T

hree congressional Democrats have asked a psychiatrist at Yale School of Medicine to consult with them about forming an expert panel to offer the legislators advice on assessing President Trump’s mental health.

Yale’s Dr. Bandy Lee told STAT that over the last few weeks members of Congress or their staff have asked her to discuss how members might convene psychiatrists, psychologists, and other mental health professionals “to review the president’s mental health, and review it on a periodic basis.” The closed meeting is expected to take place in September, she said.

The request came from three current congressmen and one former member, she said. She declined to name them, saying they told her they did not wish to be publicly identified yet.

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The invitation comes as 27 representatives, all Democrats, have co-sponsored a bill to establish “a commission on presidential capacity.” The commission would carry out a provision of the 25th Amendment, which gives Congress the authority to establish “a body” with the power to declare a president “unable to discharge the powers and duties of his office.” Under the bill, H.R. 1987, eight of the 11 members of the commission would be physicians, including four psychiatrists.

STAT contacted the sponsors’ offices, which either did not respond or declined to comment.

Trump has not released his medical records beyond a brief summary from his physician last year. He has said he never sought or received a mental health evaluation or therapy.

But since his election and, increasingly, his inauguration, a number of mental health experts have spoken or written about what Trump’s behavior and speech suggest about his cognitive and emotional status, including impulsivity and paranoia, with some offering formal diagnoses, such as narcissistic personality disorder.

In a book scheduled for publication in October that was edited by Lee, 27 experts offer their views of what Lee calls “Trump’s mental symptoms,” including his impulsivity, “extreme present focus,” pathological levels of narcissism, and an apparent lack of trust that is a sign of deep paranoia. The book is based on a small meeting Lee organized at Yale in April on whether psychiatrists have a “duty to warn” about any dangers Trump poses because of his psychological make-up.

If members of Congress form an expert panel like the one Lee has been asked to advise on, psychiatrists who participate would be at risk of violating a decades-old ethics rule imposed by the American Psychiatric Association on its members. Called the Goldwater rule, it prohibits APA members from diagnosing the mental health of public figures whom they have not examined. (Sharing such a diagnosis of someone they have examined would, of course, violate a different ethical rule, on patient confidentiality.)

In March, after growing criticism that the Goldwater rule was essentially a gag order that prevented the public from hearing from experts, the APA not only reaffirmed the rule but extended it. Now, in addition to the prohibition against suggesting that someone might (or might not) have a specific mental disorder, APA members are barred from “render[ing] an opinion about the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry.”

While there is an exception for court-ordered evaluations and for consultations even without personally evaluating someone, there is no explicit exception allowing psychiatrists to tell elected officials, in public or in private, their views of a public figure’s mental state. Last month, the American Psychoanalytic Association, another psychiatrists group, sent an email to its members reiterating that they are not bound by the APA’s rule.

Lee, whose academic research focuses on prison reform, recidivism, and the causes of violence, said she “kept with the Goldwater rule’s original conception of refraining from making diagnoses, but speaking to dangerousness and the need for an evaluation.”

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The expert panel that Lee was asked to discuss convening would have several members, she said, but it remains to be worked out who would serve, how and by whom they would be chosen, what their mandate would be, and how and when they would offer their opinions to Congress, should the proposal even get off the ground.

On Friday, Lee and four other psychiatrists sent a letter to all members of the U.S. Senate and House arguing that Trump exhibits “severe emotional impediments that … present a grave threat to international security,” and asking Congress to “take immediate steps to establish a commission to determine his fitness for office.” The letter signers are staunch Trump opponents and believe his presidency should end.

The letter echoed one that Lee and a slightly different group of colleagues sent to Congress in July. The most recent one came in the wake of Trump’s reportedly ad-libbed statement last Tuesday that if North Korea carries through on its nuclear threats, “they will be met with fire and fury and frankly power the likes of which this world has never seen before.” On Thursday, after North Korean leader Kim Jong-Un threatened to bomb the American territory of Guam, Trump said, “Maybe that statement wasn’t tough enough.”

Lee and the other signers of the new letter, including Dr. Lance Dodes, recently retired from Harvard Medical School, argue that Trump’s “alarming patterns of impulsive, reckless, and narcissistic behavior — regardless of diagnosis … put the world at risk,” posing an “imminent danger” that psychiatrists are ethically obligated to warn about.

“The role of honor or, rather, perceived humiliation is often overlooked as a powerful stimulant of international violence,” they write, adding that the “president may not have the capacity to consider an array of possible choices, due to his own emotional needs.” They ask Congress to “take immediate steps to establish a commission to determine his fitness for office.”

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  • The idea that there is a psychological science more valid than the the political judgment of Congress seems to me, well, deranged. President Trump gives evidence of his mental status in writing or public speech almost every day. Congress, administration officials, and a free press assure that his issues are widely discussed. If enough voters decide he is unfit for office, his actions will be restrained by checks and balances, and he will be released from decision-making in an orderly way. The prospect of a psyciatrist’s coup cannot be reassuring to even the most partisan opponent.

  • Trump takes medications to prevent hair loss. It is becoming clear that medications can affect the gut microbiome, which can in turn affect mental conditions. There is also the brain microbiome to consider too. It’s quite possible that the medications he is taking are affecting his gut or brain microbiome and be the root reason of some issues.

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

    Another way to look at this ; we should be examining all of the medications the president takes and whether or not the known possible side affects explain the President’s mental state.

  • Drs. Lee and Dodes are not constrained in any practical way by the APA’s Goldwater rule. It’s an ethical standard of a private, voluntary membership organization. (And if one disagrees so strongly with the ethics of an organization, why belong to it?) But at least be honest: since 1973 the Goldwater rule has prohibited psychiatrists from publicizing “professional opinions,” not merely diagnoses, about people we haven’t examined. Nothing about the rule has changed. The sad part of this is, psychiatric grandstanding is still simply political rhetoric. It weakens and casts suspicion on our field much more than it weakens the president. If Mr. Trump is impeached or even removed via the 25th amendment, it will be due to the political will of Congress, not to pleas by those who vainly hope their medical credentials give them a louder voice in a nationwide screaming match.

  • Ludicrous that any Dr could presume to diagnose anyone without meeting with them. Hillary and Obama should be diagnosed too.

  • Regardless of one’s opinion of Trump, this is sinister – an abuse of psychiatry that you would expect to see in a totalitarian regime.

    • I agree Sam. People who have never met or talked to someone, only read stories about them (by people who do not like this person and have not spent time with this person either), are voicing inflammatory thoughts about that person based on hearsay on top of hearsay. One would hope they would be smarter than that, but it does not appear to be the case. When I was in professional school, many decades ago, I was taught this was “a telephone diagnosis” and was malpractice.
      I seems to be Dolchstosslegende behavior.

    • Abuse of psychiatry is indeed an accurate characterization of this nonsense.

      President Obama was clearly narcissistic as well. I would even suggest it requires a bit of narcissism to think you should be the leader of the free world

      this is a mockery of psychiatry the kind that would see those who disagree with us to psychiatric institutions and medicated into silence

      As always this totalitarian threat comes from the left.

  • I wrote letters to all of the US representatives from my state asking them to look into the President’s mental health. I asked them to get the White House Doctor to order a psychological evaluation, mentioning that although he exhibits symptoms of sociopathy, no one who has not met him can provide a diagnosis, despite months of observations of his erratic behaviour. I had to do something – I could not just sit here feeling helpless and powerless. At least now I feel a little better. I wish all mental health practitioners who feel the President should be evaluated would write a letter to the White House Doctor and their state reps. Someone needs to tell the emperor’s doctor that emporer has no clothes.

  • The duty to warn is the primary directive. A psychiatrist or psychologist or mental health professional is ethically bound to report and seek to prevent harm if someone is a danger to themselves or others because of psychological issues. If Trump were threatening to push people off a bridge what is the difference with him threatening nuclear war with millions dead because he is a Narcissistic Personality Disorder. He is not well. He is not curable. Narcissists do not seek help. He must for our country’s survival be removed from office.

  • said it before. This kind of assessments should be done before any candidate, of any political affiliation, can run for office. Or any other position, where an individual is invested with considerable power.

  • Perhaps a challenge test for mercury and heavy metals would be helpful, and additional screening for Lyme and coinfections.

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