Psychoanalyst, Show Some Modesty

Stewart Justman, PhD
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Recently the American Psychoanalytic Association reaffirmed its members’ right to pronounce on the mental health of public figures—in particular, the controversial Donald Trump. Making the issuance of this license a controversial act in its own right is the fact that the much larger and more influential American Psychiatric Association has expressly forbidden its members to render professional judgments on public figures for decades, a policy enacted after some 1200 of their number challenged the mental stability of the 1964 Republican candidate for President, Barry Goldwater—only for the magazine that polled them to be sued for libel, successfully, by the diagnosee.

The ban on armchair diagnoses of public figures by the American Psychiatric Association (which I will call by its common name, the APA, even though it shares those initials with the other body) is known to this day as the Goldwater Rule. As for Goldwater himself, he served in the United States Senate with every appearance of sanity until 1986.

Psychoanalysts may claim the authority to judge public figures, but in the United States the authority of psychoanalysis suffered a collapse decades ago from which it never recovered. Their practices and doctrines resistant to testing, Freudians or neo-Freudians ruled American psychiatry until their overthrow in the 1970’s cleared the way for the observational diagnostic system enshrined in the third edition of the APA’s Diagnostic and Statistical Manual (DSM-III), issued in 1980. (In sharp contrast to psychoanalytic judgments based on presumed or surmised causes, DSM-III deliberately omitted causal factors except in the case of a few diagnoses, notably PTSD.) The loose interpretive practices of the psychoanalysts made the strict empiricism of the new diagnostic system look good by comparison. At least people using DSM-III could agree on diagnoses.

Whereas the selling point of DSM-III was something called “reliability”—that is, its capacity to bring different observers to identical diagnostic conclusions—the disgrace of psychoanalytic judgments was their unreliability in every sense of the word. It was when that became intolerable, both as an affront to science and a public-relations liability, that the new DSM system was instituted.

To a good extent, then, we have the psychoanalysts’ abuse of interpretive license to thank for the DSM system that now rules—one that has proven only too effective at generating agreed-upon, that is, popular, diagnoses. Those concerned about runaway DSM diagnoses like ADHD (born as ADD in DSM-III) ought to reflect on the conditions that saw them into being and the downfall of psychoanalytic authority that made them possible.

Of the many factors that identify the DSM-III diagnostic system as a reaction or overreaction to psychoanalytic dominance, two stand out. First, whereas the psychoanalysts disdained specific diagnostic categories (a high priest of the sect, Karl Menninger, once proclaimed that “There is only one class of mental illness, namely mental illness”), such categories have multiplied ever since DSM-III came into being, to the point that the APA “manual” of mental disorders now approaches a thousand pages. Second, the architect of DSM-III, Robert Spitzer—whose organizational genius presides over the finished document a bit like Oppenheimer’s over the atomic bomb—trained as a psychoanalyst, only to reject psychoanalysis in favor of testable practices. The same path was taken by his successor, Allen Frances, now a critic of the overgrown and overweening DSM system itself, and most recently a defender of the Goldwater Rule.

In assessing the psychoanalysts’ fitness to pronounce on the mental health of public figures, let us remember the sort of florid absurdity that flourished when psychodynamic theories ruled. Those were the days when boys murdered their father and married their mother—and when the very nature of evidence was deformed. What meaning can evidence have if observed symptoms are less important than the “unconscious conflicts” that theoretically generate them?

The tyranny of theory figured in a notorious case reported in Science in 1973, wherein eight volunteers put psychiatry to the test by presenting themselves at the door of psychiatric hospitals claiming to have heard voices but acting perfectly rationally; transformed into clinical specimens and summarily dehumanized, they saw their own past “distorted by the staff to achieve consistency” with prevailing psychodynamic theory. (So wrote D. L. Rosenhan in his account of the hoax.) It was this sort of thing that eventually made psychoanalytic judgments an embarrassment in the eyes of the APA. Such were the excesses licensed by psychoanalysis that a figure didn’t need to have a past to become an object of Freudian judgment, even though neuroses theoretically trace back to early childhood. Literary critics under the influence of Freud used to make free pronouncements about fictional characters who do not, of course, possess an early childhood at all.

Over the construction of political difference as psychiatric deviance flies a black flag. In the Soviet Union dissenters were locked up in psychiatric hospitals; in Mao’s China incorrect thought was subject to the brutal correction known as thought-reform. In the light of such infamous abuses of psychiatry, we might have expected a principled psychiatrist to refrain from making political judgments. However, at least since the effort to identify the sources of “the authoritarian personality” following World War II, many have been strongly tempted to bend psychiatry to political ends. The APA itself could not refrain from instating in DSM-III a diagnosis born of intensely political opposition to the Vietnam War: PTSD, a hot spot in the DSM system.

At the root of the proclaimed right to issue psychiatric diagnoses of public figures despite all we know of the fallacies and risks of that practice, and despite the biodiversity of the labels applied, is hubris. When Jane Doe declares Mr. Trump reckless, she expresses a political view just as you or I do. When a psychiatrist declares Mr. Trump pathologically reckless (like his forebear, Mr. Goldwater), he expresses no ordinary view but speaks in the name of scientific knowledge, with its higher credentials, whether or not this knowledge actually exists. Such professional opinions on public figures have a way of tracking their authors’ merely political opinions, but costuming the latter as psychiatric findings gives them the appearance of something august and imposing. The offering of professional opinions on public figures turns out to be a higher form of character assassination.

When I was a kid we were taught not to use ad hominem arguments. “Stick to the issues and keep personal comments out of it.” Maybe this rule was intended to prevent debate from spiraling down into indecency, but I wonder if the thought behind it was as instrumental as that. Ad hominem argument was just dirty pool, and everyone knew it.

Like the many objectors to the Goldwater Rule in the APA itself, our psychoanalysts now act as if they were above such a trivial restriction. They are not. Reserving to themselves the right to argue ad hominem, claiming the higher truth of a dubious science for their political verdicts, they injure civil society even as they decry the object of their hatred as a threat to civilization.

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11 COMMENTS

  1. Regardless of the APA involved, psychoanalytic or psychiatric, and that just because Goldwater sued a magazine, I don’t think there is any way to keep diagnosis out of politics and vice versa.

    “The offering of professional opinions on public figures turns out to be a higher form of character assassination.”

    The offering of professional opinions on private figures could be said to have always been a lower form of character assassination were, rarity of rarities, truth told outright.

    I don’t think much of the Goldwater Rule without an equally valid John (or Jane) Doe Rule, and as psychiatry (drug therapy) has little more validity than psychoanalysis (talk therapy), I don’t have a problem with bringing Donald J. Trump down to the level of fellow human being John Doe (AKA every-man or anonymous).

    It’s a truism to say man is a political animal. Unfortunately, in this day and age, one also might call it a truism to call man a psychiatric animal, given the pervasiveness of medicalization, and what it boils down to, the political usages for that social tool for suppression of the human animal. Let’s not pretend this ultimately harmful labeling applies only to big shots, over-blown names, and celebrities in this rapidly shrinking world of ours’ when your every-man has received more than his share of the same sort of abuse as many of the readers of MIA will readily testify.

  2. Thank you for this very important article. I could not agree more.

    To me it is the power accorded to professionals, in this case psychiatrists and psychologists, which make things so dangerous in our society: the power to treat without informed consent, the power to assert theories of ‘causation’ of mental illness as if their theoretical constructs were fact, even the power to ‘control’ use of drugs through prescriptions when so little is actual known about the real effects of psychiatric drugs in the aggregate. What is so scary to me is that I have heard good, nonconformist type people talking about how it would be good for psychologists to be able to diagnose Trump as it could control who became a political figure…..imagine a world where you would need to pass a psychiatric test to go into politics!!!!!! Then they would really have us even more than now.

  3. Does anyone have to forbid armchair diagnosis of heart disease or cancer or a broken leg?

    This is merely reflective of the negative power of psychiatric “diagnosis” in society at large. People make “armchair diagnoses” all the time, all over TV and movies and in cafes and living rooms around the country. The very subjective and judgmental nature of these labels play into the human desire to lump people into “us” and “them” and to spread blame and hostility toward someone we want to downgrade or humiliate or feel superior to.

    While I personally can’t stand Trump due to his immaturity and his deep involvement in corruption, slapping a “diagnosis” on him is simply a childish exercise of acting out against the “bad daddy.” Not only should psychiatrists and psychoanalysts be forbidden from diagnosing public figures, the whole concept of “diagnosis” based on behavior and emotional state should be scrapped, because it serves no real purpose besides stigmatizing and distancing us from those who are so labeled.

    • Totally agree, Steve.

      A truly excellent comment that anyone who has ever proclaimed a diagnosis should contemplate, whether it be about their “friends”, families, enemies or a public figure. To diagnose is to place yourself above the other and is a power game and a put down.

      It proclaims more about the diagnoser than it does about the diagnosed.

      • “To diagnose is to place yourself above the other and is a power game and a put down.” Of course, mik, what does it say about one who is so insecure as to behave in such a staggeringly immature manner? And is make believing you’re better than another, abusing one’s power, and defaming another actually diagnosis? No, I’m quite certain that is not the definition of diagnosis in “real” medicine.

        Good point, Steve, “Does anyone have to forbid armchair diagnoses of heart disease, or cancer, or a broken leg?” No, because those illnesses are provable or “real,” as opposed to the scientific fraud of the psychological and psychiatric “diagnoses.”

  4. This article only makes sense if one believes that DSM diagnoses have any validity, which I do not. While I agree that practitioners shouldn’t publicly diagnose people they don’t know or speculate about their “mental health,” I think that misses the point. People- practitioners and the public- should stop talking about Trump’s “mental health,” which is a red herring deflecting attention from the real issue – his reprehensible behavior. Putting a psychiatric label on it is not relevant, and only serves to inflame the public’s dislike and dismissiveness toward those of us with psychiatric labels.

  5. HERE It’s : APA *Plott* to overthrow Trump

    This is a psychologist’s duty to warn—most will have heard of this rule in the context of mandatory reporting of child abuse. Now the organization Duty to Warn applies this same logic to commenting on the mental health of Donald Trump, with its Facebook page writing that “Donald Trump is too seriously mentally ill to competently discharge his duties as president and must be removed according to the 25th Amendment.” The group and its petition have reached the public ear in such spaces as the Daily Kos, USA Today, New York Magazine, Salon.com, and many more.

    Now the group is making a push for signatures before multi-city town hall events, scheduled for October 14, 2017 in Atlanta, Chapel Hill, Charlotte, Chattanooga, Chicago, D.C., Los Angeles, New York, Phoenix, and San Francisco (with additional cities possibly added).

    The petition in its succinct entirety reads as follows:

    We, the undersigned mental health professionals (please state your degree), believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And we respectfully request he be removed from office, according to article 4 of the 25th amendment to the Constitution, which states that the president will be replaced if he is “unable to discharge the powers and duties of his office.