Diagnosing Public Figures is Risky ...And Very Controversial

Much has been written and discussed about the mental health (or illness) of a variety of public figures including famous politicians, Hollywood and sport celebrities, and other news makers. Those who are truly experts on this topic, mental health professionals, are often ambivalent about weighing in on the subject since most follow the Goldwater Rule put forth by the American Psychiatric Association several decades ago. This rule states that psychiatrists should never offer diagnoses or public comments about people who they have not actually evaluated or treated and thus they should not offer any speculated diagnosis for well known celebrities or public figures from afar. Other mental health professionals (e.g., psychologists, social workers, counselors) tend to follow these guidelines too. Additionally, ethical and legal principles and rules about maintaining client confidentiality also instruct mental health professionals to never comment on their client’s health and well-being in a public forum unless they have written permission to do so directly from the client. So, whether a mental health professional has evaluated or treated someone or not, they generally can’t talk or speculate about them in public or even privately among their own friends and family members either.

However, that being said, some professionals have strongly argued that the duty to warn provision suggests that mental health professionals actually should discuss the mental health or illness of important leaders and influence makers given their ability to impact others or to do potential harm. And certainly anyone who has powers that impact the health and safety of the public could do great harm if they choose to do so.

As an example, Yale psychiatrist and professor, Brandy Lee, the lead author on a recent 27 person co-authored book entitled the Dangerous Case of Donald Trump, suggests that President Trump has a serious mental illness that greatly endangers the public. She and her team invoke the duty to warn provision that, excuse the pun, trumps the Goldwater rule and conclude that he experiences a mixed personality disorder (i.e., a malignant narcissist). This diagnosis blends features of narcissistic, antisocial, and paranoid personality tendencies that are highly dangerous in their combination. Let’s unpack what these personality tendencies actually mean.

First off, personality disorders are disorders of character that include consistent and long term patterns of thinking, behavior, and emotion consistent with one's overall personality that impacts self and others in predictable, dysfunctional, and often distressing ways. So, personality disorders are disorders of character.

Now let's unpack the three character elements of the malignant narcissist or the particular personality disorder that Dr. Lee and her colleagues discuss in their book. In a nutshell, narcissistic patterns include the perspective that basically the world revolves around you and that your needs and desires are what always matters and not those of others. The narcissistic can’t really empathize with others or try and imagine being in the skin of others. Their desires and needs matter most. Nothing else is worth attending to. Additionally, they feel special, important, and better than others yet often these views are defenses against insecure and inadequate feelings that are typically under conscious awareness. Antisocial qualities suggest that the person can easily lie, cheat, and steal without any remorse or guilt finding ways to justify their actions even when they clearly victimize and harm others. Lying is very easy for the person with antisocial tendencies. They don’t feel guilt, shame, or regret for their actions regardless of the consequences to others. They would generally have no problem passing a "lie detector" test at all since they are not emotionally activated when they lie. And paranoid tendencies suggest that no one can be trusted and that others are scheming to harm you. These individuals trust no one, can become more and more isolated, resentful, and challenging to deal with while they don't take corrective feedback from others as well and thus can't learn from their mistakes.

Dr. Lee and her colleagues claim that President Trump has a serious mental illness and is in great danger of hurting others in his powerful role. Others have strongly criticized Dr. Lee and her team for violating the Goldwater Rule suggesting that they should remain silent about their views of President Trump and his mental health functioning or possible dysfunction.

It is important to note, by the way, that mental illness in general is not something that predicts dangerous at all. The most common forms of mental illness include anxiety, depressive, and substance abuse disorders impacting large segments of the population. Sometimes people fear that those with mental illness will be violent to others but in general, people with mental illness are rarely violent and when they are they are much more likely to hurt themselves than others anyway. However, some forms of mental illness can be very destructive to others (e.g., pedophilia which is diagnosed in about 3-5% of the male population).

Regardless of the presence or absence of a mental illness, it is important to examine observable behavior among those in the news and ask ourselves if the behaviors that we all observe are the behaviors that we are comfortable with, are reasonable, and should or should not be encouraged or supported. One doesn’t need to be a mental health professional to be a thoughtful and reflective observer of behavior after all.

So, what do you think?

Copyright 2019, Thomas G. Plante, PhD, ABPP