This post is in response to Shrinks Battle Over Diagnosing Donald Trump by Psychology Today Editorial Staff
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On February 28, we published a post, "The Elephant in the Room: It’s time we talked openly about Donald Trump’s mental health," which went viral with close to a million reads. People on both sides of the political spectrum—as well as some mental health professionals—weighed in with hundreds of comments.

One comment was from Hal Brown, MSW, a colleague of John Gartner, Ph.D., whom we mentioned in the post. John is the founder of Duty to Warn, an organization intent on warning our country that we are in dire trouble due to our president’s mental instability. More than 60,000 mental health professionals have signed John’s petition, which states:

“We, the undersigned mental health professionals, believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And we respectfully request he be removed from office, according to article 4 of the 25th amendment to the Constitution, which states that the president will be replaced if he is ‘unable to discharge the powers and duties of his office.’”

John requested an interview with Phil for a podcast and then asked him to participate in a short documentary film that was recently released. So far, nearly 2 million people have viewed the documentary. 

Bandy Lee

In mid-March, we received an email from Bandy X. Lee of Yale University. To give you a little of her amazing background, she is an M.D.; M.Div. (Master of Divinity); assistant clinical professor, Yale Law and Psychiatry Division; co-founder and director of the Violence and Health Study Group for the MacMillan Center for International and Area Studies; as well as co-leader of Academic Collaborators for the World Health Organization’s Violence Prevention Alliance. We were honored, and a little scared, when she asked us to contribute to a new book she was putting together, with the working title, Duty to Warn. The book was time-sensitive in that she, other contributors, and interested publishers felt an urgency to get the book into the hands of the public and governmental powers-that-be as soon possible. We had less than a month to send our essay to her.   

All other projects were sidelined as we devoted the next two weeks to researching and writing. Fortunately, we had "The Elephant" as an outline and our time perspective expertise in observing Trump’s extreme present hedonistic behavior to help us determine our findings. As we dug deeper into the fallout of Trump as president, we became increasingly alarmed by how one person can affect an entire nation. We used this newfound knowledge for our book chapter, as well as two subsequent PsychogyToday.com post: "The Trump Effect, Part I," about the increase in bullying in schools and a small adult population across the U.S. since the 2016 presidential campaign; and "Part II," about the increase in sexual harassment incidents.

A Question of Ethics

Whether or not mental health professionals should discuss, much less diagnose, a person they have not personally interviewed was the conundrum faced by Bandy and other contributors to her book. In the post, "Shrinks Battle Over Diagnosing Donald Trump: Chaos in the White House fuels discord amongst the experts," on January 31, Psychology Today editor-at-large Hara Estroff Marano brought to light “...three significant and intertwined issues. Can Donald Trump or any public figure be deemed to have mental illness, even based on specific, well-publicized criteria reflecting observable behavior? Is it ethical or appropriate for mental health professionals to venture into public acts of diagnosis? Is psychology a suitable instrument for addressing issues of governance?”

In that post, Gartner responds that the current DSM: Version 5 places pathology (the study of the nature of diseases; something abnormal) in the realm of the observable (to watch carefully especially with attention to details or behavior for the purpose of arriving at a judgment).

As Estroff Marano pointed out, “It is widely regarded as unethical—a violation of the so-called Goldwater Rule—for mental health experts to offer a professional diagnosis of any person they have not personally examined. The rule was established in 1973 by the American Psychiatric Association and is still in force today. Although psychologists are not expressly forbidden from making public pronouncements about the mental health of public figures, the American Psychological Association has affirmed the rule and psychologists generally abide by it.”

Gartner speaks for the book contributors as well as the 60,000-plus mental health professionals who signed his petition when he contends that the mental health community has an obligation to protect the public that overrides the Goldwater Rule —we’ve advanced quite a lot in 44 years—and that Trump has proved himself a clear and present danger. Also, the Goldwater Rule is not relevant because it was established before the DSM made diagnosis behaviorally based.

A Dangerous Case

Since Gartner’s organization is Duty to Warn, Bandy’s book was retitled The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. The book is slated for release on October 3 and can be preordered through Amazon; it’s already #1 in Amazon’s Popular Psychology Pathologies category.

Bandy’s introduction explains in detail the risks, legal as well as professional, of writing a book like The Dangerous Case. But those of us who took the leap are in very good company: Gail Sheehy; Lance Dodes, M.D., Training and Supervising Analyst Emeritus at the Boston Psychoanalytic Society and Institute and retired Assistant Clinical Professor of Psychiatry at Harvard Medical School; Gartner (of course!); and Noam Chomsky, to name a few.

So why are so many mental health professionals—the contributors to The Dangerous Case and the rest of the 60,000+—willing to put their careers on the line? We’ll defer to Bandy:

“We are asking our fellow mental health professionals to get involved in politics not only as citizens, but also, specifically, as professionals and as guardians of special knowledge with which they have been entrusted. How can we be sure that this is permissible? It is all too easy to claim, just as we have done, that an emergency situation requires a departure from our usual practices in the private sphere. How can we judge whether in fact our political involvement is justified?

“We would argue that the key question is whether professionals are engaging in political collusion with state abuses of power, or in resistance to them. If we are asked to cooperate with state programs that violate human rights, then regardless of the purported justification, any involvement can only corrupt, and the only appropriate ethical stance is to refuse participation of any sort. If, on the other hand, we perceive that state power is being abused by an executive who seems to be mentally unstable, then we may certainly speak out, not only as citizens, but also, we would argue, as professionals who are privy to special information and a responsibility to educate the public. For whatever our wisdom and expertise may be worth, surely we are obligated to share it.”

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