Last week, a group of prominent psychologists and psychiatrists led in part by Dr. Robert Jay Lifton, renowned for his contribution to psychological effects of warfare, signed a letter to the American Psychiatric Association petitioning them to rescind a substantial portion of the Goldwater rule, which bars therapists from making public assessments on the mental health of public figures.
The delegation last week represents thousands of psychologists and mental health professionals throughout the United States who have banded together in a large outcry against president Trump, wanting to diagnose him with various mental health disorders publicly, and to subsequently use these diagnoses to enact negative action against him. Regardless of one's personal opinion of the president, other therapists decry this as an alarming development in the mental health community that risks causing a deep chasm in the public's trust of mental health practitioners as well as increasing the already prevalent problem of stigma in our society.
It is widely considered unethical to mentally diagnose someone who is not a patient, let alone make that diagnosis public, which is a violation of HIPPA and patient privacy laws. In the mental health community, a large rift has been created with some wanting to issue a public diagnosis against the president for negative action, and others who say such action is not only unethical, but downright harmful.
One of the leaders in the quest to diagnose the president is Dr. Bandy X. Lee of Yale University who recently authored the book "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President". She stated that "We are asking our fellow mental health professionals to get involved in politics not only as citizens, but also, specifically, as professionals and as guardians of special knowledge with which they have been entrusted."
According to Dr. Bandy Lee, mental health professionals are "guardians" of "special knowledge" and she argues that it is her and other therapist's obligations to wield their power to educate the public. Their justification of "duty to warn" states that in the case of someone posing a risk to themselves or others, they are allowed to break confidentiality. But even in this case, breaking confidentiality through a mandatory reporting law means notifying the authorities, it does not mean going on tv, going into newspapers, or writing a book exposing your patient. "Duty to Warn" as it is being used by Dr. Bandy Lee and others is materially different than the same standard as it is applied in the clinician's office.
But Dr. Lee is not alone in her position. Many others in the field are leading causes aimed at removing president Trump from office on mental health grounds. William Doherty, a psychologist, created an online manifesto against "Trumpism" which goes far beyond Trump and is aimed also at those who voted for him. How ethical is it, therefore, for a psychologist to make sweeping judgments against millions of people? Is there a downside to this, so that those people may start to lose trust in the mental health community? For someone who voted for Trump to read articles all over the "Psychology Today" website insinuate that they are mentally unsound or worse, is this not compounding the problem of mental health stigma? Some would argue it is doing exactly that.
According to Dr. Allen J Frances M.D. who authored the DSM criteria for Narcissistic Personality Disorder, the outcry against the president from therapists is resulting in an embarrassment for the mental health community. The risk that mental health professionals are taking by becoming voracious political activists could alienate a large segment of the public from their offices as clients. The reality is that a huge segment of the population voluntarily elected Donald Trump as president and even now, according to the latest polls, he commands a 48% approval rating, the same approval rating as President Obama had at the same time in his tenure as president. This is a lot of people, and they have the same right to quality mental health care as anyone else, without stigma. Dr. Lee and those with her feel it is their duty to "educate" the public, with the end goal of persuading them to their point of view. Because she holds a guardianship of "special knowledge," the public should therefore listen to her expertise and be persuaded. But yet, few people actually go to a therapist's office to be persuaded to the therapist's opinions or to be told how to think (i.e. "fixed" or "educated").
Elaine Ducharme, PhD, a psychologist and public education coordinator for the Connecticut Psychological Association has stated it is highly unethical to diagnose someone you haven't sat down with to interview. She holds the same opinion as a vast amount of other therapists as well. And yet on the opposite side, there are those who want to break with this standard, and be liberated to make public diagnoses against Trump. But if we start down this path, where will it end? Will it stop with Trump? Doubtful. In a world where psychologists are free to make a diagnosis against a public figure it can easily be foreseen that any politician could wind up with a diagnosis, and we can imagine political ads that use diagnostic disorders as weapons against an opponent. "My opponent is a narcissist….vote for me instead." This is the very definition of stigma: using mental health diagnoses in order to bring negative results against another person.
Recently, a restaurant manager at the Red Hen in Virginia refused to serve food to Sarah Sanders, a Trump administration official. This was met with a massive outcry both for and against. Division in America is possibly higher now than ever before. When psychologists and therapists enter the political fray and take a definitive "side", they create a real risk of alienating a large segment of the public from mental health therapy.
Earlier in April, there was a fire in the Trump Towers in New York City which killed one and injured 6 firefighters. Dr. Jeffrey Guterman, a psychologist in Florida and best selling author, in response on his twitter feed wrote: "There is a fire in trump tower, I hope everyone is safe, but I am excited", and, "hoping there is major damage". Dr. Jeffrey Guterman has been calling for Trump to be publicly diagnosed, in agreement with Dr. Brandon Lee, and yet his statements of joy regarding a deadly fire in a NYC skyscraper were met with swift backlash. Some have wondered, "how many others in the mental health community, along with Dr. Guterman, have the same feelings and opinions, but simply did not tweet them?"
Dr. Guterman is a fierce advocate of diagnosing President Trump, but do statements like this create a safe therapeutic environment for his clients who may not vote like he does?
Any conservative client of Dr. Guterman would reasonably feel completely horrified at his comments, and the effectiveness of Dr. Guterman to treat mental health issues for those clients would be rightly called into question. How can a conservative person, for example, trust and develop a healthy therapeutic relationship with a therapist who has publicly come out as a political activist? Worse yet, imagine a married couple where one spouse voted for Hillary and the other for Trump and their therapist (unbeknownst to them) is in line with Dr. Guterman. How can this couple expect healthy, stigma-free treatment and therapy? It's one thing for a therapist to disagree with someone's politics, but quite another to vehemently hate the other side so much so, that it boils over into public comments that threaten the public perception that mental health professionals represent a place of emotional safety.
Many people in America, notably those who are conservative, libertarian, or independent Trump voters, as a result of the tens of thousands of therapists who are crying out against the president, are beginning to fear mental health community and are refusing the option of therapy because of it. This is a very alarming precedent towards an effort to lower stigma in our society. With the recent spate of high profile suicides by David Spade and Bourdain (106 famous people have committed suicide already in 2018), mental health stigma is a real and pervasive problem in our society.
Some state that for mental health professionals to diagnose someone with a disorder whom they haven't ever interviewed personally, and then use that diagnosis as a basis to get that person fired, is a similar path as what was taken at the Red Hen, it sets up a dangerous precedent going forward, which can only increase stigma, rather than reduce it. Mental health advocates fight hard to protect workers who suffer from mental health conditions from undue workplace action. To fire someone over a DSM-5 disorder is far more "acceptable" in today's culture than firing someone over a physical sickness, something that mental health advocates want to change. One of the Center for Workplace Mental Health's key missions is to "increase awareness, reduce stigma, and motivate employees and their families to seek help when needed." The possibility that we could weaponize the DSM to diagnose people without ever meeting them, and then using that against them in their workplace is counter to the philosophy of many in the mental health advocacy sphere.
A therapist who does not want to go on record put it this way, "If a group of mental health experts say 'look at this public person, he/she has a DSM-5 disorder…that is terrible for us all…they need to be fired!' the only thing that can happen as a result, is an increase in stigma."
Many would argue that if the mental health community is serious about lowering stigma, then it should stop using mental health diagnoses as a tool to get a politician fired as others who genuinely struggle with a diagnosis are watching this and could wonder if the same logic be applied to them…in order to get them fired. The laws of the United States allow for impeachment, and mental health experts are not required in order to apply them. Furthermore, some in the mental health community argue that therapists need to realize that many of their clients may not agree with their political views and they deserve the same compassionate care and consideration as anyone else.
Dr. Lee wants Trump out of office immediately and sees him as an imminent threat to the United States. However, if history proves right, America will survive Donald Trump. But the stigma in our society may only get worse. Many therapists believe that using a DSM-5 disorder as a weapon to get someone fired, whether the president or not, is a scary precedent no matter how you slice it.
The incident at the Red Hen is a microcosm of something much larger, a generalized intolerance for people on the "other side" of the political spectrum. The incident at the Red Hen should never be allowed to infect the mental health community. If it does, then the hope of lowering stigma will be greatly diminished.
Author's Note:
I wrote this article with careful forethought knowing that many who read this will be split on both sides. I myself am not a republican or democrat, and my purpose in this article is not to support Trump or to criticize those who do not support Trump. Instead, I care about stigma. I am deeply passionate about lowering stigma in our society and making mental health care something safe and non-threatening, no matter which politician you vote for.
Arthur Hunter is a computer programmer and co-founder of Theravive. He has been in the tech industry for over 20 years, with multiple Microsoft certifications. He has a love and passion for the intersection of technology and mental health and how the gadgets we use and the time we spend on them play a part in our mental well being, for better or worse. Together with his wife in 2007 they founded Theravive, which currently has thousands of licensed therapists and psychologists. He enjoys writing on occasion, reporting on mental health and technology. You can reach Arthur at 360-350-8627 or write him at webadmin - at - theravive.com.
