A Harvard Psychiatrist Wrote to Obama to Demand a Psychiatric Evaluation of Trump

Donald Trump’s erratic behavior—from his petulant response to Saturday Night Live’s depiction of him to his erratic diplomatic calls—is hardly typical of a president. And his manner is so unusual that three psychiatrists, including Judith Herman, professor of psychiatry at Harvard Medical School, have written to US President Barack Obama to request that Trump receive a “full medical and neuropsychiatric evaluation.”

The letter, reported in the BMJ and printed in full in the Huffington Post, reads as follows:

We are writing to express our grave concern regarding the mental stability of our President-Elect. Professional standards do not permit us to venture a diagnosis for a public figure whom we have not evaluated personally. Nevertheless, his widely reported symptoms of mental instability — including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality — lead us to question his fitness for the immense responsibilities of the office. We strongly recommend that, in preparation for assuming these responsibilities, he receive a full medical and neuropsychiatric evaluation by an impartial team of investigators.

The letter is signed by Herman and two University of California, San Francisco professors, Nanette Gartrell and Dee Mosbacher, and provides some vindication for those who consider Trump unfit for office.

But mental health issues are rarely clear cut, and attempting to evaluate the president’s psychiatric health will always be a complex task. Even if Obama could enforce a psychiatric evaluation, it’s far from clear what it would achieve.

Trump is not the first president-elect or presidential candidate to be associated with a mental disorder. In their letter, the three professors acknowledge that they cannot diagnose a public figure who they’ve not personally evaluated; this is a reference to the “Goldwater rule.” In 1964, Fact magazine ran a cover story stating that 1,189 psychiatrists considered Republican nominee Barry Goldwater unfit for presidency. (For full context, they surveyed 12,356, of which 2,417 responded, 657 said he was fit, and 571 said they didn’t know enough to respond.) But none of them had actually personally examined the candidate. Following on from a legal challenge against the magazine, the American Psychiatric Association officially prohibited its members from commenting on public figures’ mental states without personally examining them.

But even if psychiatric evaluations were a standard procedure for presidential elects, they would likely have little substantive effect. Robert Klitzman, psychiatry professor at Columbia University and cofounder of the Center for Bioethics, warns that such tests do not draw a clear line between fit and unfit for presidency. “It’s not like a pregnancy test where you’re either pregnant or not. There are a lot of grey areas,” he says. “There’s a question: What’s normal? How bad does someone need to be psychiatrically to say they can’t be president?” Other than clear hallucinatory psychosis, it’s uncertain which conditions would definitively prohibit a candidate from presidency.

There’s also the matter of consent. “You need the person to agree to answer questions honestly and sincerely and reveal potentially embarrassing details and I don’t think Mr. Trump would agree to that,” explains Klitzman. Without such willingness to participant, a psychiatric test would only reveal a limited result.

Scott Lilienfeld, psychology professor at Emory University, adds that a psychiatric test on Trump would unlikely reveal any behavioral tendencies that haven’t been on display throughout the presidential campaign. Plus, he says, some maladaptive behaviors can be adaptive in other scenarios—for example, narcissism can make you self-confident and persuasive. “It’s naive to think certain traits will be bad in all circumstances,” he adds.

And when it comes to evaluating presidential candidates’ mental health, there’s a long history of getting it wrong; partly because our standards of strong mental health frequently evolve. Thomas Eagleton was dropped as the Democratic vice president nominee in 1972 after it was revealed he’d had treatment for depression. Today, we’d hopefully be more accepting; after all, Abraham Lincoln’s diaries suggest that he suffered from what would today be diagnosed as clinical depression. The condition is no barrier to being an excellent president.

“Our standards change,” adds Klitzman. “Up until the early ‘70s, homosexuality was considered a psychiatric diagnosis. Anyone who was gay would have been told, ‘You have have a psychiatric diagnosis, you can’t be president.’”

Though Trump’s apparent narcissism and volatility raise concerns about whether he should be president, similar traits have been exhibited by previous presidents. Lilienfeld points out that Trump’s behavior is, in some respects, similar to President Andrew Jackson, who killed a man in a duel.

“Jackson was much more out of control, very foul-mouthed, apparently got into lots of barroom fights, was aggressive. He was a wild card and a little hard to control,” he says. “Ironically, Andrew Jackson is retrospectively rated as one of our better presidents. He’s on our $20 bill.”

On the other hand, that sort of behavior might be much more dangerous in Trump’s time than it was in Jackson’s. As Lilienfeld says: “That was an era when we didn’t have nuclear weapons.”

Olivia Goldhill
qz.com