I blew the whistle on Trump’s mental health
Mental health experts see Trump as dangerous, but our professional gatekeepers protect him
I am not a political person but a medical professional. Yet because of my field of expertise, I unexpectedly became an academic whistleblower. I have been compelled to blow two whistles: first, by publishing a book to alert the public that Donald Trump was more dangerous than perhaps any president in history, for psychological reasons; and second, on the American Psychiatric Association’s actions that have effectively silenced those of us trying to fulfill our professional responsibility to society as outlined in its own code of ethics.
Politics never interested me previously. In fact, throughout my career when I was consulted on policy issues relating to my area of violence prevention, I strictly refrained from commenting on or getting involved in political matters.
But the dangers of the current U.S. president changed everything. I had to ask myself: If I devoted my career to studying and preventing violence, do I turn away from confronting the greatest potential violence we could ever face? What called me was a medical need, not politics.
Soon after the inauguration, I organized a conference around the ethics of speaking up about a public figure, and from it came a public-service book, “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President,” a collection of essays from some of the most prominent psychiatrists and psychologists.
Our message was simple: The president was more dangerous than people suspected, would grow more dangerous with time, and could ultimately become uncontainable. Much of what we predicted in the book has come to pass: Trump’s rhetoric has clearly incited violence, cruel policies against children that could lay the groundwork for future violence, enhancing a culture of violence both domestically and abroad, and the weakening of institutions that might have contained him.
Whereas law enforcement generally looks at committed deeds, mental health experts look at patterns of behavior to try to prevent dangers based on predictable characteristics and evidence. Trump’s recent reference to his “great and unmatched wisdom,” which is supposed to reassure us in his decision to let Turkey loose on the Kurds in Syria, is only the latest manifestation of the dangerous lack of capacity.
In response, the American Psychiatric Association (APA) has effectively gagged an entire profession, thus protecting a destructive government.
The organization’s ethical guideline includes an affirmative obligation: to “contribut(e) to the improvement of the community and the betterment of public health.” In the midst of this political moment, the APA emphasized only one part of this guideline, the do-not-diagnose part, known as the so-called Goldwater Rule. Rather than take on a leadership role that acknowledges our profession’s societal responsibility at a critical time, the APA released statements that appear to suppress the educate-to-better-public-health part.
Before this presidency, the psychiatric community had been grappling with the implications of the Goldwater Rule and softening it. For instance, diagnostic practices have changed from accepting interviews to observations, so any assertion that a personal interview is mandatory for a valid professional opinion does not hold.
In one influential journal article, a review of the rule’s history found that “it contradicts regular psychiatric diagnostic practices, and its reach seems to include” everything from “legitimate academic pursuits” to “self-promoting pseudoscientific statements.” Therefore, the Goldwater Rule should be considered a matter of “etiquette rather than ethics.”
Instead, during the Trump administration, the APA expanded the Goldwater Rule and used this guideline to openly denounce professionals who would speak up as “unethical” and engaging in “armchair psychiatry.” A former APA president even released a video message warning that speaking out might be “political partisanship disguised as patriotism.“
Many in the news media have even adopted the APA’S line.
All this had a chilling effect on mental health professionals, and press interviews dried up for me and the many of the professionals who contributed to the book. A curious situation resulted whereby the most qualified people to talk about this issue were sidelined, while confusion, misinterpretation and darkness dominated. Thus, Trump’s actions and this national mental health crisis were interpreted in terms other than mental health, including political savvy and that he is “crazy like a fox.” Even those who earlier admitted the president was dangerous are constantly surprised at his profound level of dangerousness, and news outlets are willing to publish non-mental health professionals on this same topic.
Ordinary courts routinely consult experts in the same manner they ground decisions on facts. Listed before the Goldwater Rule, the APA code of ethics states that “psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative and judiciary branches of the government.” Obtaining a mental health consultation is not the same as allowing it to overtake a political process or supersede the public’s authority to decide. Rather, proceeding without being properly informed risks turning our political process into a partisan process that manipulates rather than serves the public.
After the inauguration, we spelled out what was to happen. Our track record should reveal that we were not speaking frivolously. My colleagues and I risked our reputations and careers to speak out. There are many more who wish to blow the whistle. There is still time, but we fear that the worst is yet to come.
Dr. Bandy X. Lee, a forensic psychiatrist at the Yale School of Medicine and president of the World Mental Health Coalition, is editor of “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.” Follow her on Twitter: @Bandyxlee1