Is psychoanalyzing our politicians fair game? (2016)

“We need a systematic and independent medical and psychiatric examination of all political candidates for president. I will give the most extreme example, Hitler.”

Prof. Nassir Ghaemi, Tufts Medical Center, Boston
Medscape Psychiatry, 15 August, 2016.

Nassir Ghaemi discusses the complicated ethics of discussing the mental health of our politicians, while recommending a few updates to the ‘Goldwater rule’.

“Psychiatry imposes on itself a unique kind of self-censorship… the ‘Goldwater rule’. (It) came about after a 1964 magazine poll of psychiatrists on the Republican presidential candidate Barry Goldwater.

“The basic idea is that (members of the APA, American Psychiatric Association) shouldn’t give clinical opinions about politicians.

“… This issue has been raised recently in relation to the mental or temperamental ‘fitness’ of Donald Trump to be president of the United States.

“… the Goldwater rule is needed to stop rampant speculation that uses psychiatric terms as pejorative epithets … The negative effect is that the Goldwater rule stops any talk whatsoever; it is, in effect, complete censorship…

“… there may be times of historical emergency where psychiatrists’ duties as citizens require public discussion about psychiatric diagnoses in leaders.

“I will give the most extreme example, not because it applies to current candidates, but because it makes the conceptual point: Adolf Hitler.

“Before Hitler came to power, prominent German psychiatrist Karl Wilmanns diagnosed him as having had hysteria during World War I… later research supported Wilmanns’ observation, with documentation …. by a psychiatrist, Edmund Forster. Forster committed suicide a few days after Hitler came to power in 1933; Wilmanns was fired from his university professorship …

“… around 1940, German generals plotting a coup against Hitler solicited the support of prominent psychiatrists, including the academic professor Dr Karl Bonhoeffer, father of the prominent anti-Nazi activist Dietrich Bonhoeffer. The generals knew that Hitler was mentally unwell, and they wanted the psychiatrists to agree to hospitalize Hitler involuntarily. It is unclear how the process unfolded, but the plan never went into effect.

“Would it have broken the Goldwater rule if Dr Karl Bonhoeffer had worked with the generals to hospitalize Hitler against his will? Did Hitler in fact have a psychiatric diagnosis? I have provided evidence that he did, namely manic-depressive illness, which was worsened with daily intravenous amphetamine treatment for his depression.

“Even if one thinks that there are psychological limitations to the presidential fitness of Donald Trump, as some do, we are certainly not in the same situation as with Hitler. But the question does arise: When is it acceptable, even necessary, for psychiatrists to be citizens first?

“…In agreement with non-psychiatrist physicians, such as former British foreign minister Lord David Owen….I agree we need a systematic and independent medical and psychiatric examination of all political candidates for president.

“No politician would ever ‘consent’ to being psychiatrically diagnosed (so the) profession … should insist that the public has a right to know about the medical health of those who wish to lead it…

“In a democracy, ‘consent’ sits with the governed, not those who govern. If leaders want to be in a position to send our sons and daughters to die in war, we should demand their consent to tell us about their medical and psychiatric history.

“This is not unethical, as the Goldwater rule has it. Rather, the Goldwater rule could be seen as unethical in depriving the public of knowledge regarding its leaders that it has a right to know.”

• Please note this is a heavy paraphrase of the original. Access the full article here (you may need to sign up for free Medscape membership):  Is psychoanalyzing our politicians fair game?