Does Hillary Clinton have a secret degenerative disease? Is Donald Trump a sociopath?
It's not unusual for opposing political bases to spread rumors and speculate about their opposition, but such behavior tends to stay confined to the respective fringes. This year, however, is different, with far-Right theories about Clinton's physical health making their way into mass media outlets, while many in the media actively speculate about Donald Trump's mental state.
The latter is cause for concern for many clinicians, as it flies in the face of the American Psychiatric Association's 40-year-old Goldwater Rule, which forbids psychiatrists from offering opinions on a person they have not personally evaluated, claiming that to do so is "irresponsible, potentially stigmatizing, and definitely unethical."
Paul Appelbaum is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law at Columbia University and he feels that he's seen the law dangerously flaunted this year. Bob speaks with Appelbaum about why, even in this election year, mental health experts must stay out of the punditry business.
"Life of the Party" by Jack Shaindlin
BOB GARFIELD: From WNYC in New York, this is On the Media. I’m Bob Garfield.
BROOKE GLADSTONE: And I'm Brooke Gladstone. In an ordinary election year, this might be the point at which we see candidates defending their tax plan or foreign policy vision. But, of course, this is 2016, so, instead, this is happening.
JOHN BERMAN, CNN ANCHOR: Feats of strength, Hillary Clinton opens a pickle jar to try to quash the latest campaign conspiracy theories.
BROOKE GLADSTONE: How did we get here? You already know. First, a theory originates in the right-wing fringe media, in this case that Hillary is suffering from some secret degenerative disorder.
ALEX JONES: She looks like she’s in bad shape. She’s got holes in her tongue.
NARRATOR: Weird seizures, psychotic facial tics, over- exaggerated reactions.
BROOKE GLADSTONE: The story is then picked up by Donald Trump's surrogates, who present it not as an accusation but as a troubling development.
SEAN HANNITY: Look at this video right here. It almost seems seizure-esque to me.
BROOKE GLADSTONE: Next, the man himself steps in, raising a few more questions.
DONALD TRUMP: Her speeches are so short though, like 10 minutes, let’s get out of here. Go back home and go to sleep.
BROOKE GLADSTONE: And, before you know it –
FEMALE CORRESPONDENT: The videos are now swirling online, Clinton tripping after climbing the stairs of her plane in 2011 and stumbling while stepping off the podium at a rally with Joe Biden this week.
FEMALE CORRESPONDENT: The Clinton campaign firing back aggressively, dismissing questions about Clinton’s health as “deranged conspiracy theories.”
BROOKE GLADSTONE: Many in the media were quick to condemn all this as desperate maneuvering by the Trump campaign and its supporters. But if anyone can appreciate how frustrating it is to have people diagnosing them, it’s got to be Donald Trump!
[MSNBC LAST WORD]:
NANCY GILES: He’s, I think, clinically insane.
LAWRENCE O’DONNELL: There’s that.
NANCY GILES: I mean, I really do.
LAWRENCE O’DONNELL: This is a man who has more sociopathic tendencies than any candidate in my adult life.
CONAN O'BRIEN: His doctor wrote a letter saying that, if elected, Mr. Trump will be, quote, “the healthiest individual ever elected to the presidency.
Then when asked about Trump’s mental health, the doctor got very quiet.
BROOKE GLADSTONE: Other doctors, not so quiet.
FEMALE CORRESPONDENT: Clinical Psychologist Dr. George Simon said this to Vanity Fair about Trump and narcissism, “He’s so classic that I'm archiving video clips of him to use in workshops…
BROOKE GLADSTONE: In July, the former dean of Harvard Medical School went a step further, tweeting that Trump doesn't just have narcissistic personality disorder, he defines it.
BOB GARFIELD: But for many in the mental health world, this loose invocation of psychiatric language outside of a clinical setting is raising alarm and a feeling of déjà vu. In 1964, Barry Goldwater wrested the GOP nomination from a resistant party, whereupon a similar tactic of calling into question his mental health was launched.
[1964 AD CLIP]:
ACTOR: When we come to Senator Goldwater, now it seems to me we’re up against a, a very different kind of a man. This man scares me. Often you can’t – I, I – I can]t figure out just what Goldwater means by the things he says.
BOB GARFIELD: That year, Fact Magazine ran a ran a headline blaring that 1189 psychiatrists say Goldwater is psychologically unfit to be president. The story sent shockwaves through the psychiatric community, which saw it as a flagrant breach of ethical codes and an offense against those who actually do suffer from mental illness. In 1973, the American Psychiatric Association announced the Goldwater Rule, which declared that no psychiatrist shall offer professional opinions about someone they have not personally evaluated.
Paul Appelbaum, a professor of Psychiatry, Medicine and Law at Columbia University, is a strong proponent of mental health experts staying out of the pundit business.
PAUL APPELBAUM: On top of the likelihood that conclusions reached will just be misleading is the concern about harm. Barry Goldwater, himself, testified, when he brought suit against Fact Magazine, about the negative impact on his life, of wondering what people now thought about him.
But there's also a concern, and for me this is the primary concern, that people who could benefit from mental health treatment won't seek it if they see psychiatrists and other therapists making diagnoses based on very little information and often simply their political views.
BOB GARFIELD: All right, so the Goldwater Rule is sort of the psychiatric law of the land, but there are workarounds. There are ways to discuss symptomology, while stating loudly and disingenuously [LAUGHS] that this isn’t the diagnosis of any one in particular – Trump [CLEARS THROAT] - Trump, Trump, Trump.
PAUL APPELBAUM: Well, we’ve seen a good deal of that this year. Like any ethical rule, the Goldwater Rule relies on good judgment and good faith in trying to apply it. So do we see people who either are on the border of what's legitimate or cross over that border? This year, we've seen them in spades. BOB GARFIELD: Permit me, please, to push back, actually, at the core though of your concern. One of your colleagues told fivethirtyeight.com that, quote, “Labeling Trump from afar would be no different than diagnosing President Obama with leukemia, sight unseen.” But leukemia can be diagnosed by looking at blood cells. Narcissistic disorder, let's say, and most psychiatric conditions, are really labels attached to certain symptoms, as codified in whatever the latest diagnostic manual, the DSM, has to say. If those symptoms are vividly projected to the entire world every single day for a year, indeed, far more exposure than any psychiatrist ever has to his or her patient in an office or hospital setting, why isn't that a perfectly legitimate basis for a diagnosis?
PAUL APPELBAUM: When people are in public, they are often projecting a persona that may be revealing of certain things but it certainly doesn't disclose the essence of a person's psychological functioning.
BOB GARFIELD: You mean I'm not a lunatic, I just play one on TV?
PAUL APPELBAUM: Well, I – you know, I'm not as grandiose or unrealistic as I seem, but I find that it's effective in business, politics or the like and, actually, in private I'm a very different person. When we do an evaluation, it's not just the positive symptoms that we’re looking for. It’s the negative correlations, as well. Is there a history of substance abuse? What's the family history? Are there symptoms that might not be evident in public but which the person will report to us privately? Merely to observe public behavior tells you about none of that and, frankly, if I observe a political figure or anyone else in public, my description of that person's behavior is probably no better than yours.
BOB GARFIELD: If it's really a fool’s errand, what's the impulse for us to try to get the [LAUGHS] psychiatric goods on those who would lead us?
PAUL APPELBAUM: You know, I think the attraction of psychiatric labels in a political context is their power to so completely discredit. If we say that this candidate's policies don't make sense, somebody can come along and say, well, of course they do, I like these policies. But if we say a candidate is psychotic or manic or has a personality disorder, that candidate’s supporters can hardly say, but, but we want a psychotic candidate.
BOB GARFIELD: Well, this takes us back to 1964 and the Goldwater question, which was, do we want this guy to have his finger on the nuclear button, the question that has been raised about Donald Trump.
PAUL APPELBAUM: So I would point out that almost every four- year cycle between 1964 and 2016 has seen something of this sort, mental health professionals believing that they alone can save the Republic, coming out with some sort of diagnostic formulation and often, as this year, many different diagnostic formulations. Lyndon Johnson was considered grandiose. Richard Nixon was called depressive and paranoid. Ronald Reagan's memory and mental functioning were repeatedly called into question. All sorts of labels were applied to Bill Clinton. And, of course, whole books had been written about George W. Bush and his presumed psychopathological rivalry with his father. We run the risk every four years of letting our political views color our views of the psychopathology of the people with whom we disagree.
BOB GARFIELD: Well, you say every four years but periodically special times call for special approaches. I mean, there are extremes.
PAUL APPELBAUM: But those extremes can be encountered on their own. I would have a hard time imagining a situation in which psychiatrists or other mental health professionals, through sharing diagnostic speculation, would tell the public something useful that wouldn’t otherwise be evident from a person's track record of behavior and discourse.
BOB GARFIELD: Well Paul, thank you very, very much.
PAUL APPELBAUM: You're welcome.
BOB GARFIELD: Paul Appelbaum is a professor of Psychiatry, Medicine and Law at Columbia University.