Twenty-seven psychiatrists, psychologists and mental health experts have written a book regarding the mental health of the republican President Donald Trump. Their argument for acting counter to the rule of not publicly providing a mental health diagnosis for anyone without having first met with that individual, is that they have a duty to warn the public if a person presents a clear and present danger to others. They indicate that the president fits this category.
Here’s the rest of the story….
On September 24, 2017, Bill Moyers approved the publication of the following report by Mother Jones penned the following report, “A Group of Experts Wrote a Book About Donald Trump’s Mental Health—and the Controversy Has Just Begun.” (Bill Moyers talks to co-author Robert Jay Lifton about the complications of diagnosing the president.)
“There will not be a book published this fall more urgent, important, or controversial than The Dangerous Case of Donald Trump, the work of 27 psychiatrists, psychologists and mental health experts to assess President Trump’s mental health. They had come together last March at a conference at Yale University to wrestle with two questions. One was on countless minds across the country: “What’s wrong with him?” The second was directed to their own code of ethics: “Does Professional Responsibility Include a Duty to Warn” if they conclude the president to be dangerously unfit?”
“As mental health professionals, these men and women respect the long-standing “Goldwater rule” which inhibits them from diagnosing public figures whom they have not personally examined. At the same time, as explained by Dr. Bandy X Lee, who teaches law and psychiatry at Yale School of Medicine, the rule does not have a countervailing rule that directs what to do when the risk of harm from remaining silent outweighs the damage that could result from speaking about a public figure—”which in this case, could even be the greatest possible harm.” It is an old and difficult moral issue that requires a great exertion of conscience. Their decision: “We respect the rule, we deem it subordinate to the single most important principle that guides our professional conduct: that we hold our responsibility to human life and well-being as paramount.”
Hence, this profound, illuminating and discomforting book undertaken as “a duty to warn.”
The foreword is by one of America’s leading psychohistorians, Robert Jay Lifton.
The Dangerous Case of Donald Trump will be published Oct. 3 by St. Martin’s Press.
Here is my interview with Robert Jay Lifton:
Bill Moyers: This book is a withering exploration of Donald Trump’s mental state. Aren’t you and the 26 other mental health experts who contribute to it in effect violating the Goldwater Rule? Section 7.3 of the American Psychiatrist Association’s code of ethics flatly says: “It is unethical for a psychiatrist to offer a professional opinion [on a public figure] unless he or she has conducted an examination and has been granted proper authorization.” Are you putting your profession’s reputation at risk?
Robert Jay Lifton: I don’t think so. I think the Goldwater Rule is a little ambiguous. We adhere to that portion of the Goldwater Rule that says we don’t see ourselves as making a definitive diagnosis in a formal way and we don’t believe that should be done, except by hands-on interviewing and studying of a person. But we take issue with the idea that therefore we can say nothing about Trump or any other public figure. We have a perfect right to offer our opinion, and that’s where “duty to warn” comes in.
Moyers: Duty to warn?
Lifton: We have a duty to warn on an individual basis if we are treating someone who may be dangerous to herself or to others herself or to others—a duty to warn people who are in danger from that person. We feel it’s our duty to warn the country about the danger of this president. If we think we have learned something about Donald Trump and his psychology that is dangerous to the country, yes, we have an obligation to say so. That’s why Judith Herman and I wrote our letter to The New York Times. We argue that Trump’s difficult relationship to reality and his inability to respond in an evenhanded way to a crisis renders him unfit to be president, and we asked our elected representative to take steps to remove him from the presidency.”
Moyers: “Yet some people argue that our political system sets no intellectual or cognitive standards for being president, and therefore, the ordinary norms of your practice as a psychiatrist should stop at the door to the Oval Office.”
Lifton: “Well, there are people who believe that there should be a standard psychiatric examination for every presidential candidate and for every president. But these are difficult issues because they can’t ever be entirely psychiatric. They’re inevitably political as well. I personally believe that ultimately ridding the country of a dangerous president or one who’s unfit is ultimately a political matter, but that psychological professionals can contribute in valuable ways to that decision.”
Moyers: “Do you recall that there was a comprehensive study of all 37 presidents up to 1974? Half of them reportedly had a diagnosable mental illness, including depression, anxiety and bipolar disorder. It’s not normal people who always make it to the White House.”
Lifton: “Yes, that’s amazing, and I’m sure it’s more or less true. So people with what we call mental illness can indeed serve well, and people who have no discernible mental illness — and that may be true of Trump — may not be able to serve, may be quite unfit. So it isn’t always the question of a psychiatric diagnosis. It’s really a question of what psychological and other traits render one unfit or dangerous.”
Moyers: “Witnessing professionals? Where did this notion come from?”
Lifton: “I first came to it in terms of psychiatrists assigned to Vietnam, way back then. If a soldier became anxious and enraged about the immorality of the Vietnam War, he might be sent to a psychiatrist who would be expected to help him be strong enough to return to committing atrocities. So there was something wrong in what professionals were doing, and some of us had to try to expose this as the wrong and manipulative use of our profession. We had to see ourselves as witnessing professionals. And then of course, with the Nazi doctors I studied for another book—doctors assigned, say, to Auschwitz—they were expected to do selections of Jews for the gas chamber. That was what was expected of them and what for the most part they did—sometimes with some apprehension, but they did it. So that’s another malignant normality. Professionals were reduced to being automatic servants of the existing regime as opposed to people with special knowledge balanced by a moral baseline as well as the scientific information to make judgments.”
Moyers: “And that should apply to journalists, lawyers, doctors—”
Lifton: “Absolutely. One bears witness by taking in the situation—in this case, its malignant nature—and then telling one’s story about it, in this case with the help of professional knowledge, so that we add perspective on what’s wrong, rather than being servants of the powers responsible for the malignant normality. We must be people with a conscience in a very fundamental way.”
Moyers: “Some of the descriptions used to describe Trump—narcissistic personality disorder, antisocial personality disorder, paranoid personality disorder, delusional disorder, malignant narcissist—even some have suggested early forms of dementia—are difficult for lay people to grasp. Some experts say that it’s not one thing that’s wrong with him—there are a lot of things wrong with him and together they add up to what one of your colleagues calls “a scary witches brew, a toxic stew.”
Lifton: “I think that’s very accurate. I agree that there’s an all-enveloping destructiveness in his character and in his psychological tendencies. But I’ve focused on what professionally I call solipsistic reality. Solipsistic reality means that the only reality he’s capable of embracing has to do with his own self and the perception by and protection of his own self. And for a president to be so bound in this isolated solipsistic reality could not be more dangerous for the country and for the world. In that sense, he does what psychotics do. Psychotics engage in, or frequently engage in a view of reality based only on the self. He’s not psychotic, but I think ultimately this solipsistic reality will be the source of his removal from the presidency.”
Moyers: “What’s your take on how he makes increasingly bizarre statements that are contradicted by irrefutable evidence to the contrary, and yet he just keeps on making them? I know some people in your field call this a delusional disorder, a profound loss of contact with external reality.”
Lifton: “Well, in one part of himself, Trump can know there’s no evidence that Obama was born in any place but Hawaii in the United States. But in another part of himself, he has the need to reject Obama as a president of the United States by asserting that he was born outside of the country. He needs to delegitimate Obama. That’s been a strong need of Trump’s.”
Moyers: “How can someone believe and not believe at the same time?”
Lifton: “He doesn’t have clear contact with reality, though I’m not sure it qualifies as a bona fide delusion. He needs things to be a certain way even though they aren’t, and that’s one reason he lies. There can also be a conscious manipulative element to it. When he put forward, and politically thrived on, the falsehood of President Obama’s birth in Kenya, outside the United States, he was manipulating that lie as well as undoubtedly believing it in part, at least in a segment of his personality. In my investigations, I’ve found that people can believe and not believe something at the same time, and in his case, he could be very manipulative and be quite gifted at his manipulations.”
Lifton: “The false beliefs become part of a panorama, all of which is fantasy and very often bound up with conspiracy theory, so that (Trump) immerses himself in it and believing in it even as at the same time recognizing in another part of his mind that none of this exists. The human mind can do that.”
Moyers: It’s as if he believes the truth is defined by his words.
Lifton: “Yes, that’s right. Trump has a mind that in many ways is always under duress, because he’s always seeking to be accepted, loved. He sees himself as constantly victimized by others and by the society, from which he sees himself as fighting back. So there’s always an intensity to his destructive behavior that could contribute to his false beliefs.”
Moyers: “Do you remember when he tweeted that President Obama had him wiretapped, despite the fact that the intelligence community couldn’t find any evidence to support his claim? And when he spoke to a CIA gathering, with the television cameras running, he said he was “a thousand percent behind the CIA,” despite the fact that everyone watching had to know he had repeatedly denounced the “incompetence and dishonesty” of that same intelligence community.”
Lifton: “Yes, that’s an extraordinary situation. And one has to invoke here this notion of a self-determined truth, this inner need for the situation to take shape in the form that the falsehood claims. In a sense this takes precedence over any other criteria for what is true.”
Moyers: “What other hazardous patterns do you see in his behavior? For example, what do you make of the admiration that he has expressed for brutal dictators—Bashar al-Assad of Syria, the late Saddam Hussein of Iraq, even Kim Jong Un of North Korea—yes, him—and President Rodrigo Duterte of the Philippines, who turned vigilantes loose to kill thousands of drug users, and of course his admiration for Vladimir Putin. In the book Michael Tansey says, “There’s considerable evidence to suggest that absolute tyranny is Donald Trump’s wet dream.”
Lifton: “Yes. Well, while Trump doesn’t have any systematic ideology, he does have a narrative, and in that narrative, America was once a great country, it’s been weakened by poor leadership, and only he can make it great again by taking over. And that’s an image of himself as a strongman, a dictator. It isn’t the clear ideology of being a fascist or some other clear-cut ideological figure. Rather, it’s a narrative of himself as being unique and all-powerful. He believes it, though I’m sure he’s got doubts about it. But his narrative in a sense calls forth other strongmen, other dictators who run their country in an absolute way and don’t have to bother with legislative division or legal issues.”
Moyers: “I suspect some elected officials sometimes dream of doing what an unopposed autocrat or strongman is able to do, and that’s demand adulation on the one hand, and on the other hand, eradicate all of your perceived enemies just by turning your thumb down to the crowd. No need to worry about “fake media”—you’ve had them done away with. No protesters. No confounding lawsuits against you. Nothing stands in your way.”
Lifton: “That’s right. Trump gives the impression that he would like to govern by decree. And of course, who governs by decree but dictators or strongmen? He has that impulse in him and he wants to be a savior, so he says, in his famous phrase, “Only I can fix it!” That’s a strange and weird statement for anybody to make, but it’s central to Trump’s sense of self and self-presentation. And I think that has a lot to do with his identification with dictators. No matter how many they kill and no matter what else they do, they have this capacity to rule by decree without any interference by legislators or courts.”
In the case of Putin, I think Trump does have involvements in Russia that are in some way determinative. I think they’ll be important in his removal from office. I think he’s aware of collusion on his part and his campaign’s, some of which has been brought out, a lot more of which will be brought out in the future. He appears to have had some kind of involvement with the Russians in which they’ve rescued him financially and maybe continue to do so, so that he’s beholden to them in ways for which there’s already lots of evidence. So I think his fierce impulse to cover up any kind of Russian connections, which is prone to obstruction of justice, will do him in.
This story first appeared on the BillMoyers.com. (Link to the entire report.)