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Wednesday, January 30, 2019

Tragedies of anti-Trumpism: Extra-clinical and public mental health diagnoses

Statement of the problem

I have been critical of others' decisions to issue extra-clinical and public diagnoses of Mr. Trump's mental health. (See asterisked* footnote below about my word choice here.) While it seems almost everyone (who opposes Trump) does it, I have reserved much of my criticism for mental health professionals who do so. (See, for example, this post, cross-posted with Hit Coffee. Be sure to read this comment on Hit Coffee from Dr. X, who disagrees with what was then my argument.)

I have since come around, albeit grudgingly, to admitting that mental health professionals are not violating professional ethics when they make well-considered statements about Mr. Trump's, or any other public figure's, mental health. I still believe that these professionals, even those for whom I have a lot of respect, too often fail to parse what they know from observing Mr. Trump and what they can't know without further knowledge to which they don't have access. They also seem to flounder when it comes to distinguishing between their views as citizens and their views as professionals. Or, if they believe the roles of "citizen" and "professional" are so entwined as to be inseparable, they tend not to acknowledge the problems inherent in mixing professional opinions and political opinions. Finally, I suspect the claims that mental health professionals "can't" offer such opinions to be greatly exaggerated.

With that out of the way, though, I'll stipulate for the sake of this blog post that such public discussion and diagnosis of Mr. Trump's mental health are necessary. I'll also stipulate that mental health professionals participate in these discussions as responsibly as we can expect in a free society when an important matter of public controversy is at hand.

Tragedies of extra-clinical and public diagnoses

With those stipulations, I find "tragedies" from the extra-clinical, public diagnoses:

Extra-clinical, public diagnoses stigmatize mental health problems

No matter how much mental health professionals say that identifying dangerous tendencies is not the same as saying all, or even most people with mental health problems, members of the public will likely infer that from those professionals' public pronouncements. That's on the members of the public for not heeding what is said. But it's a predictable result nonetheless.

Extra-clinical, public diagnoses creates a backlash

Trump supporters, or even people who purport to oppose Trump but who question the tenor of some of the opposition, will respond negatively to these diagnoses. These diagnoses will help solidify some persons' support or temper some persons' opposition.

Extra-clinical, public diagnoses create a dangerous precedent

There's always going to be some mental health professionals, or at least people with the appropriate credentials, who will offer an assessment of a politician's mental health. And there will always be at least superficial evidence to support that assessment. That doesn't mean every situation is equivalent. Sometimes people are peculiarly unfit for their position and that unfitness needs to be assessed and acted on. But offering public, extra-clinical diagnoses in the one instance makes it marginally easier for others to do so later.

Send off

I've said a lot about professionalism. As a layperson in this area, I realize I'm speaking out of turn. A professional, speaking as a professional, needs to conform to the rules of that profession or at least note when they depart from those rules. As someone trained in U.S. history, for example, I must state in good and honest conscience that the Civil War was primarily a war over slavery and that the South seceded from the North primarily to protect slavery, even though my saying so might anger a good number of people who in other circumstances and on other issues I might wish to count as friends. (Why I'd want to count them as friends is perhaps a different question. But just suffice it to say that we all have friends and family who we love but cannot agree with everything they believe in.) That's burden of professionalism, and I recognize that members of other professions share like burdens.

I also wish to remind readers that I'm speaking of what I think are almost inevitable outcomes, of outcomes that are part of the expected costs people pay for doing what they believe is the right thing. Those costs, or "tragedies," as I call them, are there whether or not it's necessary to incur them. I'm less convinced than some mental health professionals that declaiming against Mr. Trump's mental fitness is as necessary as they seem to believe. But even if it is necessary--and even though it's unfair to all those mental health professionals who make public, extra-clinical diagnoses out of a sense of duty and with the fullness of caution their ethics require--those costs will nonetheless be exacted.

See introduction and table of contents for this series

*Footnote about word choice

By "extra-clinical diagnoses," I mean diagnoses offered without the benefit of the typical face-to-face evaluations mental health professionals usually engage in before making diagnoses. I also mean diagnoses offered without the follow up information gathering that may lead a mental health professional to revise (or confirm) their diagnoses. Finally, I mean "diagnoses" that venture to state what can't be known. It's one thing, for example, to say that Mr. Trump "probably won't change" or will "find it very difficult to change" or even, "on the basis of everything I've seen so far, and acknowledging that there's a lot I can't know from my vantage point, Mr. Trump can't change." It's another thing to say simply that "he can't change." I'm just a layperson, but I find it hard to believe that responsible mental health professionals say a person "can't" change without ever having had a chance to evaluate and work with that person for a time. I might be overly exacting in my demands on others' word choices. But professionals who purport to speak as professionals should be exacting in their word choices.

By "public," I mean information and evaluations offered about the mental health, or personality constellation, of a person that a mental health professional would not be permitted to offer without that person's consent if that person were a client. I suppose there's a gray area here, where a mental health professional may sometimes be permitted or even required to alert the public about a client who, for example, may hurt themselves or others.

By "mental health," I mean not only the distinction between "healthy" and "unhealthy" mental states, such as is indicated by finding a given person suffers from OCD, bipolar disorder, or psychosis. I also mean comments about "personality constellation" or other attributes that don't fit as easily onto a spectrum of what is mental health and what is mental illness.

UPDATE 3/8/2019: I've fixed a few broken links.