A prohibition against psychiatrists discussing the mental health of public figures — a rule that has become especially controversial, and sometimes flouted, since the inauguration of President Trump — is “premised on dubious scientific assumptions,” researchers concluded in an analysis scheduled for publication in a psychology journal.
The American Psychiatric Association (APA) defends its “Goldwater rule” by arguing that an in-person psychiatric examination is the gold standard for diagnosing mental illness and psychological traits — given that there are no blood tests or brain scans for psychiatric disorders. In fact, however, numerous studies suggest that the interview-based exam can be misleading, psychologist Scott Lilienfeld of Emory University and colleagues argue in the paper, which will appear in an upcoming issue of Perspectives on Psychological Science.
Patients lie or hide facts, they often have poor self-insight, and psychiatrists err, the authors write. In contrast, the accounts of people who know the individual, plus his or her public behavior, writing, speech — and, yes, tweets — can provide more accurate insights into a public figure’s mind, they contend.
From the Stalin regime in the Soviet Union to the Mao era in China to the Pol Pot tyranny in Cambodia, mental health professionals have been used to control political opponents. It would be wise to be careful…very careful…about giving a large amount of credence to those who are self-appointed to answer the call to the duty to warn when in fact they simply politically despise the one whom they claim is mentally challenged. It has the appearance that that is exactly what is going on here, and if so, it appears that they are the ones who are unhinged.
When the Goldwater episode happened 50 years ago, psychiatric nosology in the US was fraught with unreliable, psychoanalytically inspired, inference. Back then, the Goldwater rule was a good idea. Today, not so much. In the UK tradition, information from knowledgeable informants always was factored in to diagnostic assessments, and sometimes the data from those sources was decisive. There is enough information in the public domain about Trump’s cognitive difficulties, his personality, his projective style, and his insecurity to allow opinions that a full psychiatric evaluation is warranted. Provisional diagnoses include early dementia, narcissistic personality disorder with pathological lying, and possibly an attentional disorder.
Had it been me vice Trump our problem would be how to divide what would be left of N Korea after a Pre-emptive (Nuclear) strike post ICBM test. I am amazed at how intellectuals pander to an Animal with Nuclear Weapons? Time for change in America.
Diagnosing public figures may be hazardous for the profession, I’m afraid. And most people, which I’m sure includes psychiatrists, have political bias which may be hard to exclude. Having said that, it would be nice to have a relatively reliable idea of a candidates mental issues before voting. But I can’t see a reliable, unbiased way to do that. Of course, anyone with an open mind can tell that certain politicians have some kind of mental problem, even if they can’t quote the DSM 5. Disclaimer: In this field, I’m just a layman.
If a personal interview is not the best way to diagnose a patient, then psychiatrists should avoid them, wherever possible! If Facebook and Twitter entries can do a better job in much less time (and, therefore, expense), personal interviews can be reserved for those unfortunates (like myself) who have no Facebook or Twitter presence. I shudder to think how psychiatrists would diagnose my online comments elsewhere. But I am not the President of the United States, so I have nothing to worry about. Pres. trump is the obvious intended target of this implied change in the “Goldwater Rule, and probably the only one.
Neither does Lilienfeld have any basis of scientific evidence to support his point. Neither sides do. And thus goes listening to him.
I would concur about difficulties with in-person evaluation. But that same problem is compounded by assessment at a distance or by press release. Consider Harvey Weinstein, could you argue that a precise or accurate assessment of his personality could be made upon his public persona before his recent outing? The value of an expert opinion is degraded by acting outside of professional bounds and standards. I have no problem with physicians expressing views, as long as it is clear that they are personal rather than professional.
This is clearly an important study, which goes to validation of personality diagnoses by behavioral observation. Caution in public statements is always important, but is offset by a duty to warn.
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