Is it unethical to opine on Donald Trump’s mental health?

Donald Trump Official Portrait (Wikimedia Commons)

Over the last couple years there has been extensive discussion concerning the fact that Donald Trump demonstrates characteristic of the clinical diagnoses of psychopathy and Narcissistic Personality Disorder (NPD). (See for example this important June 2016 article which appeared in The Atlantic.)

As we proceed, I will focus the discussion on NPD. The Mayo Clinic offers the following definition:

“Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.”

Let’s see, inflated sense of one’s own importance, check; deep need for admiration from others, check; lack of empathy for others, check; fragile self esteem that is vulnerable to the slightest criticism, check.

Wait a minute, is this a description of NPD or of Donald Trump? Frankly, it appears to be both. And that’s why it seems so puzzling that some people insist it is unethical to connect the dots by drawing a conclusion — even a tentative and provisional one — about the state of Trump’s mental health.

The Goldwater Rule

So from where does this aversion to distance diagnosis derive?

The concern is rooted in deference to the so-called Goldwater Rule which was added to the American Psychiatric Association’s Code of Ethics after several mental health professionals offered armchair diagnoses of Barry Goldwater’s fitness to be president in 1964. Here is the relevant passage cited from the above-linked entry on the Goldwater Rule at Wikipedia:

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

And so many people draw the conclusion that it is unethical to offer any distance diagnosis of Trump’s mental health, whether that diagnosis comes from a mental health professional or a layperson like myself.

In response I’ll make four points.

1. The Goldwater Rule is Limited to Psychiatrists

First, let me start with this important point: I have not signed the American Psychiatric Association’s Code of Ethics and so I am not bound to observe that code. Consequently, I do not violate the code when I read the definition of NPD, see Donald Trump looking back at me, and then make the observation, “Gee, based on this description of NPD combined with my knowledge of Donald Trump, I believe The Donald likely has NPD or some other personality disorder close to it.”

And if I can reasonably believe The Donald has NPD, surely I am within my rights as a concerned citizen in sharing that tentative lay diagnosis with others, all the more so if I believe the common good is served by doing so. Indeed, depending on the conditions, I may even be morally obliged to share my opinion with others.

2. The Goldwater Rule is Not Absolute

Now let’s imagine a psychiatrist who has become persuaded based on publicly available evidence that Trump likely suffers from NPD. You might think that the psychiatrist is thereby obliged to remain silent given her adherence to the APA’s Code of Ethics. However, the APA’s Code of Ethics is not the same thing as the moral law. If a psychiatrist believes they have a moral obligation to violate the Goldwater Rule by offering a diagnosis of Trump based on publicly available evidence, then I believe they ought to violate the Goldwater Rule. At the very least, it is very far from obvious that their commitment to maintain the APA’s Code of Ethics would supersede their commitment to act in a manner that they believes helps to protect society and further the common good.

3. One May Observe that Trump Fits the Profile without Making a Diagnosis

The objector is concerned with distance medical diagnoses. But one need not make a diagnosis. All one need do is observe that Trump’s behavior is consistent with the diagnosis of NPD. One need not draw the inference that Trump suffers from NPD. That may be all you need to raise a concern, for from there one can make the further observation that any person who behaves in a manner that is consistent with the diagnosis of NPD is likely to do grave harm in the office of the presidency irrespective of whether that person, in fact, suffers from NPD.

4. The Goldwater Rule is Arguably Obsolete

But wait, isn’t all this missing the point that neither mental health professionals nor lay people are able to make distance diagnoses, however tentative, because the available information is too thin? On this view, an attempt to diagnose The Donald from afar is akin to the meteorologist’s attempt to forecast the weather three weeks from now: a reliable diagnosis, like a reliable forecast, simply cannot be made from that distance.

I’m not so sure. And this brings me to my final point. Here I’ll observe simply that the Goldwater Rule was formulated more than forty years ago, long before the current information age of social media in which we find ourselves. Those who originally formulated it could not have envisioned the complete saturation of media coverage we have on Donald Trump from multiple interviews, media appearances, press briefings, and biographies over the last forty years down to the disturbing stream-of-thought and real time consciousness from his Twitter feed.

In short, there may be ample evidence in this case to make a clinical diagnosis by distance. And thus, it may be time for the APA to revisit the assumption that it is not possible to make reliable and ethical clinical diagnoses — however tentative they may be — based on publicly available evidence.


5 thoughts on “Is it unethical to opine on Donald Trump’s mental health?”

  1. I agree. Ethics rules do vary by context. It is unethical for medical professionals to diagnose any patient they have not examined. It’s right in the oaths they take as part of registry. Diagnostic speculation by members of the general public does not have equal validity to a diagnosis made by a licensed professional, so the ethics of the situation are what applies to any unqualified opinion. People are free to make guesses, and we are free to regard them as guesses.


  2. You’re playing into Donald Trump’s game. (Or if you prefer the alternative story: those manipulating Trump.) Nothing conducive to the nation’s health will come out of these rumblings of Trump being mentally ill because of the insane polarization. Without the intense polarization, Trump would not be in office. Furthermore, Section 4 of Amendment 25 tells us who could actually oust Trump: Pence and Trump’s advisers. The people least likely to oust him, because he is the one who facilitated their rise to power.

    This is all a distraction from the fact that the leader of the Free World is an unvarnished reflection of that Free World—the power elite, not [necessarily] the intellectual elite. See, for example, Christopher Lasch’s 1979 The Culture of Narcissism, a book so penetrating it got him invited to the White House to consult on how to revitalize the nation. If you care one single shred about democracy, face the empirical fact that any existing democracy is mostly a façade—Democracy for Realists—and then use bona fide spiritual reasoning to show how we could actually progress toward the “until” in Ephesians 4:11–16.

    If you want to really face the reality of our situation, go check out the Yanis Varoufakis–Noam Chomsky NYPL discussion and especially the bit where Varoufakis, former finance minister of Greece, describes his first meeting of the Eurogroup. The topic is how to deal with the Greek debt crisis. This is the response he got from Doctor Wolfgang Schäuble: “Elections cannot be allowed to change the economic policies of any country.” (1:20:05) You can go to WP: Wolfgang Schäuble § Criticism and find this:

    Schäuble came under criticism for his actions during the “Grexit” crisis of 2015: it was suggested by Yanis Varoufakis that Schäuble had intended to force Greece out of the Euro even before the election of the left-wing Syriza government in Greece.[77] This was confirmed by former US Treasury Secretary Tim Geithner in early 2014; calling Schäuble’s plan “frightening,” Geithner recorded that Schäuble believed a Greek exit from the Eurozone would scare other countries in to line.[78] Schäuble also received extensive criticism toward his austerity recommendations from Twitter via the hashtag #ThisIsACoup.[79] Such criticism focused on the fact that Schäuble’s insistence on policies of austerity was contradicted both by the empirical evidence that the policies he had insisted on had shrunk the Greek economy by 25%, a degree hitherto paralleled only in wartime, but also by reports from the IMF insisting that only massive debt relief, not further austerity, could be effective.[80][81]

    How’s that for psychopathy/​sociopathy? But nobody is talking about such things. Instead, we pretend that Trump is something other than a reflection of We The People. No, most of us are not actively intentionally evil. The “banality of evil” does not require active intention on the part of many. “The only thing necessary for the triumph of evil is for good men to do nothing.” Edmund Burke could have added: “Scapegoating that which is evil in yourself is also conducive to evil triumphing.” As Aleksandr Solzhenitsyn observed, “the line dividing good and evil cuts through the heart of every human being.” Do we believe this? Or is Trump so much more evil (or: “mentally ill”, noting Foucault’s criticism of that concept) than us that deep introspection simply is not required?


  3. NBC News 2017-02-16 Donald Trump Isn’t Mentally Ill. He’s Just Unpleasant, Psychiatrist Says:

    Reports speculating that President Donald Trump has narcissistic personality disorder are misguided and incorrect, a leading psychiatrist argues this week.

    He should know. Dr. Allen Frances, professor emeritus of psychiatry at Duke University Medical College, wrote the book on it.

    “Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them,” Frances wrote in a letter to the New York Times.

    Frances chaired the team that defined psychiatric disorders for the mental health profession — the Diagnostic and Statistical Manual of Mental Disorders IV (called DSM 4). The DSM V or 5 is the most recent edition.

    Not that this is particularly relevant given my previous comment, but it seemed sufficiently relevant.


    1. Thanks. I read that yesterday and was hoping to write a response in the next day or so. Three points. First, the doctor just violated the APA’s prohibition on making distance diagnoses of public figures. So that’s ironic. Second, the doctor seems to view Trump as worse than a person who suffers NPD so saying Trump doesn’t suffer this personality disorder is not necessarily a good thing. Third, the fact that this doctor was the main figure behind the original definition of NPD doesn’t give him special authority over other clinicians in assessing whether a particular public figure meets the criteria.


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