No president should assume office without a ‘fitness for duty’ exam

Since the beginning of Donald Trump’s presidency, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone who exhibits what we have called his “dangerous” signs.

The observed signs have included “grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality.”

As a psychiatrist and expert on violence, I worked with my colleagues to put our observations into a book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President,” responding to the hunger for understanding on the part of the public.

I was never interested in domestic partisan politics until it coincided with my concerns for public safety as a violence scholar. As a scientist and physician, my training leads naturally to making conclusions that are based not on ideology or personal preference, but on research evidence and medical needs.

Now, since the Democratic Party will have the majority in one-half of the legislative branch of government and can provide some oversight of the presidency, it seems a propitious time to begin an important, civilizing conversation about mental health in the presidency.

All American military personnel must pass a fitness for duty exam before they serve. Further, those who handle nuclear weapons undergo an especially rigorous screening process that is updated every year.

That United States commanders-in-chief are not put to the same test before they are allowed to lead the troops or to order the use of nuclear weapons is, I believe, a serious omission.

Trump shakes hands with White House physician Dr. Ronny Jackson after his first medical checkup as president in January 2018. AP/Carolyn Kaster

Assessing fitness for the job

Evaluations of fitness, or capacity, or competence, are specific to the requirements of a task or job. The exam can be suited to any job.

The U.S. Army’s field manual, for example, includes elements that are critical for fit leadership: trust, discipline and self-control, judgment and critical thinking, self-awareness and empathy.

One can deduce, for example, that the minimal requirement for a U.S. president is to have the ability to take in information and advice, to process that information and to think about consequences before making sound, reality-based decisions.

Fitness for duty tests also assess an employee’s capacity to work without putting their own or others’ health and safety at risk.

In the case of Trump, there have been numerous, concerning signs that suggest he may lack that capacity.

The potential for violence is best assessed through a past history of violence, including verbal aggression and incitement to violence, and a structured checklist of personal characteristics.

Courts and employers may legally request capacity evaluations, which forensic mental health professionals – who practice at the interface of mental health and the law – usually perform. They are independent of the interested parties and are not engaged in treatment with the person being evaluated.

Ideally, these exams would be given before a person takes the job. They can also be ordered after a worker has shown signs of incompetence.

Incapacity is not the same as mental illness. Mental illness per se does not make a person unfit for duty, just as one can be unfit and yet not have a diagnosis of mental disorder. Abraham Lincoln famously suffered from debilitating depression, which may have helped him to be a better, more compassionate leader.

The House of Representatives, under new Democratic leadership, could begin a discussion of presidential fitness for duty. AP/J. Scott Applewhite

Mental capacity should inform political discussion

Since President Trump took office, news reports have revealed that discussions had been held among GOP members and even high-level government officials about the 25th Amendment. That amendment allows the removal of a president who is unable to discharge the powers and duties of his office.