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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 president Dr. Prudence Gourguechon, a psychiatrist in Chicago. “We don’t want to prohibit our members from using their knowledge responsibly.”

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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.

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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.

Reporters, pundits, and government officials “have been stumbling around trying to explain Trump’s unusual behavior,” from his seemingly compulsive tweeting to his grandiosity, said Dr. Leonard Glass, a psychiatrist at Harvard Medical School. The rule against psychiatrists offering their analysis of the emotions, thought patterns, and beliefs underlying such behaviors, Glass said, robs the public “of our professional judgment and prevents us from communicating our understanding” of the president’s mental state.

Last week, in an essay in Psychiatric Times, Glass called the prohibition on such communication “an unacceptable infringement on my right and duty” to discuss issues “where the perspective of psychiatrists could be very relevant and enlightening.” He ended the essay by announcing his resignation from the American Psychiatric Association, which adopted the rule in 1973. He had been a member for 41 years.

Called the “Goldwater rule,” the prohibition on offering opinions about the mental state of public figures was adopted after some psychiatrists answered a 1964 survey on whether Sen. Barry Goldwater, the Republican presidential candidate that year, was mentally fit for the Oval Office. The rule states that it is unethical to offer a professional opinion about a public figure’s mental health, including the presence or absence of a disorder, without that person’s consent and without doing a standard examination. In March, the psychiatric association reaffirmed the rule.

The group acted despite growing criticism that the Goldwater rule is outdated and even unethical for preventing psychiatrists from pointing out behaviors that raise questions about a government official’s mental state. No other medical specialty has such a rule; cardiologists are not prohibited from offering their views of an official’s fainting spell, for instance, as long as they make clear that they have not examined the person.

Although opposition to the Goldwater rule has existed for years, it intensified with Trump’s candidacy and then election. In October, a book titled “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President” will be published.

“When the book comes out, there will be renewed furor about the Goldwater rule, since it is precisely about what is wrong with him,” said psychiatrist Dr. Lance Dodes, a retired professor at Harvard Medical School who is now in private practice in Los Angeles.

A number of psychologists have spoken to reporters about what Trump’s statements and actions might reveal about his emotional and cognitive state. Although the American Psychological Association “prefers” that its members not offer opinions on the psychology of someone they have not examined, it does not have a Goldwater rule and is not considering implementing one, an official told STAT.

The psychoanalytic association went further. In its July 6 email, it explicitly stated for the first time that the organization does not subscribe to the rule. That position had been implicit for years, but the association’s “leadership has been extremely reluctant to make a statement and publicly challenge the American Psychiatric Association,” said one psychoanalytic association member who asked not to be publicly identified criticizing the other group.

One stated rationale for the Goldwater rule is that psychiatrists need to examine patients in order to properly evaluate them. In fact, for decades the State Department and other federal agencies have asked psychiatrists to offer their views on the psychological state of foreign leaders, Glass pointed out, evidence that government officials believe it is possible to make informed inferences about mental states based on public behavior and speech.

“In the case of Donald Trump, there is an extraordinary abundance of speech and behavior on which one could form a judgment,” Glass said. “It’s not definitive, it’s an informed hypothesis, and one we should be able to offer rather than the stunning silence demanded by the Goldwater rule.”

The Goldwater rule has long been odd in that violating it carries no penalties. In principle the psychiatric association could file a complaint with a member’s state medical board. That has apparently never happened. Nor has the association ejected a member for violating the Goldwater rule. That is something it, as a private association, would be legally permitted to do.

A state agency, however, is subject to the U.S. Constitution, civil liberties experts say, and penalizing psychiatrists for speaking out would likely be a violation of their First Amendment rights.

Correction: The headline of this story has been changed to make clear that the American Psychoanalytic Association has told its members that they are free to ignore the “Goldwater rule” and comment about public figures’ mental state.

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  • I believe that it is normally better not to comment about public officials, because of him we do not have enough detail having not seen them individually for a thorough evaluation. However, in Donald Trump’s case I believe that a hypothesis can be put forth based on the abundance of information we have at our disposal. There is an abundance of information suggesting that Trump has a narcissistic personality disorder. He also displays many characteristics and history of a psychopathic deviant. Evidence of the narcissistic personality disorder or is more abundant than the psychopathic deviant. However, there is a great deal of overlap in symptomology when considering these two diagnoses. There is also the factor of the degree of the symptoms which should be considered when differentiating. It should also be mentioned that it isn’t necessarily a question of which one. People often present with dual diagnoses. The symptomology am referring to includes but is not limited to the following: consistent pattern of lying either out right or by omission. Grandiose perception of self demonstrated repeatedly. Extreme sensitivity to criticism. Outbursts of anger and rage. Difficulty displaying empathy for others. Preoccupation with self. Long history of deceit for self gain. Emotional lability. Blames others often. Never admits he is wrong or excepts responsibility for mistakes. The aforementioned is not conclusive and should not be considered a professional opinion, but rather an informed hypotheses put forth due to the absence of competing explanations for trumps behavior and concern for the welfare of our country due to his apparent lack of ability to lead effectively.

    • –consistent pattern of lying either out right or by omission.
      –Grandiose perception of self demonstrated repeatedly.
      –Extreme sensitivity to criticism.
      –Outbursts of anger and rage.
      –Difficulty displaying empathy for others.
      –Preoccupation with self.
      –Long history of deceit for self gain.
      –Emotional lability.
      –Blames others often.
      –Never admits he is wrong or excepts responsibility for mistakes.

      Shoot, I thought you were describing Hillary Clinton.

  • What could they reliably know about his mental health if they have never even talked to him. What a bunch of unethical nuts.

    • Once one has dealt with one narcissist no need to talk to diagnose him/her. One only needs to listen to their words, watch the same manerisms they all exhibit. After all, they all have the same traits which they exhibit & perform over & over & over & over again & again. They are so unimaginative one who has worked one out actually finds their behsviour quite pathetic. Also you dont even need to be a psychiatrist to know whats coming next. Trump’s no different & it shows thru lies backstabbing manipulation gaslighting mirroring deflecting & his need for ‘drama’.

  • I’m so happy they’re allowed to do this. Can’t wait for the book to come out. As professionals, they do have a duty to warn.

    Congress should make certain requirements for all presidential candidates.

    Within 30 days of announcements for their presidential runs the presidential candidates would have to provide the following: (1) a copy of the previous 10 years of tax returns provided by the IRS to the public, (2) a full physical by an independent physician selected by congress and all test results provided to the public, (3) a blood and hair sample test for the detection of drug usage where the results of the tests are provided to the public and the physician and lab is chosen by congress, (4) and a full psychological evaluation by an independent psychiatrist chosen by congress and the results available to the public.

  • Trump takes medications for hair loss. It is becoming more and more understood that medications can affect the gut microbiome, which can in turn affect mental conditions. We also need to consider the brain microbiome. It is entirely possible that the medications that he is taking are affecting his gut or brain microbiome, and playing a role in his mental condition.

    I’ll give an example ; depression has been linked with damage to the gut microbiome. Now, if you look for the published research, depression has also been reversed by re-storing the health of the microbiome.

    Another way to look at this would be to examine the potential side affects of all medications the president is taking.

  • Im proud of Donald because he doing and saving America from economical dysasters of and from the pass Nothing wrong from doing an additional extra to put US first …

  • Shouldn’t it stand to reason that candidates for high office professions should undergo testing for psychiatric disorders? Should this not be required ?

    • The only one who can vouch for Trump’s narcissism is Melania who at this point in time knows exactly who Trump is due to the fact that he is aware that she has worked him out and in her presence he has dropped his mask in her presence. He will not do that with a psychiatrist, unless he is tricked by a very knowledgeable psychiatrist who knows everything there is to know about narcissism and I do not believe many professionals actually fully understand the illness. Once has to experience ‘it’ in order to ‘get it’.

    • No it should not be required. The posts from your profession show a political bias. Do you think your opinion is more important than the people’s vote. Just who is the real narcissist? Perhaps you are!

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