Why psychiatrists should not be involved in presidential politics

The media, politicians, celebrities, athletes and other groups have questioned the fitness and mental health of the president, but one group has largely refrained: mental health professionals.

This recently changed. One of the latest efforts is a book, a collection of assessments by 27 psychiatrists and mental health providers, called “The Dangerous Case of Donald Trump.” Indeed, the book’s editor publicly renewed her concerns on Nov. 30, 2017 in a letter to The New York Times.

As an academic psychiatrist and advocate for those with mental illness, I want to discuss something important that has been missing in this debate: why bringing mental health, and mental health professionals, into politics in this way could end up causing substantial harm and be very dangerous.

Past perspectives, current concerns

When it comes to discussing the mental health of public figures, most psychiatrists and mental health professionals follow guidance – subsequently dubbed the “Goldwater Rule”– that the American Psychiatric Association issued in 1973.

In 1964 Fact Magazine had polled APA members about the “psychological fitness” of presidential candidate Barry Goldwater, a conservative Republican senator from Arizona.

The late Barry Goldwater’s conservative views led many Americans to question his mental health. AP Photo/file
In the considerable fallout that followed Fact’s provocative cover story, the APA formally stated that is is unethical for psychiatrists to give a professional opinion about public figures they have not examined in person and from whom they have not obtained consent to discuss their mental health in public.

On Oct. 17, 2017, the APA reaffirmed this stance.

Still, many mental health providers believe that commentaries about the current president fall within the realm of “duty to warn.” This principle basically says that if a patient is an imminent danger of harming another person, confidentiality should be broken, and the potential victim and legal authorities informed.

The APA, however, asserts that the duty to warn is a legal concept that does not apply if there is no “physician-patient relationship.”

A return of stigma?

Mental disorders are very common: Nearly one in five people experiences depression during their lives, one in four an anxiety disorder, nearly eight percent post-traumatic stress disorder, one percent schizophrenia and one percent bipolar disorder.

And yet, these patients have long been subject to different forms of discrimination, prosecution and dehumanization. Until recently, having a psychiatric illness or seeing a psychiatrist was something embarrassing to hide from others. That led to avoiding treatment, delays in seeking help and loss of potential for a prosperous life.

Stigma still affects political support and funding for mental health services and research. Our society has just begun to bring awareness to the public that, like any other medical condition, a psychiatric disorder is a disease that needs treatment and not to be embarrassed by. It has taken us centuries to gradually overcome the stigma, and we still have a long way to go.

When a politician calls a perceived enemy a paranoid schizophrenic, for example, as did former White House Communications Director Anthony Scaramucci, the public may see it as an uninformed and undignified insult. As a colleague and I recently wrote, however, the media and the medical professions should inform the public at such times that it is insensitive to use mental illness in this way.

Such insensitivity is harmful enough coming from a politician. A mental health professional should be even more cautious in using mental illness in the realm of politics. It could add to stigma. Psychiatrists need to keep in mind the first principle of medical practice: First, do not harm.