TO THE EDITOR:
Recently, Robert Friedman wrote an op-ed piece in the New York Times arguing that psychiatrists should not be diagnosing President Trump with a mental illness (“Is it time to call Trump mentally ill?” February 17, 2017). Professor Friedman notes that the Goldwater Rule prevents psychiatrists from diagnosing a public figure they haven’t evaluated. I contend that the Goldwater Rule needs updating. Psychiatric evaluations aim to extrapolate from the interview to understanding real world behavior.
Compared to 1964, when Barry Goldwater was publicly “diagnosed,” we now have a staggering database of public information about Trump’s behavior in the form of interviews, speeches, autobiographies, etc. Isn’t actual behavior a better guide to diagnosis than a person’s self-reports obtained during a psychiatric interview?
Professor Friedman notes that mental illness alone says little about fitness to serve. However, the issue is not President Trump’s mental state alone, but his behavior. Consider his troubling pattern of obfuscating the truth. Setting aside what intentional fabrication says about his mental state, if he believes those lies, doesn’t that suggest serious problems with reality testing? If so, isn’t this a red flag about his psychological fitness to serve?
Professor Friedman’s piece concludes that we don’t need a shrink to decide whether President Trump’s mental state renders him unfit to serve: he should be judged on the merits of his actions, statements, and tweets. I take this argument one step further: actions, statements and tweets are reflective of one’s mental state.