Lieberman, chairman of the Department of Psychiatry at Columbia University, writing a response in the New England Journal of Medicine, called Pouncey and Lee’s actions “a misguided and dangerous morality.”

On Tuesday, the American Psychiatric Association reaffirmed its adherence to the so-called Goldwater Rule, which stipulates that member psychiatrists should not publicly discuss the mental health of a public figure, leader, or candidate. This rule is wise, protects our integrity as physicians, and continues to apply here.

And yet the ridiculing of the president goes on, as every Trump statement and tweet is put under a microscope. The president’s upcoming physical with White House physician Rear Admiral Dr. Ronny Jackson this week is not likely to quiet the critics, since Jackson is an emergency-medicine specialist and not a psychiatrist and, in any case, is not likely to perform a complete mental-status examination. Of course, if Admiral Jackson thought one were necessary, he would.

If half of all presidents have suffered from mental illness, the question is what degree of mental illness would constitute sufficient concern to consider the president unfit to perform his duties. One answer is if he were suffering from severe or suicidal depression, which the president does not in any way appear to be suffering from, though — again — I have not examined him, and I am not a psychiatrist. Another true concern would be psychosis, which is defined by the National Institute of Mental Health as follows:

During a period of psychosis, a person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not. Symptoms of psychosis include delusions (false beliefs), and hallucinations (Seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech, and behavior that is inappropriate for the situation.

Though President Trump clearly has millions of enemies and detractors, many who have a personal animus towards him and would do anything to get him out of office, there is simply no evidence whatsoever that the staff and officials who work with him on a daily basis have noticed anything that is anywhere close to the bizarre and out-of-place behavior of psychosis.

What is closer to psychotic is the constant invocation of Section 4 of the 25th Amendment to the Constitution by Trump’s enemies. Consider the relevant language:

Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

Isn’t it delusional for Trump’s enemies to ignore the facts that 1) the vice president or the president’s appointed cabinet or a Republican-controlled Congress would never go along with such a coup d’état and 2) none of them have expressed any concerns whatsoever about President Trump being “unable to discharge the powers and duties of his office”?

It is certainly possible to disagree with or even loathe someone or their point of view without calling them crazy. By using mental health as a way to denigrate or diminish someone (especially a political leader), we are doing people with actual mental-health problems a real disservice. We need to stop doing this in order to return as a society to a crucial level of civility.


25th Amendment Talk is all Nonsense

The Media’s Treatment of Barry Goldwater

Judge Trump by His Record, Not Gossip

Marc Siegel is a professor of medicine and the medical director of Doctor Radio at NYU Langone Medical Center. He is also a Fox News medical correspondent.

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