On March 8, 2017, two distinguished psychiatrists, Judith L. Herman and Robert Jay Lifton, warned about Donald Trump's mental fitness for the office of President of the United States. They cited "alarming symptoms of instability, repeated failure to distinguish between reality and fantasy, and his outbursts of rage when his fantasies are contradicted." They added that "he repeatedly resorts to paranoid claims of conspiracy." Most alarming is their belief that "when faced with a crisis, President Trump will lack the judgment to respond rationally."
In compliance with the American Psychiatric Association's "Goldwater Rule" (the American Psychological Associating has a similar rule), which restricts psychiatrists from rendering an opinion or diagnosis about people they have not personally examined, Dr. Herman and Dr. Lifton issued a disclaimer: "We are in no way offering a psychiatric diagnosis, which would be unwise to attempt from a distance."
But are they, as well as other psychiatrists and psychologists who have offered mental assessments of Donald Trump, really rendering their evaluations "from a distance"?
Although it's true that neither Dr. Herman nor Dr. Lifton has interviewed Donald Trump, it's also true that Donald Trump has exhibited his personality and behavior in social media outbursts, extensive television exposure, and spontaneous reactions in public appearances and press conferences. In fact, for the last several years Donald Trump has given us a portrait of his mental health far richer and more revealing than what can typically be observed in a fifty-minute diagnostic office visit. And, according to the Goldwater Rule, it's only such a visit (or several visits) that would permit a psychiatrist or psychologist to render an opinion or a diagnosis--although they would still be bound by the confidentiality rule.
The Goldwater Rule was invoked in 1964 (and formalized in Section 7.3 of the American Psychiatric Association Code of Ethics in 1973)--more than half a century ago--in response to 1,189 psychiatrists commenting in a poll that presidential candidate Barry Goldwater was psychologically unfit to be President. At that time, little public data about political figures was available. Television coverage of candidates was new and relatively sparse compared to the 24-hour coverage today by cable news media. Social media was non-existent and home computers wouldn't appear on the scene until nearly a decade later. The psychiatrists who "diagnosed" Senator Goldwater were drawing on meager public information.
Today the Goldwater Rule stands on less firm ground. Indeed, it imbues the "psychiatric office visit" with an unwarranted mystique, as if only an in-person professional encounter can provide vital information about a person's mental health.
What is so sacred about the office visit and personal interview? Shouldn't the emphasis be on the amount and quality of information gathered for a diagnosis? In applying that standard, the office evaluation might look pale in a face-off with public information and observational data that is often available.
Actually, many individual personal interview sessions yield little in-depth understanding or even sufficient data for a diagnosis of the patient. Sometimes extensive visits are necessary to gain such insight--and still the data obtained might not be equal to the plethora of raw material that Donald Trump's public exposure has generously provided. Just as comedians say about Donald Trump's antics that the jokes write themselves, psychiatrists and psychologists might say that the diagnosis writes itself.