Is Trump Nucking Futs? Many Psychiatrists and Psychologists Want Ethical Permission to Say Trump is Clinically "Cray Cray".
The Goldwater Rule
Back in the 1960s when Barry Goldwater was running for President, many Psychiatrists and Psychologists publically opposed him, saying he was mentally unstable. That was when psychology was based almost entirely on the Freudian and Jungian psychology of thought and feelings analysis. In the aftermath, the psychiatric profession decided it was not a good idea to use subjective Freudian and Jungian psychology to “diagnose” someone publicly without first examining him. The American Psychiatric Association adopted the “Goldwater Rule” as part of its Code of Ethics, proclaiming it was unethical to do so:
"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."
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
For many decades, the psychiatric community was searching for a more objective way of identifying mental disorders based upon the subject’s observable behavior instead of the subject’s thoughts and feelings. The Diagnostic and Statistical Manual of Mental Disorders (abbreviated DSM) was another approach to diagnose mental disorders. It started a decade before The Goldwater Rule and began to slowly gain popularity. Instead of using the subjective interpretations of Freud and Jung, DSM looked at observable behaviors of the subject and used those behaviors in forming diagnoses.
DSM reached its second level of maturity and started gaining limited acceptance among the psychiatric community in the late 1960s, with revisions and enhancements that culminated in DSM Axis II. By DSM Axis III in 1980, the psychiatric profession had adopted DSM as a mainstream diagnostic tool, although there were still a number of notable detractors. DSM Axis IV was published in 1994 and it took almost 20 years for DSM Axis V to be published, Also known as DSM-V or DSM-5, it is broadly accepted in the psychiatric community with far fewer detractors than in previous levels.
“Both the categorical and dimensional representations of DSM-IV personality disorders had stronger relationships to impairment in functioning in the domains of employment, social relationships with parents and friends, and global social adjustment and to DSM-IV axis V ratings than the three- and five-factor models. DSM-IV dimensions predicted functional impairment best of the four approaches.”
Given the subjective approach of DSM-5 and Trump’s recent public displays of antisocial behavior, many in the psychiatric community are calling for the repeal of the Goldwater Rule from their code of ethics. Why? They feel it is their medical responsibility to call out the danger of Trump’s antisocial behavior to Americans and the world at large. The American Academy of Psychiatry and the Law published an opinion paper on National Institute of Health, National Library of Medicine website that differs with the Goldwater Rule. Excerpt:
“However, the Goldwater Rule presents conflicting problems. These include the right to speak one's conscience regarding concerns about the psychological stability of high office holders and competing considerations regarding one's role as a private citizen versus that as a professional figure. Furthermore, the APA's proscription on diagnosis without formal interview can be questioned, since third-party payers, expert witnesses in law cases and historical psychobiographers make diagnoses without conducting formal interviews. Some third-party assessments are reckless but do not negate legitimate reasons for providing thoughtful education to the public and voicing psychiatric concerns as acts of conscience. We conclude that the Goldwater Rule was an excessive organizational response “to what was clearly an inflammatory and embarrassing moment for American psychiatry.”
The DSM-5 has rendered the Goldwater Rule obsolete. More reading material: NYT letter: 15 psychiatrists break Goldwater rule warning about Trump’s grave emotional instability -- DailyKos; Psychiatrists fight over the ethics of diagnosing Trump -- CNN
Diagnosing Trump based upon the Mayo Clinic definition and characteristics
The simplicity of the DSM-5 methodology comes from being based upon observable behavior and not analysis of thoughts and feelings. It doesn’t require a Ph.D. in Psychology or an M.D. in Psychiatry to observe antisocial behavior and match it to the criteria established for various personality disorders. It only takes a modicum of inferential and deductive logic to understand Trump exhibits nearly all of the characteristics of a Narcissistic Personality Disorder. Let’s examine the definition of Narcissistic Personality Disorder and behavioral characteristics as defined on the Mayo Clinic website:
“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.”
- Requiring constant admiration: “I'm rich”.
- Believing that you are superior and can only be understood by or associate with equally special people: “I'm rich”; “I'm smart”; “You're stupid”.
- Behaving in an arrogant or haughty manner: “I'm rich”; “I'm smart”; “You're stupid”; “Look at that face”; “Grab ‘em by the pu**y”.
- Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate: “I’m rich”; “I’m smart.”; “Perhaps, I’d date my daughter”; 3 wives who were professional models.
- Having an exaggerated sense of self-importance: “Nobody’s ever been more successful than me.”; “Nobody knows more about trade than me.” “Nobody knows banking better than I do.”; “Nobody knows more about debt than I do.”; “Nobody’s bigger or better at the military I am.”
- Exaggerating your achievements and talents: “I turn on one of the networks, and they show an empty field, I'm like, wait a minute. I made a speech. I looked out, the field was, it looked like a million, million and a half people.” In reality, there were about 250,000 on the Mall. In his book Art of the Deal, Trump admits making extensive use of “truthful hyperbole”, which itself is an oxymoron.
- Expecting to be recognized as superior even without achievements that warrant it: “My dad gave me a small loan, only a million dollars.” In reality, Daddy Fred Christ Trump bailed out DJ Trump numerous times, the last time buying $3.4 million in chips from Trump’s failing Casino, chips which Fred Trump never intended to cash in and never did.
- Expecting special favors and unquestioning compliance with your expectations: “I give to everybody. When they call, I give. And do you know what? When I need something from them two years later, three years later, I call them, they are there for me.”
- Taking advantage of others to get what you want:Trying to take an old lady’s house under eminent domain so Trump could build a limo parking lot; Shortchanging vendors and investors. 3,500 lawsuits.
- Having an inability or unwillingness to recognize the needs and feelings of others: Mocking a reporter with a physical disability; Total disregard for the plight of refugees; Misogynistic remarks.
“ As with other mental disorders, the cause is likely complex. Narcissistic personality disorder may be linked to:
Mismatches in parent-child relationships with either excessive pampering or excessive criticism
Genetics or psychobiology — the connection between the brain and behavior and thinking.”
Conclusion
It is time for the American Psychiatric Association to dump the Goldwater Rule and assume the responsibility of letting us know what they really think about our President’s mental health condition. Will they tell us Trump is cray cray? Probably so, but not in those exact words. They’ll call it a Narcissistic Personality Disorder, or maybe even an Antisocial Personality Disorder (formerly called a Sociopathic Personality Disorder). Everyone will exhibit narcissism to some extent, but that’s not even close to having a clinical disorder.
Nixon once said “People have got to know whether or not their president is a crook”. We already know our President is a scofflaw crook, what we really need to know is whether or not our President is clinically nucking futs, and an obsolete Code of Ethics should not prevent us from finding out.