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troutman · 08-18-2016, 12:42 PM

Diagnosing Mental Illness in Presidential Candidates

http://theness.com/neurologicablog/i...al-candidates/

A recent editorial on Medscape Psychiatry by Nassir Ghaemi asks a very interesting question, Is Psychoanalyzing Our Politicians Fair Game?

As Ghaemi also points out in detail, psychiatric diagnoses exist on a spectrum from scientifically solid to vaguely pragmatic. Schizophrenia, for example, is a well established diagnosis with some clear features and we understand a fair amount about its pathophysiology (although it is a complex category of diseases). Narcissistic personality disorder, on the other hand, lacks the same level of scientific validity. It was almost removed from the DSM V for lack of evidence, but was kept in for pragmatic reasons. Is it fair to give a public figure a diagnosis that is not even scientifically valid?

For psychiatrists there is the Goldwater Rule, which constrains psychiatrists from publicly commenting on the mental health of public figures. The general public has no such constraints, only decency.

I do agree with Ghaemi who concludes that in extreme cases there may be a duty as a citizen to comment on the mental health of a public figure. Professionals should only comment if they have access to sufficient documentation to inform their opinions, and if they restrict their opinions to scientifically valid and uncontroversial diagnoses.

For non professionals my opinion is a lot simpler – stop. Do not make armchair diagnoses of public figures. Chances are, you have no idea what you are talking about. The risk is even greater that you are just following your political bias, you are likely using a mental illness diagnosis as a pejorative, and you are likely just psychologizing the usual range of human behavior.

But here’s the thing – you don’t have to couch your opinions in fake clinical terms you don’t really understand. Just give your opinion of someone’s behavior and temperament in non-clinical terms.

It’s OK to say that Trump is a self-serving, ambitious, childish egomaniac with a thin skin, a penchant for bull####, and an apparent utter disregard for facts and expertise. That is clearly just your opinion from his public behavior.

Don’t say, however, that Trump has a narcissistic personality disorder, is a pathological liar, is “clinically” anything, or is a psychopath. These are diagnoses that you are not qualified to make, you likely don’t have a working knowledge of the scientific basis for these diagnoses and their utility and accuracy in clinical use.

Further, you don’t know Donald Trump. You know his public persona, and largely what the media choose to show.

08-18-2016, 12:42 PM	#10583
troutman Unfrozen Caveman Lawyer Join Date: Oct 2002 Location: Crowsnest Pass Exp:	Diagnosing Mental Illness in Presidential Candidates http://theness.com/neurologicablog/i...al-candidates/ A recent editorial on Medscape Psychiatry by Nassir Ghaemi asks a very interesting question, Is Psychoanalyzing Our Politicians Fair Game? As Ghaemi also points out in detail, psychiatric diagnoses exist on a spectrum from scientifically solid to vaguely pragmatic. Schizophrenia, for example, is a well established diagnosis with some clear features and we understand a fair amount about its pathophysiology (although it is a complex category of diseases). Narcissistic personality disorder, on the other hand, lacks the same level of scientific validity. It was almost removed from the DSM V for lack of evidence, but was kept in for pragmatic reasons. Is it fair to give a public figure a diagnosis that is not even scientifically valid? For psychiatrists there is the Goldwater Rule, which constrains psychiatrists from publicly commenting on the mental health of public figures. The general public has no such constraints, only decency. I do agree with Ghaemi who concludes that in extreme cases there may be a duty as a citizen to comment on the mental health of a public figure. Professionals should only comment if they have access to sufficient documentation to inform their opinions, and if they restrict their opinions to scientifically valid and uncontroversial diagnoses. For non professionals my opinion is a lot simpler – stop. Do not make armchair diagnoses of public figures. Chances are, you have no idea what you are talking about. The risk is even greater that you are just following your political bias, you are likely using a mental illness diagnosis as a pejorative, and you are likely just psychologizing the usual range of human behavior. But here’s the thing – you don’t have to couch your opinions in fake clinical terms you don’t really understand. Just give your opinion of someone’s behavior and temperament in non-clinical terms. It’s OK to say that Trump is a self-serving, ambitious, childish egomaniac with a thin skin, a penchant for bull####, and an apparent utter disregard for facts and expertise. That is clearly just your opinion from his public behavior. Don’t say, however, that Trump has a narcissistic personality disorder, is a pathological liar, is “clinically” anything, or is a psychopath. These are diagnoses that you are not qualified to make, you likely don’t have a working knowledge of the scientific basis for these diagnoses and their utility and accuracy in clinical use. Further, you don’t know Donald Trump. You know his public persona, and largely what the media choose to show.