Much has been written recently about the so-called "Goldwater Rule" of the American Psychiatric Association and organized psychiatry's official policy banning the psychiatric diagnosis of politicians and public figures. What is generally missed in these discussions is an appreciation of the historical use and misuse of psychiatry for sociopolitical purposes--in this country and around the world.

Public domain
Thomas S. Szasz, M.D., professor of psychiatry who identified the uses of state-sanctioned psychiatry and psychiatric diagnosis as methods of social control.
Source: Public domain

The famous psychiatrist-psychoanalyst Thomas S. Szasz brilliantly pointed out years ago the social role of psychiatry as an arm of the state. Unlike physicians from other specialties, psychiatrists--and, by extension, nonmedical mental health professionals like psychologists and social workers--occupy a unique position at the interface of medicine and the legal system and wield a great deal of power to treat their patients coercively. This is not accidental; it highlights psychiatry as an agent of social control. If a person has diabetes, the state has no power to force such a person to take their insulin. If a person is said to have schizophrenia, the state--via psychiatry--can compel such a person into involuntary treatment. Much has been said about this topic (see Szasz's Law, Liberty, and Psychiatry), and I will not belabor that point here. Needless to say, the social role played by the psychiatrist is much different than that of the oncologist or ophthalmologist.

In the Soviet Union, political dissidents who disagreed with socialist rule were labeled with a nonexistent disease called "creeping schizophrenia" (Russian: vyalotekushchaya shizofreniya) and locked in mental hospitals. Today, in the United States, we label politicians with whom we disagree with mental disorders like "narcissistic personality" or as "psychopathic" (see criticisms of both Presidents Obama and Trump). This is nothing more than a watered-down psychiatrization of social-political disagreements.

Instead of labeling those with whom we disagree with mental disorders, we would be better served to have substantive discussions about policy and the issues of debate. Resorting to psychiatric labels to describe politicians and their behavior not only applies psychiatric diagnosis imprecisely (of course, it makes no sense to talk of psychiatric diagnosis of a nonconsenting patient--diagnosis always requires consent, as Szasz points out), it also serves to excuse the behavior of our political opponents, explaining it in terms of psychopathology instead of policy. This point has been astutely pointed out by the well-known psychiatrist Allen Frances.

Of course, any person may suffer from problems in living, including politicians, and this is not to discount the fact that such problems exist and may affect political leadership. It is merely to point out the problems inherent in using psychiatric diagnosis within the realm of politics and to warn of the consequences of doing so.

Mark Twain once quipped that "to a man who wants to use a hammer badly, everything looks like a nail." I urge psychiatrists and psychotherapists to put down the DSM, quit playing doctor, and focus not on diagnosing those with whom we disagree but rather putting forth policy alternatives and sticking to the issues. Our professional identity depends on it.

References

Szasz, T. S. (1963). Law, liberty, and psychiatry: An inquiry into the social uses of mental health practices. New York, NY: Macmillan.

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