The follow-ups to this diary: Paranoia, strawberries, non-existent icebox keys and Donald Trump (When a paranoid has real enemies)
How would an expert in psychological "fitness for duty" evaluations examine Donald Trump in person?
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Yesterday a Salon published an article by Chauncey DeVega where several distinguished mental health professionals plus frequent MSNBC guest contributor, ethicist Richard Painter gave their reactions to the publication of the New York Times OpEd by an anonymous member of the White House senior staff.
Exclusive: Psychiatrist Bandy Lee says White House officials told her Trump was “unraveling” — Yale shrink says Trump officials reached out to her last fall, suggests his mental state is rapidly deteriorating.
Bandy Lee, the Yale University psychiatrist who edited the bestselling book "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President"described how deeply Trump’s "troubles run and what effort is required to protect the nation from what are obviously psychological symptoms." Last December, lawmakers concerned about the president’s mental state held a private meeting with Dr. Lee. Reference
The reveal in this article, headlined in the RawStory republication of the Salon article (Right), is White House officials told psychiatrist they were scared of Trump because his mind was ‘unraveling’: report.
Lawrence O’Donnell referred to the quote from the Salon article on his show last night as well. (Down, Right)
Psychiatrist David Reiss, who does “fitness for duty” evaluations for police departments and is another contributor to "The Dangerous Case of Donald Trump," said that the president “likely would not qualify to be an Air Force officer entrusted with a nuclear weapon.”
Dr. John Gartner, founder of the Duty to Warn movement (see article Mar. 22, 2017), who DeVega describes as a leading voice about the perils of Trump's presidency and the dangers he poses to the United States and the world, is quoted as saying that the OpEd is an "extraordinary document by any standards.” He said further:
Essentially, the White House staff have de facto informally invoked the 25th Amendment, recognizing among themselves that [Trump] is incapable of carrying out the duties of the office. Knowing that he is dangerously mentally unbalanced, they are seeking to provide ballast to keep him from capsizing the ship of state. This is a madness of King George situation. Or perhaps we should say the emperor's new clothes, where everyone can see the emperor has no sanity, even though no one is allowed to say it aloud.
Chauncy DeVega published a long interview with Dr. Gartner on June 13th which proves to be prescient:
Psychologist John Gartner on Trump’s behavior: “It’s a coup that’s not moving slowly anymore”
Here are my favorite excerpts:
DeVega: How would you respond to those people who would say that you are panic-stricken? The world hasn't ended because of Donald Trump, and this is all misplaced concern and worry. You are possessed by what his defenders call "Trump derangement syndrome."
Gartner: It's a little bit like that patient who falls forward nine stories. He goes, "So far, so good." We just haven't hit the ground and splattered yet, but we are falling.
DeVega: As this crisis continues with Donald Trump, his party and his voters, will we reach a crescendo at some point? Or given his personality and behavior, will it be a series of seemingly never-ending events that just keep dragging the United States farther down?
Gartner: It all reminds me of the saying about how people go broke very slowly and then all at once. I think that's what we're heading for right now. What if there is a global crisis like a war? What if Trump refuses to step down, if he is impeached and convicted? It is a coup that is not moving slowly anymore. It is accelerating.
The elder statesman of all living psychiatrists, 92-year-old Robert Jay Lifton was not interviewed for the Salon article. However, he was interviewed by Bill Moyers in September 2017, where he discussed, among other things, why he believed it was justified to break the Goldwater rule. What he said then is even more relevant today as we have seen Trump's mental health deteriorate.
We have a duty to warn on an individual basis if we are treating someone who may be dangerous to herself or to others — a duty to warn people who are in danger from that person. We feel it’s our duty to warn the country about the danger of this president. If we think we have learned something about Donald Trump and his psychology that is dangerous to the country, yes, we have an obligation to say so. That’s why Judith Herman and I wrote our letter to The New York Times. We argue that Trump’s difficult relationship to reality and his inability to respond in an evenhanded way to a crisis renders him unfit to be president, and we asked our elected representative to take steps to remove him from the presidency.
Lifton is the author of “Thought Reform and the Psychology of Totalism;” “Death in Life: Survivors of Hiroshima;” and “The Nazi Doctors: Medical Killing and the Psychology of Genocide.”
Here’s what I have to say about the OpEd, as least distinguished mental health professional claiming to be a Trumpology expert to weigh in on this subject in this diary and elsewhere.
The author does not go into many specifics about clinically significant behaviors that lead to the conclusion that there is “instability” although I have no doubt such behavior was “witnessed by many, leading to early whispers within the cabinet of invoking the 25th Amendment.”
The author says that “senior officials will privately admit their daily disbelief at the commander in chief’s comments and actions. Most are working to insulate their operations from his whims.” I want to know more about how his whims played out, about who these whims were generated.
There are some significant observations in the OpEd which I do consider more suggestive of clinically significant dysfunctionality.
The author reports that Trump veers off topic and off the rails, he engages in repetitive rants, and his impulsiveness results in half-baked, ill-informed and occasionally reckless decisions that have to be walked back” and that according to a top official “there is literally no telling whether he might change his mind from one minute to the next." These parts of the OpEd suggest that Trump is a malignant narcissist prone to outbursts of what is called narcissistic rage when he doesn’t get his way. His reported impulsiveness suggests he may have some kind of adult attention disorder (which I am not qualified to give an opinion on). Added to reported impulsivity, he seems to have elements of an intermittent explosive disorder, which considering his aggressiveness, vindictiveness, ignorance, inability to think through consequences, and impulsivity could be very dangerous.
In the last two days, his anger over this OpEd has been described as volcanic. It may be that his reactions to the OpEd may be the most clinically significant and telling information we have. The only aspect of his reaction is his paranoia because as the saying goes, even paranoids have enemies.
What all this does is confirm our assessment that his psychopathology makes him dangerous.
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Addendum: The Goldwater rule does not apply to me as a retired clinical social worker, though even if it did I would break it for the same reason Dr. John Gartner and other mental health professionals believe this is justified: our duty to warn (reference Tarasoff decision) takes precedence over our not giving a psychological diagnostic assessment of anyone from a distance, even of a dangerous person. As has been said repeatedly here in my writing and elsewhere there is controversy about whether we have enough data about Trump to make a diagnostic assessment from afar or whether, even if we thought we did, whether we ethically should do so. John Gartner says:
When I first started talking about Trump as a malignant narcissist, people could see the narcissism, the paranoia and the antisocial element. But the fourth component of malignant narcissism is sadism. You see it in everything he does, from the separating of the children at the border to how Trump tortures anyone who doesn't give him what he wants. There's a way in which he takes a kind of manic glee in causing harm and pain and humiliation to other people.
Bandy Lee does not offer a diagnosis. She says:
“ … all consistent with the psychological signs we observed and warned against 18 months ago. Mental health is a science-based field of serious conditions that have predictable patterns. We foresaw the course of this presidency, based on our knowledge and clinical experience, and were concerned enough to put our warnings into a book. We now warn that things will rapidly deteriorate and that the president should submit to an urgent, independent mental health evaluation by an appropriate specialist, as is warranted.”
Our conclusion was overwhelmingly that our responsibility to society and its safety, as outlined in our ethical guidelines, overrode any etiquette owed to a public figure. That decision led to the collection of essays in the book, which includes some of the most prominent thinkers of the field including Robert J. Lifton, Judith Herman, Philip Zimbardo and two dozen others. That decision was controversial among some members of our field.
Critics of my point of view and the positions taken by those referred to in the diary should read this review by Allan Stone, a graduate of Harvard University (1950) and Yale Medical School (1955). Professor Stone is the Touroff-Glueck Professor of Law and Psychiatry in the Faculty of Law and the Faculty of Medicine, Harvard University, Emeritus. To his question at the end of a long article I answer a resounding YES.
What stands out in this book is Dr. Lee’s cri de coeur: “[T]he only people not allowed to speak about an issue are those who know the most about it.” I wish I believed that psychiatrists did in fact know the most about cases of dangerousness, but the totality of the empirical evidence available today refutes that. Lee claims in a crucial footnote that “dangerousness” is more about the situation, and not so much about the person. If that were so, on this view, there would be less need for a psychiatrist to have known or personally examined Donald Trump. But does anyone believe that psychiatrists know more about the presidency and the situation in the White House than other professionals?