Sunday, January 14, 2018

Is Trump Mentally Unfit for Office? The Goldwater Rule Violated

Many of my readers do not know who Barry Goldwater was, let alone of the Goldwater rule established by the American Psychiatric Association in 1973.  The rule advises against psychiatrists commenting on the mental health of public figures they have not examined.   Obviously, a psychiatrist or any physician who has treated a public figure is prohibited to offer any public comment unless he has been authorized by the patient to do so.  On Tuesday, Dr. Ronny Jackson, the president’s personal physician, will discuss the results of the president’s recent medical examination with the press.  The boundaries of what Dr. Jackson can report will have been set in advance by the president.  

Senator Barry Goldwater

In the past month, the Goldwater Rule has appeared in our newspapers and all over cable news and commentary programs.  Goldwater has probably been a 'trending topic'.  This is in response to suggestions that the president may be mentally unfit for office.  I have heard physicians who have never examined the president making this claim.  And, seemingly beyond the reach of the Goldwater Rule, I have heard pundits and politicians – presumably with no medical training – suggesting or asserting that the president is non compos mentis. 

It is beyond obvious that many of these ‘mental health experts’ are simply using a new tool to attack a president whom they oppose politically or despise personally.  I oppose this practice both as a physician and as a citizen.  We cannot normalize average citizens or medical professionals on the sidelines offering psychiatric assessments of folks they don’t really know.  If this objectionable process were to become accepted, then it would be ultimately applied throughout society.  There would be an inexorable mission creep that would make all of us potential targets of these inquisitions.   If a boss at work, a teacher, an athlete or a customer started arguing, might this individual be labeled by onlookers as having a condition?

This practice disrespects those among us who truly have mental illnesses.  It furthers the societal stigma associated with these diseases that we have all worked hard to reverse.
There may be instances when it seems inescapable that a person is psychiatrically afflicted.  For example, folks who claim they are Napoleon, came from another planet or wrap their heads in tin foil likely have some psychiatric dysfunction.  But we don’t make policy based on rare anecdotes.

Mental illness is serious business.  Mental health professionals train for years and throughout their careers to gain and maintain necessary skills for diagnosing and treating these illnesses.  Leave it to the professionals. 

Political adversaries, columnists, cable news jockeys and average citizens have enough fodder to criticize the president without shooting arrows from psychiatric quivers.  

The wisdom of keeping silent is aged and timeless.

Those who guard their mouths and their tongues keep themselves from calamaity.
Proverbs 21:23.



  1. @kyste, you are absolutely correct and I am grateful that you pointed out my typo. I hope there will be no harsh judgment waged upon me from on high.

  2. I agree with you in your assessment on how we're assuming things about our POTUS. However, when you look at just the last few months on how the POTUS has berated immigration, Mexico, N.Korea with the childish responses with their leader. If the POTUS acts in this manor it seems to make sense for the rest of us to act the same way towards the POTUS doesn't it?

  3. Good point, Larry. I do think that our standards should be higher. Let's see if our dysfunctional government will shut down on Friday!

  4. Although in normal I would agree with you Michael, but this time I have to agree with Larry M. I have had my fill of POTUS and the damage he has done to this country.

  5. @bluerose, as usual you bring an artist's humanity to this blog. Neither of us voted for POTUS, but tens of millions of Americans did, who felt cast off by both parties. Personally, I think our legislators on both sides of the aisle are an embarrassment.

  6. I agree about both parties. All are more worried about being re-elected to a cushy job then trying to represent and protect the rights of the citizens.

  7. "It is beyond obvious that many of these ‘mental health experts’ are simply using a new tool to attack a president whom they oppose politically or despise personally. I oppose this practice both as a physician and as a citizen."

    Dr. Kirsch, you are a gastroenterologist, not a "mental health expert." I realize this is a blog post and, essentially, a personal opinion piece. However, when you comment as a physician and then assail the credibility of other physicians, your own credibility -- in my view -- comes into question. There are a number of unfortunate statements in your post (tin foil hats) and misinformation which do not further or elucidate a definitive judgment about this complex issue (the 25th amendment, Goldwater rule), but instead obsfuscate. Please note, I am NOT defending our president. My personal feelings about him are probably better served in a post elsewhere. I too share the general concern you have tried to express here.

    However, before commenting further on the issue of the assessment of mental health (an area in which I am qualified) in our President, I would urge you to read this piece, written by Michael Smerconish. It is an interview with a psychiatrist, Dr. Nassir Ghaemi. I found the thesis quite compelling and plan to read Dr. Ghaemi's book. Perhaps you might like to as well.

  8. George, I thank you for the comment. I never miss watching Smerconish each wk as he is one of the bright lights on CNN, in my view. I did watch the episode where Dr. Ghaemi was featured. I maintain that I do not favor physicians speculating on potential diagnoses of individuals they have not personally examined, which are generally offered without the consent of the target. I think it is irresponsible and has add'l consequences, which I outlined in my piece. Even worse, we read and hear political pundits, presumably with no medical training, offering their medical opinions on the president. The 'tin foil' reference that you cited was merely to admit the obvious - there are instances when a diagnosis of a thought disorder/psychosis can be made from afar even by a layman.

  9. Thanks for your response. A little too much coffee this morning. I, too, as a mental health professional get quite piqued when print and cable media trot out mental health experts, psychologists and even psychiatrists, to speculate on a psychiatric diagnosis for President Drumpf (his actual birth name - I refuse to acknowledge him and is "stage name" - what does that say about my own mental health?). It is all a rapidly vanishing point. He will never be removed from office for a mental health diagnosis because, as evidenced by our little back and forth, there will never be a disagreement on the nature, level, severity or impact of his supposed impairment. If you have 100 psychologists in a room, you will likely get 100 different opinions, etc. I do have to say that this whole exercise in speculation about the "personality" of the president has really awakened so many who, like me, for most of my life, looked at our American President as an almost "mythic" figure. Thanks for taking the time to respond. All the best to you.