Does It Take a Shrink to Evaluate Trump?

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One of my fellow Yale psychiatrists thinks President Trump ought to have his head examined—by force if necessary.

Bandy X. Lee

is calling for an “emergency evaluation” of Mr. Trump’s mental state. “In an emergency, neither consent nor confidentiality requirements hold,” she told Vox. “Safety comes first. What we do in the case of danger is we contain the person, we remove them from access to weapons.”

Is she serious? Democratic members of Congress seem to think so. In early December, she spent two days on Capitol Hill privately briefing a dozen of them about Mr. Trump’s purported dangerousness. “He’s going to unravel,” she told Politico, in summing up her message to lawmakers. “Trump is going to get worse and will become uncontainable with the pressures of the presidency.” Reps.

Rosa DeLauro

of Connecticut and

Jamie Raskin

of Maryland plan to host her at future events.

I wish Dr. Lee would stop making House calls. Her actions risk discrediting our profession.

Dr. Lee is editor of a book, published in October, titled “The Dangerous Case of

Donald Trump

: 27 Psychiatrists and Mental Health Experts Assess a President.” It grew out of an April conference on the “duty to warn.” That legal term of art originated with a 1976 California Supreme Court ruling, which found that mental-health professionals are obliged to breach confidentiality when a patient poses an impending danger of bodily harm to others.

Since neither Dr. Lee nor any of her contributors have treated Mr. Trump, the duty to warn does not apply here, except in some metaphorical sense. In calling Mr. Trump dangerous, Dr. Lee is expressing a view that millions of Americans share—and millions reject—and claiming that her expertise as a psychiatrist lends it added authority. Does it?

Under the American Psychiatric Association’s “Goldwater rule,” it is unethical for a psychiatrist to comment on a public figure’s mental health without examining him and obtaining permission for the disclosure. But that doesn’t stop us from forming opinions. Psychiatrists, like all members of the public, can learn a great deal about the president’s behavioral patterns and temperament from news coverage and interviews, tweets, biographies and testimonials of those who know him.

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Many of my colleagues say privately they believe Mr. Trump probably has a narcissistic personality disorder. If so, he likely wouldn’t be the first. A 2013 study in Psychological Science ranked the 42 past presidents on measures of “grandiose narcissism” and found that

Lyndon B. Johnson

scored highest, followed closely by

Theodore Roosevelt

and Andrew Jackson.

Mental health and the capacity to serve as president—or to do any job—are different. Historians believe

Abraham Lincoln

suffered from clinical depression, and they also rank him one of the greatest presidents. Nor is psychological health a guarantee of fitness.

Importantly, Mr. Trump’s grandiosity, impulsivity and short attention span were already evident during the campaign and earlier; they are baseline features. Had his personality undergone rapid deterioration, there would be reason to suspect a disease process at work. If that process affected his ability to govern, the cabinet and Congress would likely ask psychiatrists and neurologists for a diagnosis, treatment options and prognosis in the course of invoking the 25th Amendment to deprive him of his powers temporarily. But ultimately that is a political process, not a medical one.

Psychiatrists would be alarmed if mental illness were considered an unconditional bar to public service. They should also worry when their colleagues promote stereotypes that equate mental illness with dangerousness. Most mentally ill people are not violent. Whatever one thinks of Mr. Trump, his actions and words are on display for all to see. The public doesn’t need experts to interpret them.

The actions of Dr. Lee and her colleagues politicize psychiatry, and in doing so squander the profession’s authority and goodwill.

Dr. Satel is a resident scholar at the American Enterprise Institute, and a lecturer in psychiatry at Yale.

Appeared in the January 17, 2018, print edition as ‘Does It Take A Shrink To Evaluate Trump?.’



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