Psychiatrists Challenge a Gag Order

The Constitution of the United States established America’s national government and foundational laws, guaranteeing for its citizens certain basic rights. Signed on September 17, 1787, it is a plan for a stable federal government with three branches—legislative, executive, and judicial—along with a system of checks and balances to ensure that no single branch seizes excessive power. Executive power comes second to legislative power, in Article II, which mostly describes limitations: “the Term of four Years,... [Eligibility and Election]…. Case of the Removal of the President from Office,… not [receiving] Emolument,” and the Oath of Office: “I do solemnly swear … that I will … to the best of my Ability, preserve, protect and defend the Constitution of the United States” (Constitutional Convention, 1787).

In other words, the Constitution was meant to restrict the powers of any single individual and to prevent tyranny from the start. The progression from autocracy to democracy is analogous to the progression from dependence on parents to independence as an adult in an individual. We are a nation that has broken away from dependence, historically, to achieve autonomy and independence. Nevertheless, as in an individual, regression (or halted development) can occur in the form of desire to revert back to dependence. This is a particularly dangerous disposition at a time when an autocratic nation is lurking to undermine, or to usurp, power for its own gain (Polantz and Collinson, 2018).

Maintaining a healthy democracy involves each of us following norms and standards, especially in times of intense social and political pressure. Laws have been established to prevent exploitation and personality-based rule. Medical standards have served to offer correct treatment, regardless of an individual’s position or ability to pay. Scientific methods have been established to learn about natural phenomena and the effects of our interventions in an objective way.

All have been adulterated in these highly politicized times. The legal system, when stepping out of protocol, can lead to untoward, even devastating, effects (Abramson, 2018). So would be undermining the law for the protection of Donald Trump, or declaring the president exempt from the law when he has been appointed to uphold it. It is therefore important to return to proper norms and standard procedures, regardless of ideology or outcome. “De-politicizing” our political system will help the health of our polity, giving us room to focus on solving problems and finding the right solutions, rather than “winning” or “losing”.

Keeping with norms and standards means not changing guidelines under political pressure. In my own field of mental health, professional standards of evaluation and management have been established based on decades of research and clinical experience of disorders and their treatment. Medical neutrality is a professional standard that allows health professionals to treat individuals across enemy lines and to offer humanitarian assistance beyond boundaries of social identity.

This is why psychiatrists have challenged our own professional organization’s unprecedented modification of ethical guidelines under this administration. The American Psychiatric Association’s (APA’s) new interpretation of the so-called “Goldwater rule,” or Section 7.3 of the APA code of ethics, published in March 2017, went far beyond requiring that we simply refrain from diagnosing public figures without conducting an examination and without proper authorization. In its original form, it was a sensible rule intended to serve “the improvement of the community and the betterment of public health” and our overarching “responsibility to patients … as well as to society” (APA, 2013).

The new interpretation, barely two months into the Trump presidency, prohibits psychiatrists from discussing “the affect, behavior, speech, or other presentation” of a public figure (APA, 2017), in any manner, even in an emergency—effectively silencing the one field that is qualified to comment expertly on a matter of national and international security.

After numerous calls for a discussion, if not a commission, to reexamine the rule and receiving only refusals from the APA, we authors of The Dangerous Case of Donald Trump submitted a formal proposal for its revision (Lee, 2018). Among us 22 are internationally renowned scholar of political violence and thought reform Dr. Robert Jay Lifton; pioneering researcher of trauma and recovery Dr. Judith Herman; eminent expert on violence Dr. James Gilligan; and Dr. Leonard Glass, former distinguished life member of the APA who resigned over the Goldwater rule expansion.

Keeping the public in the dark not only disempowers but also increases stress and anxiety levels, as both the American Psychological Association (2017) and the American Psychiatric Association (2018) have documented since the start of this presidency. We believe that our role as “witnessing professionals” can help to prevent pathology from being rationalized and normalized, which renders populations vulnerable to would-be tyrants. This is where guarding public mental health supports democracy and where our professional and civic responsibilities merge.

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We have a president who has yet to demonstrate the mental capacity to carry out substantial decision-making in a sound, rational, and reality-based manner. He attended a summit with North Korea, a hostile nuclear power, unprepared and unaware of his deficiencies. He woke up one morning and decided to launch a trade war. Now, he has threatened to quit the North Atlantic Treaty Organization (NATO), in the same manner that he has pulled out of other crucial global collaborations. When one has yet to reach a state beyond dependence (where relationships are based on command and obedience) into independence, then the interdependence of global collaboration is threatening and unthinkable.

It is important that we as mental health professionals speak up when we observe that state power is being abused by a mentally unstable president, or when mental defects are being covered up for the purposes of political gain. When a president with such questionable capacity insists on nominating a Supreme Court justice, or holding a summit with Russian President Vladimir Putin, who attacked our 2016 elections, we must alert that those surrounding the president are obviously failing to contain him. We should not deprive the president of the medical standard of care, and lawmakers and the public have a right to the benefits of our expertise. This is how functioning democracies are supposed to work.