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Promoted from the diaries by streiff. Promotion does not imply endorsement.
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Political opponents have long traded accusations of insanity in an effort to discredit one another with the public. 

For the last three years Democratic lawmakers, pundits, and activists have floated the impeachment of President Trump for mental illness or the deployment of the Twenty-fifth Amendment to declare him mentally unfit to discharge his office. 

Unusual among these commonplace political theatrics are the bands of mental health professionals who have elbowed their way to the front lines and demanded an outsized voice in the president’s removal.

PSYCHIATRY RETURNS TO POLITICS

Lead by Yale professor of psychiatry Bandy Xenobia Lee, one consortium published The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Professionals Assess a President. Lee’s book reawakened a furious debate going back to the 1960s about the ethics and good sense of mental health professionals’ exploiting their positions of trust and supposed objectivity to stigmatize politicians.

The debate has focused mostly on legalistic arguments over medical guidelines. Lee and some of her fellow travelers seem to believe their activism avoids the American Psychological Association’s Goldwater Rule and similar ethical restrictions against diagnosing public figures from afar. Lee said:

The American Psychological Association allowed for the spread of this misconception that we cannot speak about anything unless we have examined the president. But we’re not speaking about the president’s personal mental health. We’re speaking about the effects of his mental pathology and behavior on the public. So we are responding to our public health responsibility, not speaking as the president’s personal physician.

Other professionals believe the danger posed by the president supersedes all ethical guidelines. Lee’s colleague and Duty to Warn co-founder John Gartner, a psychotherapist at Johns Hopkins, told a conference at Yale School of Medicine:

We have an ethical responsibility to warn the public about Donald Trump’s dangerous mental illness … Worse than just being a liar or a narcissist, in addition he is paranoid, delusional and grandiose thinking and he proved that to the country the first day he was president. If Donald Trump really believes he had the largest crowd size in history, that’s delusional.

Gartner publicly and directly characterizes the president in a way that—said about a private person rather than a public figure—would form grounds for the mother of all defamation lawsuits, coming as it does from a mental health expert. Nobody pays attention when Hollywood celebrities and CNN pundits call the president “crazy;” but doctors’ words carry weight and harm reputations for life.

PSYCHIATRIC OVERSIGHT OF GOVERNMENT?

Legalistic wrangling aside, Lee and Company’s campaign raises monumental questions of government that dwarf quibbles over medical ethics. When asked about screening future vice-presidential and presidential candidates, Lee said:

I think it’s reasonable, given our recent experience and given the history that those with pathological personality disorders disproportionately attain positions of power and wreak havoc on societies. It is far easier to prevent [the election of psychotic politicians] than to try to intervene after things have happened. And a simple fitness-for-duty test would allow for screening of many destructive personalities.

“Simple fitness-to-duty test”? Lee here proposes that the people of the United States may elect their own leaders contingent on the approval of psychiatrists, who may veto candidates–or impeach leaders–they find unsuitable.

No matter how softly Lee peddles this suggestion, it amounts to a new estate of government with awesome power. In effect, future presidents would serve at the pleasure of a committee of psychiatrists, or those who controlled them. Equally troubling, it amounts to infringement of every constitutionally qualified American’s civil right to run for public office.

Lee and her colleagues have used criteria for diagnosis so far that hardly seem objective. Lee said:

[W]e put out an urgent letter to Congress, signed by 250 mental health professionals, asking for constraining measures at the same time as proceeding with impeachment. Within three days of our letter, [The president] withdrew troops from northern Syria, allowed the massacre of our allies and handed over dominance to our enemies. This was the kind of thing [our group of mental health professionals ] were afraid of.

Delusions of “crowd size”? Tweeting attacks at political opponents? Contentious Middle Eastern foreign policy decisions? None of those appear in the Diagnostic and Statistical Manual of Mental Disorders. 

Diagnosis-from-policy raises uncomfortable questions. In the future, will the Standing Psychiatric Committee on Presidential Mental Fitness discover psychosis in a candidate’s policy on gun rights? On oil and gas energy? On transgender service in the military? On confronting hostile nations of non-white peoples, such as Iran?

Will the Committee conclude in the end that political conservatism is a psychopathology rendering “sufferers” ineligible for public office?

DIAGNOSING “DEPLORABLE DISORDER”

Presidential advisers, elected lawmakers, countless military experts, and tens of millions of Americans supported the president’s withdrawal from Syria. If the withdrawal was “crazy,” the only conceivable explanation is mass insanity. Lee has an answer for that:

Because of the president’s position and his direct access to a large proportion of the population, either via Twitter or his direct rallies, there is a phenomenon of shared psychosis going on at a large scale, at a national scale.

That is, a voter (or highly trained military expert) may *believe* he supports the president and his withdrawal from Syria on rational grounds, but not really. The voter is sick. The voter disagrees with the psychiatrists only because he has lost touch with reality, courtesy of a lunatic president’s Twitter feed and rallies.

Lee and Company’s clairvoyant assessments do not confine themselves to the president. They have stigmatized half of Americans so far with “deplorable disorder.” And for good measure, they have included Harvard law professor Alan Dershowitz and Supreme Court Justice Brett Kavanaugh.

PSYCHIATRY’S CHECKERED HISTORY AND MISSION CREEP

If Lee’s suggestions and pronouncements seem to carry the whiff of totalitarianism, color historians of medicine unsurprised. 

The mental health profession and Marxist totalitarian regimes share a storied background over the last 100 years. Punitive psychiatry was deployed extensively behind the Iron Curtain to suppress and discredit political dissenters and bulldoze their civil rights.

Professionals in the USSR and Eastern Europe fabricated conditions such as “slow-progressive schizophrenia” and “philosophical intoxication” to transmute political and ideological crimes into sickness—crimes that would otherwise require trials embarrassing to the state. Then … off to the gulags or mental prisons for  “therapy.” 

Among the symptoms of Marxist mental illnesses were criticizing or demonstrating against the state and party leaders; speaking well of the West; evincing a “pessimistic attitude”; practicing the Christian religion; publishing unseemly literature; and advocating for human rights.

Unfortunately, punitive psychiatry does not confine itself to the past—reports suggest communist China is following the same playbook right now, particularly in their treatment of Muslims.

Examine the time or country you like—not excluding the United States—the mental health profession has demonstrated a reoccurring pattern of mission creep, beginning in healing individuals but veering into social engineering and cooperation with the state or a party.

The partnerships grew of symbiosis: mental health professionals have received wider and wider extrajudicial powers to decide who is “sane” and worthy of full personhood in a legal sense; and the state has gained enforcers of orthodoxy in return.

Psychology and psychiatry lack quantitative and objective diagnostic criteria, leaving the mental health profession singularly vulnerable to subjective judgements and motivated reasoning. Well-grounded psychiatrists and psychologists know their weakness and cleave to diagnostic and ethical guidelines carefully to avoid it.

But without rigorous diagnostic criteria, mental health activists have fallen to diagnosing behavior through the lenses of intellectual fads, state dogmas, and political hysterias. Without strict ethical boundaries, activist professionals have lapsed into equating mental illness with lifestyles, political beliefs, religious beliefs, and social movements they find odious, stupid, or threatening. 

The separation of psychiatry and state disappears.

THE PSYCHIATRIST-OCRACY

The state and psychiatry seem to be collapsing to a singularity again—or at least one party and psychiatry. The mental health profession votes overwhelmingly liberal-progressive these days.

In service to “correct” thought, professionals disregard or roll back ethical guidelines and wander far outside their areas of knowledge (e.g. policy in Syria). They declaim not only about the mental illness of political figures they dislike but also the mental illness of politically incorrect viewpoints.

Those of a conservative persuasion are told more and more that their “mass psychosis” should preclude them from owning weapons; voting for policies they find compelling; running for public office; speaking about politics; or demanding full rights. In a nutshell: “Civil rights for me, but not for thee … head case.”

Conservatives are not to be argued with but “assessed” and treated for their abominable viewpoints. Until they realize their mental illness and recant, they must not be allowed to interfere.

As Ian Tuttle observes: “Freud and Foucault are dead, but their methods thrive. On the left [today], politics is not about debate; it’s about diagnosis.”

IT TAKES ONE TO KNOW ONE?

John Gartner proclaimed the president a grandiose narcissist. He and other activist professionals bring to mind the adage: It takes one to know one.” 

For who else thinks he or she qualifies to “warn” the country of what’s in front of every citizen’s eyes for his own judgement? Who else desires to second-guess and veto the electors of the world’s most successful democracy? Who else peppers Congress with letters and and entreaties to listen to his or her aspersions and speculations on a seemingly limitless array of persons and subjects? Who else believes that—no matter how egregious their profession’s mistakes and abuses in the past—they themselves can flout the protective barriers that grew out of those mistakes and abuses?

A physician of my acquaintance once observed: “They taught us in medical school that we are gods. Unfortunately, some of us believed them.”