Does psychiatry add to political discourse?

Quick, grab a weapon!

Millions of alarmed Americans, and people the world over, grabbed the nearest bludgeon to fend off the Trump presidency. They reached for anything handy: street marches, sympathetic pundits, counter-tweets, progressive infotainment, social media. Unfortunately, most of these reactions only fed a vicious cycle of attack and counter-attack.

For the relatively few psychiatrists and other mental health professionals who took up arms, the bludgeon readily at hand was psychiatric diagnosis and a self-proclaimed “duty to warn.” Hastily written petitions and books preached to the choir. If you already knew Trump was disturbed, here was confirmation by experts.

The converse was also true. If you believed the left played underhanded tricks to disempower a democratically elected President, these statements were your proof as well. Condemnation of Trump by woolly-headed liberal therapists was hardly news. It simply confirmed that educated elites are not above it all. We merely chant our political slogans in fancier language.

The warrior psychiatrist

A prominent voice in this chant was Bandy X. Lee MD, a psychiatrist affiliated with Yale University who helped organize a small conference to discuss Trump’s mental state — the “Duty to Warn” conference — and who later authored the bestseller, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President (Thomas Dunne Books, 2017). Dr. Lee published an expanded edition in 2019, and another book about Trump in 2020.

Positions like Dr. Lee’s led to wide debate over the “Goldwater Rule” of the American Psychiatric Association (APA). This ethical standard prohibits APA members from issuing a professional opinion about a public figure’s condition unless the psychiatrist has conducted an examination “and has been granted proper authorization for such a statement.” During the Trump administration the APA defended this standard, while others, including Dr. Lee, held that a duty to warn the public superseded it.

In reality, most of the debate over the Goldwater Rule was moot. The Rule only applies to members of the APA. Dr. Lee is not a member. Nor, of course, are the vast majority of mental health professionals who are not psychiatrists. The ethical standard of a voluntary membership organization is hardly the “gag rule” Dr. Lee and others claimed.

No constitutional right to teach at Yale

However, other “gag rules” hit closer to home. As reported this week in the New York Times, Yale canceled Dr. Lee’s volunteer faculty position last year after colleagues warned that her public statements called into question her “clinical judgment and professionalism.” Dr. Lee then sued Yale, alleging that her dismissal violated her First Amendment rights and impinged on her academic freedom.

The courts will decide the merits of her case. However, on the face of it, Yale has not prevented Dr. Lee from writing or speaking. The First Amendment protects speech from government restriction, not from deplatforming by a private university. Indeed, Yale has countervailing First Amendment rights of its own.

It is also worth emphasizing that Dr. Lee had a non-tenure, volunteer faculty teaching position. I have held such positions myself throughout my career. A psychiatry department’s decision to use or not use someone to teach trainees often boils down to subjective personality factors. If an instructor has an “agenda,” or brings unwanted controversy to the department, that alone may be enough to end the affiliation.

Do we help or hurt?

The bigger question, which goes well beyond Yale’s choice of teaching faculty or a rule for APA members, is whether academically-toned denunciations of political figures by mental health professionals add anything to political discourse.

The practical implications seem quite limited. Dr. Lee’s books didn’t move the needle. They merely fed the the cycle of attack and counter-attack. Trump’s critics and supporters alike found confirmation of their prejudices. Moreover, Americans were again reminded that our means of removing a sitting president — impeachment and invoking the 25th Amendment — are political acts, not governed by medical or psychiatric wisdom. Diagnosis is a sharp instrument for helping patients, but at best a blunt weapon in politics.

Psychiatric outcry can do very little, whether in the court of public opinion or the actual machinations of government. Ours is one small voice in a sea of voices, all clamoring to be heard.

Risk of self-harm

Meanwhile, there’s a real risk of self-harm to the mental health professions. When we make dubious claims to authority, we appear smaller not larger. When we trade professional integrity for momentary media coverage, the whole field suffers.

Worse, we may unwittingly invite a dystopia where all political factions deploy mental health experts to declare their opponents unfit. A cacophony of warnings to shun the allegedly unbalanced — the very thing misguided psychiatrists did to Senator Goldwater in 1964 — bodes poorly for a democratic process premised on voters making independent assessments of character. Such warnings are also the very definition of an ad hominem attack. Little surprise Yale drew the line.

Image courtesy of bplanet at

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