Trumpcare, Mental Health, and the Goldwater Rule

Back to politics today for  a moment…because there’s something I want to say, and because I’m struggling with something about Donald Trump and the Goldwater Rule.

Content Note: Ableism, Healthcare, Politics, Trump, Mental Health

Senator Susan Collins, a white woman with short red hair wearing a dark blazer, white blouse, and pearls, stands in front of an American flag background. Keyword: Goldwater Rule

Image Description: Senator Susan Collins, a white woman with short red hair wearing a dark blazer, white blouse, and pearls, stands in front of an American flag background.

Although I have Republican friends that I cherish in spite of our differences in opinion, regular readers know that as a group I’m hard on them. I’ve called them out, sometimes by  name (some have told me unfairly.) I don’t believe that I’ve been off-base.

But I also believe in giving credit where it’s due. So, to Senator Susan Collins of Maine and Senator Lisa Murkowski of Alaska, who’ve stood firm in this round of Obamacare repeal deliberations that what’s been included in the proposed repeal scenarios are not good for their constituents, despite bullying from Donald Trump, thank you. Thank you on behalf of my disabled American friends, and the children, families and elderly people of America that not only depend on Medicaid to keep them happy and healthy, but depend on it to keep them alive. Thank you for insisting that America be a country where everyone is taken care of. Your integrity and courage give me hope.

Senator Lisa Murkowski of Alaska, a white woman with short blonde hair wearing a red blazer, a write blouse, and a pendant on a chain, stands in front of some trees. Keyword: Goldwater Rule

Image Description:  Senator Lisa Murkowski of Alaska, a white woman with short blonde hair wearing a red blazer, a write blouse, and a pendant on a chain, stands in front of some trees.

Thank you also to John McCain, a man with whom I’ve definitely had my disagreements, who came to Washington in spite of his cancer diagnosis, right after brain surgery, speaking eloquently about bipartisanship and the need to work together to craft a plan for healthcare, pushing himself through the week and into the early hours of the morning last Friday night to cast the vote that brought down Trumpcare. Sir, I salute you.

Senator John McCain, a white male in his 70s with white hair wearing a navy blazer and blue dress shirt. stands against an American flag background Keyword: Goldwater Rule
MESA, AZ – June 4: Senator John McCain (R – AZ) appears at a town hall meeting on June 4, 2010 in Mesa, Arizona.

Image Description: Senator John McCain, a white male in his 70s with white hair wearing a navy blazer and blue dress shirt. stands against an American flag background.

I won’t ever forget what the three of you have done for my American friends.

And to the rest of GOP who are struggling with the idea of single-payer as an idea for health care in the US…on one level, I get it.

Didn’t think I’d say that, did you? Well, I’m nothing if not practical. Single-payer isn’t a perfect system. Not by a long shot. Are there wait times? There can be, for non-emergency issues especially. Is it bureaucracy-heavy? Not any more than the bureaucracy created by the American system having to deal with many insurance plans, I’d argue, but I could be wrong. But even though I waited a couple of months for the functional MRI that the AVM Clinic at Toronto Western Hospital needed to decide how to best treat my AVM, I didn’t have to worry about whether my family could afford to have one of the best neurosurgeons in North America specializing in AVM treatment rooting around in my head for 14 hours.

Take our system and make *your* single-payer system better. Show us up. In fact (if it’ll get you moving on this), I’ll bet that you can’t do it. Go ahead and prove me wrong.

Please! 🙂

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Now…why I’m struggling.

Donald Trump, Mental Health, and the Goldwater Rule

Last week, two friends who work in the mental health field, for whom I have a great deal of respect, said that despite their concerns about the Goldwater Rule, they firmly believe Donald Trump has a mental health condition and needs evaluation to determine whether he’s psychologically healthy enough to continue on as President. The American Psychoanalytic Association officially said recently that members shouldn’t feel restricted by the the Goldwater Rule when discussing Trump.

This is a tough one for me. I don’t like Trump at all, simply because I don’t tend to like people that are lying, arrogant bullies.  But I’ve fought hard against the idea that he’s unfit for office because he’s “crazy” because:

  • Even the most qualified mental health diagnostician would need time and access to Trump to make an accurate diagnosis
  • If the policy is that a clean bill of mental health is required to be the President, then Presidents as far back as Lincoln have been in violation
  • It’s ableist. There’s no reason that a President with a well-managed mental health condition should be treated any differently, in terms of perception of ability to govern, than a President with any other sort of well-managed condition.

And I think that ultimately I still believe that the Goldwater Rule should apply to the position of the President, provided that some other safeguards are put in place (because we do know that Presidents have had mental health conditions, and even degenerative brain conditions, that went largely unnoticed while they were in office):

  • Any President (not just Donald Trump) gets his or her mental health evaluated by an independent mental health practitioner on a regular basis. (I don’t know if this happens, or how often.) The Presidency is an extremely high-stress job, and it’s not unreasonable to periodically check at the very least whether that stress is having an adverse affect on the President’s well-being.
  • Concerns about the President’s mental health are treated like concerns about the President’s physical health – they are quickly, and thoroughly evaluated and, if necessary, treated. The President takes time off work if necessary, but the assumption is that he or she will be able to return to work, and that it will happen as soon as possible. The public is entitled to no more information than it would be if the President had a physical issue.

In other words: If the White House properly monitored the President for mental health conditions and ensured that if there were any conditions that were affecting the President so much that they interfered with his or her ability to govern that the President took time off (if necessary) and received the treatment and education needed to ensure that the condition was well-managed and no longer an issue…then I’d continue to stand on the Goldwater Rule and say, “It isn’t up to people who’ve never spoken to President to make a diagnosis. It’s up to the White House.”

But I don’t have that confidence in this White House. They can’t even make Donald Trump stop using his phone. They’re not going to convince him to let someone do even a simple mental health evaluation, or start treatment if that was deemed necessary – and Donald Trump is not a man that would step down. Not for the good of his health. Not even, I don’t think, for the good of his country.

So, I Struggle…

I’ve struggled as I’ve watched mental health diagnosticians openly break the Goldwater Rule since Trump’s election with their pronouncements in the media that he’s got any number of mental health conditions.

I struggle now, wondering if they were right to break the Goldwater Rule the way they did.

I don’t think that a mental health condition should automatically disqualify anyone from any job – I know too many people with well-managed mental health conditions that are in high-stress positions and that do an excellent job. But, like my friend said:

Whether someone agrees or disagrees with the content of his inflammatory statements, that is not the issue. This is not a matter of attributing mental illness because of disagreement with his views/statements. If you go back and view interviews with him from decades ago, he’s still the same big jerk, but his behavior has changed.”

It’s one thing to be a seventy-year-old civilian man with no insight into behaviour change and perhaps the need for help, and with apparently no one around you who will call you on that blind spot. It’s quite another thing when you’re the most powerful man in the world.

I think I know now where I land on this. If the White House won’t take action when there are indicators that the President needs treatment for a mental health condition, other people with experience and knowledge in the field of mental health need to be allowed to speak without fear of what it could cost them. It’s ableism to say, “People with a mental health condition can’t be President,” but it’s not ableism to expect Presidents that do have mental health conditions to work with their staff and medical team to manage those conditions so that their ability to govern isn’t affected.

To be clear:  Mental health professionals who are worried that Donald Trump isn’t competent to lead need the freedom to speak about it. Someone has to.

 

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Armchair Psychology and Election 2016

So I’ve been working on my post about the Democratic National Convention (which I’m finding very difficult to write, for a number of reasons) and I’m hoping to get it online soon. But something else has come up that I want to talk about: how armchair psychology has entered the campaigning in the 2016 election.
Content Note: Ableism, Mental Health, Donald Trump, Hilary Clinton, Politics, Election 2016
The word "crazy!" on a white cloud against a psychadelic background. Keyword: Armchair psychology

Image Description: The word “crazy!” on a white cloud against a psychedelic background.

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Now, I’m certainly not the first to write about this and I won’t be the most eloquent. But I’ve actually noticed this happening since the primaries, when Donald Trump likened Ben Carson’s self-described “pathological temper” to the pathological issues of a child molester (in that neither can be cured, Trump said, but that’s not how the public took his comments.) Nonsense with a recent petition put me over the edge.

Yes, nonsense.

For Clarity’s Sake

Let me say it again, for those that haven’t heard me say it before: I intensely dislike Donald Trump and just about everything he stands for. I think that he’s a bullying, abusive liar and the idea of him as President of the USA is terrifying to me. Despite having some misgivings about Hilary Clinton that I’m finding fairly difficult to navigate my way around at the moment, I’ll still do whatever I can to get her elected, because the alternative is just unthinkable. (And for what it’s worth, the idea of voting someone in to keep someone out doesn’t create any real cognitive dissonance for me — as a Canadian voter, I’ve had to do this several times.)

But despite my dislike for Donald Trump, armchair psychology in the form of speculation about any potential mental health diagnoses he may have has made me uncomfortable right from the get-go, from everybody but a select group of friends and colleagues that I know have a lot of experience in the mental health sector and the qualifications to diagnose someone given the opportunity to spend adequate time with a person. Not that I’m perfect — I’m not qualified to diagnose, and I can remember discussions with these colleagues where, as we’ve speculated on what might motivate some of Trump’s behaviour, I’ve said that it seems like narcissism or perhaps even sociopathy are possibilities. Even those discussions were ones in which I shouldn’t have engaged in, and I don’t anymore. I should have known better than to engage in that sort of speculation.

But I will say this: the difference between this discussion between me, as a person with education about mental health issues and experience in the field and these colleagues presently working in the field and able to diagnose, and the average person on the internet saying, “Trump is such a psychopath” (or “Could Trump Pass a Sanity Test”, where noted media figure Keith Olbermann evaluates Trump for psychopathy using the Hare Psychopathy Checklist) is:

  • My colleagues and I know that it’s dangerous to toss around mental health terminology in the general public arena with regards to a person’s potential mental health diagnoses, especially if you’re someone with the power to influence the way people vote (another candidate, a speaker at a convention, a media person), when you’re not qualified to diagnose people. Armchair psychology has consequences.
  • My colleagues and I are careful to avoid even the suggestion that a mental health diagnosis makes people unfit for certain kinds of work, because that’s ableist bullshit.

And this, which really should be most obvious reason to end all this armchair psychology, and the reason why the internet petition encouraging the Republican party to have Donald Trump evaluated for Narcissistic Personality Disorder is in particular so objectionable: My colleagues and I know that even if a person has the credentials required to diagnose mental health conditions, it’s unethical to do so without meeting the person and spending time with them.

(This petition is still up, but I’m not going to link to it. It’s easy enough to find if you want to look for it.)

Unethical! And the petition’s creator knows this — she said so in the preamble to the petition. The interesting thing about this petition is that while its creator seems to know why asking people to sign a petition saying “Donald Trump is a narcissist and I think it makes him unfit for President” would be inappropriate, and makes it appear like she’s not asking people to do that…she ultimately really is. And if she is a mental health professional (she doesn’t state her qualifications), that makes the petition particularly egregious.

Let’s unpack this.

The Petition to Have Trump’s Mental Health Evaluated

The creator, stating that she knows that it’s unethical for clinicians who haven’t spent time with a person to diagnose them, is calling on mental health diagnosticians who have observed in Trump’s behaviour (in the media, presumably) the nine diagnostic criteria for Narcissistic Personality Disorder as listed in the DSM-V (she then lists them) to endorse the idea that the Republican party should evaluate Trump’s mental health fitness to hold office based on what they’ve seen. The petition was specifically targeted (as you can apparently do with the particular company that she used to create it) to clinical psychologists and psychiatrists.

I would imagine that her argument is that she’s not asking anyone to diagnose, but instead asking people with the credentials to diagnose to suggest to the Republicans that they find someone who can ethically evaluate Donald Trump and have it done for the good of the country. But there are a couple of problems with this:

  1. This petition didn’t stay among mental health diagnosticians. I found the link to it in a Facebook group whose members work in all sectors, and a lot of people indicated that they signed. The link to the petition also went out over Twitter using a hashtag that trended. It invited armchair psychology from all over the world.
  2. Even if it stayed in circulation only among mental health diagnosticians, it’s a request with a bias toward the idea that Trump *does* have a personality disorder that will make him unfit to govern. Obviously the creator, despite her acknowledgement that it’s unethical for someone in her position (assuming that she’s a diagnostician; again, she doesn’t state her qualifications) to do so, has decided that Trump has Narcissistic Personality Disorder and is asking other diagnosticians to support her (again, unethical.)
  3. Even if we completely ignored what I said in Bullet #2…she’s asking diagnosticians to support a request to the Republicans to have Trump evaluated for mental fitness based on media footage of his campaign. We don’t see or hear what Trump is like at home, church, in his office every day (at least not unfiltered through the media). We see him in only one facet of his life, and a request to evaluate him based on that is unfair. And unethical.

Story time.

The Unfair Assumption That Unwanted Behaviour is Always Due to Disability

I was in a support position for a family where a 17-year-old male had a developmental disability. The parents came to me at one point and asked if I could arrange for an appointment with a behaviour consultant from a children’s support agency.

“His disability is making him disrespectful, argumentative, and very difficult to deal with,” they said. “We can’t get him to do anything we ask.”

“We can do that,” I said, “There’s a waiting list, but I’ll get the referral started. But keep in mind…him being disrespectful, argumentative, difficult to deal with, and unwilling to do what you ask might have more to do with the fact that he’s a 17-year-old boy than it does with his disability.”

My point? Trump could have an off-the-scale case of Narcissistic Personality Disorder. Or he could simply be in possession of the “healthy dose” of narcissism that psychology professor Dan McAdams told the Toronto Star “most people running for high office must have.” Adams did go on to say that “It does seem to be the case that he’s kind of off the map,” but also said that he wouldn’t give him a mental health diagnosis.

Trump certainly has been described as a narcissist by many people, and this tendency appears to be accompanied by an inflated healthy self-esteem, a tendency to speak off the top of his head and behave erratically, and a strong dislike of admitting he’s wrong. Inappropriate trait for someone who wants to be President just on their own — why, asks David Perry, the need to further pathologize them? The insistence on doing so without evidence that it’s merited reinforces ideas that:

  1. If there’s something “off” about a person, they must be “crazy”
  2. A mental health diagnosis makes someone unstable and therefore unfit to hold political office (bullshit ableism)
  3. The stigma that continues to exist around having a mental health diagnosis is justified and even rational

Armchair Psychology is Dangerous -Especially During Election 2016

It kills me that I’ve spent over 15oo words talking about why Trump needs to be treated more fairly. But this isn’t merely about defending about Trump. *He* also needs to be called out for how he uses armchair psychology diatribes about Hilary’s mental instability. Questioning the mental stability of those who disagree with him is part of Trump’s modus operundi, as pointed out in Vanity Fair (from the preamble to the the results of Keith Olbermann’s afore-mentioned piece about Trump and psychopathy):

“Except that in his year of campaigning, Donald Trump has called Lindsey Graham “a nut job,” Glenn Beck “a real nut job,” and Bernie Sanders “a wacko.” Trump has insisted Ben Carson’s got a “pathological disease,” and asked of Barack Obama: “Is our president insane?” He called Ted Cruz “unstable,” “unhinged,” “a little bit of a maniac,” and “crazy or very dishonest.” He also called the entire CNBC network “crazy.” He called Megyn Kelly “crazy” — at least six times.”

Here are some recent comments from him attacking Clinton’s mental health status:

This armchair psychology needs to end. We also need to call out people like the speaker at the RNC who explicitly talked about Clinton being unstable (I wish I could remember who this was; I’ve tried to find the clip, but I can’t. Does anyone remember who I mean?) and individuals from the far, far right media crowd like Info War’s Alex Jones who have made “Hilary Clinton is crazy” a stock part of their message.

The campaigns, the media, and people who seek to influence voters need to work in the world of facts, not ableism and messages that contribute to stigma.

Because that really is bullshit.

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