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Dr. Lee goes to Washington

Let freedom ring

President Trump’s mental fitness for office has emerged as one of the most contentious political debates of the new year. One notable participant in this debate is Dr. Bandy Lee, a Yale psychiatrist who edited “The Dangerous Case of Donald Trump,” a book written by 27 mental health professionals who claim that President Trump represents a clear and present danger to the nation. Dr. Lee’s work has sparked additional public interest after Politico reported that she travelled to Washington in December to brief more than a dozen lawmakers, including an anonymous Republican Senator, on the president’s mental condition.

Lee’s work has drawn criticism from a number of notable detractors. The American Psychiatric Association’s (APA) “Goldwater Rule” prohibits medical professionals from publically commenting on the mental health of public figures without conducting a formal examination of the subject. Dr. Lee’s work clearly ignores this edict. And in a letter to the editor in The New England Journal of Medicine, Dr. Jeffrey Lieberman of Columbia University accused Lee’s work of promoting a “misguided and dangerous morality.”

These critics seem to have a point. It only makes sense that psychiatrists should issue diagnoses based on rigorous medical analysis rather than distant speculation from afar, especially when the subject is someone as polarizing as President Trump.

Dr. Lee has responded to these criticisms by claiming that the book does not specifically diagnose the president and therefore does not violate the original text of the Goldwater Rule, which prohibited specific diagnosis but not general discussion of a public figure. In March of 2017, the APA’s Ethics Committee modified its position on the Goldwater Rule to prohibit “all professional opinions,” and not just diagnoses. Dr. Lee has also repeatedly emphasized that her actions are inspired by a duty to warn the country of an impending danger to public health rather than by political motivations.  

I remain perplexed by the movement that Dr. Lee and her book represent. First, Dr. Lee has taken to drawing psychiatric inferences from legitimate political decisions President Trump has made while in office. In a recent interview, for instance, she suggested that President Trump’s decision to move the United States’ Embassy in Israel to Jerusalem constituted a telltale sign of his pathological desire for violence. I disagree. Decisions such as where to locate an embassy represent legitimate policy considerations, and stigmatizing political disagreement through the language of psychiatry sets an immensely dangerous precedent in political discourse.

The book’s tendency to issue de facto diagnoses of President Trump through insinuation is also alarming. The APA’s response makes it quite clear that Dr. Lee’s work violates the letter of the Goldwater Rule, but this perverse form of argument seems to violate its spirit as well.

The formula that Dr. Lee and her co-authors employ goes something like this. After acknowledging that the Goldwater Rule prohibits the unauthorized diagnosis of public figures, they describe in immense detail the specific symptoms of a certain condition and chronicle a litany of instances where they believe President Trump’s behavior aligns with those symptoms. Lee and others then advance the natural conclusion that would come from diagnosing the president with severe conditions ranging from sociopathy to dementia, affirming that his presence in the Oval Office represents a clear threat to national security.

In short, the book comes about as close as one can to psychiatrically diagnosing President Trump without explicitly doing so. Any reasonable reader will walk away from the book concluding that its authors believe the president suffers from the psychiatric deficiencies they describe in their respective chapters. Its authors’ formula clearly diverges from the overarching spirit of the Goldwater Rule, which seeks to avoid public hysteria by demanding that such weighty accusations be supported by an actual examination rather than armchair psychiatry from the sidelines.

Perhaps the most unfortunate consequence of this style of argument is how it diminishes the book’s broadest point on the relationship between mental health and the American presidency more broadly, irrespective of President Trump. A 2006 Duke Medical School study claimed that half of US Presidents before 1974 displayed symptoms of various psychiatric conditions, and this is an issue that should concern all Americans on both sides of the aisle.

Lee and her co-authors’ points on this important topic will likely be forgotten, for Democrats will embrace the book as a political weapon in their opposition to President Trump, and Republicans will dismiss the book as slanderous due to its violation of the Goldwater Rule to target the President.

And to the members of Congress who took the time to attend Dr. Lee’s presentation on Capitol Hill, I would emphasize the following: in the current political climate, you would do well to focus on issues where your efforts could better serve the country—such as ensuring that the government does not shut down by Friday and improving Congress’s meager approval rating, which remained at 15 percent as of last week.  

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