Five Reasons for Therapist to Not Diagnose Trump
A number of prominent mental health professionals have offered their clinical assessment of Donald Trump and declared him unfit for office. Others have opposed doing this. When I wrote of one of earliest therapist statements about Trump and Trumpism (the Citizen Therapist Manifesto Against Trumpism (published on June 22 and subsequently signed by over 3,800 therapists), I came out firmly against diagnosing Trump. The new membership organization I started, Citizen Therapists for Democracy, takes the same position.
My reasons are not primary ethical: public figures are fair game for responsible speculation about their state of mind, and the famous “Goldwater Rule” about not offering diagnostic opinions public figures is not really an ethical rule (just a guideline) and it applies only to psychiatrists. Here are my five central reasons for therapists to not engage in public diagnosis of Donald Trump.
1. It won’t be effective. The whole country has access to the same “data” on Trump’s personal behavior, and his supporters in the public and Congress are going to be extremely loath to declare him unfit just because of a number (and not all) mental health professionals think so. He’d have to be flagrantly psychotic for there to be a consensus—and absent a consensus, nothing will come of our declaring him diagnostically unfit for the office, except the harms described next.
2. It would be perceived as partisan and political. I’d wager that none of the signatories on the various diagnostic statements voted for Trump. There is no way to avoid the accusation that their professional views are influenced by their political beliefs and opposition to Trump.
3. It would “weaponize” diagnosis. Future political campaigns would likely engage in a new form of attack: declaring that the opponent is not only misguided but mentally unfit. I’m sure there will be enough mental health “consultants” out there to argue for such positions about any Presidential candidate. (I’ve had conservative therapists offer me diagnoses of Hillary.)
4. It could further stigmatize people dealing with what would inevitably become the “Trump Diagnosis.” Psychiatrist Allen Frances, chief architect of DSM IV, has repeatedly urged his colleagues not to create further stigma for people who have significant personal distress from personality disorders—more than Trump appears to have. Like Legionnaire’s disease was the unfortunate name identified with an infectious disease outbreak, pinning a label on Trump would identify many innocent people with his personality.
5. The end result could be a “tribal” backlash against mental health treatment. Once an issue becomes caught up in political loyalties (think: climate change), millions of people reflexively see it as identified with the other side. If Trump and his loyalists were to go on the attack against the “unfit for office” proclamations of mental health professionals, they could drive a large swath of people away from getting help for a generation—and to no good effect for the public good (see point #1). I can even write Trump’s public statement:
"Those navel-gazing losers are using their so-called professional platform in the most disgusting way. They all voted for Hillary and now they're taking revenge. They are disgusting people. I wouldn't send anyone to them for help. The fact is that I am sanest person I know--maybe the sanest person in the whole world. If these shrinks don't see that, they're the crazy ones. They're the unfit ones, totally unfit."
This doesn’t mean that I don’t personally agree with many of my colleagues’ concerns about Trump. It’s just that there more effective and less risky ways to oppose what he is doing. We turn diagnosis into a stigmatizing political weapon at our own peril and that of the American public whose trust we need.