The President’s Fitness: Can Professionals Help Decide?

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Even before Donald Trump became President of the United States, speculations about whether he was fit to serve were rampant. Although it is beside the point, much time and heated debate consisted of questions such as, “Is he mentally ill?” and “Which kind of mental illness does he have?” In our psychiatrized nation, such discussions have widely been heard as meaning: “Trump is mentally ill, and that makes him unfit to serve as President.”

Most readers of Mad in America know that both the overarching category of “mental illness” and the hundreds of alleged subcategories listed in psychiatric classification systems have no scientific basis and are not useful in helping people who are suffering or stopping those who make other people suffer. I addressed this in an article I wrote fairly early in the debate, called “The Truth about Trump and Psychiatric Diagnosis.”

Most readers of Mad in America also have a healthy skepticism about what—or whether—professionals have anything to contribute to the benefitting of society. So the question is whether that skepticism applies to determining whether Trump or any President is fit to serve in that office. I think that, for once, it does not, but I have a very specific reason for saying this.

The 25th Amendment to the United States Constitution was supposed to provide for the removal of an unfit President. It was “proposed by Congress and ratified by the states in the aftermath of the assassination of President John F. Kennedy” and “provides the procedures for replacing the president or vice president in the event of death, removal, resignation, or incapacitation.” However,  the devil is in the details, and the Amendment turns out to be woefully inadequate. Why? Because Section 4 provides that:

Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

However, even if that happened in Trump’s case, the Amendment provides that if the President just declares in writing that “no such inability exists,” he continues in his office unless the Congress determines by two-thirds vote of both Houses that the President is unable to discharge the powers and duties of the office. It’s not hard to imagine that with the current Senate, that would be unlikely to happen, given the Senate’s utter failure to act after the House of Representatives impeached the President.

Congressman Jamin Raskin (D-MD).

Congressman Jamin Raskin (D-MD), a brilliant Constitutional law scholar, has tried to draft legislation that would get around the highly political nature of the process as it is described in the Amendment. He aimed to create a mechanism for determining fitness to serve by creating a Commission for that purpose. In correspondence with me (Sept. 4, 2017), he explained the further wish to avoid making the process solely “psychiatric or medical,” because then, “people will say the decision has been medicalized or psychologized when it is properly a public policy question.”

His idea was to constitute a Commission with a mix of public policy, medical, and psychiatric professionals. Since fitness to serve can be affected by such physical impairments as those caused by strokes and comas, it makes sense to include medical personnel who are not psychiatrists. The legislation he proposed was HR 1987 from the 115th Congress, to which 70 members of the House of Representatives signed on, all Democrats.

I sent Congressman Raskin a proposal in which I strongly argued against including mental health professionals who would likely focus on psychiatric diagnosis. I pointed out not only that such diagnoses are unscientific but also that many people who have been given such labels have done great work and done no harm.  I then pointed out that some psychologists and educators can offer information and tools that are directly relevant to fitness to serve.

In fact, it strikes me as quite simple: Determination of fitness to serve should be based on whether the office-holder can carry out the crucial elements of the job. Professionals who are trained in developing and administering reliable, valid achievement tests and tests of memory and abstract thinking—primarily some psychologists and educators—could play crucial roles in such a Commission.

Here are excerpts from what I wrote to the Congressman on January 4, 2018, and which still applies. I have added slight clarifications in square brackets.

  1. If you have [psychiatrists] on the Commission, whatever they say will not be scientific, not empirically demonstrable, and thus open to accusations that the process is improperly political. Where there is no science (there is none in psychiatric diagnosis), there is only opinion, and opinion is always highly susceptible to bias of many kinds.
  2. The Commission ought to include a neuropsychologist, since they are trained to give standardized memory tests, and memory is of course an essential component of fitness to serve.  The Commission should arrange to have [chosen or] constructed the relevant tests of fitness, which are in many ways achievement tests — tests of knowledge about the Constitution ([a] book being published tomorrow includes…that someone tried to discuss the Constitution with Trump and got as far as the 4th Amendment before he changed the subject, so this is a timely way to point out the usefulness of the approach I suggest), how a bill becomes a law, geography, political systems globally, and tests of memory and of the understanding of abstract concepts including but not limited to cause-effect relationships.
  3. The tests described in (2) have a parallel in the achievement tests a person applying for U.S. citizenship needs to take. As you said, the Constitution does not include requirements as in (2), but those become relevant once the question of fitness to serve is raised.
  4. Various people throw around the term “mental” as in “mental impairment.” It is essential to distinguish between two kinds of “mental impairment”: There is emotional impairment [or difference] (e.g., absence of empathy and compassion, believing oneself to be Jesus Christ [if one is not]), and there is cognitive impairment (e.g., dementia, reading disability, math disability, inability to form or comprehend abstract concepts). Just a note: Trump may be suffering from both lifelong cognitive impairment (one of his professors from Wharton called him the dumbest student he ever had) and perhaps now, some dementia. [T]he way he slurred “United States” recently is not explained by dry mouth as was suggested. He could be having small strokes. That’s why a neurologist as well as a neuropsychologist would be good to have on the Commission.
  5. If you left out Trump’s name and just told anyone some things he has said and done, they would assign labels such as “bully,” “whopping sense of entitlement,” “power-hungry,” “stunning lack of empathy and compassion” [and “thug,” “criminal,” or “evildoer]. These are more than adequate to explain a huge amount of what we see in him. Ask people what they think calling him “mentally ill” would add. What does it explain that is relevant to fitness to serve as President? Saying he is unfit to serve because of being mentally ill is causing huge offense to people who have psychiatric labels, and that may well come close to 1/3 of the U.S. population. Abraham Lincoln would have been diagnosed as mentally ill. A psychiatric label is orthogonal to the matter of fitness to serve.
  6. The kinds of tests described in (2) are exquisitely specific, jargon-free, and inarguably relevant to fitness to serve.

Congressman Raskin, in a May 6, 2020 email to me, said that if he were to rewrite the legislation today, he would include Governors and a neurologist. He noted: “All of the events we are living through reconfirm for me that the critical concept under Section 4 of the 25th Amendment is ‘dangerous unfitness’ to discharge the powers and duties of office.”

Despite all of the above, many psychiatrists and psychologists have claimed that they have “special expertise” and extensive training that qualify them to judge Trump to be mentally unfit and dangerous to this nation’s “public health.” Their position is that they have a “duty to warn” that justifies their ignoring of the Goldwater Rule, which prohibits the giving of professional opinions of anyone the therapist has not evaluated in person.

Of course, given that psychiatric diagnoses are not valid, the Goldwater Rule by all rights should specify that no one should ever give anyone a psychiatric diagnosis. But the rule refers to more than just diagnosis, so the professionals who claim special expertise—who tend to vary among themselves, and some of whom vacillate between saying he is mentally ill and saying diagnosis is beside the point—should stop claiming that they must speak out because of that alleged expertise.

For psychiatrists, psychologists, social workers, and other therapists to claim that they are essential for warning people that Trump is dangerous is to claim special expertise and insight to which they are not entitled, and it simultaneously demeans the judgment of nonprofessionals and helps strengthen the power of their guilds.

The fact is that, as longtime expert on dangerousness Dr. James Gilligan has said, the only good predictor of dangerous behavior is past commission of dangerous acts, and as Dr. Gilligan pointed out in a press conference at the National Press Club in February, 2018, Trump himself has acknowledged his own dangerous behavior, including but by no means limited to his sexual assaults.

My middle-school grandchildren observed this with no help from any professional or anyone older than they. There is, then, a role for some professionals in trying to remove unfit officials from office, but it is not the one that some would like us to believe.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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160 COMMENTS

  1. Thanks Paula.

    Obviously since psychiatry is nothing more than out dated, used up bunch of non sense, we could never use their hierarchy to yell that word of old, “TREASON”. Sure they have fancy words for “treason”, but it works out the same.
    But then, we should surely just get rid of psychiatry altogether, since we are pretty sure that Trump would fail the absolute normalcy tests as would most everyone else. And that is the danger, any system powerful enough to get rid of someone in a job, then it becomes possible to oust a “good guy”.

    THAT is what psychiatry is NOT capable of, prediction. Psychiatry cannot “KNOW” someone anymore than I can, and let me tell you, I used to “diagnose” people even without licence tsk tsk.
    Now I try to limit it to diagnosing professionals 🙂

    I’m not sure what a perfect system looks like, it is SO complicated. I think back on Canadian history and all the GREAT leaders we have had, yet I know HOW HORRIBLE it was for indigenous under these fabulous men who created Canada.

    It really seems to be all about authority and power, which we would all like some of. It is one thing that hurts so much, that psychiatry can basically strip people of complete power and it is condoned and applauded.

    So in one way, because Trump believes in psychiatry so much, perhaps he should taste it? But not just ousted, make him see what the process feels like.
    Okay just kidding 🙂

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      • Although the vast majority of “the right” also supports psychiatry, if often for different reasons. There are few of any political stripe willing to really challenge the psychiatric status quo or the drug companies who line our politicians’ pockets in a very non-partisan manner.

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        • Steve,

          Oprah Winfrey doesn’t seem to criticise Psychiatry.

          Deepak Choprah seriously questions western medicine but does not seem to criticise Psychiatry.

          Even Jordan Peterson after his dreadful drug withdrawal experience is not critising Psychiatry (too much).

          The majority of politicians would be too legitimately frightened to challenge Psychiatry.

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        • Well, as we are seeing with the COVID situation, the former “left” has become even more totalitarian than the “right” in many ways. I see neoliberals as more fervent in their support of psychiatric eugenics and 2-bit junk science theories about “personality disorders” and “chemical imbalances.” “Conservatives” are less nuanced and more concerned about protecting themselves from violent “crazies,” but also less impressed with psychiatric rhetoric. Right now I consider the faux-“left” the biggest problem by far. (It wasn’t like this when there was a true left.)

          As it stands there are NO politicians who would publicly support abolishing psychiatry or anything close, as can be seen from the essentially unanimous vote for the “Murphy”/Cures Act in 2016, which was enthusiastically signed by Obama.

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          • The key word is “eugenics”. It’s primarily a philosophical (or political) ideology dating back to at least Plato’s Republic. The chemical imbalance theory, and all the other theories that come out of “psychiatry science”, are, in their view, “noble lies”. That’s why the “left” pretend to be impressed by “psychiatric science”. It’s sort of the “soft” option. The end result is the same. Straight out euthanizing the undesirables causes more problems. It’s harder to argue on ethical grounds when it’s done in that way. At least with poison, there are a lot of “scientists” willing to make up things to make it seem “scientific”.

            I think the 80’s, with Thatcher and Reagan, saw the end of the “true left”. That was when I stopped being interested in politics.

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        • They do seem to favor Ben Franklin as opposed to Abe Lincolns.

          As far as the fear goes, politicians are certainly afraid of psychiatrists. They know that the dog has rabies and has been let out of the cage, because they’re the ones who unlocked the cage in the first place to create the fear. Obviously thinking they could exploit the fear they created, and not thinking through the fact that the mad dog doesn’t care who it bites, just that it gets to bite. And now who is going to put it back into the cage? As an abolitionist I have a method not available to reformists. Put it down rather than try to pat it into submission lol.

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        • Doctors, including psychiatrists, have a sort of “special place” in society because they know things about you that others don’t know and can do things with you that others can’t. They have special professional privileges with their clients which are supposedly guarded by a professional code of ethics. If a professional turns criminal he would normally be barred from continuing to practice. For some reason, this has not happened to many psychiatrists. Psychiatrists, in particular, can develop “leverage” with clients (which may include, by the way, people in politics or their family members) because of confidences some clients share with their doctors.
          This is over and above the general societal tendency to give the body more importance than it is due and the mind more mystery than it actually has. In this sense they are a kind of modern magician or witch doctor and can cultivate acceptance in society way beyond their actual contributions (or even in spite of destructive behaviors).
          You could actually say something similar about political leaders!

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  3. Hi Paula,

    this caught my attention. “The fact is that, as longtime expert on dangerousness Dr. James Gilligan has said, the only good predictor of dangerous behavior is past commission of dangerous acts”

    The reason being that the justifcation for chemically koshing me by a psychiatrist was that I had “potential for violence, but no actual history or clear intent”. My response to our Chief Psychiatrist was that this constituted every person on the planet, and I consider it to be nothing more than the paranoid delusion of the author of the comment. In fact much of the writings of these delusionals seems to revolve around the use of certain terms such as “violent”, “substance abuse”, “dangerous”, and as a fan of Lost in Space “Warning Will Robinson”. They create fear and suspicion and then exploit that very fear.

    “For psychiatrists, psychologists, social workers, and other therapists to claim that they are essential for warning people that Trump is dangerous is to claim special expertise and insight to which they are not entitled, and it simultaneously demeans the judgment of nonprofessionals and helps strengthen the power of their guilds.”

    We nonprofessionals should be offended by this conduct of people who have in my case demonstrated the morals of sewer rats. negligence fraud and slander disguised as medicine, and it is only that they have managed to destroy any and all avenues of remedy that allows them to continue with their abuses.

    I appreciate your opinion on these important matters by the way.

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    • “For psychiatrists, psychologists, social workers, and other therapists to claim that they are essential for warning people that Trump is dangerous is to claim special expertise and insight to which they are not entitled,” since “psychiatric diagnoses are not valid.” To the contrary, the DSM disorders are all “invalid.”

      https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

      “the Goldwater Rule by all rights should specify that no one should ever give anyone a psychiatric diagnosis.” Excellent point, Paula.

      “But the rule refers to more than just diagnosis, so the professionals who claim special expertise—who tend to vary among themselves, … some of whom vacillate between saying he is mentally ill and [some] saying diagnosis is beside the point—should stop claiming that they must speak out because of that alleged expertise.” Alleged expertise which is scientifically “invalid,” thus “irrelevant to reality.”

      Waaalaaaa, those Holy Spirit blaspheming “mental health” workers, who denied the Holy Spirit’s existence, and claimed the Jewish name for god to be “irrelevant to reality,” are now the “irrelevant to reality” themselves. “There is, then, a role for some professionals in trying to remove unfit officials from office, but it is not the” scientifically “invalid” DSM “bible” thumpers. Thank you for speaking the truth, Paula.

      And let’s hope some day soon, that the DSM “bible” thumpers will garner insight into what a scientifically “invalid” group of “mental health” industries should do when their “bullshit” “bible” is debunked … flush it.

      https://www.wired.com/2010/12/ff_dsmv/

      And I hope the majority of “mental health” workers may start to garner some insight into reality at some point. Like, for example, the fact that it’s appalling and unacceptable that the doctors are killing 8 million people EVERY year, supposedly with the “invalid” DSM disorders, but no doubt with the neurotoxic psychiatric drugs.

      https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders.shtml

      It’s way past time to end our modern day psychiatric holocaust. “8 million people die” EVERY year! And yet some “mental health” workers have the gall to claim others are dangerous? As my beloved grandmother used to say, that’s like the “pot calling the kettle black.”

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  5. “Of course, given that psychiatric diagnoses are not valid, the Goldwater Rule by all rights should specify that no one should ever give anyone a psychiatric diagnosis. But the rule refers to more than just diagnosis, so the professionals who claim special expertise—who tend to vary among themselves, and some of whom vacillate between saying he is mentally ill and saying diagnosis is beside the point—should stop claiming that they must speak out because of that alleged expertise.
    For psychiatrists, psychologists, social workers, and other therapists to claim that they are essential for warning people that Trump is dangerous is to claim special expertise and insight to which they are not entitled, and it simultaneously demeans the judgment of nonprofessionals and helps strengthen the power of their guilds.”

    I suppose psychiatrists will argue that trump actually never stepped over the “threshold”, whereas those with “labels” did. (I can’t get myself to say the word “diagnosis, lol)
    But according to the “assessments” of psychiatry, they simply “observe” and “listen”. For a mere 15 minutes to an hour. THAT is where people get their descriptive label.
    Now generally, there is only a dribble psychiatry EVER knows about a person, any of their clients, in fact less than the grocery clerk.
    However, someone like trump who is on TV 24/7, we hear the words, see the mouth, the eyes and the dialogue and in this way, we can judge if we like a person, or the things they stand for, or if we trust them.
    Psychiatry would only know as much as any of us, and in fact some must like what he spews.

    Indeed psychiatry knows nothing about their clients, especially never enough to slap some weird labels on them that they themselves concocted as if they are teenyboppers.
    Those trait tendencies that they made labels for and called “illnesses” are laughable.
    The best of them could not pick someone out of a lineup

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  6. Thank you Dr Paula, I like this article.

    I think the American voters more or less knew ‘capacity wise’ what they were getting when they voted Donald Trump in, and he doesn’t seem to have changed much over the years as President.

    I wouldn’t trust the average Psychiatrist to be competent to judge the Capacity of an American President, as most are at least intentionally deluded.

    I’m very interested to see though, whether Donald Trump will get voted in again.

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  7. Miss Paula Caplan, please do explain in more detail why you find Donald Trump is an “evildoer”. It’s described as profoundly wicked and immoral. Do give us the details. Sexual misconduct is not enough.

    You say: “Trump himself has acknowledged his own dangerous behavior, including but by no means limited to his sexual assaults.” Do tell, what are the more dangerous things he’s admitted to? What does dangerous behavior mean, anyway? Bungy jumping?

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      • I think, taking a historical perspective, calling someone an evildoer is much less scientific than, say, schizophrenia. There is science behind what’s called schizophrenia (and it’s not what you think), even though it’s been completely turned upside-down and manipulated by psychiatry. The author has an unhealthy obsession with Allen Frances, on display once again with the Huffington Post article she links to (which she authored).

        Why would the author be involved in the DSM IV in the first place, if she is opposed to psychiatric diagnoses? If the author could clarify the seeming dichotomy, I’m all ears.

        The whole article is political, and, the author is aware that psychiatric diagnoses are too vague to oust Trump, it’s just a tactical ploy on her part. Nothing to do with opposing psychiatric diagnoses.

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      • I would like to know, how does one accept a (paid) position as consultant to the DSM IV task force for 2 years (no less), and change position based on being lied to by Allen Frances and associates? What was it about psychiatric diagnostic categories she found credible when accepting the position? She must have read the DSM III.

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        • Sometimes we believe we can change things, or the pile of data doesn’t reach critical mass until a certain point. There are many of us here who had “epiphanies” at one time or another in our lives/careers. At a certain point, I think a person comes to see that it’s not just a matter of confusion or needing training, it is the intention of the SYSTEM that is wrong headed. I’d guess a DSM IV conference would make that point pretty clear to anyone who was participating.

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          • I would submit this as an example:

            “Trump may be suffering from both lifelong cognitive impairment (one of his professors from Wharton called him the dumbest student he ever had) and perhaps now, some dementia.”

            Now, if someone has critical, independent thinking capacity, taking the opinion of one professor at Wharton as a valid argument, is not appropriate. It’s quite possible (even probable) the professor just disliked Trump.

            I could argue that Paula Caplan is impressionable (a quality that would not make for a good president). The DSM IV is from 1994. That means that she was close to 50 when it dawned on her that diagnostic categories for mental health are not scientific. She’s a clinical psychologist, which means she must have studied the DSM at some point in her education.

            The article is political and heavily biased, no more, no less.

            Suggesting that psychologists are a crucial component in assessment, is also a way to help bolster her profession above psychiatry.

            You have to at least concede my points.

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          • I will go a little further. Someone who studies “Africans and American Africans” at Harvard makes my skin crawl.

            Also, the whole article is contradictory. At one point she argues against professionals, then she names someone as an “expert” in dangerous behavior.

            She ends by trying to convince you she is right by saying her grandchildren, who are in grade-school, agree with her.

            Take a look at most things she writes, there are frequent references to things she has published. Go to Youtube and watch the play she made about “they call me crazy”. I can’t watch more than 5 minutes of it. Sorry.

            I’m appalled. Aren’t you?

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          • Steve,

            Since you’re a moderator, can you explain to me why some comments have a “reply” button under them and others don’t? I could not reply directly to your most recent comment to me and had to search for this one earlier in the thread so that I could reply to you.

            Re: your comment “Part of the challenge of this set of events is the inability to know what information is reliable or not,” that’s true for some information (e.g., the actual number of cases and deaths isn’t totally reliable, due to lack of sufficient tests to assess all suspected cases), but it’s false for a great deal of other information that’s relevant. All of the following is reliable:
            We can read a copy of the Pandemic Playbook that the Obama Administration left for the Trump Administration, and no one contests its existence. We know that the NSC pandemic response team was disbanded in 2018 and can read the contemporaneous news and criticism of that choice. We can read/view the widespread pleas for PPE from healthcare workers, and it’s a fact that Trump has never invoked the Defense Production Act to produce them, even though he could have. We know that Trump was warned by government officials about diverse concerns that he didn’t respond to in a timely way, as there are copies of the written warnings. We know Trump’s many public lies, as we have video of them. We know that we still don’t have a test and trace program, and months have been wasted when one could have been established. We know that the test and trace program was central to South Korea’s containment of the disease and that orders of magnitude fewer people have died there. Etc.

            FWIW, I’ve worked on research that involved distinguishing between knowledge (true and warranted belief) and not-knowledge (false beliefs, beliefs whose truth-value is unknown, beliefs that lack a sufficient warrant, values that aren’t T/F). I’m actually quite sensitive to the reliability of information.

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          • It seems that only a certain number of comments in a thread can “nest” as replies, after which they are just listed one after the other, with no “reply” button. You have to go back up the chain to the last one that had a “reply” button on it if you want to continue on this thread.

            I agree that there are things which are concretely known and some which are purely speculative, but there are also partly-knowns which have to be evaluated, and that’s where a lot of conflict occurs. For instance, it is known that COVID19 virus can be found in droplets in the air 2-3 hours after they have been deposited. But what does that mean? Are they still infectious at that point? Do ACTUAL cases get passed that way or don’t they? Is this important for people who are infected to prevent spread, or people who are trying to prevent infection in themselves? These are all questions that people are willing to weigh in on heavily, either shaming people for not wearing masks or dismissing the possible risks as nothing but hype. The truth is, we don’t know if masks help or not, or how much, or on whom. A lot of this stuff is guessing.

            As to how Trump is handling all this, again, I think this subject is pretty well pooped out, and I’m going to ask more directly that the two of you move on from this subject, as it is now deteriorating into a more personal “thing” that is not productive.

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          • Steve,

            Thanks for clarifying about the reply button.

            Re: “The truth is, we don’t know if masks help or not, or how much, or on whom,” I think we do already know that masks help (as long as they’re worn properly, and depending to some extent on the material(s) used), as they reduce the expulsion of drops from an asymptomatic or presymptomatic infected person who doesn’t know s/he’s infected, but who can nonetheless transmit the disease. If fewer droplets get into the air, it’s less likely that someone who isn’t infected will breathe enough of them in to become infected. There’s already research about how much masks decrease the exhaled aerosols, and how it varies with fabric type. There are aspects of mask wearing that are less certain (like “how much” — I’m not sure if you’re looking for an average percent reduction if everyone wears masks, …), and there’s lots of ongoing research about all of this (e.g., how the kind of expulsion — breathing, talking, singing, sneezing, … — influences the number of droplets and likelihood of transmission).

            I’m pretty good about distinguishing between “known” and “possible” / “uncertain.” I try not to confuse them.

            I won’t respond further re: Trump, per your request.

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          • Do we know that reduction of droplets extruded reduces the likelihood of infection when distancing and surface sanatiziation and hand washing are all in effect? A recent study showed that outdoor transmission almost never has been shown to occur. So maybe we should only wear masks indoors? There are lots of imponderables, which is my point.

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          • Steve,

            I don’t think that these questions are imponderable. But with few exceptions, we don’t want to purposefully expose people, so some of these questions have to be addressed through observation studies and not randomized controlled trials. Here’s a discussion (not a research paper) that I found helpful: https://www.erinbromage.com/post/the-risks-know-them-avoid-them

            As she notes, there are other important factors, such as: how long is the exposure? what is the exhalation force (is the person breathing, talking, singing, yelling, sneezing)? how many droplets are released on average per exhalation?

            Agreed that the risk of outdoor transmission is low, but if you’re standing closely together (say, at an outdoor rally) and someone next to you is infected but asymptomatic and sneezes, or if you’re simply standing next to each other for a long time, then that’s still higher risk — even though it’s outdoors — than being outdoors and having an infected walker or cyclist pass by briefly a few feet away.

            If you’re indoors and trying to stay distant (say, at a grocery store or in a non-crowded bus), wearing a mask will help protect others if you’re unknowingly infected/asymptomatic. Will it guarantee that there’s no transmission? No, but it will lower the number of people who are affected, which is important. As it’s getting warm, we also have to worry about air conditioning, as the virus lives longer in the cold than in heat and the air circulation is different.

            Each of several different choices — handwashing, distancing, masks, keeping in-person interactions short, … — reduces risk, and the more of these actions we combine, the lower the net risk.

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          • I think you’re making total sense. My point is only that there are, in fact, any number of imponderables, and it is possible, even likely, that some measures in place are not particularly helpful while there are others we will later learn we ought to be doing. We’re flying blind to a large extent, as there is not much prior experience to draw on, and we don’t have time to do controlled experiments. So “playing it safe” and reducing risk is probably the best we can do. But I do think it’s important to acknowledge (not saying that you aren’t) that our knowledge is limited and to some extent we’re making educated guesses as to what will be most helpful, which explains at least in part why at first we were told no masks, then we were told to mask up. New information is coming in and best practices will change as we learn more.

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          • Steve,

            Our knowledge is incomplete, but I wouldn’t say that we’re “flying blind,” as quite a bit of relevant knowledge exists: about earlier coronaviruses (SARS, MERS, etc.), about effective responses in earlier pandemics (e.g., the 1918 flu), from our ability to genetically analyze DNA, …

            Agreed that “New information is coming in and best practices will change as we learn more.” I’m struck by the vast number of researchers working around the world to help us learn more about all sorts of aspects of this (medicine, genetics, epidemiology, sociology, political science, …).

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          • Hi Steve,

            Just a quick note of appreciation. I’m fairly new to this site, and I’m glad that you take time to moderate comments and prevent the kinds of personal insults that are so common in many online discussions. I’ve found that there’s a huge difference in the kinds of exchanges that occur on moderated vs. unmoderated sites. Thanks for your time.

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        • I respect the Author for having had the experience, and the guts to leave a good position and income.
          There are many that peak inside cults and belief systems, only to find out how fucked up those systems are.
          If a system is more fucked than myself, I have to reassess 🙂

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          • I don’t have access to her finances, so I really can’t comment on that. I just find it inappropriate to publish a clearly political biased article on a forum like this. Yes, most here would agree psychiatric diagnoses are not scientific. But this is not an appropriate way to argue the point. The ulterior motive is quite clear.

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        • I have found no evidence that masks do anything at all except perpetuate an atmosphere of fear, and apparently the CDC agrees, or used to before it decided to change its narrative.

          I don’t wear one, except when in a store, which describes maybe 10% of those where I live. Maybe people are looking at me disapprovingly, but I’m usually rolling my eyes so I’m not sure. Consider me a canary.

          I guess it’s time for some alternative facts. I just received this, I hear it’s being banned all over social media: https://youmightsharethis.com/plandemic-documentary/

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      • Anyone who believes Trump is not dangerous can start by reading about his history, which is available online in many reliable places. And of course there’s the Access Hollywood tape of him describing his sexual assaults, but I thought everyone already knew about that.

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    • I think he’s an extremely dangerous person as president. Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day. And it’s not as if his response to the pandemic is the first example of his dangerousness. His willingness to tear kids from their parents and cage them, to remove environmental safeguards, to embolden white supremacists, to fire skilled civil servants who don’t display personal loyalty to him, to weaken international alliances, and his gaslighting, his failure to safeguard our elections from foreign interference because it benefits him, his refusal to eliminate his business conflicts of interest, … — there’s a long list of acts that endanger people and the country’s broader well-being.

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        • oldhead,

          I’m not sure that I understand your comment.

          I’m not “psychiatrically labeling” anyone. If you’re referring to my use of terms like “narcissism” and “sadism,” these terms first entered the English language about 200 years ago, before they were used in medicine, and I’m using them in their everyday sense, not as some sort of psychiatric diagnosis. I’m claiming some these things as my opinion (an opinion shared by many others), not as medical facts. I’m claiming others as facts that aren’t medical; for example, it’s a fact that he makes a huge number of false claims (what I referred to as dishonesty), but medicine doesn’t enter into that.

          How would you rather that I talk about these features?
          Or are you suggesting that one cannot make an argument for why one believes him to be dangerous without “psychiatrically labeling” him? If so, I disagree. And I think it’s essential for those of us who believe he is dangerous to be able to say so and explain why we believe that.

          With COVID-19, do you dispute that his choices/actions have directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more?

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          • Narcissist or Narcissistic Personality Disorder. What’s the difference? I’m not asking which of the two are listed in the DSM, or how psychiatry profits from diagnostic labeling, I’m asking, what’s the difference?

            Everyone knows the DSM consists of a group of people voting on what characterizes a certain diagnostic label. An “educated” opinion. You validate the DSM process of consent by vote when you say “many people share my opinion”. What’s the difference?

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          • “Narcissistic” is a colloquial description of a certain kind of behavior, kind of like “cowardly” or “noble” or “conscientious.” “Narcissistic Personality Disorder” is an alleged “mental disorder” that can purportedly be “diagnosed” by people with a “professional background.” What would you think if they diagnosed someone with “Cowardly Personality Disorder?” Wouldn’t that seem pretty far out there, to take a set of personality characteristics and call it a name and then claim it is somehow a “diagnosis?”

            You could replace “narcissistic” with “childish” or “selfish” or “ill tempered” or “thoughtless” or “mean-spirited” and it would still just be a description of a person’s behavior. A description of a person’s behavior can not logically be a medical “diagnosis.” That’s the difference.

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          • Thanks for clarifying this Steve, so I guess I can describe a psychiatrist as “narcissistic” and that does not mean I am “diagnosing” her. I have no desire to “diagnose” anyone with any spurious DM label and since the dictionary describes “narcissistic” as:

            “egocentric; egoistic. Having an inflated idea of one’s own importance. Obsessed with one’s own self image and ego.”

            it does describe her (and other psychiatrists) quite accurately.

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          • I’m not disagreeing with your distinction, but it’s more of a philosophical distinction than pure logic. It’s based on accepting the “medical model” of illness (correct me if I’m wrong) as the correct model medicine should adhere to, which is very reductionist. Accepting psychiatry as a legitimate field of medicine is mostly just a social contract.

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          • Steve, it seems you are causing more confusion with “colloquial”. It now seems people think they can, in their own words, label a person’s entire being with a word like narcissist, and claim it’s an accurate description, so long as it’s not a psychiatric diagnosis.

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          • Hey, people do it all the time. I was just making it clear that there is a difference between people calling someone names because they don’t like their behavior vs. calling someone official names with the power of a medical degree behind it. It’s still name calling, and I am generally opposed to name calling, as it is usually very unproductive and avoids planning to overcome the problem. But there is a very important difference in quality between being called a name by someone who is no more or less powerful than you are vs. being officially sanctioned by the medical profession to call people names as “medical diagnoses.” The second is far more insidious and destructive.

            Hope that makes my point clearer. At least in the colloquial situation, we KNOW it’s a matter of name calling or generalizations with no scientific basis. No one is pretending that the other person “has” some brain problem or whatever. They’re just saying the othe person is a jerk.

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        • No, Berzerk asked “What does dangerous behavior mean, anyway?” and I said why I personally think Trump is dangerous. That’s not changing the subject, because I was initially replying to Berzerk. You said “Once again you confirm the author’s point,” and I disputed that. At no point have I been trying to discuss “the legitimacy of psychiatrists making such judgements.”

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      • “Magic solutions”. You mean, for example, HCQ (hydrochloroquine). There is science behind that. In combination with zinc, as a first-line treatment, seems to be very effective. There is science going back at least 10 years for SARS viruses.

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        • So far controlled trials haven’t shown HCQ to be effective against SARS-CoV-2, and it was rash to encourage people to try it without controlled trials. The answer to his question “what can you lose [by trying it]?” is: you can die from the medication or have other serious adverse effects. IIRR, one of the controlled trials was stopped early because of adverse effects.

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          • You are too trusting of protocol. That’s the problem with medicine and psychiatry. It’s a long debate. You really need to investigate for yourself, there is enough information on the internet, but you need to have a critical mind.

            Chloroquine and the Hydroxychloroquine derivative have been around for a long time. There is a danger, but it’s for people who have what’s called favism. In the african population it’s quite high, around 20%. But you can easily test for it.

            And it’s not even hydroxychloroquine that’s needed, you can use quercetine. It increases the level of zinc in the cells which inhibits the replication of viruses.

            If your interested, read this:

            https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

            If you read it carefully, putting people on respirators is probably the worst thing you can do. With almost 100% fatality. It’s the immune system response that kills, not the virus.

            There is a lot of disinformation going around.

            You can also read this:

            https://swprs.org/a-swiss-doctor-on-covid-19/

            Just yesterday, I heard in the news that there was a spike in Corona infections in Russia. They fail to mention it’s because they were testing many more people. Do you see how the media tries to manipulate?

            The media is not what it used to be. They are bought and payed for to spread propaganda. There is no critical analysis, just “this is how you need to think”.

            And it’s not Trump that’s the mastermind behind everything, he is advised by Fauci, who has been in many administrations.

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          • Since probably 10-25% of the population has interacted with the virus all they have to do to get the requisite amount of “new cases” to keep things shut down is keep testing till they have enough. Even if most of them will never even feel sick.

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        • Berzerk,

          IIRR = “if I’m remembering right”

          At the top of your link, it says “This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.”

          If you do a Google Scholar search (https://scholar.google.com ) on something like [COVID-19 Efficacy safety hydroxychloroquine], you’ll find much more research. I’m guessing that most of it consists of preprints and letters. (Google Scholar attempts to limit results to research or other scholarly responses, like letters to academic journals.)

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          • Yes, I did as you suggested, and did a search on Google Scholar for “covid-19 and Hydroxycholoroquine”. The vast majority are positive and urge further testing. But, I went for the one that seems most important to you (possibly because you dislike Trump, like our dear author):

            http://atomicfifteen.com/~TREATMENT_INEFFECTIVE_HYDROXYCHLOROQUINE.pdf

            As reported, they managed to find 11 patients (already at deaths door, almost all with severe comorbidity) and treated them with HCQ and concluded it doesn’t work.

            The point of HCQ (or any other treatment) is to treat people as EARLY AS POSSIBLE.

            They link to another article from China (of people with mild symptoms) as a way to corroborate their findings:

            http://www.zjujournals.com/med/EN/10.3785/j.issn.1008-9292.2020.03.03

            1 day till fever subsides, comparable to the control group. Transient diarrhea seemed to be the most severe side-effect.

            As most people don’t progress beyond mild symptoms, I don’t see how this corroborates their findings.

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        • No, I’m not too trusting of protocol. I have a critical mind, a strong math background (so I understand how increased testing impacts number, the difference between absolute #s and per capita rates, the difference between total cases and reported cases, log scales, etc.), and I search out and read quite a bit on my own. I was already familiar with chloroquine, having taken it decades ago as a Peace Corps vol in Africa (though we later had to switch to Fansidar, as there was chloroquine-resistant malaria in my host country), and I also participated in a clinical trial for Loa loa prophylaxis and understand that drugs can have adverse effects.

          It’s totally irresponsible for Trump to be promoting a drug that hasn’t been approved for *this* and hasn’t been tested sufficiently for *this*. There are other medical problems where it has been tested and approved; in fact, Trump’s advocacy of HCQ to treat COVID-19 has created access problems for people who use it as ongoing treatment for conditions like lupus.

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        • Berzerk,

          Just to be clear, the bracketed comment “[what does this mean?]” appeared on the page you directed me to; it wasn’t inserted by me / wasn’t a question from me. I do know what peer-review is (I worked as an assistant to a journal editor while in grad school), and I disagree that “It means people at the bottom arse-licking those higher up.” Not only does it not mean that for the reviewers, it doesn’t mean that for the authors. A researcher worth his/her salt will use productive feedback from reviewers to strengthen the paper.

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          • “Richard Smith was editor of the BMJ and chief executive of the BMJ Publishing Group for 13 years.”

            Here’s his conclusion of the peer-review process:

            “So peer review is a flawed process, full of easily identified defects with little evidence that it works. Nevertheless, it is likely to remain central to science and journals because there is no obvious alternative, and scientists and editors have a continuing belief in peer review. How odd that science should be rooted in belief.”

            Once again, you seem to be showing too much trust in protocol.

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        • I accept that you think I’m “showing too much trust in protocol,” but you don’t actually have a good basis for your claim, since you have made zero effort to gather sufficient data from me (via interview) that would allow you to justifiably conclude this.

          I found and skimmed the paper you quoted from, which focuses on peer review in biomedical research, not peer review across all fields that use it. So it’s relevant to the discussion of research on HCQ, but not great evidence re: my response to your claim that peer review “means people at the bottom arse-licking those higher up,” as my response was about peer-review in general, not peer review solely in biomedical research. More to the point, Smith’s paper doesn’t support your claim.

          I’m not going to read all of the articles he cites in order to assess whether his is a good analysis, but I did skim the second one (https://jamanetwork.com/journals/jama/fullarticle/194989 ), and strangely, the quote that Smith attributes to those authors doesn’t appear in their paper. If I were trying to do a good review of Smith’s paper, I’d also want to look at research on peer-review that’s been published since his (2006), but I’m not going to take the time to do that.

          All of science is “rooted in belief,” with a focus on the proper subset of beliefs that constitute knowledge: true and warranted/justified belief. But knowledge isn’t the only kind of belief that’s relevant to science. For example, conjectures/hypotheses are central to science, and those are known not to be warranted (the hope is that a warrant will be confirmed or disconfirmed). And when scientists judge that a piece of research is “important,” that’s a different kind of belief: opinion.

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          • A lot of science is also rooted in what is known NOT to be true. It’s a lot easier to disprove a hypothesis than it is to prove one unequivocally. The most certain data in science are which theories are absolutley wrong. Unfortunately, these days such vital information is often buried or at least not published. Especially when conflicts of interest are involved. Peer review’s job ought to be to poke holes in the methods or conclusions of the researcher based on the data. Unfortunately, that role is not always played fully by the reviewers these days.

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          • A lot of drugs are made for hypothesis and prescribed for hypothesis.
            Antipsychotics and speed for children, hypothesis.
            Millions.
            People die regularly from “hypothesis”.
            The creation of poison is science. You breathing is science.
            Giving people poisons and calling them meds is crap. Yet it’s “science”
            It’s embarrassing to even use the word “science”.
            We are the only ones observing our “science”, or our “intellect”.

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          • Well, I would submit this for the area of physics:

            https://physicstoday.scitation.org/do/10.1063/PT.5.8057/full/

            One of the major problems being that the raw data is not shared.

            A recent article here on MiA discussed the flaws in the Fin11 and Fin20 studies on mortality. Most psychiatrists believed the findings and the articles were subsequently cited over and over again. The raw data and the statistical modeling software, to my knowledge, is not open-source.

            Recently, the modeling software that Imperial College used to advise the UK government on the pandemic has been posted on Github (after being improved by Microsoft). The original is not available yet. The improved version that was made publicly available, if you look at the comments, speak for themselves.

            The original comment you made regarding Trump’s dangerous behavior when speaking about HCQ as a promising treatment, led you to conclude he was directly responsible for 10’s of thousands of deaths. Could you qualify that? What evidence do you base it on?

            I read some articles on it, the problem being that the HCQ arm
            (the ones I read) were more severely ill to begin with before being given HCQ. Also, there was no mention of zinc. I would like to emphasize that you should treat people as early as possible for any disease, that’s common sense.

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          • My justification would be this: From your initial comment on Trump with regards to HCQ, from what you say, at least 25% of deaths in the US from Covid-19 are attributable to HCQ alone or in combination with those needing HCQ for other diseases and not being able to get them at the pharmacy due to a shortage.

            Here’s an article from Forbes:

            https://www.forbes.com/sites/stephaniesarkis/2020/04/13/trumps-hydroxychloroquine-focus-causes-a-shortage-for-others/#3a525262539e

            There is no evidence in the article that there was actually a shortage. It’s fear mongering. Also, the article mentions remdesivir, without any evidence remdesivir is a promising treatment. Why would promoting remdesivir for Covid-19 not lead to a shortage. HCQ is on the list of essential medicines, which (I assume) means it’s more readily available worldwide.

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          • You said: “… are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more.”

            If you didn’t mean to say it had anything to do with his public comments on HCQ, then I stand corrected. Which dangerous behavior directly led to > 20,000 deaths?

            On a side-note, I found the video where you got the idea that Trump has the nuclear codes and could suddenly use them in a fit of rage. It was an interview with a psychiatrist and an author of one of Trump’s books.

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          • In terms of dangerous behavior of Trump causing over 20,000 deaths directly due to his handling of the pandemic (if it can even be called a pandemic), since you know what per capita deaths mean, according to official death counts from Covid-19, Belgium, Spain, Italy, the UK, France, Ireland, the Netherlands and Sweden, all rank higher than the US. You could say Trump (if you want to put the blame on one person) is doing better than any of these countries. It would, at the least, suggest something else is going on. Are the death counts attributed to Covid-19 accurate? Or, is something more sinister going on?

            Why would all these countries promote an experimental vaccine as (in the words of Bill Gates) the ultimate solution? Do you see how insane that is?

            And what does Bill Gates know about biology and medicine? His Windows operating system is riddled with vulnerabilities.

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        • Berzerk,

          You say “From your initial comment on Trump with regards to HCQ, from what you say, at least 25% of deaths in the US from Covid-19 are attributable to HCQ alone or in combination with those needing HCQ for other diseases and not being able to get them at the pharmacy due to a shortage.”

          That’s a drastic misinterpretation of what I wrote. What I said was “Many features of his dangerousness — his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, … are all on display in his astoundingly harmful response to the pandemic. His dangerousness has directly contributed to the deaths of tens of thousands and to longterm health and economic problems for many more. If you doubt this, compare the responses in South Korea and the U.S., knowing that the first case in each country was diagnosed on the same day.”

          You then responded “‘Magic solutions’. You mean, for example, HCQ…”

          But now you seem to think that my long and incomplete list “his narcissism, rejection of expertise, unwillingness to take responsibility, lack of empathy, sadism, extreme dishonesty, transactionalism, advocacy of magic solutions, …” (incompleteness indicated by the ellipses in the original) just refers to HCQ. Not only is HCQ *not* the only “magic solution” that I was referring to (and I assumed that you understood this, since you originally said “for example, HCQ,” which implies that that example is one of several), but “advocacy of magic solutions” was only one of the many issues in my list.

          I’m absolutely not blaming “deaths of tens of thousands and to longterm health and economic problems for many more” on use of HCQ or people who need HCQ not being able to get it. By “advocacy of magic solutions,” I was mostly referring to his response that he doesn’t need to do much, because a magic solution will take care of the problem (not just his advocacy of HCQ when it hadn’t gone through clinical trials as a preventative or treatment for this, but all of his claims that COVID-19 would just “go away”: https://www.youtube.com/watch?v=r8yOv4PwttM , his later comment “I see the disinfectant, where it knocks it out in a minute, one minute. And is there a way we can do something like that by injection inside or almost a cleaning …,” etc.). But that’s only one of the factors that influenced his awful response. Other drivers of the needless deaths and other harm are things like his choice to ignore the Pandemic Playbook that the Obama Admin created (https://www.documentcloud.org/documents/6819258-Playbook.html ), trying to cut pandemic-preparedness and global health funding, disbanding the NSC pandemic team, refusal to take the illness seriously in January and February and immediately make sure that there would be widespread effective testing available, sufficient PPE available for healthcare workers, capacity to do contact tracing, checking for symptoms in people returning to the U.S. from areas where the virus was already known to be infecting people, etc., and endlessly lying about the situation (e.g., in March: “We’re having to fix a problem that, four weeks ago, nobody ever thought would be a problem,” when he was literally handed a playbook years earlier and had received warnings months earlier). He crows about having shut down travel from China, but ignores that 40,000 Americans who’d been in China returned and he made no attempt to test them or advocate that they self-quarantine. When Americans were finally flown back from the infected Diamond Princess cruise ships, he mixed infected passengers and healthy passengers on the flight home (letting the State Dept. take control of this, where they chose to act against CDC guidance) and then didn’t provide PPE or guidance to the people meeting them in the U.S. When he created the Europe travel ban, there were no plans for how to keep the thousands of returning Americans sufficiently far apart in the airports (and airplanes are themselves a context that increases spread, because air is recirculated). He kept talking about the Defense Production Act but hasn’t invoked it to produce PPE. He lied over and over about sufficient tests being available (e.g., “Anybody that wants a test [for the coronavirus] can get a test.”) and when asked if he took responsibility for the lag in testing, responded “No, I don’t take responsibility at all.” He has frequently tried to shift responsibility to governors for things that could more effectively and cheaply be done by the federal government (e.g., PPE production and distribution), forcing states to compete with each other and sometimes seizing supplies that states had ordered. He’s allocated items from the national stockpile not on the basis of state need but as a reward to the states where he has more political support.

          I could go on and on with the list of his mistakes, which originate in the many features of his dangerousness that I listed originally. But the bottom line is: until there is a vaccine, then testing / tracing / self-quarantine for exposed people is the primary means of reducing the number of infected people, and he has squandered MONTHS refusing to deal with this, months during which tens of thousands of people have become infected and many have died unnecessarily and many others now have other health and economic harm. It’s been over 4 months since he became aware of this pandemic and we STILL don’t have an effective test and trace program.

          For a very helpful “timeline of major U.S. policy events related to the novel coronavirus pandemic”: https://www.justsecurity.org/69650/timeline-of-the-coronavirus-pandemic-and-u-s-response/

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          • Some of my comments don’t show up for some reason. Trump set up a task force to deal with the Corona virus spread. It was (set up in late January) headed by former pharmaceutical lobbyist Alex Azar. You can look up who the others are. Including Fauci. Trump isn’t smart (or dumb) enough to have made all those decisions himself. Emphasizing Trump distracts from what the real motive behind all this is. Other countries are making the same (apparent) blunders.

            In any case, the article was about dangerous behavior and neurological impairment. I can’t wait for the presidential debate between Biden and Trump (I’m not taking sides here). Didn’t Biden recently say (you can find it online) that over 80,000 have lost their jobs during the crisis.

            Finally here’s a video excerpt from someone with a solution for everyone that won’t take their vaccine (I won’t comment on it):

            https://www.youtube.com/watch?v=wyXuPwsLGWI

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        • Berzerk,

          For some reason, there is no “reply” button under most of your comments, so my replies aren’t threaded appropriately for the comments I’m replying to. I’ll just quote from your most recent comments here.

          You say “I found the video where you got the idea that Trump has the nuclear codes and could suddenly use them in a fit of rage. It was an interview with a psychiatrist and an author of one of Trump’s books.” But I said nothing about him “suddenly us[ing] them in a fit of rage.” That’s something *you* added. Nor was my comment motivated by an interview with a psychiatrist.

          Re: “if it can even be called a pandemic,” yes, it can absolutely be called a pandemic. It’s a novel virus that’s infected people all over the world. Johns Hopkins has good global data: https://coronavirus.jhu.edu/map.html So does the Financial Times: https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441 and https://ig.ft.com/coronavirus-chart/ (which lets you compare country graphs in diverse ways.

          Re: “In terms of dangerous behavior of Trump causing over 20,000 deaths directly due to his handling of the pandemic …, since you know what per capita deaths mean, according to official death counts from Covid-19, Belgium, Spain, Italy, the UK, France, Ireland, the Netherlands and Sweden, all rank higher than the US. You could say Trump (if you want to put the blame on one person) is doing better than any of these countries. It would, at the least, suggest something else is going on. Are the death counts attributed to Covid-19 accurate? Or, is something more sinister going on?”

          In comparing deaths/million in different countries, there are a bunch of things to keep in mind: the age profiles of the countries (because the virus is more deadly for older people), the relative dates of first deaths (because you want to compare the same length of time for each country), the quality of the testing and other data collection (because you’re comparing deaths identified as caused by Covid-19, and there may be undercounts if there aren’t enough tests to confirm whether that’s the cause), population distribution (because it’s mainly transmitted by close contact, so dense countries or those with higher mass transit use makes transmission easier — that’s one of the reasons it’s been so awful in NYC), …

          All of thee countries you listed have a larger % of people over 65 (https://en.wikipedia.org/wiki/List_of_countries_by_age_structure ). The other countries all reached 3 deaths per million sooner than we did and so their cumulative #s are over a longer time span.
          For example, this is a log scale graph of cumulative deaths per million comparing the U.S. and Belgium:
          https://ig.ft.com/coronavirus-chart/?areas=usa&areas=bel&areasRegional=usny&areasRegional=usnj&cumulative=1&logScale=1&perMillion=1&values=deaths
          You can see that their graph is longer, meaning that they reached 3 deaths per million earlier than we did. If you look deaths per million after 49 days for both countries, Belgium is still much worse, but not as bad as comparing the totals to date.
          I’m not going to look up data for the other issues that affect how directly comparable countries are; I’m just telling you that looking solely at deaths/million isn’t an appropriate comparison, especially since my comment wasn’t solely about the people who’d died but also about “longterm health and economic problems for many more.”

          “Why would all these countries promote an experimental vaccine as (in the words of Bill Gates) the ultimate solution? Do you see how insane that is?”

          I haven’t seen quotes showing that they’re all promoting a vaccine as “the ultimate solution,” but vaccines have long been important in dealing with highly contagious and harmful diseases (small pox, polio, etc.). I don’t think this is “insane,” and I have no desire to get into a vaccine debate, nor would I focus on Bill Gates rather than health experts.

          “Trump set up a task force to deal with the Corona virus spread. It was (set up in late January) headed by former pharmaceutical lobbyist Alex Azar. You can look up who the others are. Including Fauci. Trump isn’t smart (or dumb) enough to have made all those decisions himself. Emphasizing Trump distracts from what the real motive behind all this is. Other countries are making the same (apparent) blunders.”

          I don’t think it’s a distraction at all. Trump has final say on key issues and more than once has overruled things recommended by his task force. He is the only person authorized to invoke the Defense Production Act. He’s the one who OK’ed disbanding the NSC pandemic response team at Bolton’s prompting. He’s the one complaining about skilled people like Dr. Bright and Dr. Messonier when they push back on stupid ideas of his, even removing Bright from his position. (An insightful comment of Laurie Garrett’s: “When a leader uses kill-the-messenger governance, underlings stop sending bad news upstairs. That’s what happened in China: local Wuhan CCP bosses didn’t tell #XiJinping about the new #coronavirus. And that’s what’s happ’ing in USA, as #Trump offs bearers of bad #COVID19 tidings.”) Trump was the one having rallies where the virus could circulate among large #s of people packed together. And on and on.

          And I don’t need to look up the other members of the task force; they’re listed in the JustSecurity document I referred you to, where they noted that “Officials are alarmed by the absence of the FDA Commission[er], Dr. Stepehn Hahn on the task force, which they believe hampers coordination between the FDA, CMS, and commercial labs on testing.” Did you even skim this document?

          Again: we need an extensive testing and tracing effort, and despite months having passed, we still don’t have one. Do you seriously believe that Fauci would choose not to have this if he could move forward on it without Trump’s approval. Did you hear Trump’s nutso comments yesterday? He said:
          “we’ve been doing testing at a level that nobody has ever done it before” (this is false)
          “we’ve done more testing than all of the countries in the world added up together.” (this is false)
          “It could be that testing is, frankly, overrated.” (no doubt that’s why so many people want tests and can’t get them)
          “And don’t forget: We have more cases than anybody in the world. But why? Because we do more testing. When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.” (this is the craziest of the quotes, as it conflates “cases” and “confirmed cases” and pretends only the latter matter)

          I don’t know that it makes sense to continue this exchange, which has already gone on for quite a bit. I’m open to changing my mind in response to good evidence, but simply claiming that Trump is a distraction is an opinion, not evidence. You and I have very different opinions here.

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          • Posting as moderator:

            I agree that this exchange has been interesting, but has perhaps reached as far as it can go. I think we’ve seen both perspectives fleshed out pretty thoroughly, and I doubt very much if either of you will sway the other. Part of the challenge of this set of events is the inability to know what information is reliable or not. I think this exchange makes that point very clear.

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          • “(this is the craziest of the quotes, as it conflates “cases” and “confirmed cases” and pretends only the latter matter)”.

            He’s not conflating, he just used the wrong words. When he says “when you test you have a case”, it’s obvious (at least to me) he means “confirmed case”.

            I’m not going to discuss politics. Which is why I disliked this article and responded to it.

            Calling people crazy, evil, and all those other words and pretending that’s ok, and then opposing psychiatric diagnostic wording, is, at least to me, the pot calling the kettle black.

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          • If you read it, and like to discuss confirmed cases and cases, and the significance of distinguishing between the two, have politicians and the media exaggerated the severity of the pandemic? Based on the link I sent, and the information there? Not just in the US.

            For example, it links to an article from Japan, where it’s estimated that between 450 to 900 times more people were infected than what you call “confirmed cases”.

            You didn’t comment on the Imperial College model which predicted up to 2,000,000 deaths in the US alone. Altered source code (by Microsoft) of the model was posted on Github. The point is, not that they got it wrong, but the model was awful. They suggest insurance companies are much better suited to make such predictive models.

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          • Getting back to psychiatric terminology. Let’s take schizophrenia as an example. The DSM description of it is intentionally confusing (it’s actually intentionally moronic). There is a reason why Eugen Bleuler coined the phrase. It goes back millennia and has to do with his philosophical or religious beliefs. I haven’t seen anyone discuss that aspect of it. If something could be described as “evil”, it’s the word schizophrenia. Psychiatry is a religious cult. And, like any cult, it punishes those they see as a threat.

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          • If you take the DSM seriously and attack it’s unscientific nature based on what’s written there, you fall into it’s trap. It’s like battling against windmills. A smoke screen. Just like fake politics. Democrats versus Republicans. Trump was actually a huge miscalculation. In Europe, there is the same game being played in politics, a lot of promises, but once in power, everything changes.

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        • Just to be clear, I haven’t at any point been discussing “psychiatric terminology” or the DSM. My “craziest of the quotes” claim was about a statement, not about a person, and as I noted earlier, my use of terms like “narcissism” was intended in its everyday sense (which preceded the psychiatric use), not as a diagnosis.

          Steve McCrea has asked that we not discuss Trump further, and I’m going to abide by that.

          I’ve briefly looked at your link (https://swprs.org/a-swiss-doctor-on-covid-19/), but I don’t have the time to look at the underlying data in order to reach a conclusion about their claims.

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          • My question would be, and I will leave it at that, what prompted you to comment on this article? If I recall, you were in favor of the same kind of tests pilots take. Most probably without any knowledge of what such tests are composed of. Of-course, you were vague enough to say “the same kind of tests”.

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        • My first comment was prompted by your question about “dangerous behavior” (https://www.madinamerica.com/2020/05/presidents-fitness-can-professionals-help-decide/#comment-172009). You can reread that exchange if you want.

          We already discussed those tests as well: https://www.madinamerica.com/2020/05/presidents-fitness-can-professionals-help-decide/#comment-172139

          I agree with Steve’s response (“‘Narcissistic’ is a colloquial description of a certain kind of behavior …”) to your other question to me and don’t have anything to add.

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        • I’ve read two columns here that discussed Trump and dangerous behavior. I wrote my comment for the first column (as you can tell from the date it was posted), and when I saw that a second column had been posted that touched on this, I decided to copy and paste instead of composing it anew, as the former is faster.

          Ciao.

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    • For one thing, there is the environment. If Donald J. Trump weren’t an evil doer he would admit that global warming is a fact, and do something about it! Instead he turns the Environmental Protection Agency (EPA) into an Environmental Destruction Agency (EDA).

      You think COVID is bad now, just you wait.

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    • This is a good point: Who gets to define “dangerous behavior?” I don’t wear a mask when I go out. Am I indulging in “dangerous behavior?” I have ridden a bicycle without a helmet. Is that “dangerous behavior?” I once want out onto a sandstone bridge in Utah. The drop down was about 600 feet. I had someone take a picture of me doing a jumping jack. Was that “dangerous behavior?”
      This is actually a key “power” that anyone seeking to control or in the business of managing people can attempt to have conferred on himself: The power to decide if someone else is “dangerous” or not. The whole concept of that 25th Amendment is a bit alarming to me. But those who created it considered it a real possibility that a president could become disabled in some way yet not volunteer to step down. It is not an amendment about “dangerous behavior.”

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    • You responded to me saying “I’m not disagreeing with your distinction, but it’s more of a philosophical distinction than pure logic.”

      I’d say that it’s more a social science distinction than a philosophical one, in the sense that psychology (not psychiatry), sociology, linguistics, … are social sciences. Are you familiar with the construct of “linguistic register”? One aspect of registers is that the same word can be used by different subsets of people with different meanings, sometimes overlapping and sometimes not. For example, in everyday English, “rational” refers to logical thinking, whereas in math, “rational” refers to a number that can be expressed as a ratio (non-overlapping meanings). “Narcissist” is an example where the meanings in psychiatry vs. everyday English overlap but aren’t identical.

      “It’s based on accepting the “medical model” of illness (correct me if I’m wrong) …”

      No, it only accepts that psychiatrists exist and have a linguist register, and that some of the words they use are also used in everyday English.

      I’m unlikely to respond further. Take care.

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      • You must be confused. I was responding to Steve. I wasn’t talking about what you seem to think I was. It has to do with the legitimacy of psychiatry and psychiatric diagnoses, something I oppose for the most part. If someone is happy being diagnosed as having schizophrenia, that’s their choice.

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          • Just to make it clear. I didn’t respond to you by mistake. There is a certain amount of nesting possible with comments (a comment to a comment, I’m not talking about bird nests). It necessitates using the last reply button up in the hierarchy when the nesting has reached it’s limit. It’s less confusing for others who are browsing through the comments.

            You might consider subscribing to all comments from a particular article. I find it helpful if the topic of the article (in general) interests you.

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  8. Thank you Paula! On the CBC’s Sunday Edition last week, the Dunning-Kruger Effect — “ignorant, incompetent people being overconfident in their expertise,” was resurrected. It gave the host and social psychologist being interviewed permission to unleash labels and stereotypes directed at Trump and pandemic conspiracy theorists. While really, their anger, fear and disgust–revealed in their reckless use of labeling–can only be used to perpetuate harm against victims of psychiatry. I was infuriated but didn’t know how to begin a letter of complaint to Michael Enright, the host. I’ll forward this blog which includes your letter to Congressman Raskin. Thank you for your thoughtful and courageous expertise.

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  9. I don’t know why this issue keeps coming up.

    I agree with what Sera Davidow said in her article 3 years ago: “I have yet to see a single article that does a good job of challenging the claim of ‘crazy’ where Trump is concerned that doesn’t also legitimize the diagnostic process overall. This is a serious problem.” https://www.madinamerica.com/2017/02/trump-diagnosis/

    With due respect, why, Paula, do you bring this up yet once again, and why not include the most crucial point-psychiatry is legitimized when a diagnostic term for him is sought.?

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  11. Yes, in 2016, i voted Trump for exactly 3 reasons. 1. The FakeNews/MSM media was so blatatly pro-Hilary and pro-Democrat party, and anti-Trump and anti-Republican party, that i voted Trump as a way to say, “screw you!”, and even out the balance. 2.The way Hilary & the Dems treated Bernie Sanders was appalling. I think a Clinton/Sanders ticket could have, and would have won. 3. Hilary is WORSE THAN TRUMP.
    That’s what i think. And i will be disappointed, but not surprised, if i actually get kicked off MiA for expressing my personal truth here, and daring to “defend Trump”. But so what? I’m an escaped mental patient, and survivor of psychiatry, too….can YOU handle the TRUTH? I can…. (this could get interesting….

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    • Actually I have been voicing comparably deplorable sentiments the whole time, haven’t you noticed? I think Trump throws a wrench in the works of both parties, no matter what his personal ideology may be (i.e. largely nonexistent). Aren’t the anarchists always screaming “let’s fuck shit up”?

      But for the record I would never have voted for Clinton in any form, even with Bernie tacked on for show. And I hope she doesn’t show up again when they sack Biden.

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      • A pure anarchist simply believes that things would work better without the existence of a central state power structure. Older cultures on Earth could be said to be “anarchist” to the extent that they had no permanent central control system.
        Of course, any criminal can destroy and say it was because of his political philosophy. Most criminals, however, have no political philosophy.
        The traditional “Right” believes less government is better. I think Trump tries to identify with that sentiment. I have no idea how much he believes it.
        The problem I see with modern times is that “government” is no longer the only centralized control system on the planet. But it gets all the attention as if it were the only such system. What about Corporate? What about Crime? All these systems today, it seems to me, are trying to muscle in and get a part of the action. Corporate has done very well for itself using Marketing, PR, and a few private security forces here and there. Crime survives by feeding on our fears and creating the apparancy of a dangerous environment. They are rumored to be as organized as Corporate. I don’t believe that, but I know they employ private security forces! Crime and Corporate tend to cross in people’s minds. Yet there are many honest people in Corporate and in Government who want to do the right thing. To the extent that they select criminals to advise them, they of course end up not doing the right thing.

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        • A point I have always shared and agreed with. Corporations are a force of their own and are often subject to no government at all, yet can do as much ore more damage than any government, and many of the problems with government (though certainly not all) are due to their being in bed with Corporations and/or Crime. And I do see an increasing crossover between Corporate and Crime that also needs to be addressed.

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        • “Government” is a neutral term unless it is specified who that government is meant to serve. How “big” is less important than how effective (for good or bad).

          By “anarchist” i was ironically referring to your garden variety disaffected middle class “street anarchist” who breaks windows and scrawls grafitti, not the traditional more intellectual, more revolutionary type.

          Communism is also a stateless society btw.

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  12. The “mental health” industrial complex is perpetuating the greatest pseudo-medical fraud/crime against humanity in history of snake oil cons using unscientific DSM labels & neurotoxic drugs documented to alter the brains & hormones of masses until they are damaged and unable to reproduce.
    “MH” workers are essential to perpetuating the fraud and they just got a massive windfall of “customers”.

    Nero, fiddled while Rome burned.

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    • It has been said that the story about Nero was just propaganda put out by his political enemies (of which he had many, as he wasn’t that competent). There are accounts, however, that he acted to save lives by giving people burned out of their homes a place to camp and get food.

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  13. If Trump had a psych assessment and was labelled with a DSM label to remove him from office that would only serve to give credence to the spurious DSM labels. It would be extremely detrimental to those unfortunate enough to have been given one of these bogus and defamatory labels.

    A great piece Paula, as always and thanks for your ongoing work in speaking out against the spurious DSM labels.

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  14. I don’t particularly agree with the idea of having a “panel of experts” or Commission or anything like that to determine the “fitness to serve” of any political official. After all, we have elections every few years through which the public is expected to make this decision.
    In the business world many of us have had to endure monthly, quarterly or annual “reviews” which seek to determine whether one should get a raise, be promoted, or perhaps be demoted or fired. Done right, such procedures only seek to answer one question: Are you doing your job?
    In the political world, there is no real “job description,” particularly for the office of President. But if I were to set up a review process for the President, that’s what I would have to ask: “Are you doing your job?”
    There are people who I know personally who seriously think Trump is leading this nation out of economic and societal troubles that were taking us closer and closer to disaster. These people think that ALL the serious flak that Trump gets is politically-motivated. That is, it comes from a bunch of “hard losers” who thought they could maintain control at the federal level but could not. I don’t have enough hard data to be able to tell the true situation when it comes to Trump. And I doubt anyone else does; I really wish they’d just skip it and start talking about something more important.
    It may be noted, though I may be incorrect about this, that most of the public bad impressions about Trump (or anything else they desire to deride) is being originated by the mainstream media or their supporters or allies. Remember that this is the same media that features numerous ads for psych drugs, and supports psychiatry and the whole “medical model” quite thoroughly. We are relying on this same source to tell us the truth about Trump? Or about anything else, for that matter? Why? To the extent that this is occurring, it doesn’t make sense.
    At this point, the main reason the media exists is to make us feel powerless, crazy, and buy things that make us “feel better.” Trust it at your own risk; I don’t.
    I think we should let the political process handle Trump. As far as I’m concerned, all this stuff about his fitness to remain in office amounts to nothing more than the pot calling the kettle black. I’d fire all of them and start over, if I could. I don’t think any of them are doing their jobs!

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    • Remember that this is the same media that features numerous ads for psych drugs, and supports psychiatry and the whole “medical model” quite thoroughly. We are relying on this same source to tell us the truth about Trump? Or about anything else, for that matter? Why?

      Nothing to argue with there!

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  15. Berzerk,
    I think most people are politically biased, but I highly doubt that was “a motive”. She simply made a point that NO ONE should be “diagnosed” by psychiatry. Not even people she does not like.

    Not only is it not “scientific”, although even if they found the particle of every single behaviour or feeling, they would still need to define it as an “illness”, they would still need to explain why people lose their rights… the name calling is invalid and certainly is not a “medical” specialty.
    Okay so we know that.

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    • We’ll, here’s Dr. James Gilligan explaining why he thinks Trump is dangerous:

      https://www.youtube.com/watch?v=1uJv22DGefA

      He mentions as the most serious a comment Trump made about his willingness to use nuclear weapons. Gilligan called that insane. He fails to mention Hiroshima or Nagasaki. It would also be strange if a President said publicly he would never contemplate using nukes under any circumstances.

      He also mentions Trump’s incitement to violence. He fails to mention evidence of paid agitators (DNC) at Trump rallies.

      What stood out most, was that Gilligan criticized German psychiatry in the 30’s. The only crime, in Gilligan’s view, was that they were unwilling to speak out against Hitler when he came to power. He fails to mention Aktion T4. It shows the mindset of psychiatry at the time.

      I wouldn’t take anything he says seriously.

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  17. I had stopped reading the comments to this post when it looked like they were slowing down, so I was surprised to check in just now and see how many more were posted. I haven’t yet read them all and am also surprised to see how many veer WAY away from the subject of my article but will try at least to read the relevant ones. However, I need to point out a libelous statement I noticed by someone who won’t use their real name but signs on as “Berserk.” That person alleged, among other offensive and totally uninformed comments, that I was paid to be a consultant on DSM-IV. That is completely untrue, and the idea that I did it for money is libelous. If “Berserk” or anyone else is genuinely interested in why I agreed to be a consultant and stayed for two years (I hoped to have a role in encouraging their Task Force to be honest about the relevant research and to take steps to prevent harm from psychiatric diagnosis, and I resigned when it became clear that both were hopeless), as well as learning about how the DSM process looks from the inside, it’s all described in https://www.amazon.com/They-Youre-Crazy-Paula-Caplan/dp/0201488329/ref=sr_1_1?crid=1AQJEHVRUMWX6&dchild=1&keywords=they+say+you%27re+crazy&qid=1592498360&sprefix=They+Say+You%27re%2Caps%2C127&sr=8-1

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  18. This is about a post way up the line. I wanted to respond to Steve McCrea’s comment that terms like “narcissistic” are different from “Narcissistic Personality Disorder.” I TOTALLY agree! Nearly every head of every DSM Task Force and nearly every president of its publisher, the American Psychiatric Association, which is officially registered as a lobby group, has either said nothing publicly about the DSM or has proclaimed that psych diagnosis is scientific! Nothing could be further from the truth. Steve is right that terms like “narcissistic” have long been used by the novelists, the poets, and ordinary people to describe people who are totally self-absorbed, etc. But to use a term like “NPD” that comes from the DSM is to become complicit with the DSM authors and marketers and profiteers who benefit from the false claim that such labels represent scientifically validated entities…and from further false claims that, because they “are” scientific, therefore whatever “treatments” they recommend inevitably follow from the diagnostic label.

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