Appeal for Principle Before Rule, and Uniform Application of Rules

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In this blog post forĀ Bioethics.net, Dr. Brandy X. Lee, editor ofĀ The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, discusses the harsh pushback against the book led by Dr. Jeffrey Lieberman. Lee argues that the authors of the book do not break the Goldwater Rule and instead fulfill their obligation to warn the public about danger.

“Dr. Lieberman has likened our efforts to Nazi or Soviet misuse of psychiatry, but as Dr. Judith Herman and I discuss in our prologue, ‘Professions and Politics,’ we caution about the American Psychiatric Associationā€™s (APAā€™s) recent expansion of the Goldwater rule as potentially leaning in that direction. In March 2017, barely two months into the current administration,Ā the APA announced an interpretationĀ that is inconsistent with the way the rule is written in the code and contradicts the principles of medical ethics. More importantly, it was a dramatic reversal from the way it had been interpreting the rule in the past (the latest interpretation of the rule had been restricted to giving a specific diagnosis of a public figure to the media, in the midst of discussions about turning the rule into an etiquette or abolishing it altogether). Under the current interpretation, it is by fiat a gag rule, whereby psychiatrists are forbidden from makingĀ anyĀ comment onĀ anyĀ aspect of a public figureā€™s speech or behavior, even in an emergency.”

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5 COMMENTS

  2. In all honesty, I have always had a problem with the tendency of psychiatrists to label or diagnose posthumously, based entirely on public image, or to diagnose having never interviewed or even seen a case file for someone. I think it not only stigmatizes but spreads misinformation and is often used to manipulate the public.
    However, the APA shouldn’t be allowed to write standards to fit its agenda or to punish others for entertaining an opinion that is not shared by the APA.
    Also, does Lieberman ever respond within anything vaguely resembling a logical argument? It seems like all he offers is a condescending air and add hominem attacks, and even those are never supported.

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  3. As one of the co-authors of “Dangerous Case of Donald Trump” I can say that our message is that Trump is dangerous. We don’t need to diagnose to assess dangerousness and there is ample evidence in the public record of his propensity toward violence, violating the rights of others, believing he is above the law, impulsivity, recklessness, harm, lack of empathy and compassion, abusive behavior, lack of moral judgment, etc, etc. Part of the challenge related to “stigma” is that the DSM/ICD lumps personality/character issues in with those with things like anxiety and depression. As I write about extensively on my website (www.HarperWest.co), we should consider a framework of assessing emotional and behavioral problems with an understanding that most are caused by poor shame tolerance. Blame-shifting is the result, with Other-Blamers like Trump behaving in ways that would be judged as immoral. The DSM might label these people Narcissistic or Sociopathic. Self-Blamers and Blame Avoiders do not generally behave in ways that society judges as immoral. Until we make this distinction with assessment this problem will continue. I believe we all — mental professionals or not — should and must judge those who behave immorally and address that issue. When the person doing so controls nuclear weapons, it is absolutely a danger to society.

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