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Political opponents have long traded recriminations of insanity in an effort to discredit one another.

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.

Lead by Yale professor of psychiatry Bandy Xenobia Lee, one consortium published The Dangerous Case of Donald J. 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 common sense of psychiatrists’ and psychologists’ exploiting their position of trust 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—or that semantics at least grants them plausible deniability. As Lee told Salon recently:

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 other ethical considerations. 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.

Forget “not speaking about the president’s personal mental health” or (as the Goldwater Rule says) “sharing expertise about psychiatric issues in general.” 

Gartner publicly and directly characterizes the president in a way that—said about a private rather than a public person—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 a doctor’s words carry social weight and affect careers and reputations.

Legalistic wrangling and semantics aside, the campaign of Lee and her colleagues 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 [their election] than to try to intervene after things have happened. And a simple fitness-for-duty test would allow for screening of many destructive personalities. I would advise that not just for our own country, but for the countries around the world. It would do them a lot of good.

That is, the people of the United States may elect their own leaders contingent on the approval of a psychiatric committee, who may veto candidates they do not find suitable.

No matter how softly Lee peddles this suggestion, it amounts to a new estate of government, a high priesthood of medical experts who may block leaders—or impeach them for removal—based solely on their professional opinion. In a very real sense, future presidents would serve at the pleasure of psychiatrists and those who control them, e.g., the AMA, APA, universities, and Legislative-Branch committees overseeing the medical profession.

Lee and her colleagues’ proposal—that they would screen for mental illness and block or impeach only those demonstrating objective signs—ring dubious in light of the criteria they have used so far.

Witness the symptoms (aside from “delusions of crowd size” and “tweeting attacks at political opponents”) they have referenced to assess President Trump. 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 we were afraid of.

Does a psychiatrist’s expertise extend to military and geopolitical strategy? Lee seems to have discovered psychosis in the president’s *foreign policy*. This is bizarre, to put it mildly.

Were the president to introduce himself to the nation as Napoleon or wear his underpants on his head, Lee and Gartner’s assessment might spark less controversy. But presidential advisers, elected lawmakers, countless military and geopolitical experts, and tens of millions of Americans supported the president’s withdrawal from Syria. If the withdrawal is “crazy,” the only conceivable explanation is mass insanity. Lee has an answer for that:

Psychosis is a severe condition of mental impairment when you lose touch with reality, and shared psychosis happens when a highly compromised person is exposed to other people who would be otherwise healthy. But because of close contact, healthy people take on the symptoms of the person who is compromised. 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 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.

Is such mass psychosis within the realm of possibility? It certainly is. Societies have lost their collective minds in the past, and the United States—or rather half the United States (pick which half you dislike)—may turn out to be the latest example.

But 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 Iran?

Will the Committee pathologize the candidate’s policies as extreme fear and paranoia, denial of climate catastrophe, creeping transphobia, and unconscious racism against Middle Eastern peoples, respectively? Will the Committee conclude in the end that political conservatism is a psychopathology rendering “sufferers” ineligible for public office?

PSYCHIATRY’S CHECKERED HISTORY

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.

These unfortunate souls received sham diagnoses and wound up in gulags or incarcerated in mental institutions, where they were “treated” with a gamut of forced drugging, isolation, “labor therapy,” shock therapy, and ditch executions (the last of which boasted a 100% cure rate).

Professionals in the USSR and Eastern Europe fabricated conditions such as “slow-progressive schizophrenia” and “philosophical intoxication” to transform political and ideological crimes into sickness—crimes that would otherwise merit embarrassing trials. 

Among the “symptoms” of these Marxist mental illnesses were criticizing or demonstrating against the government; speaking badly of communist leadership; 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 today, particularly in their treatment of Muslims.

Examine the time or country you like—not excluding the United States today—the mental health profession demonstrates a consistent and disturbing pattern of mission creep, starting with healing but veering into politics and social engineering of all sorts. For reasons that aren’t entirely clear, a portion of professionals seem unable to restrain themselves from moonlighting as sociologist-kings and arbiters of unified knowledge. As they do, activist psychologists and psychiatrists style themselves experts of law, hard sciences, philosophy, art, journalism, history, business, social mores, religion, and—as Bandy Lee exemplifies—politics and war. Professionals wind up parlaying their knowledge of psychology, medicine, and mental illness into a Theory of Everything and Everyone.

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 psychologist know their weakness well and cleave to diagnostic and ethical guidelines carefully. History suggests that—absent rigorous diagnostic guidelines—professionals have fallen to diagnosing behavior through the arbitrary lenses of intellectual fads, state dogmas, political hysterias, social prejudices, and biases in favor of atheistic scientific materialism (a metaphysics which psychology happens to share with Marxist dialectical materialism). Absent strict ethical guidelines, professionals have lapsed into equating mental illness with persons, lifestyles, political beliefs, religious beliefs, and social movements they find odious or threatening.

The mental health profession’s extensively chronicled tendencies and checkered history highlight a less-discussed truth about the Goldwater Rule and similar restrictions: they not only protect the public figures and groups activist professionals sometimes defame in their polymathic frenzies—they also protect the fragile credibility of the field. Why have the medical community not leapt up in unison to embrace the strictest interpretation of the Goldwater Rule? Why do they not sanction and reign in activist professionals? Why are professional associations and universities seemingly unconcerned about discredit to their institutions and a new loss of public trust?

The complacency of mental health leaders suggests Lee’s ideas hold currency among her colleagues who remain in the background. The mental health profession votes overwhelmingly liberal-progressive today, and a symbiotic relationship between leftist politics and the mental health profession seems to be emerging. As Ian Tuttle coyly observes: “Freud and Foucault are dead, but their methods thrive. On the left [today], politics is not about debate; it’s about diagnosis.”

The mental health profession seems to be moving toward more activism and political involvement. Ethical guidelines on public commentary are disregarded or in process of rolling back. Professionals speak publicly not only about political figures but also policies ranging across transgenderism, red flag laws, climate change, abortion, and immigration.

It stands to reason the medical community would welcome an enlargement of their power and authority in government and culture. Should the medical profession come to function as the gatekeepers to elected office, we can expect future lawmakers and presidents to think twice before interfering with the medical profession’s self-determinism.

Up till now, the government has regulated the medical profession, not visa versa; but that could change. The proposed enlargement of mental health powers does not constraint itself to a forced assessment of President Trump or future presidential candidates. During the Kavanaugh confirmation, Lee cosigned a letter calling for the psychological examination of Justice Brett Kavanaugh. Lee told Democracy Now!:

Some of the troubling signs that we saw were poor regulation of emotion, evasion of questions, exaggerated entitlement—which actually makes someone more likely to be capable of violating others’ rights. Other troubling signs that we’ve seen were paranoia, conspiracy theories and an inability to have empathy for others. Those were some of the signs that we feel, as mental health professionals—it is our duty to call out signs that are abnormal and signs that indicate possibly a troubling condition on the part of Mr. Kavanaugh.

One might ask these Lee and her cosigners: how should a man accused on television of a decades-old attempted rape behave? In what manner should he answer senators and inquisitors bent on ruining his career, reputation, and life, using only the word of one woman? Moreover, what is the proper amount of entitlement for a giant of jurisprudence on the doorstep of the most powerful court position in the land? Does Lee believe there wasn’t a coordinated behind-the-scenes effort (or conspiracy, if you will) to stigmatize Kavanaugh and make him unconfirmable? Since his elevation, has Justice Kavanaugh gone on an empathy-free rampage against “others’ rights,” staggering down the hallways of the Supreme Court in a beer haze and leaping on unsuspecting women? Lee and her colleagues provide answers to none of these questions, only vague aspersions.

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, or the court appointments of the president and the Senate? 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 guidelines 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.”