Verified by 
“I do believe the President is mentally unstable.”
—Ruben Gallego, Democratic Congressman from Arizona, January 27, 2017
“What I think is really mentally unstable is people that don’t see the positive impact that this President is having on the country.”
—Sarah Sanders, White House Press Secretary, January 5, 2018
If we cannot agree on what is real, we cannot agree on who is sane.
One of the core definitions of insanity is perceiving something that is not there—a giant rabbit, a dog telling you to commit crimes—or on the other hand, refusing to perceive what clearly is there. If climate change is “as clear as is the summer’s sun,” then those who deny it may not be perceived as just stupid or lying, but crazy. The rise of dueling fact perceptions has led predictably to increasing accusations of mental illness.
The Goldwater Rule
In 1964, a magazine article used a survey of psychiatrists to argue that Barry Goldwater was nuts. Ironically, the article appeared in Fact magazine, which asserted it knew the facts, and that the questionable survey data supported its facts, though the American Psychiatric Association disavowed them. In Fact’s view, Goldwater wasn’t just an ideologue, or someone who held different partisan opinions, but was truly mentally ill. Why? Because he believed things that those psychiatrists (and the editors of Fact) believed no sane person could believe. His facts did not match reality; therefore he was crazy.
The editor, Ralph Ginzburg, wrote that Goldwater was “divorced from reality.” He quoted psychiatrists who claimed that Goldwater was “suffering from a chronic psychosis,” was “basically a paranoid schizophrenic,” and “has the same pathological makeup as Hitler, Castro, Stalin, and other known schizophrenic leaders.” Even before the internet and the rise of Godwin's Law, the Hitler comparisons still were prevalent. What may be odder is the blasé assertion that Castro and Stalin were schizophrenics. They were surely ideologues who were willing to murder thousands or millions for what they thought was the greater good, but there is no evidence that they were divorced from reality or couldn’t control themselves effectively. We should be clear that holding a vile ideology is no indication of insanity.
However, even small disagreements over facts now lead to that accusation.
In response to the Fact article and the uproar that followed, the American Psychiatric Association instituted the “Goldwater Rule,” formally Rule 7.3 of the APA’s Principles of Medical Ethics: “it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.” In the current era of dueling fact perceptions, that rule has come under attack.
The Trump Rule?
When the APA adopted the Goldwater Rule, one of the dissenters described it as a denial of “every psychiatrist’s God-given right to make a fool of himself or herself.” Other leaders of the APA have reinforced the rule and criticized violators.
But a new group of psychiatrists led by Bandy X Lee are arguing forcefully for the repeal of the Rule and the open criticism of Trump’s mental state. An op-ed in the Boston Globe makes their case based on the results of the Mueller Report.
Dr. Lee asserts that Trump displays “reckless, impulsive moves that are self-destructive, and despite the intention of self-protection, are characteristic of dangerous impairment.” She observes “a paranoid stance that can quickly turn into violence when a paranoid person is feeling cornered.” Trump’s “lying becomes a part of a pervasive, compelling, reflexive pattern of distraught gut reactions for handling challenges by misleading, manipulating, and blocking others’ access to the truth.” Dr. Lee concludes that Trump “apparently believed he could use all the powers at his disposal to have his way, and almost delusionally expected impunity.”
Lying and mental illness are not the same thing. Lying is a sign of bad character and willingness to manipulate others for selfish ends, but it is not necessarily "crazy." Lee asserts that Trump believes he can do many outrageous things and nonetheless get away with them. Is that crazy? Or is it accurate? Has he not gotten away with them? So aren’t his beliefs about impunity accurate, which is to say not at all crazy? Is Trump delusional or are those who foresee with certainty that he will be punished actually the deluded ones?
It is worth noting that the perceptions of mental imbalance run in both directions. One of the favored accusations employed by Trump supporters is “Trump Derangement Syndrome,” an alleged form of psychosis induced by the shock of his presidency. Fareed Zakaria (no friend of Trump) defined TDS as a “hatred of President Trump so intense that it impairs people’s judgment.” Both camps—those upset about the Trump presidency and those upset by criticism of it—have lowered their standards of evidence for believing and repeating accusations of wrongdoing. And of mental illness.
Accusations of Mental Illness as a New Norm
No less than four recent articles share the same title of “The Madness of King Donald.” But this growing perception of mental illness is not just about Trump and it will not fade when he does.
The black activist Huey Newton famously defined power as “the ability to define phenomena.” Foucault argued that the power to define reality and hence who was crazy (and belonged in a mental institution) was a very powerful thing indeed. But far beyond official institutions of power and influence, perceptions of craziness seem to be growing among ordinary people. When ordinary voters recognize that others hold perceptions of reality that clash with their own, they could attribute it to several things. Stupidity. Being duped by others. Lying. Or being crazy. The more charitable view that the other person might have good reasons to believe their interpretation of the facts (or that our own interpretation could be wrong) is far harder to believe.
Barry Goldwater’s 1964 presidential campaign slogan was, “In your heart, you know he’s right.” To those who disputed his perceptions, it quickly became, “In your guts, you know he’s nuts.”
The problem is that the things we “know” in our guts are often full of crap. Yet we have great (and rising) confidence in the perceptions dictated by our gut-level values or the desires of our hearts. The more we hold dueling (and certain) fact perceptions, the more we will accuse others of mental illness.
