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.