Thursday, February 2, 2017

A SOCIOPATH IN THE WHITE HOUSE? by Jacob M. Appel, MD JD


A SOCIOPATH IN THE WHITE HOUSE?
by Jacob M. Appel MD JD

As both a practicing psychiatrist and the author of the forthcoming The Mask of Sanity, a novel that features a high functioning sociopath, I find myself asked with increasing frequency about the mental health of our incoming President.  Readers inquire:  Is Donald Trump mentally ill?  What is his diagnosis?  Could he truly be a sociopath and what does this bode for our country? 

 Even if I were able to answer these questions—and my sense is that you do not need a fancy medical degree to answer the first two—I may not.  Since 1973, section 7.3 of the American Psychiatric Association’s code of ethics, colloquially known as the “Goldwater rule,” has prohibited headshrinkers like myself from offering “a professional opinion” about “an individual who is in the light of public attention...unless he or she has conducted an examination” of that person “and has been granted proper authorization for such a statement.”  So I am prohibited from commenting on Mr. Trump’s mental health based upon his public behavior—at the risk of losing my hospital privileges or even my medical license. 

 Similarly, I’d be remiss to claim that Charles Manson or the “Son of Sam” suffers from mental illnesses, as I have never evaluated either of them personally.  In the early 1990s, the APA adopted a more lax approach regarding deceased historical figures, so I am at liberty to suggest that the Roman Emperor, Caligula, was troubled, and to offer general comments on the mental health of Joan of Arc and Vincent Van Gogh.  But Fred Trump’s pride and joy is clearly off limits.  

The “Goldwater rule” arose out of a specific set of disturbing historical circumstances.  In the lead up to the 1964 Presidential election, a magazine called Fact published an issue on “The Unconscious of a Conservative” that focused on the psychological makeup and alleged pathology of Republican candidate Barry Goldwater.  The magazine’s editor, Ralph Ginzburg, included a survey of psychiatrists in which 1,189 out of 2,417 respondents declared the conservative Arizona senator unfit for the nation’s highest office.  Some of the comments published alongside the survey proved damning, even by modern standards.  

One anonymous critic wrote:  “I believe Goldwater to be suffering from a chronic psychosis.”  Another observed:  “I believe Goldwater has the same pathological makeup as Hitler, Castro, Stalin, and other known schizophrenic leaders.”  And a third:  “A megalomaniacal, grandiose omnipotence appears to pervade Mr. Goldwater’s personality giving further evidence of his denial and lack of recognition of his own feelings of insecurity and ineffectiveness.”  

Understandably, a backlash arose—both inside and outside the professional.  Bioethicist Jonathan Moreno makes a persuasive case that much of this handwringing among shrinks stemmed from fears that “amateurish psychological assessments and poor political prognostication” threatened the credibility of psychoanalytic psychiatrists.  Rather than an anomaly, concern over attacks on Goldwater followed similar reactions to A.A. Brill’s diagnosis of Abraham Lincoln as “a manic schizoid personality” and preceded William Bullit’s controversial “necro-analysis” of Woodrow Wilson.

During the recent presidential campaign, a number of leading psychiatrists and psychologists—myself included—called for the repeal of the “Goldwater rule.”  (APA President Maria Oquendo has led an impassioned public defense.)  Other thought leaders in mental health have circumvented the rule by offering “image” assessments without formal clinical diagnoses, an approach noted forensic psychiatrist Paul Appelbaum derided in the New York Times as “splitting hairs.”  As I have argued elsewhere, the cases where the “Goldwater rule” proves most harmful are not those involving politicians or celebrities, but criminal prosecutions of deranged spree killers like Gabrielle Giffords shooter Jared Loughner and Aurora movie theater gunman James Holmes. 

 In many of these cases, psychiatrists could offer a likely diagnosis based on public documents and courtroom “performances,” diagnoses that might help the American people understand these tragedies and could lead to both to more appropriate punishments and better prevention.  (Certainly, these killers should never walk the streets again, but many belong in psychiatric facilities, rather than prisons.)  Instead, the experts most fit to comment are unable to do so, ceding the public forum to uninformed talking heads.  In contrast, whether the political process truly suffers because I cannot comment publicly upon my congressperson’s sanity is not so readily apparent.

 What is rather clear in hindsight is that the late Barry Goldwater was not mentally ill.  While I disagree with many of the five-term senator’s political stances, nothing in his conduct over more than four decades in the public eye—including as a military pilot during World War II—suggests anything other than a noble, well-adjusted servant of the commonweal.  As a liberal myself, I fear one of the repeated canards of the American Left is the claim that political conservatives are mentally ill, rather than merely misguided or wrong.  From painting Ronald Reagan as a madman in 1980 to questioning John McCain’s temperament in 2008, the myth of the “crazy” right-winger has become a consistent theme in progressive politics. 

It is the meme that cried wolf.  (As far as I know, the only major party candidate who suffered from a mental illness between 1945 and 2016 was 1972 Vice Presidential choice Thomas Eagleton of Missouri, a fine United States Senator who had undergone shock treatment for depression, and who was rapidly pushed off the Democratic ticket by George McGovern when this became known.)  Only through the lens of the current political situation does the damage done by those false claims against earlier Republicans become fully clear.

Up to a certain point, of course, all presidents—and many successful people—have narcissistic and antisocial traits.  A bit of narcissism helps a psychiatrist get through medical school; a dose of sociopathy helps Presidents send American soldiers overseas to risk their lives.  But traits are not the same as pathologies.  Nobody wants a psychiatrist who does all the talking or a trigger-happy leader for the Free World.

This might be a good moment to make an observation that is not a popular view in liberal circles where I travel, nor presumably in conservative ones either:  By both international and historical standards, the differences between Barack Obama and Mitt Romney, in terms of policies and values, were rather small.  So too of Bush and Gore, even Reagan and Mondale.  All of these men believed in certain fundamental norms—norms that are outliers in a world where half of the global population lives without basic civil liberties or political rights.  Among these common norms are the belief that if you lose the election, the other side gets to assume office.  No tanks or martial law involved.  And that if you disagree with your opponents, you are welcome to denounce them on television or the Internet—but not to poison them with polonium.  And, most important, that leaders of the other political party are opponents, or rivals, but not enemies.  None of these men ever conflated the elected officials seated across the aisle with the foreign operatives across the Bering Sea.  These are enormous commonalities, ones that dwarf any differences regarding tax policy or abortion rights or the wisdom of the War in Iraq

Certainly, the policy differences between the parties will affect the lives of ordinary Americans in countless, meaningful ways.  That is why we have elections:  For voters to determine the direction of these policies.  But the shared values of our recent political leaders in both parties far outweigh their disagreements.  Anybody who scoffs at the importance of these shared beliefs should spend a few weeks in Eritrea or Equatorial Guinea—or read a history of the Weimar Republic.  When someone challenges these common values, as Mr. Trump has arguably done, both sides need to step back from the brink and acknowledge their importance.  As Grandpa Vanderhof observes in the Kaufman and Hart comedy, You Can’t Take it With You, “Got all worked up about whether Cleveland or Blaine was going to be elected President—seemed awful important at the time, but who cares now?” 

The Goldwater rule prevents me from answering the question:  Is Donald Trump a high functioning narcissistic sociopath?  I must allow readers to evaluate that matter on their own.  What I can say is that high functioning sociopaths are dangerous.  Highly so.  They are often unable to accept criticism and incapable of adjusting their conduct to circumstances.   Great presidents are rarely judged by their Supreme Court appointments or infrastructure programs, but by their responses to cataclysmic challenges like Pearl Harbor, Soviet warheads in Cuba, or 9-11. 

 Had a   high functioning narcissistic sociopath been president during the Cuban Missile Crisis, we would all likely be dead.  Food for thought.  (I highly recommend that book on Weimar, by the way, for the next fool who declares, “Mike Pence would be worse.”)  Alas, I cannot comment on Mr. Trump’s mental health—either to bury it or to praise it.  But if I were a reader, I might ask myself what distinguishes Mr. Trump from Bernie Madoff or Martin Shkreli other than circumstance?


When George W. Bush was first elected president, I used to joke that the great thing about America is that even the son of a President can grow up to be President.  But I never doubted that George W. Bush was sane or rational or genuinely believed he was serving the public good.  Maybe the question we should be asking ourselves is not, Is the President a high functioning sociopath?  A better question might be:  How did we ever reach the point where anyone might even have to ask whether the President is a high functioning sociopath?  Once you’ve asked that question, does it really matter whether the clinical answer is yes or no?

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