Every day my Twitter feed contains references to a debate on Donald Trump’s mental health. And then came a letter from 34 psychiatrists, who suggest that he is not fit to be president. And I decided to offer my view.
Much has been said in the discussion. On the one hand, we have Allen Frances, with whom I agree, who opposes diagnosing Mr Trump, pointing out that it stigmatises those with mental illness (plenty of places on the Internet). On the other, there are the abovementioned psychiatrists who simply do not beat around the bush, or an Australian shrink who understands psychiatry’s shameful past, yet is happy to circumvent the diagnosis from afar. Somehow the fact that diagnoses/assesssments should be part of a therapeutic process, and they are established to help/treat people disappears from sight, but there you are.
My take on this all is different. You see, I come from a country where psychiatry’s involvement in the political process is very much in the living memory. I come from Eastern Europe where the shameful history was forged! And in contrast to those who write about ‘the shameful history’, I came in touch with it. Yes, I do know psychiatrists who were involved in politics. No, they did not commit people on the basis of phony diagnoses, but they ‘saved’ their political friends (mostly, middle class, university graduates, ‘intellectuals’) from military service and other parts of the oppressive communist state.
I heard the stories of false diagnoses which saved (almost) ordinary members of the anti-communist opposition and I loved them. Isn’t it great? We fooled the bastards! And yet, when you stop to think about it, you start thinking about those (like me) who didn’t have friends amongst the shrinks. As much as the intentions were good, what those doctors did, was create more inequality. Was it different from the diagnosis that oppresses? At one level, of course it was. It saved people from indignity, probably discomfort. But at another, no, it wasn’t. It was doctors who exercised their power at the behest of people who had some political goals. But it was in the ‘right’ cause, so it was OK, wasn’t it? Wasn’t it?! Except, it didn’t save me, I was drafted, because at that time I didn’t have friends with a medical degree.
I was also told that Polish psychiatrists on the whole behaved well and they didn’t offer diagnoses for the communist regime (I take it with a little bit of scepticism). So, I guess, I should say – lucky us. Diagnoses were only for the good guys! But so, you see, my perspective on psychiatrists determining who is fit or unfit in public life is somewhat different from those who write about it ‘theoretically’. And even though I disagree with just about every breath Donald Trump takes, I still think psychiatry should not be engaged in politics. It doesn’t end well and it has consequences well beyond the individual diagnosis.
But here is my main problem. What is the limit of such diagnoses? As you, psychiatrists, diagnose the president, can you also offer some insight into prime ministers? And after you do, perhaps you could also do members of governments? But let’s not stop there – can you do some others too? Civil servants? How about psychiatrists themselves? You misdiagnose, and you get diagnosed? Or perhaps professors? You know, you disagree with what I teach and, hey presto, you slap me with a diagnosis. You baulk at the thought? Well, don’t. Here is my story.
A few years ago, I was invited to give a guest lecture in a department of psychology. My talk was a challenge to psychometry (it became my paper on the BDI) and it went down like a lead balloon. The audience, mostly clinical psychologists, hated it. The discussion became war. They were attacking me, I was defending myself, (metaphorical) blood was on the floor. As they got more and more personal, my defence consisted in showing absurdity of their arguments and at one point, in the fray, I used a very colloquial phrase, for some, colloquial to the point of rudeness. That made them even more furious. And so, the session ended.
On the whole, I thought it was quite fun, the students who were present seemed to enjoy the intellectual carnage. But my mood was spoiled a couple of hours later when I heard that there was a discussion about my lecture continued behind the scene. Again, my arguments were rejected, but I also got a diagnosis. My colloquial phrase earned the diagnosis of the frontal lobe disorder. Apparently, I was disinhibited, apparently, my opponents’ arguments were not enough. And, in contrast to me, they also had the diagnosis they could slap on me. Bravo!
And so, here’s my take on diagnosing (or simply assessing) Mr Trump by psychiatry. As you throw away the principle of the therapeutic diagnosis, the so-called Goldwater rule, anything goes, doesn’t it? As much as we, anti-Trumpists, might think he deserves what he gets, just imagine psychiatrists who think he is a great president. If Mr Biden wins, will he also be fair game? Also, just imagine you might be next. Scary thought, isn’t it?