This post is in response to Shrinks Battle Over Diagnosing Donald Trump by Psychology Today Editorial Staff

On January 31, 2017, the Psychology Today editorial staff published a well-balanced summary of the debate over whether to declare President Trump mentally ill. While the debate focuses on mental health professionals such as psychiatrists and psychologists who are credentialed to make such diagnoses, the question clearly goes further.  Public commentary following this and other articles expresses outrage — not only at the behaviors and policies of Trump himself, but also at any suggestion that diagnosis is off-limits as a form of political criticism. We want to be able to call public figures crazy when we don't like them. We defend our right to do so.

Criticizing a person's character, not the content of their arguments, was recognized by ancient Greek philosophers as a logical fallacy: argumentum ad hominem. Yet the character of powerful politicians seems vitally important. Does our president have integrity? Is he trustworthy? Will he stand by what he says? There is no avoiding questions of character when global war could result from a leader's imprudence, irritability, or petty revenge.

Our armamentarium of terms of disapproval is large. Some are purely moral, terms like "bad" or "evil." Some highlight impaired intellect: "shortsighted," "foolish," "idiot." Some take aim at undue self-interest and self-aggrandizement: "selfish," "cold-hearted," "narcisssist." There is no clear distinction between putdowns that derive from psychological concepts and those that derive from religious morality and other roots. It is as legitimate to criticize Trump as narcissistic as it is to say he's too hot-headed (or inexperienced) to be president. And it is equally legitimate to argue against these criticisms, if one happens to support him.

Using psychiatric diagnoses — not just psychologically derived adjectives — adds rhetorical weight to one's critique, particularly, but not only, if the speaker is a mental health professional. A diagnosis, e.g., Narcissistic Personality Disorder, connotes a carefully considered conclusion based on scientific research — far more than a mere personal opinion. There is an implied consensus: Unbiased experts would concur if they looked carefully at the data.  

Critique-by-diagnosis also unfortunately capitalizes on prejudice against the mentally ill, tarring the target with a label that diminishes him and sets him apart from the rest of us. Diagnosis would not serve as political disapproval if it primarily called forth pity and generosity. It is offered as disqualification, hardly the thing mental health advocates would want associated with, say, a personality disorder.

The "Goldwater Rule" instructing psychiatrists not to diagnose public figures was promulgated by the American Psychiatric Association to protect its brand. Psychiatric diagnosis was, and is, already fraught. Some who are opposed to psychiatry reject diagnosis on principle, while many others fear its negative impacts. The authority to pass judgment on the mental functioning of others is not to be taken lightly.  By analogy, society would not grant police officers the right to make arrests if they did so for political expediency or to express a strongly held personal opinion.

Little is gained by arguing that President Trump meets criteria for a DSM-5 psychiatric disorder. Other terms of disapproval can be just as powerful, without the liability of adding to psychiatric stigma, dulling the tools of our trade, and popularizing the use of psychiatric terms to double for everyday personality descriptions.

It also makes no practical difference. Diagnosis is mainly for treatment, clearly not the point here, and Mr. Trump's character is what it is. (And lest we forget, many people like it.) The public will continue to use terms like "liar" and "idiot" and even "narcissist" for disliked politicians. As private citizens we mental health professionals may do so as well — with the added advantage that we're more apt to use psychological terms accurately, and can sometimes extrapolate character style to predict future behavior.  But all this is different than diagnosis proper. Diagnosis is a sharp instrument for helping patients, but only a blunt weapon in political discourse.

You are reading

Sacramento Street Psychiatry

Diagnosing Donald Trump

Diagnostic language adds weight to our disapproval.

A Christmas 2016 Fable

A familiar Christmas tale with a moral for our times.

Prescription Drug Abuse and the Physician Gatekeeper

Can we cleanly separate good drug use from bad?