The ‘mad king’ conundrum – a question of ethics

5 minute read

Some US psychiatrists are breaking their professional code of ethics to warn the public about Donald Trump Where were you when Donald Trump was elected President of the United States? I was at my desk. Work had ground to a halt, and I was feverishly hitting refresh on the New York Times election prediction barometer. […]

Some US psychiatrists are breaking their professional code of ethics to warn the public about Donald Trump

Where were you when Donald Trump was elected President of the United States? I was at my desk. Work had ground to a halt, and I was feverishly hitting refresh on the New York Times election prediction barometer. The needle swung to 95% certainty, triggering the rumblings of a seismic political shift felt around the world.

Dr Bandy Lee, a forensic psychiatrist and violence expert at Yale University, found herself in centre of the emergency response.

“The day after the election, I was flooded with phone calls and emails from people and organisations that were afraid of the violence that was to come,” Dr Lee tells Rheumatology Republic.

Many people fear that President Trump isn’t exactly the “very stable genius” he claims to be.

“His impulsivity, recklessness, paranoid reactions, lack of empathy, loss of touch with reality, constant need to burnish a sense of power, attraction to violence –  these are psychological signs that point to dangerousness,” Dr Lee says.

As the election results rolled in, Dr Lee had a choice to make. Either she could abide by the new “gag rule” laid down by the American Psychiatric Association, or she could speak out.

“I had to ask myself, after devoting my entire career to preventing violence, do I turn away from the greatest violence we could possibly face?”

The association’s Goldwater Rule was expanded in March last year to prohibit psychiatrists from not just diagnosing, but from making any comments on the effect, behaviour or speech of public figures, even in an emergency.

It goes much further than the original Goldwater Rule, established in 1973, which allowed psychiatrists to share their expertise in general, so long as they did not actually diagnose a public figure without first examining them, and obtaining their consent.

Dr Lee is a proponent of the Goldwater Rule in its original form, but she believes the new rule asks psychiatrists to violate a higher principle of medical ethics: the protection of human health and wellbeing. This principle was clarified in the Declaration of Geneva adopted by the World Medical Association in 1948.

Most psychiatrists privately consider President Trump a threat to public health and safety, says Dr Lee. But few are willing to say this publicly, and none of Dr Lee’s colleagues would sign their name to a letter to Congress following the 2016 election.

“I thought that was odd,” she says. “I then decided to organise a conference to talk about it. No one would co-organise it with me and so I did it alone.” The conference took place in one of Yale’s 500-seat auditoriums. Only 20 people showed up.

Some of Dr Lee’s colleagues told her quietly that they were afraid of retaliation in the form of physical violence from Trump supporters, or legal action from the President himself.

The media caught wind of the Yale conference, and the international headlines that followed gave Dr Lee a way to connect with thousands of colleagues. Together, they formed the National Coalition of Concerned Mental Health Experts.

Twenty-seven of these psychiatrists and mental health professionals published their views in a damning treatise, The Dangerous Case of Donald Trump, in October last year.

The book, edited by Dr Lee, presents a laundry list of psychological issues that may explain President Trump’s seemingly difficult relationship with reality.

It didn’t directly diagnose President Trump, which would be in violation of the 1973 Goldwater Rule. But the book does provide education on narcissistic personality disorder, sociopathy, hedonism, paranoia, delusional disorder, cognitive impairment and dementia. You connect the dots.

This kind of information isn’t just relevant to the electorate, says Dr Lee. US legislators have the power to declare the President unfit and remove him from office under the 25th Amendment.

In early December, Dr Lee agreed to brief around a dozen members of the House of Representatives and the Senate who were worried about the president’s mental fitness. This meeting included one unnamed Republican senator.

While this may appear uncomfortably close to politics, Dr Lee says she abided by ethical guidelines, providing medical information in a politically neural way. This is a public service similar to a psychiatrist commenting on a defendant in a court of law, she says.

While knowledge of psychiatric conditions can help legislators make a decision, the question of whether President Trump is fit for office is a political one, not a medical one, she says. Dr Lee says she would provide the same service in relation to a Democrat president.

Dr Lee is very strict when it comes to conflicts of interest.

Late last year, she received a series of unexpected phone calls from close associates of President Trump, who said the President was frightening them. “They used the word ‘unravelling’,” she says.

Dr Lee explained she could not adopt a treatment role while she was involved in public education and told them to call the local emergency room.

Psychiatrists speculating about the President’s mental state have been savaged by the psychiatric association, which declares this kind of “armchair psychiatry” unacceptable and unethical.

“Simply tawdry, indulgent, fatuous, tabloid psychiatry,” was how past president Dr Jeffrey Lieberman described Dr Lee’s book.

“Psychiatry has made too many past missteps to engage in political partisanship disguised as patriotism – witness its collusion in Nazi eugenics policies,” he warned.

But psychiatrists who believe they have an ethical obligation, and a legal right, to speak freely have pushed back.

The German Psychiatric Association said nothing during the rise of Hitler, psychologist Dr John Gartner, one of the 27 authors in Dr Lee’s book, said.

“Should they be our moral role models? As a Jew, I was raised with the mantra ‘never again’, which means it is a grave and terrible sin to be silent in the face of rising fascism.

“We are fiddling with the Goldwater Rule while the world burns.”

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