I've not been shy in my criticism of President Trump's candidacy or his first year in office. However, I draw the line at the public debate over his mental competence. Some were critical when I said on CNN on Saturday that I find it both unfair and unseemly.
Recently an increasing number feel emboldened to discuss the matter because Michael Wolff's new bestseller, Fire and Fury, quotes Steve Bannon as saying that Trump has "lost his stuff" and claims that every single person around the president questions his fitness.
Wolff's words follow the recent release of a book by 27 mental health professionals who expressed their concerns about the president as evidenced by its title: The Dangerous Case of Donald Trump. This sort of thinking is not entirely new. Last week news broke that the book's editor, Yale University psychiatry professor Bandy Lee, met on Capitol Hill in December with more than a dozen Democratic members of Congress who were concerned about Trump's recent behavior.
I expect those drumbeats to grow louder this Friday, when the president undergoes an annual physical at Walter Reed Medical Center. Still, even if Trump's behavior is objectionable – and it often is — none of it is sufficient reason to change what has been the 40-year practice of not armchair diagnosing a president's mental state.
In 1964, a magazine called FACT polled mental health professionals on U.S. Senator and presidential candidate Barry Goldwater's mental fitness to serve as president.
The magazine published a cover story claiming that many found him unfit. After the election, Goldwater sued the editor for libel — and won. The entire ordeal engendered a debate in the mental health community and in 1973, the American Psychiatric Association (APA) adopted the "Goldwater rule," which says:
"… 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."
Today some psychiatrists say this clause is a gag rule. They claim that they have seen enough of Trump from his public utterances and tweets to decide the state of his health. But such diagnosis is inexact and subjective.
I find it in poor taste and an invasion of privacy — a view I expressed when the subject was Hillary Clinton's physical health after she took a spill on Sept. 11, 2016 in the midst of the general election.
Abandoning the Goldwater rule would set a dangerous precedent that would allow professionals and lay people to judge others to be mentally ill. With this sort of analysis, why stop with elected officials? Why not speculate about policemen? Or journalists? Or a high school principal? In fact, why not open the floodgates about psychiatrists?
We might discourage some extraordinary people from seeking public office. If people used this approach historically, we would have missed the noble leadership of many fine public servants.
Long before any debate about Donald Trump, in 2011, Dr. Nassir Ghaemi, a Tufts University professor, published a book titled: A First Rate Madness: Uncovering the Links Between Leadership and Mental Illness. In the book, Ghaemi sums up his thesis thusly:
"The best crisis leaders are either mentally ill or mentally abnormal; the worst crisis leaders are mentally healthy."
Ghaemai applied his expertise to the available medical records of noted leaders and asks a provocative question in his book:
"Why not just exclude the mentally ill from positions of power? As we've seen, such a stance would have deprived humanity of Lincoln, Churchill, Roosevelt and Kennedy. But there's an even more fundamental reason not to restrict leadership roles to the mentally healthy: they make bad leaders in times of crisis just when we need good leadership most."
By the way, Ghaemi does not entirely share my current opinion about Trump. He organized the meeting of the APA last year on the Goldwater rule and argued against it. "I think the problem with the rule is that it's too absolute, not that it's completely wrong but it goes too far."
"On the other hand, absolute censorship doesn't make sense either and that there are public behaviors and signs as well as documentary evidence like medical records that should allow for a legitimate psychiatric diagnosis to be made in public figures in some situations," he said.
We both worry about the impact of further stigmatizing those with mental illness by making diagnosis a political football. Ghaemi makes a good point when he says that one of the problems of the Goldwater rule is that it actually enhances the stigma: "We should be willing to make psychiatric diagnoses in our leaders and thereby not necessarily disqualifying them, but maybe even qualifying them in some ways."
If we as a society wish to impose a standard that any person seeking a particular office must first be evaluated by professionals to be physically and mentally competent, fine, let's do that. But to arbitrarily impose a post hoc analysis after voters have seen such a person run a campaign is not right.