Earlier this year, Philadelphia psychiatrist Claire Pouncey was invited to contribute to a new book that says President Trump is so mentally unstable that he is a danger to the country and should be ousted.
Pouncey declined. She decided to abide by the American Psychiatric Association's rule that it's unethical for psychiatrists to diagnose someone without a proper examination and the subject's permission.
Yet this week, Pouncey decried that rule and defended her colleagues who have broken it.
"Protecting the public health and safety is part of the ethical commitment we make as physicians," she said in an editorial in the New England Journal of Medicine, which sought her thoughts on the controversy surrounding the book.
The volume, she wrote, "is unapologetically provocative and political, and the authors clearly take themselves to be contributing to the improvement of the community and the betterment of public health."
In an interview, Pouncey added, "I'm not saying there's an ethical obligation for psychiatrists to speak out. I'm saying, where they feel compelled to speak, they have an ethical right."
The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, edited by Yale University psychiatrist Brandy Lee, was published in October and quickly became a bestseller. Like other anti-Trump books, it's unlikely to change his supporters' minds.
But unlike other tomes, it has stoked a debate over the ethics of shrinks shrinking public figures.
This is not a new debate. In 1964, after Republican presidential nominee Barry Goldwater sounded too eager to use nuclear weapons in Vietnam, Fact magazine polled psychiatrists about whether he was fit to be president. Goldwater sued the editor for libel and won. The APA's resulting "embarrassment," Pouncey wrote in an editorial, was one reason the organization came up with the so-called Goldwater rule against such commentary – but not until years after the Fact article.
Pouncey, a philosopher and bioethicist as well as a psychiatrist with a private practice in Rittenhouse Square, trained at the University of Pennsylvania. She has long studied conceptual and practical problems related to her medical field, and is a recent past president of the Association for the Advancement of Philosophy and Psychiatry.
The summer before the 2016 election, she argued in a scholarly article that the Goldwater rule is no longer relevant and may keep psychiatrists from following their consciences.
No one seemed to care — it was "a totally dead topic," she said — until Trump won the election. Suddenly, pundits, politicians, and unhappy voters were bandying medical terminology such as "narcissistic personality disorder," "sociopath," "delusional," and even "demented" to describe the leader of the free world.
"Psychiatrists are the only members of the citizenry who may not express concern about the mental health of the president using psychiatric diagnostic terminology," Pouncey wrote in her editorial.
Columbia University psychiatrist and APA past president Jeffery A. Lieberman — who advised Democratic presidential nominee Hillary Clinton on mental health policy — has become a leading defender of the Goldwater rule, though he says he is "shocked and saddened by the president's behavior."
Rebutting Pouncey in the New England Journal, Lieberman pointed to psychiatrists' history of support for Nazi eugenics and involuntary confinement of religious and political dissidents.
"Psychiatry has made too many past missteps to engage in political partisanship disguised as patriotism," he wrote.
Ethical debates aside, what does Pouncey think of Trump's mental health?
"That's exactly what I'm not speaking to," she insisted. "I won't speak about Trump. I actually uphold the Goldwater rule."