Fellow doctors, please don’t “diagnose” Trump—it’s dangerous for everyone


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13 comments

  1. Aurelia C

    It’s important to keep that rule, because not everything is caused by an untreated mental health issue. Funny enough, some people and some politicians are just average everyday jerks. Being unkind, rude, and greedy are not mental illnesses.
    In fact, most people with mental health conditions are much nicer than guys like Trump.

  2. D.W. Taylor

    I agree with the principle of no formal psychiatric diagnosis without a formal psychiatric examination, but a formal diagnosis is not what the many professionals who have spoken out against Trump are offering. Warnings, based on the countless transcripts, audio and video recordings available for all to see do no constitute a formal psychiatric diagnosis, nor does the use of psychological terms which have entered the common vernacular, like narcissism, megalomania or pathological lying.

    No member of society should be prevented from expressing their concerns about political leaders they view as profoundly incompetent and potentially dangerous. It would be folly to muzzle those members of society who by virtue of their training and professional experience are likely to be the most informed and articulate voices in the public space. In a time when we are awash in opinions of dubious veracity do we really want to filter out those that are likely to be the most accurate?

    • Lawrence Loh

      Thanks for your thoughts. I would perhaps respond by suggesting that it’s fine for anyone, doctors especially, to express concern. That’s our right enshrined in our fundamental freedoms.

      Where the line becomes fuzzy is where we bolster our expressions of concern with expert insight – discussing behaviours, signs and symptoms, and leaving nothing to the imagination about where we would proceed if we were given the opportunity to formally assess. In seeing what certain quarters have put forward it’s disingenuous to say that isn’t formal diagnosis semantically because they aren’t writing “Dx: ____” at the end of their thoughts.

      Simply put, once physicians start leveraging their expertise to add detail and colour to their commentary, they’ve crossed the line from simple expression of concern to providing expert opinion. Inferring or suggesting a diagnosis is as dangerous as formally making one.

    • Lawrence Loh

      With respect – there is a difference between expressing concern as a citizen as is one’s right, and expressing a professional opinion standing with your credential. No one is limiting the former and I myself above say that much of what Trump says is concerning.

      The analogy would be the dreaded “is there a doctor aboard the plane?” Once you identify yourself as such, even if you don’t end up examinining the patient in question, your words and advice carry a different weight than if you were simplynthe sick passenger’s seatmate and simply sharing your concern incognito.

  3. The Rick

    Donald Trump is no more or less crazy than any of the particular medical staff I have encountered at any of the downtown (Toronto) teaching hospitals (late 80’s to mid 2000’s). These ICU, CCU or CVICU senior attending clinicians each had their characteristic ‘big personalities’. We took instruction from them, verbal abuse from them and in fact, at times, praise from them. For example, on break we bitched and moaned about Dr. X and laughed at things Dr. Y said. Each of us had our opinions about these clinicians – some liked Dr. X and others disliked Dr. Y (and vise versa). We did not *hate* these staff clinicians nor did we think that they were crazy. American politics is extremely polarized now – and haters are always going to hate – and as evidence, this above opinionated article was constructed to proffer some rules on how to gently hate.

    • Lawrence Loh

      On the contrary, this article is calling for respect of professional standards and due process in respect of The Donald, suggesting that the decision of some physicians to publicly offer their expert opinions on Trump’s mental health is not in the interests of anyone.

    • Haz

      Seems like you are gently hating on this article, as you have misunderstood the argument the writer poses. He simply argues that professionals need to refrain from giving a diagnosis without an appropriate consultation, let alone breaching patient privacy. Not sure what that has to do with the personalities of your seniors…

  4. Terry Hill

    True, but mere opinion differs from a diagnosis. All medical professionals are allowed to have a public character that can post personal opinions. The risk of course, is that those who know you, or of your credentials, may fault you rightly or wrongly, for abusing the Goldwater rule. Speaking outside your field protects you somewhat. Note that there is a vast difference between saying “He has Narcissistic Personality Disorder”, and “In my unverified opinion, he may be exhibiting some symptoms of NPD.”

    • Lawrence Loh

      But is there really that vast of a difference? In both cases, you are providing an expert opinion. The insinuation in the latter statement is just as much based on your professional credentials and expertise than the former; the only difference is semantics, and the public does not know the difference other than an MD is saying so.

  5. Gerald Goldlist

    On US media, psychiatrists HAVE been brought on as EXPERT physicians to give their DIAGNOSES of President Trump. That is definitely in violation of the Goldwater Rule. Opinions are ok. Psychiatrists and other physicians are free to make their assessments from TV and radio and discussing them privately. But as Dr. Loh says, they should not proclaim these as professional opinions in a public forum.

  6. Diego Silva

    I really enjoyed reading this article, as I think it raises some important points to consider.

    1. Regarding your first pillar of Goldwater: assuming it’s true “no examination, no diagnosis”, any reasonable person might wonder, given the amount of publicly available evidence, that something is ‘wrong’ with Donald Trump. Doctors, as reasonable persons but more so because of their professions, might also think that something is ‘wrong’ with Donald Trump and may posit a diagnosis without examination. At that point, might it not be reasonable for doctors to suggest that that Trump ought to undergo an actual examination to, in fact, see if there’s a diagnosis to be made? This is intentionally a weaker conclusion than the one you address in your article, but I’m wondering if this would satisfy the Goldwater rule, in your opinion? If so, would this be in keeping with what is permissible for a doctor to do, under the guise of a doctor, in a public forum? (NB: If the answer to the first question is ‘yes’, it would also raise the specter that doctors not only have a permission, but also an obligation to publicly ask for Donald Trump to undergo a proper examination.)

    2. Regarding your second pillar: as you yourself write, a diagnosis doesn’t imply incompetence. As such, it’s moot to assume that if those two presidents and the prime minister were diagnosis that their actions would have been deemed incompetent. It’s just that in the case of Trump, he’s incompetent (my belief) and we’re all searching for a cause(s).

    3. In keeping with others on this thread, Trump may very well just be a “bad hombre” and not much else. Perhaps that’s the cause.

    4. Under the 25th amendment, section 4, it just says that the VP has to demonstrate to congress that the president is “unable to discharge the powers and duties of his office” but doesn’t actually say what that means or how this is demonstrated. It’s a political decision and it doesn’t seem like you need a psych diagnosis. This is more so an FYI.

    5. Re: pillar three: that’s a big, big can-of-worms and I’m not sure to what extent it’s even true (though, again, there may be versions of it that are true).

    Again, thanks again for getting the ol’ brain wheels turning!

    • Lawrence Loh

      Thank you, Diego! To respond:

      1. I think it’s fare for MDs to say “There’s something clearly wrong, he should undergo a formal assessment.” We do this many times with family members, e.g. “That might be a fracture – I think you should get it checked out.” – and that’s would be fine. Where I disagree is whether it obliges doctors to go public. Duty to warn typically applies in cases of threatened suicide or homicide, child abuse, or in defined legislative pieces such as ability to drive. Still, there isn’t anything from stopping MDs from publicly expressing their concern. However, in using their credentials in that manner, I would argue the concerns around potential partisan perceptions (e.g. Dr. Bandy Lee’s sessions have only ever been attended by Democrats) and the question still arises – why this one, why not others? (e.g. where were you when Chavez was around, or Mugabe, or etc.)

      2. I would posit that the parallels of certain historical figures was not to negate the point I made around competence vs. mental health, but extending the argument that “Trump = harm” to its logical end – if we want to use a diagnosis to take on one leader, arguably this could have been also done with these historic figures with serious repercussions.

      3. Indeed, and bad hombre is not a diagnosis – in an earlier version of this paper, I suggested Martin Shrekeli was similarly well disliked, but was never publicly diagnosed given his activities. Some suggest that this is falsely equivalent, but I think it’s a slippery slope once you start diagnosing public figures – where do you arbitrarily draw the line about “who’s dangerous and needs to be diagnosed” and “who isn’t?” Eventually, are we all up for grabs in the public sphere?

      4. This is correct – decision is taken by Vice-President and Congress. A diagnosis is not required, though may be considered. Precedent suggests that this amendment was only invoked in the past in serious cases of incapacity.

      5. Simply put, in our line of work as public health physicians, diagnosing a politician has never been a pre-requisite to objectively supporting or opposing the positions taken by those politicians.

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