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Inside the debate therapists like me are having over Donald Trump’s mental health

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“Why can’t therapists do something about a psychopath getting his dirty little fingers on the nuclear codes?” a patient asked me.

It was a week after the presidential election. There was anguish in my patient’s voice.

I put on my therapist-wise air and intoned, “I hear how upset you are at what’s happening in the country and that people who should know better aren’t taking care of you the way they should…”

She said, “Precisely, I feel so let down.” We were back on safe ground.

It’s been three months since that conversation. Donald Trump is now in the White House. And what I haven’t told this patient, or any of my patients, is this: The other day I added my name to a petition signed by thousands of mental health professionals calling on Trump to be removed from office due to his apparent mental illness.

The author of the petition, a Maryland-based therapist named John Gartner, who specializes in personality disorders and depression, called Trump’s disorder “Malignant Narcissism,” which has four toxic components: narcissism, paranoia, anti-social personality disorder, and sadism. I’m in unequivocal agreement.

My position, along with the others signing onto the petition, is controversial. Since public calls to diagnose Republican presidential candidate Barry Goldwater in the 1960s, the mental health community has stuck to a code: Do not diagnose a person in the public eye, only in a diagnostic setting, no matter how tempting. It’s a good rule: Mental illness carries a stigma and it’s irresponsible, as well as ethically wrong, to impugn someone’s reputation based on an uninformed opinion. I've stood by it.

But Trump is different. In just a few weeks in office he has managed to petrify and enrage the world, obsessing over how many people were at his inauguration, hanging onto a ridiculous voter fraud conspiracy theory, repeatedly lying, threatening foreign leaders, signing ill-thought out executive orders, using his POTUS Twitter account to carry out personal vendettas, ordering Navy Seals to carry out a half-baked raid. … It seems there is no impulse control or apparent ability to consider feedback from anyone who disagrees with him. This is not normal. It is extremely dangerous.

The mental health community has been grappling with how to respond to Trump for months

The therapist community has been debating what to do about Trump since long before he won the election. During the endless campaign, I read articles by renowned analysts diagnosing Trump — stressing with alarm his extreme narcissistic tendencies. I also supported several shrink-created petitions that were circulating to keep Trump from attaining power.

One petition, an anti-Trump “manifesto” citing his alarming qualities — such as his lack of empathy, pathological lying, bullying and impulsiveness that rendered him unfit to hold office — attracted more than 3,000 signatures from mental health professionals.

This response to Trump was remarkable and unusual. President George W. Bush was reelected while I was in my first semester at Wurzweiler School of Social Work. Therapists are notoriously liberal and for days the somberness on campus felt appropriate to mourning a death. But no one contemplated calling the media and making armchair diagnoses. We were unhappy, not incensed and quaking with apprehension at what the future would bring.

The origins of the Goldwater Rule

In response to the public psychoanalyzing of Trump by prominent mental health professionals, the American Psychiatric Association, the major professional organization of psychiatrists in the US and the largest psychiatric organization in the world, invoked the Goldwater Rule.

This rule stipulates that while it is permissible to answer questions from media about psychological symptoms that typically characterize a disorder, it is unethical to tie that disorder to a person they have not personally examined.

The rule was instated after a 1964 issue of Fact magazine polled psychiatrists to discern if then-Republican presidential candidate Barry Goldwater was fit for the highest office in the land. Over 1,000 psychiatrists answered in the negative. One, in fact, called Goldwater “a dangerous lunatic.” Goldwater won a libel lawsuit against the magazine.

As a member of the National Association of Social Workers, I am required not to divulge details about clients to the media, but there is no statute gagging me from unloading in public on outrageous behavior by famous personalities. Still, therapists of all kinds take our role very seriously.

The debate explodes

The Goldwater Rule has been much debated in Facebook groups I've joined since Trump rose to political prominence. “Therapists Against Trumpism,” “Therapists for Social Justice,” and “Therapists for Self Care” contain post after post comparing Trump’s megalomania to Hitler circa the 1930s, interspersed with tactics for soothing our patients’ fears that the end of the world is nigh, and suggestions for calming our own.

We all believe that there is, as one poster put it, “responsibility in our licensure.” Which means that mouthing off to one another, guarded by privacy settings, about what we see as Trump’s mental issues is cathartic. But it’s a world apart from calling CNN to emphatically accuse the leader of the free world of suffering from a specific and damning diagnosis.

Some of my Facebook colleagues rightly expressed fear that too many people are stigmatized and discriminated against due to mental health issues that don’t necessarily mean they will be incompetent at their jobs. Stephanie Saklad, an art therapist, has attended trainings given by someone high up on the food chain in the Social Security office who has schizophrenia and hears multiple voices, yet is an extremely knowledgeable and skilled professional.

This is not surprising. According to 2014 statistics from the National Alliance of Mental Illness, approximately one in five American adults experience some kind of mental illness. When acknowledged and treated, those issues are not in themselves disqualifiers for holding jobs — including public office.

Another suggestion advocated by some cohorts is not labeling Trump with a specific diagnosis, but rather pointing out symptoms highlighted in the Diagnostic and Statistical Manual of Mental Disorders, considered the bible for laying out standard criteria for diagnosing psychiatric illnesses. One therapist on my Facebook thread said, “We don’t really need a full diagnosis to state our concerns if we deem he is dangerous. Why not do a petition demanding a licensed professional examine him?”

Where the debate needs to go

Of course, mental health professionals wield no real power. It’s up to Congress to impeach a sitting president, and with a Republican majority, movement is unlikely to happen. Still, it’s vital to voice our concerns.

And some influential people are listening to us. Democratic Congress member Ted Lieu is introducing legislation requiring the White House to have an in-house psychiatrist. Lieu told a Huffington Post reporter, “It’s not normal for the President of the United States, within 24 hours to write about death and destruction and fake news and evil.”

I am proud of being a therapist, and in my practice will always put the needs of my patients ahead of my own. However, if it’s between obeying some arcane, decades-old rule and doing everything I can to bring down a dangerous administration, there is no contest.

Sherry Amatenstein LCSW is a New York-based therapist and editor of the anthology How Does That Make You Feel? True Confessions from Both Sides of the Therapy Couch.

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