Should Therapists Analyze Presidential Candidates?

NOT long ago, a journalist asked me what I thought, as a psychiatrist, of Donald J. Trump.

Many psychologists have been quick to offer diagnoses, calling him and other presidential candidates “narcissists,” and even providing thoughts about possible treatments.

I wondered what, if anything, to say. I’ve watched Mr. Trump on TV like everyone else, but never met him. So, I hesitated — for ethical reasons. The American Psychiatric Association (A.P.A.) prohibits its members from giving professional opinions about public figures we have not interviewed.

This ban stems from a bad incident in my field. In 1964, Fact magazine published an article, announced on its cover as “1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President”. The magazine surveyed these professionals, and 49 percent of respondents said Barry M. Goldwater was unfit for the job, describing him as “unbalanced,” “immature,” “paranoid,” “psychotic” and “schizophrenic,” and questioning his “manliness.” Leading psychiatrists were among those quoted. A famous Johns Hopkins professor said Mr. Goldwater’s utterances should “disqualify him from the presidency.”

Mr. Goldwater was “extremely upset,” saying he did not know if people seeing him on the street now thought, “There goes that queer, that homosexual.” He sued for libel. A Federal District Court awarded him $1 in compensatory damages, and $75,000 in punitive damages. An appeals court upheld the decision, and the Supreme Court denied the defendants’ request to review the case.

In response, the A.P.A. issued “The Goldwater Rule”:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

To diagnose conditions in someone we’ve never met — let alone offer treatment recommendations — is fraught both ethically and scientifically. Assessing patients face to face and finding out their experiences and history, much of which is private, and has perhaps never been disclosed to anyone, is essential. Otherwise, we risk making big errors and fostering confusion.

Psychiatric diagnoses are after all stigmatized (calling someone “narcissistic,” “psychotic” or “in denial” is commonly a denigration), and are frequently misunderstood. Insurance companies still grossly underfund mental health treatment, leaving millions of seriously ill Americans without care. These restrictions reflect, partly, widespread biases that psychiatric diagnoses (e.g., depression) are not “real problems” warranting insurance coverage. Hence, to legitimize psychiatric disorders and treatment is important. Doctors who loosely and freely offer diagnoses for individuals they have never interviewed threaten to make these terms cheap and ubiquitous, fueling misperceptions.

Over the 50 years since the Goldwater incident, researchers have thus conducted careful studies to make psychiatric diagnoses clearer and more precise, advancing scientific understanding and treatment. Since the Hippocratic oath, physicians have also sought to act professionally, to follow very high moral standards and respect privacy and confidentiality, partly to gain and preserve patients’ trust.

Nonetheless, many mental health providers have challenged the Goldwater Rule. Psychologists (with Ph.D.s, as opposed to psychiatrists, with medical degrees) argue that this principle does not fully apply to them, and that offering diagnoses of public figures can be in the national interest. Recently, several psychologists ranked all of the presidents in order of narcissism (L.B.J., Nixon and Teddy Roosevelt scored on top), and argued that this trait helped in persuading the public and advancing legislation, but could also lead to rigidity and impeachment.

Diagnoses may at times perhaps be in the national interest, but when — and for which public figures — has been debated. In 1990, the psychiatrist Jerrold Post presented to Congress a psychological profile of Saddam Hussein. Dr. Post interviewed people who knew Mr. Hussein, but not the leader himself. Yet in a Times article subsequently describing the report, some experts questioned how accurate such a profile could be. The A.P.A. then received complaints that Dr. Post had violated the rule. Dr. Post responded that he had provided “not a psychiatric expert opinion” but “a political psychology profile,” and that the national danger posed by Mr. Hussein overrode other considerations.

The A.P.A. then clarified the ban slightly. When asked if the principle applied to careful scholarly research on public figures that did not give diagnoses, and aimed to enhance public and governmental understanding, the A.P.A. answered that the rule did not cover such studies of “historical” figures. Yet the organization did not address whether the principle extended to living individuals. Still, it clearly aims to bar flip, off-the-cuff remarks to the media.

Biographers have also faced controversies regarding diagnoses of conditions in the deceased — specifically how accurate and meaningful these labels are. Since his suicide, van Gogh, for instance, has received diagnoses of over 30 different conditions, from lead poisoning to temporal lobe epilepsy, manic-depression and Ménière’s disease. Joyce Carol Oates has decried “pathographies” — biographers diagnosing diseases in famous writers, artists and others, seeing the work of these remarkable individuals as resulting, often simply, from their “madness.”

Rigorous scholarly studies about militant enemies such as Mr. Hussein may occasionally aid the nation’s interests as a whole. But do comments about Mr. Trump?

To the journalist who contacted me, I thus explained the Goldwater Rule, and that I had not examined Mr. Trump, so could not say anything specific about him, but that, in general, egoism unfortunately motivates many presidential candidates. I said I hoped that would not impede them from acting in the public’s best interests — but that it was a danger.

The writer published my comments. Glenn Beck, the conservative commentator, then asked me to speak on his radio show about Mr. Trump. I declined.

Our current presidential candidates present various psychological issues that we ultimately must all assess and weigh on our own.