Is it Fair to Blame President Trump’s Behavior on Mental Illness?

On October 25, former Oklahoma Senator Tom Coburn (a Republican) said that President Trump has “a personality disorder.”  He was not the first to posit that President Trump has some form of mental illness. The press has been engaging with such speculation since the start of his campaign, though there has been a decided increase of late. On October 26, New York Times columnist David Brooks reported that some Republican senators thought Trump is “suffering from early Alzheimer’s.” In an article titled “Some Republicans are starting to more openly question Trump’s Mental health,” Business Insider reports that “One psychiatric professor at Yale said about half a dozen lawmakers had contacted her over the past several months.”

Representatives Zoe Lofgren and Earl Blumenhauer have both introduced proposals in the last six months that would allow the president’s mental health to be investigated, with Rep. Lofgren asking, “Does the President suffer from early stage dementia? Has the stress of office aggravated a mental illness crippling impulse control? Has emotional disorder so impaired the President that he is unable to discharge his duties? Is the President mentally and emotionally stable?”

With articles titled, “Worried about Trump’s Mental Stability? The Worst is yet to Come” (The Intercept), “Trump’s mental health poses danger, psychologists warn” (Salon), “The conversation about Trump’s mental health is finally changing. But is it too late?” (Esquire), and “The 25th Amendment proves why Trump’s Mental Health Matters” (NBC), we see that questions about the president’s mental health are not going away anytime soon.

 President Trump’s often objectionable, shocking, and erratic behavior has drawn commentary from laypeople and psychologists alike. It is important, however, to proceed with care when we use the state of someone’s mental health as a way to criticize or warn about their abilities. Mental illness is stigmatized already in our society, and it isn’t clear that the traits critics are finding distressing about the president’s leadership are necessarily tied to mental illness – incompetence and radically different values do not always track a dysfunction that is diagnosable.

These ethical considerations have not been enough to keep a discussion of the president’s mental health at bay. Concerns regarding addressing the public diagnosing a public figure with mental illness brings the “Goldwater rule” to the fore. According to the American Psychiatric Association, “it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” Barry Goldwater lost a presidential election to Lyndon B. Johnson. During the campaign in 1964 Fact magazine published an article surveying psychologists who claimed that Goldwater was psychologically unfit for office, and Goldwater successfully sued for libel. Since 1973, the policy of the APA has been for psychologists to refrain from diagnosing public figures whom they haven’t examined.

This restriction has been strained, tested, flouted, and ignored during the reign of President Trump, with 33 mental health professionals signing a letter to The New York Times in February expressing professional concern regarding “the grave emotional instability” exhibited by the president, and psychologists resigning from the APA in protest of what they came to see as a “gag” order in the face of the seriousness of President Trump’s lack of fitness.

A recently published book, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, includes an introduction placing the text as a response to a “duty to warn,” outweighing possible consideration of the Goldwater rule. Professor Bandy Lee, editor of the volume, says that, “anyone as mentally unstable as this man should not be entrusted with the life-and-death-powers of the presidency.” Esquire reports, “In writing the book, Lee and her colleagues were ‘not so much deterred by the Goldwater rule as we were by fear of being targeted by a litigious president or some of his violence-prone followers.’”

The president has exhibited behavior that is petty and impulsive. He has denied facts and made things up. He is arrogant and brazenly resistant to acceding to the structure of the office of the presidency that would, to most, make the most sense in terms of optics, politics, and international relations. He exhibits fits of rage in the form of temper tantrums and speaks grandiosely of himself. It’s unclear that anyone denies these features of Donald Trump.

What is objectionable about Trump may not be able to be boiled down to a matter of a disorder. He has been uninterested in both briefings and nuances of diplomacy, and his values regarding human rights and dignity are anathema to many Americans (consider his lack of concern over appearance of hypocrisy with Russia dealings, his immigration ban, attitudes towards women, dismissiveness towards issues relating to health care, etc.). The extent to which these are personality traits versus mental illness is unclear. Someone can find the president’s character to be unfit for office – indeed someone can find a spectrum of personality make-ups to be dangerously unfit for office – without diagnosing them with a medical condition.

To see this, consider a person that all you know about them is that they have a particular disorder. Could they be president? Start to fill in the person a bit – what sorts of qualifications for president do you consider important? What values and background, what commitments and frameworks for working with people. Can someone with the disorder have such things in their life? Taking into consideration all the ways that individuals live with mental illnesses successfully, either by healthily managing them or by having support systems, it may at least be an open question whether mental illness disqualifies an individual from performing the office successfully.

A review of biographical sources concluded that roughly half of our presidents up until 1974 met criteria for mental illness. It is not the case that half of our presidents have been met with widespread public concern about their mental ability to perform the duties of the office.

One aim of the Goldwater rule is to prevent inaccurate diagnosis. A beneficial byproduct, if not actual aim, is to reduce the effects of validation of diagnosis-as-take-down. The psychologists who are speaking out in other media are attempting to highlight the president’s lack of fitness to perform the duties of his office by pointing to medical issues. The authors consider the president’s state of mind to pose a threat requiring action.

To look beyond mental illness and diagnosis means that we need to characterize the behavior and traits we find troubling about having the behavior of President Trump in the White House. It also moves the conversation away from particular illnesses to the importance of mental health more broadly, and our ability as a society to be conversant not just in DSM-speak, but in healthy, functional, and kind ways of existing in the world.

To say that the president has a mental illness may seem like a paraphrase for his having undesirable mental features, but it is importantly different, especially for those who have mental illnesses.

We can see that someone is a jerk, a flake, or is selfish, shortsighted, self-destructive without the aid of a diagnosis, even if, when provided with a diagnosis, we see the behavior as unified in a helpful way.

Those psychologists who contributed to The Dangerous Case of Donald Trump avoid particular diagnoses and instead suggest that the president’s behavior suggests that he is a dangerous individual to be in a position of power, suggesting warning signs in his “verbal aggressiveness, history of sexual assault, incitement of violence at his rallies, attraction to violence and powerful weapons, provocation of hostile nations.”

In the case of the president we have a remarkably dysfunctional individual to be sure. To what extent is it helpful to pathologize his behavior with a suggested diagnosis of mental illness, and to what extent is it ethical?

Lee’s book suggests we submit future presidents to a mental fitness test. Such a suggestion isn’t completely anomalous – mental fitness tests are required for the military, and in Argentina psychoanalysis isn’t abnormal as a step in the hiring process for such everyday jobs as copywriters in Buenos Aires. To insert this step in the election process would be a significant divergence, especially at a time where public understanding of mental health is filled with lacuna and stigma. Further, president-elects aren’t required to submit to physical health exams, with the standard of health required of the presidency left up to the public in the voting booth. That has been the standard for mental and cognitive well-being as well.