DOCSLIB.ORG

It Is Ethical to Diagnose a Public Figure One Has Not Personally Examined John Gartner, Alex Langford and Aileen O’Brien

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
It Is Ethical to Diagnose a Public Figure One Has Not Personally Examined John Gartner, Alex Langford and Aileen O’Brien The British Journal of Psychiatry (2018) 213, 633–637. doi: 10.1192/bjp.2018.132 In Debate It is ethical to diagnose a public figure one has not personally examined John Gartner, Alex Langford and Aileen O’Brien Summary mental health professionals who advocate the president’s Should psychiatrists be able to speculate in the press or social removal under the 25th Amendment on the grounds that he is media about their theories? John Gartner argues the risk to warn psychologically unfit and dangerous. the public of concerns about public figures overrides the duty of confidentiality; whereas Alex Langford suggests this is beyond Keywords the ethical remit of psychiatric practice. Diagnosis; history of psychiatry; media. Declaration of interest A.O’B is joint debates and analysis Editor of the British Journal of Copyright and usage Psychiatry. J.G. is the founder of Duty To Warn, an association of © The Royal College of Psychiatrists 2018. Introduction Few in the general public had ever heard of this obscure rule until the emergence of Donald Trump. Many mental health professionals felt they had a ‘duty to warn’ the public about what they viewed as the ‘I think a guy running for office who says exactly what he really frank signs of dangerous mental disturbance they saw in Trump, just thinks would astound a hell of a lot of people around the country’ as they have an ethical and legal statutory ‘duty to warn’ any poten- (p. 68).1 The words of an anti-establishment maverick businessman tial victims of violence who might be threatened by one of their turned politician, standing as the Republican candidate for the US patients. This ran afoul of the Goldwater rule, precipitating enor- Presidency. Public disquiet about his mental health leads to psychia- mous controversy and debate, not only within the profession, but trists speculating about potential psychiatric diagnoses. in the US media, as well as that of other countries, including the UK. This is 1964, the candidate is Barry Goldwater and the case leads ‘Duty To Warn’, an association of mental health professionals to the American Psychiatric Association (APA) stating that ‘it is that I lead, advocates for Trump’s removal on the grounds that in unethical for a psychiatrist to offer a professional opinion unless their view he is dangerously psychologically disordered and unfit, he or she has conducted an examination and has been granted arguing that warning the public about a dangerous president proper authorization for such a statement’.2 During his tenure as trumps the Goldwater rule. President of the Royal College of Psychiatrists Simon Wessely sug- gested UK psychiatrists should abide by the same principle. ‘ ’ ‘ ’ However, on both sides of the Atlantic speculation about the Goldwater was intended to be a principle not a rule mental health of public figures is rife. When this debate was When I spoke with Dr Allen Dyer, the last living member of the ori- commissioned the aim was to avoid a focus on Donald Trump, ginal APA ethics committee that drafted Goldwater in 1974, he said but it became apparent that this would be disingenuous; it is the the current interpretation of Goldwater had drifted far from the debate about Trump which is taxing the limits of Goldwater, and framers’ intentions. Goldwater was meant to be a ‘principle,’ that Trump is the reason this issue is being discussed. professionals needed to keep in mind, not a ‘rule’ to be followed Here, US and UK psychiatrists – John Gartner and Alex slavishly in all circumstances. The ‘Goldwater Principle’ has been Langford – debate the ethical principles and practical implications ‘ossified,’ applying ‘rule-based legalistic thinking to a matter of pro- of abiding with the Goldwater rule or UK equivalent. Should specu- fessional judgment’. lation about diagnosis be limited to the individual’s doctor with In ethics there is often a conflict between two competing prin- their consent; or is there a duty to warn the public if we are con- ciples. ‘There might be a conflict within the conscience of a particu- cerned about the mental health of our leaders? lar psychiatrist between the principle of restraint and a more overriding principle, like the duty to warn’ he said. The resolution ’ Aileen O Brien of that conflict should be ‘up to the professional judgment of the individual professional’. Therefore, Goldwater should not ‘constrain psychiatrists from making a useful contribution to society’ if that means warning about a ‘potentially dangerous president’. The For Goldwater principle was not intended as ‘a gag order’. This May, the APA expanded Goldwater, barring not just diag- In 1964, a now defunct magazine, Fact, published a survey of psy- nosis, but the ‘rendering any professional opinion’ whatsoever chiatrists weighing in on the mental health of then presidential can- about a public figure. Dr Rebecca Brendel, of Harvard, a consultant didate Barry Goldwater: ‘1,189 psychiatrists say Goldwater is to the APA ethics committee, wrote: ‘even if a “psychiatrist, in good psychologically unfit to be president!’3 Goldwater lost the election, faith, believes a public individual poses a threat to the country or in part because his opponent, Johnson, exploited the image of national security,’ he should remain silent”.4 Goldwater as an unstable finger on the nuclear button. But after the election Goldwater won his libel suit against the magazine. Embarrassed by the incident, the APA adopted the principle that More important than national security? a psychiatrist should not diagnose a public figure unless they had Imagine a gunman entering the New York Public library, brandish- both personally examined them and received their permission. ing a pistol. If a patron shouted ‘call the police,’ librarian Brendel 633 Downloaded from https://www.cambridge.org/core. 02 Oct 2021 at 04:57:29, subject to the Cambridge Core terms of use. Gartner, Langford & O’Brien would chastise them: ‘Sir, you must remain silent. No speaking receives multiple death threats. We are trolled by hundreds. My allowed in the library’. Yes, that is a rule – but no sane person private practice dwindled by half until I realized my Google rating would follow it under those circumstances. had been downgraded to two stars in response to an organized Unfortunately, this analogy understates our actual situation. online effort, involving dozens of people, to systematically drive Trump is brandishing, not just a gun, but nuclear weapons, and down my professional rating. he has threatened to ‘destroy the country of North Korea’. See some- thing, say nothing, would appear to be the current national security Diagnosis can be essential information for the policy of the APA. public’s safety One of the common arguments against diagnosing Trump is that it is unnecessary. The public can observe his behaviour for themselves, An accurate diagnosis does not necessarily require a the argument goes and throwing in a diagnosis does not add any- psychiatric interview thing useful to the public debate. On the face of it, it is really hard ‘ The critical comments about Goldwater in Fact,tookplacein the era to believe that our decades, centuries really, of research and clinical of DSM-II, which was theoretically based, relying largely on psycho- experience have no information value. ’ 5 ‘ analytic theory, wrote Dyer. Chargessuchashewas scarred by his But more specifically, we know in both psychiatry and medicine, ’ ‘ ’ ‘ potty training or a latent homosexual were frivolous extrapolations diagnosis yields information about prognosis. Before the election, ’ ‘ that had no basis in reality . We might have written the principle dif- I wrote in the Huffington Post that Trump was in my view a malig- ’ ‘ ferently if DSM III had existed at that time, said Dyer. We might not nant narcissist.8 At that point, in June of 2016, there was still a ’ have made such a hard and fast stand on interviewing the patient, as a strong hope that Trump would ‘pivot’ and become more ‘presiden- ‘ necessary condition for making a public statement. Because then it tial’. I argued, ‘the idea that Trump is going to settle down and ’ would be possible to explain to the public our evidence and rationale . become presidential when he achieves power is wishful thinking. The goal of DSM-III was to establish diagnostic criteria that Success emboldens malignant narcissists to become even more ’ were behaviourally observable and did not rely either on a clinician s grandiose, reckless and aggressive. Sure enough, after winning the theoretical outlook or inferences about internal psychic processes. nomination, there has been no “pivot” towards more reasonable From that, it logically follows that if I could directly observe a behavior and ideas, just the opposite. He has become more shrill, ’ patient s behaviour, read his communications and hear from close combative and openly racist’.8 And, in my view, since winning the informants, I would be able to make a valid diagnosis. In the case election he has, predictably, deteriorated further. of Donald Trump, I have observed literally hundreds of hours of Imagine a different 2016, one where the public had been ’ Donald Trump s behaviour. I have read thousands of his tweets. adequately informed that, contrary to their optimistic hopes, And I have read the testimony of dozens of informants. I would based on a diagnosis, it was far more likely he would become dare say I have a stronger basis for diagnosing Trump than most much worse. If the public had been allowed to receive such informa- of the patients in my practice. tion, history might have turned out very differently. ‘The Goldwater Rule privileges the personal interview as the ’ standard by which a practitioner may form professional opinions, You do not have to diagnose to warn wrote Kroll & Pouncey,6 even though research shows the psychiatric Many psychiatrists have endeavoured to resolve the Goldwater interview is not the magic Rosetta Stone to divining a patient’s dilemma by refusing to diagnose him, often explicitly stating, illness.
Load more

Recommended publications
  • Interpreting the Goldwater Rule
    ANALYSIS AND COMMENTARY SPECIAL SECTION: THE GOLDWATER RULE Interpreting the Goldwater Rule John Martin-Joy, MD Section 7.3 of the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry (the so-called Goldwater Rule) provides guidance on the ethics of making psychiatric comments about public figures who have not been interviewed and have not given consent. I argue that the wording of Section 7.3 is ambiguous, and I document disagreement over the scope of the rule and consider the implications of this disagreement. If one reads Section 7.3 narrowly, as banning media comments without interview and consent, but allowing such comments in institutional settings, then the general principle articulated in the text and often repeated in the media begins to appear insubstantial. If one reads Section 7.3 broadly, then the work of psychiatrists in the courts, in government agencies such as the Central Intelligence Agency, in insurance companies, and in the academy becomes ethically problematic. I trace the American Psychiatric Association’s own interpretation of Section 7.3 and conclude that the APA has advocated a narrow reading. I assert the need for an integrated theory of psychiatric ethics for settings where interview and consent are absent. Such a theory, articulating why comments in institutional settings are ethical, but comments to media are not, may reduce public confusion and provide a basis for revising Section 7.3. J Am Acad Psychiatry Law 45:233–40, 2017 Adopted in 1973 in the wake of a controversial inci- Although a scholarly discussion has now begun to dent involving Fact magazine,1 Section 7.3 of the develop,8–13 in some respects, psychiatrists who wish American Psychiatric Association’s Principles of Med- to study the foundations of the Rule’s ethics and ical Ethics with Annotations Specific to Psychiatry (the implications still have relatively little to work with.
    [Show full text]
  • A Rift Among Experts Over Analyzing Trump's Mental Health by Jen Christensen, CNN  Updated 1745 GMT (0145 HKT) July 26, 2017
    A rift among experts over analyzing Trump's mental health By Jen Christensen, CNN Updated 1745 GMT (0145 HKT) July 26, 2017 Source: CNN Six months of the Trump presidency in photos 00:52 (CNN) — You might expect partisan politicians to question Story highlights the sanity of a president, but now there's an unusual and growing public debate among those qualified to make the One mental health association says members assessment -- psychiatrists and other mental health experts -- as to whether they should be allowed to publicly raise should feel "free to comment about political those questions. figures as individuals" Two professional mental health associations -- the Another discourages its members from American Psychoanalytic Association, known as the APsaA, speaking publicly about a public figure's and the American Psychiatric Association, known as the APA -- have opposite opinions about what would be ethical, mental health and what is not. If members want to share their educated opinions about President Donald Trump, or any public figure for that matter, the associations' ethics guidance conflict, leaving dual members with a touch choice. It might sound like an arcane conversation about medical ethics, but the debate has heated up as more experts have publicly shared their concerns about the President's mental health. Dozens of mental health professionals signed on to a letter in February that said Trump's "speech and actions demonstrate an inability to tolerate views dierent from his own, leading to rage reactions," and show "a profound inability to empathize." How the policies dier The American Psychoanalytic Association represents about 3,500 members from all mental health professions and academia.
    [Show full text]
  • Reflections on the Goldwater Rule
    ANALYSIS AND COMMENTARY SPECIAL SECTION: THE GOLDWATER RULE Reflections on the Goldwater Rule Paul S. Appelbaum, MD The APA’s Goldwater Rule, precluding psychiatrists from rendering opinions to the media about public figures whom they have not examined, has often engendered controversy. Here, I consider the justifications for the rule, how well they stand up to criticism, and the extent, if any, to which modifications might be called for. Although embarrassment to the profession is often cited as the basis for the Rule, it reflects more substantive concerns, including the risk of harm to living persons and discouraging persons in need of treatment from seeking psychiatric attention. The most potent criticisms of the Rule are that it discourages public education about mental illness and its effects and precludes legitimate scholarly endeavors by psychiatrists studying foreign leaders, historical figures, and others. However, there are many ways of providing education about mental illness without violating the Rule, and read properly, it should not prevent legitimate historical investigation, though some clarification of the Rule on this point might be helpful. Even psychiatrists who seek to aid policymakers in dealing with international or domestic threats should not find that the Rule interferes with their efforts. On balance, the Goldwater Rule continues to be an important underpinning of ethical behavior by psychiatrists. J Am Acad Psychiatry Law 45:228–32, 2017 In 1973, in the wake of the notorious Fact magazine Purpose of the Rule
    [Show full text]
  • Impeachment, Donald Trump and the Attempted Extortion of Ukraine
    Pace Law Review Volume 40 Issue 2 Article 4 July 2020 IMPEACHMENT, DONALD TRUMP AND THE ATTEMPTED EXTORTION OF UKRAINE Lawrence J. Trautman [email protected] Follow this and additional works at: https://digitalcommons.pace.edu/plr Part of the Law Commons Recommended Citation Lawrence J. Trautman, IMPEACHMENT, DONALD TRUMP AND THE ATTEMPTED EXTORTION OF UKRAINE, 40 Pace L. Rev. 141 (2020) Available at: https://digitalcommons.pace.edu/plr/vol40/iss2/4 This Article is brought to you for free and open access by the School of Law at DigitalCommons@Pace. It has been accepted for inclusion in Pace Law Review by an authorized administrator of DigitalCommons@Pace. For more information, please contact [email protected]. IMPEACHMENT, DONALD TRUMP AND THE ATTEMPTED EXTORTION OF UKRAINE Lawrence J. Trautman1 TABLE OF CONTENTS I. INTRODUCTION ............................................................... 143 II. THE CONSTITUTIONAL PROVISION FOR IMPEACHMENT ....................................................................... 144 A. Treason ......................................................................... 145 B. Bribery .......................................................................... 145 C. Other High Crimes and Misdemeanors ..................... 145 D. Impeachment Is An Emergency Measure .................. 146 III. HISTORY OF U.S. PRESIDENTIAL IMPEACHMENT PROCEEDINGS ........................................................................ 148 A. President Andrew Johnson ......................................... 149
    [Show full text]
  • Psychiatric Evaluation of Trump
    Psychiatric Evaluation Of Trump Coplanar Ludvig episcopise her championship so aerobiotically that Filbert containerizes very magnificently. Llewellyn still citifies cursedly while rheological Rodolphe subjugating that Miranda. Organicism and cardboard David discards her irretentiveness pigeonholes logistically or gillies infrangibly, is Shlomo curule? Moreover, it is possible to understand Trump without ever invoking disability. He was taken to a nearby hospital for a medical evaluation. This shopping feature will continue to load items when the Enter key is pressed. Republicans Failed the Country. We are approaching your tds up where is done studies have shared psychosis at what is too? It is a standard process that involves an interview, various tests, and information from outside sources. Baltimore psychologist heads effort to 'warn' the Trump's. They would probably spread from some psychiatric care just weld a given. This fraud an historic work in asset history beyond American psychiatry. Without a great vision of renew is happening, this through nearly impossible. While there may be many reasons for this, when the level reaches the point of irrationality, we must consider contagion. Thanks to consider themselves, psychiatric evaluation of trump himself at least dissemble, marco rubio told the trainees. Muslims all over this world goes wrong. The vaccines appear that our concept of flattery that some evaluation of psychiatric evaluation. Singer wondered what authoritarian regimes, if he was quite another state. The credential this quarter without significant single redeeming human quality leaves the WH should be declared and celebrated as a National Holiday! Charlie has to be the center of attention. Personally, I must never really such than for another human husband, and apparently I am old alone.
    [Show full text]
  • Goldwater Rule’ and Comment on Trump’S Mental Health
    Psychiatry Group Tells Members They Can Ignore ‘Goldwater Rule’ and Comment on Trump’s Mental Health By Sharon Begley Region: USA Global Research, July 26, 2017 Theme: Law and Justice, Police State & STAT 25 July 2017 Civil Rights Featured image: Former US Senator Barry Goldwater (Source: NPR) A leading psychiatry group has told its members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures —even the president. The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, represents the first significant crack in the profession’s decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians’ behavior. It will likely make many of its members feel more comfortable speaking openly about President Trump’s mental health. The impetus for the email was “belief in the value of psychoanalytic knowledge in explaining human behavior,” said psychoanalytic association past presidentDr. Prudence Gourguechon, a psychiatrist in Chicago. “We don’t want to prohibit our members from using their knowledge responsibly.” That responsibility is especially great today, she told STAT, “since Trump’s behavior is so different from anything we’ve seen before” in a commander in chief. An increasing number of psychologists and psychiatrists have denounced the restriction as a “gag rule” and flouted it, with some arguing they have a “duty to warn” the public about what they see as Trump’s narcissism, impulsivity, poor attention span, paranoia, and other traits that, they believe, impair his ability to lead.
    [Show full text]
  • The Psychiatric Trainees' Committee Magazine February 2021
    THE REGISTRAR The Psychiatric Trainees’ Committee magazine February 2021 Contents Editor’s introduction 3 PTC officers’ update 5 Speaking truth to narcissistic power with our psychiatric values 7 The Registrar’s profile series: Dr Amanda Brickstock 10 Coping with COVID-19 in Malaysia: The Mental Health Psychosocial Support Action Plan 11 Open Dialogue: A social model of mental healthcare ripe for current times? 13 Reflections on my visit to Save Our Souls Children’s Village Lahore, Pakistan 15 The Psychiatric Trainees’ Committee @rcpsychTrainees www.facebook.com/RCPsychTrainees/ [email protected] Disclaimer: The opinions expressed in this magazine are those of individual authors and do not officially represent the views of the Royal College of Psychiatrists. Editor’s introduction Dr Ahmed Hankir, Editor of The Registrar, Academic Clinical Fellow in general adult psychiatry at the South London and Maudsley NHS Foundation Trust @ahmedhankir –‘The Wounded Healer’ educational supervisors are important points of “Do not go gentle into that good contact for you which we highly recommend night. Rage! Rage! Against the you take full advantage of. “Seeking help is a dying of the light…” sign of strength…” –Dylan Thomas In this latest issue of The Registrar, we have an array of articles which I am sure you will find Happy new year everyone! Greetings and interesting and informative. Our Psychiatric welcome to the first issue of The Registrar in Trainees Committee Officers’ update briefly 2021! Last year was a year like no other, right?! touches upon the role that technology plays I do not know about you, but my mental health in psychiatry training in the UK during the certainly took a real battering in 2020.
    [Show full text]
  • Front Matter
    Cambridge University Press 978-1-108-48658-3 — Diagnosing from a Distance John Martin-Joy Frontmatter More Information DIAGNOSING FROM A DISTANCE Ever since the rise of Adolf Hitler, mental health professionals have sought to use their knowledge of human psychology to understand – and to intervene in – political developments. Psychiatrists have commented, sometimes brashly, on the mental health of public figures from Barry Goldwater to Donald Trump. But is the practice ethical? While the American Psychiatric Association prohibits psychiatric comment on public figures under its “Goldwater Rule,” others disagree. Diagnosing from a Distance is the first in-depth exploration of this controversy. Making extensive use of archival sources and original interviews, John Martin-Joy reconstructs the historical debates between psychiatrists, journalists, and politicians in an era when libel law and professional standards have undergone dramatic change. Charting the Goldwater Rule’s crucial role in the current furor over Trump’s fitness for office, Martin-Joy assesses the Rule’s impact and offers a more liberal alternative. This remarkable book will change the way we think about psychiatric ethics and public life. John Martin-Joy, MD, is a psychiatrist in Cambridge, Massachusetts, and a part-time instructor in psychiatry at Harvard Medical School. © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-108-48658-3 — Diagnosing from a Distance John Martin-Joy Frontmatter More Information © in this web service Cambridge
    [Show full text]
  • Introduction to the Special Section on the Goldwater Rule
    ANALYSIS AND COMMENTARY SPECIAL SECTION: THE GOLDWATER RULE Introduction to the Special Section on the Goldwater Rule John Martin-Joy, MD J Am Acad Psychiatry Law 45:223–27, 2017 The publication of this special section offers a chance Times, Psychology Today, and other popular publica- to reflect on a topic of perennial interest in psychia- tions. Until recently, however, there have been re- try: the ethics of commenting on public figures. markably few scholarly contributions on the ethics of Since at least the election of 1964, when publisher the Rule. Ralph Ginzburg became concerned about Barry Goldwater’s psychological fitness, psychiatrists have debated the ethics of speaking out about the mental Ethics Inquiry and Scholarship health of public figures. In that year Mr. Ginzburg By 2002, when Jerrold Post wrote “Ethical Con- commissioned a partisan “survey” of U.S. psychia- siderations in the Psychiatric Profiling of Public Fig- 1 trists for his new magazine, Fact. Although many ures,”7 there had been many developments in the psychiatrists said that Mr. Goldwater was mentally psychiatric community on the subject of the Rule. At ill, some called Mr. Ginzburg’s survey unethical. It least one APA trustee acknowledged having voted was later proved that Mr. Ginzburg had shaped the against the Rule, and a former APA president had results to support the conclusion he had already considered the possibility of “rigid overscrupulosity” 2,3 reached. The American Psychiatric Association in interpreting the Rule (Ref. 7, pp 642, 645). But (APA) quickly condemned the survey, but Mr. Gin- with the exception of Slovenko,8 who was indebted zburg published it anyway.
    [Show full text]
  • The Specialist Volume 42 2019.Indd
    ® specialistthe Volume 42 2019 ABPP Board of Trustees PRESIDENT - Executive Committee John Piacentini, PhD, ABPP Contents PRESIDENT-ELECT-Executive Committee Christina Pietz, PhD, ABPP President's Column ........................................................................................................................... 2 PAST PRESIDENT-Executive Committee Michael Tansy, PhD, ABPP Executive Offi cer Message ................................................................................................................ 4 TREASURER-Executive Committee Editor’s Column ................................................................................................................................. 5 Sylvia Marotta-Walters, PhD, ABPP SECRETARY - Executive Committee American Board of Clinical Psychology ........................................................................................ 6 Joel Frost, EdD, ABPP BEHAVIORAL & COGNITIVE Early Career (BOT) Members ......................................................................................................... 8 Linda Carter Sobell, PhD, ABPP CLINICAL Th e Disgruntled Examiner ............................................................................................................. 11 Alina Maria Suris, PhD, ABPP Th e Ripple Eff ect and the Th ree Generational Cure ................................................................... 14 CLINICAL CHILD & ADOLESCENT Kathleen Hart, PhD, ABPP Kandahar Airfi eld: Afghanistan ...................................................................................................
    [Show full text]
  • An Ethical Dilemma
    Cambridge University Press 978-1-108-48658-3 — Diagnosing from a Distance John Martin-Joy Excerpt More Information INTRODUCTION An Ethical Dilemma T he election of donald trump in 2016 raised profound ethical questions for many psychiatrists. Is it ethical to diagnose a public figure without examining him or her? If so, why? If not, why not? Are there compelling reasons for a psychiatrist to comment on a president’s mental health if nuclear warfare or the conduct of an unjust war is at stake? Is the media the right place for such comment? Under what circumstances, and in the name of what higher principles, may a psychiatrist violate the ethical code of her own professional organization? In Diagnosing from a Distance, I explore and reflect on these ethical questions using a historical and philosophical lens. This book is a study of the development of professional ideas in a political context – and ulti- mately an argument about how we might approach the ethics of psychia- tric comment on public figures. HOW DID WE GET HERE? As a psychiatrist myself, and one with a long-standing interest in history, politics, and ethics, I became interested in the question of what a professional owes to the larger society some time after I graduated from my psychiatry residency at the Harvard Longwood psychiatry train- ing program in Boston. During college, I had learned about psycho- analyst Erik Erikson and his efforts in “psychohistory” from a teacher and mentor, psychiatrist Robert Coles. Later, I read and admired Erikson’sinfluential book Young Man Luther (1958).
    [Show full text]
  • Leadership Analysis and Political Psychology in the 21St Century
    ANALYSIS AND COMMENTARY Leadership Analysis and Political Psychology in the 21st Century Kenneth B. Dekleva, MD The election of President Trump has led to interest in his mental health and has resulted in heightened scrutiny regarding the American Psychiatric Association’s Goldwater Rule, with its prohibition on opining psychiatrically on the mental health of public figures whom one has not examined in person. This article highlights the historic, methodological, forensic, and ethics challenges regarding psychiatric approaches to leadership analysis, and how these can offer policy makers options regarding national security decision-making. J Am Acad Psychiatry Law 46:359–63, 2018. DOI:10.29158/JAAPL.003771-18 The 2016 campaign and election of President choanalytic approach of the day, Langer created a Trump has led to a flurry of interest in not only his multidisciplinary team that analyzed raw data in- mental health,1 but more generally, in the mental cluding Hitler’s writings, speeches, movies of rallies, health of world leaders. This has resulted in extensive classified intelligence data, his medical reports, defec- scholarly commentary regarding the American Psy- tor accounts, and collateral accounts of persons who chiatric Association’s Goldwater Rule,2 with its pro- had met Hitler in person. Langer emphasized under- hibition on opining psychiatrically on the mental standing of Hitler’s psychological makeup, and also health of public figures whom one has not examined made accurate predictions of his future behavior. in person.3–7 This article, by a psychiatrist who has Langer’s work exerted a powerful intellectual influ- published numerous profiles of world leaders,8–15 ence, both in the fields of leadership analysis and outlines challenges regarding psychiatric approaches political psychology, as developed by Dr.
    [Show full text]