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My Turn: Duty to warn

  • President Donald Trump boards Air Force One on Oct. 25 at Andrews Air Force Base, Md. AP file



For the Monitor
Wednesday, November 01, 2017

During the presidential campaign of 1964, hawkish senator Barry Goldwater emerged as the Republican candidate for the presidency. His threat to unleash low-yield thermonuclear weapons on North Vietnamese supply lines was a source of great concern among the electorate.

His campaign slogan – “In your heart, you know he’s right! – was countered by this reply from Democrats: “In your guts, you know he’s nuts.”

As the campaign progressed, 1,189 psychiatrists went on record as stating that Goldwater was not psychologically fit to be president. The editor of Fact magazine, where the article appeared, was the target of a successful libel suit brought by Goldwater, which was eventually settled for $75,000. Of more lasting significance, however, is the impact that this ruling has had upon the American Psychiatric Association and the American Psychological Association, which have both imposed gag rules upon their membership to keep them from rendering professional opinions regarding the diagnoses of public figures who have not been personally examined or given consent.

Hence, the “Goldwater Rule.”

Fast forward to the present. In the political cauldron of 2016, a witch’s brew of failed economic policy for the middle class, xenophobia, simmering racism and special ingredients, including eye of Newt and toe of Putin, all led to the creation of a toxic brew also known as the Trump presidency.

Relative to Trump’s unfiltered rants, which lack the most casual relationship to the truth, the rhetoric of Barry Goldwater seems an innocuous as a basket of puppies.

Yet, the “Goldwater Rule” has remained intact within the code of conduct for psychiatrists and psychologists – until recently.

In early October, a book titled The Dangerous Case of Donald Trump, edited by Bandy Lee, was released. This book is a compilation of essays by 27 prominent psychiatrists and psychologists who have long acknowledged their duty to warn individuals if lives are in imminent danger based upon information that they, as therapists, may have gained during confidential sessions with clients.

These professionals, upon careful examination of all available information on Donald Trump, now convey a sense of urgency in their “duty to warn” the American public about the emotional state of their president. Their consideration of impending danger “trumped” any loyalty to an outdated oath of silence.

Psychiatry, like other medical specialties, needs to provide input into the public health system, and should be as vigilant in reporting the hazards of a psychologically unfit and dangerous president as our infectious disease experts are in monitoring Ebola outbreaks.

Trump’s bizarre behaviors, as troubling as they were during the presidential campaign, have only worsened during his first year in office. He is a pathologic narcissist, as defined by the “triple E’s” of entitlement, exploitation and impaired empathy. But just because an individual is mentally ill does not mean that he or she cannot be president, or even a good president.

Abraham Lincoln suffered from debilitating depression, while Theodore Roosevelt likely suffered from bipolar disease.

Rather, it is the degree of dangerousness posed by the behaviors ascribed to the diagnoses that demands closer scrutiny.

Trump’s behaviors, while unsavory and antisocial, would be of much less consequence if he did not have access to nuclear codes. The dangerous traits shown by Trump include aggression when his ego is threatened, vindictiveness, extreme envy, boasting, bullying, name dropping and denial of wrongdoing. He adds to a national angst while detracting from world security.

His unique brand of malignant narcissism is only getting worse. And now, with his enhanced sense of feeling special, the president has evolved a pattern of remorseless lying and manipulation.

Trump’s frequent assertions that “I have a very good brain” and “I am like a very smart person” are called into question every time he speaks.

Cognitive scientists, comparing Trump’s relatively fluent speech patterns of past decades with his current daily struggles to cobble together a single well-structured sentence, raise some serious concerns about an evolving dementia. His flight of ideas, grandiosity and abnormally brief sleep requirements are hallmarks of a hypomanic state. And his persistent support of “alternate facts” (birtherism, inaugural crowd size, Obama wiretapping of his New York City residence, etc.) create even more worry about a full-blown delusional state.

It is apparent, in his uncaring dismissal of those who have actually sought out military service and not deferments (including John McCain and the fallen Army Capt. Khan) that no empathy can escape Trump’s black hole of malignant narcissism.

As one who is intolerant of criticism, Trump is able to maintain his grip on his separate reality only by surrounding himself with family members and sycophants – those who can be controlled, manipulated, intimidated and ultimately disposed of – all at the pleasure of the president.

Several members of Trump’s own party, including Sens. John McCain, Bob Corker and Jeff Flake, have joined the growing chorus of politicians, journalists, former military officers, national security experts and foreign policy experts who have questioned Trump’s fitness for office with their highest level of concern. With each nonsensical tweet and spiteful executive order, another thread of the American tapestry is unraveled.

It’s painful enough to witness daily initiatives that degrade the environment, endanger our credibility in the world, jeopardize access to health care, threaten public education, accelerate income inequality, and undermine the rights of women and minorities. Trump is now leading the way from reasonable political discourse to tribalism in this country.

We now find ourselves at a crucial junction, faced with a reckless and feckless president who once asked, “Why do we have so many nuclear weapons if we are not going to use them?” If we accede passive permission for our president to act out his delusions, we are shirking our responsibilities to ourselves, our planet and future generations.

(Robert S. Kiefner lives in Concord.)