For psychiatrists, Donald Trump’s third run for the presidency means that we’ll once again face the challenge of diagnosis: Should we, or shouldn’t we? For 50 years, the American Psychiatric Association’s code of ethics has forbidden any member from diagnosing public figures unless the doctor has interviewed them and obtained their permission, a constraint known as the Goldwater Rule. During the 2016 presidential race, some psychiatrists skirted the rule and, through indirection, labeled Trump paranoid, sociopathic, or pathologically narcissistic. In justification, they referred to a competing obligation to warn the public about impending disaster.
Ever since, the field has debated the merits of diagnosis from a distance. I won’t rehash the arguments. Instead, I want to make a strange, speculative prediction: that the need for resolution will soon be behind us. We won’t have to rely on doctors to diagnose public figures. Bots will do that job.
One objection to diagnosis based on public behavior is that it lacks the nuance and specificity of face-to-face interviews. But it’s not as if the record contains no relevant information. Calling Trump narcissistic, one psychologist pointed to Trump’s tendency to assert unique superiority — “Only I can fix it” — and to claim expertise in a host of different subject areas. (The constraints on psychologists resemble those for psychiatrists.) The media, this and other experts said, contained ample evidence on which to base a diagnosis.
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