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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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  • No biases here
    Traits are hang ups and are only facets of human behavior but disorders are severe manifestations that teansecf all interactions
    This is not my definition but how modern psychology and psychiatry discern the two

    • PL – not all traits can be healthy. For example, Hallucinating is not healthy. Being unable to recognize reality facts. For example, there is a class of people who describe being able to feel empathy and imitate it by watching other people, rather than feel it. Testing shows that for a large subset of them, it can be identified by differences in brain scans from people who do feel describe feeling empathy, so it’s scientifically evident.

      One could argue whether feeling empathy is healthy. But it’s unbias to say that it’s helpful for people who feel it, to be aware that the other group exists. Con man and abusers come from that 2nd group, and get away with it because the first group doesn’t know the much smaller 2nd one even is possible. So it is helpful to inform people that such a trait can exist, whether it’s a healthy trait or not.

      Trump fits the bigger pattern (additional traits) of the group without direct empathy — sociopathic traits — extremely well, based on his behaviors so far. So it’s while it’s not a diagnosis, it is not bias, to point out what is observable, then to add to it the fact that the pattern of behavior is already known about in the scientific community.

      Makes it easier for voters to have more information to decide for themselves what matters to them when they vote.

      ————

      For example, gaslighting is a type of lying used by sociopaths. It’s different from regular lying in that it tries to convince the listener that THEY are mishearing and unable to judge what’s truth. It isn’t just a lie about what’s true. That’s a trait Trump has used repeatedly. It’s worthwhile for people to know that such a trait can exist. Not because of bias, but as self-protection from it, so that they can be less confused and more certain about their first instinct that told them about what they heard.

      You may consider this a great trait in a politician. But it’s still good to know such as a trait exists, whether in a politician or a co-worker.

  • I’be monitoring the situation even though this matter is controversial. The future of the nation is at stake.

  • You may change the rules but common sense tells ordinary people how absurd it is to make these unjustified comments about President Trump. You just bring skepticism onto your profession. It’s incredibly self serving.

  • In my travels to many of their home offices: Shrinks appear to be a unstable bunch, as well! Maybe, that explains their career path!

  • Curls:
    Unless Hillary Clinton (and many other high office occupants and aspirants) undergo formal neuropsychological evalauation for psychogenic behavior that in my opinion was very bizarre you are never going to know. I work and help people like this and if you paid me a million bucks I could play the part very well ( stated rhetorically). Bottom line is that you are never going to know unless formal testing is done. Hillary and many others have never had the benefit of this approach. Otherwise the deranged are smart enough to surround themselves with an army of enablers and apologists that will never dawn upon their minds that such behavior exists and can dwell among our most trusted political and social circles. I believe this is possible due to our own empathy and compassion that blocks us from identifying the problem for what it truly is. Think about that

    • Jorge – you’ve just repeated your belief again, but still not referenced any movements in her. None exist!

      I pointed out facts on why the parkinson’s video isn’t abnormal and you didn’t respond to those facts.

      BTW, Clinton did have a neuropsych exam by hospital doctors (not her regular doctors) as part of her neurological history and the records were made public.

      On the other topic, it would be good to have external physical exams of the candidates in my view. We humans do tend to give people passes.

      However, from a distance one can still assess to some extent, which I’ve done with detailed reasoning.

  • It is not just Trump that has a clear case of personality disorder it’s both sides of the aisle. This is painfully obvious and discernible longitudinal evaluation or psychometric testing no Matter how you split or lump together the political topography.

    What is more important Is the breakdown of our social values from the permissiveness of our country’s leadership to have let sick but consummately self centered minds reach a critical threshold of high office occupation. Personality disorders transect politics, socioeconomic status, gender, creeds and ethnic origin
    Leaving little to be unaffected on a social scale. Trump is the latest actor but preceded by Obama and many on both sides of the political aisle which is merely a single facet of how the disordered affect our society.

    We must develop ways to spot mental health concerns in high office occupations.

  • Trump is a clear case of personality disorder, narcissistic personality disorder and antisocial personality disorder. This is the most dangerous combination for a national leader. Anyone who wants to include Clinton, Pelosi, Cuomo in one of these classifications either doesn’t understand these disorders or is committed to the “they all do it” cop-out.

    The evidence for Trump’s NPD was very obvious during the campaign–thin-skinned, grandiose, insulting, unable to accept responsibility for any of his misdeeds. The sociopathy has been more obvious since he became president. It is an American tragedy that Trump was elected–a tragedy that so many Americans could be charmed by someone so unfit for the office. It will take a tremendous amount of work and previously unseen courage on the part of Republican members of Congress to prevent catastrophic damage to the U.S. and world.

    • Hillary Clinton is not thin-skinned? Has she ever accepted responsibility for any of her failures? She is not insulting?

      I’ll grant you Pelosi and Cuomo, although Cuomo has a pretty mean streak of grandiosity and his handling of the various corruption scandals in NY are not exactly a textbook example of personal responsibility, but Clinton has certainly displayed the behaviors you, correctly in my view, attribute to Trump.

  • Most narcissists learn some social conventions as trump has; he uses a fork and he wears a suit. The mental instability the American public note is his flagrant disregard for the conventions of the office of the presidency. He seems to know how to get to Mar-A-Lago and to rent his buildings to taxpayers; why the adversity with confrontation approaches, the frenzy over Hillary and the maniacal tweeting and compulsive lying?

    • Jorge – Hillary doesn’t have any movement disorders, psychogenic or otherwise. The parkinson’s tape shows her making a joke – it’s incredibly obvious she’s joking about the mics shoved into her face. There’s no evidence that she has any psychological disorders.

      She isn’t a compulsive liar. Being bad at lying compared to the usual politician, just makes you just look ridiculous when trying, which is why you know about when she’s tried to lie. (She honestly believed her husband about not having affairs way back when – so she wasn’t lying, she was being lied to and duped.)

      Bill appeared to have a sex addiction disorder or something like that. (Wonder what Kennedy was doing.) We’d still be hearing about new cases if it was an assault-based disorder – those don’t go away and can’t be hushed away once out of the bag.

      If Trump was running the country and government without the chaos and evidence of his disorder all over the place, then it wouldn’t be a topic of discussion either, and he could be president and have a disorder. But whatever he has, is causing us all harm.

      (It appears to be sociopathology, not merely narcissism. Narcissism is more of a continuum spectrum condition and SOME degree of it will show up in a lot of powerful people. Sociopathology are able to look normal by mimicking, but they really don’t know what normal is or how to be normal – especially, they lack real compassion, hence they are so self-focused.)

    • Of the many who likely fall on the spectrum of one or more personality disorders, many will be functional. Some will not. It seems more and more clear that Trump is not able to function sufficiently/stably/respectably/productively and without severe turbulence within the magnitude of the office. To what end, who knows??

  • It is absurd to label as a condition, any personality quirk one may find irritating. What head of state, what successful individual, is not to some extent a narcissist? There is nothing psychologically wrong with Mr. Trump – it is only that individuality is frowned upon by liberals – notably those whose political beliefs have become their
    religion.

    • A personality disorder is a condition in which there IS something wrong psychologically, where the person’s personality traits drive waves of turbulence and dysfunction through any possibility of harmonious, stable relationships; communication; and everyday interactions with the world.

    • I voted for Trump for the sake of this nation given the other options. Trump is undoubtedly Narcissistic and not in traits but in disorder. But don’t believe me just have him undergo neuropsychological testing by a conservative Republican neuropsychologist and settle it. It would explain a lot of the unnecessary behaviors.

      I’m also sure Gingrich and Pelosi , Cuomo and leaders of the Democratic Party (Clinton , Sanders) would also score high on the personality disorder testing,

      The main point is that our Society is plagued by this condition

    • Trump is very compulsive, neurotic and totally unaware of the complexity of his position. You can’t see that?!!!

    • As for Narcissists i suppose we are all Narcissistic in our behavior to isolate or feelings when making critical determinations in certain categories but we become Narcissistically personality disordered when our behavior of malignant self centerednesss contaminated our relationships across all domains of interaction with our friends, profrssionals and family. When this level is reached it’s no longer a trait. As far as Hillary’s bizarre behaviors in public I must confess that I strongly believe it’s psychogenic and will maintain this position until a formal neuropsychological evaluation is completed on Hillary as well as a movement disorder evaluation is formally completed. These evaluations should be performed on every high office candidate. We are paying a big price on both sides of the aisle for not having done so sooner by caving in to the Goldwater rule

    • Jorge –
      “”I strongly believe it’s psychogenic “”

      Based on what? You’ve restated your beliefs but not added any data to back them up.

      Clinton during the famous “parkinson’s” video, maintained eye contact and and a smile on her face. That’s proof that it’s not an uncontrolled behavior of psychological (psychogenic) or other origins. It’s proof that it’s normal behavior, a joke. I haven’t seen any other moments that are claimed to be abnormal movements.
      (If one were trying to claim a disability and used that tape as evidence, doctors would quickly rule it out as not being what abnormal behaviors look like — because of things like eye contact. Plus people right there didn’t reach out to support her body – which is automatic if someone is wobbling in front of you without control.)

      Part of what’s seeped into our system that is a problem — is this showing the public supposed issues and supposed situations — that just aren’t as claimed. So part of the solution of what’s seeped into everything, is the public assessing stuff for themselves. Hillary doesn’t have emotional abnormalities any more so than the average person. President Clinton had something with women going on, that needs assessing (for whether he was using assault or merely doing a lot in the sexual arena), but so did a bunch of prior presidents.

      Sure there’s plenty of abnormalities in politicians. That’s always been true. But equally important is to not dump on claims of issues just because something is pointed out by the other side, or seems a little weird. Better to add in professional experience before reaching any conclusions.

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