The following is the opinion and analysis of the writer:
In the upcoming months, we will have a campaign to elect the next president of the United States. The issues for discussion, as usual, will center on domestic and foreign policies. But, what about the mental health of the person who will enact and carry them out? Isn’t that a more fundamental issue? Shouldn’t mental fitness be a core requirement if not a prerequisite for the person holding our nation’s highest office?
Isn’t it ironic that when we discuss the presidential candidates with friends or co-workers, a frequent and common concern is not their foreign or domestic policies but rather, in some form or another, their mental condition? It’s the issue that most resonates with me and I’ll bet with you too. It’s just common sense to analyze the man before his politics.
I am not a mental health professional and likely neither are you. Granted, we observe, contemplate and judge the personalities, behaviors and actions of everyone we encounter. If you’re like me, you form opinions about a person’s mental stability within minutes, if not seconds. Often we’re right but sometimes we’re wrong.
In a June 23 article in The Washington Post (“Trump increasingly preoccupied with defending his physical and mental health”), Donald Trump acknowledged the importance of a mentally healthy president. He challenged Joe Biden to take a cognitive test similar to the one he reportedly took and passed in 2018. Trump said he didn’t think Biden could pass it.
But, that 10-minute screening test is only aimed at detecting mild cognitive impairments. It did not address other more serious and problematic mental health disturbances.
Let’s face it. Unless mandatory, these presidential candidates will never undergo comprehensive mental health evaluations.
Nevertheless, we need professionals to give us guidance on how to better assess the mental health of these two men.
Here’s why:
Both presidential aspirants, Biden and Trump, are well known to us.
Their personalities, behaviors and actions have been observed, contemplated and judged for years.
At 77, to many, Biden is too old for the presidency. He sometimes fumbles when speaking and loses his train of thought in discussions. At times he seems to have difficulty formulating his thoughts. Is he forgetful (age appropriate?) or cognitively impaired? To what extent does his history of stuttering influence how he currently expresses himself?
At 74, to many, Donald Trump has a major personality problem. He constantly lies, insults, bullies and shows no empathy for those who are suffering. He makes impulsive decisions, speaks in incoherent word salads that often go wildly off topic, and acts in ways that are only self-serving. Does his personality pose an inherent danger for us and the world as our nation’s highest legitimate authority?
What exactly is going on with these men? Are they mentally stable or not?
If full in-person psychiatric evaluations are off the table, we voters should get the next best alternative: an assessment by observation from mental health professionals.
This, however, may not be easy: Enter the “Goldwater Rule.”
The Goldwater Rule is Section 7.3 in the American Psychiatric Association’s Principles of Medical Ethics. It states: On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, 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.
Fortunately though, there is another and arguably more primary ethical and legal position called the “Duty to Warn” — the obligation of health-care providers to advise people of the potential risks that others may pose to them.
For example, in October 2017, in the bestseller “The Dangerous Case of Donald Trump,” 27 psychiatrists and mental health experts weighed in with their opinion of his mental status.
While mindful of the Goldwater Rule, these specialists agreed that the duty to warn was a higher calling. They concluded that to not alert the public that their president displays clear signs of mental impairment would be a dereliction of professional responsibility. Lead authors Bandy Lee, M.D., and Judith Herman, M.D., stated: “Assessing dangerousness is different from making a diagnosis: it is dependent on the situation, not the person.”
Regarding Joe Biden, some of the same specialists and others have suggested that while he does not meet the threshold for dangerous mental instability, a mental fitness-for-duty exam would be in order.
Major caveats to consider: These assessments and warnings may not express the entirety of psychiatric opinion on the mental health of Trump or Biden and may be influenced by political bias.
That said, let’s still do this:
In letters to the editor, in emails to elected representatives, etc., let’s push for Biden’s and Trump’s mental status to be assessed by experts — even though it will only be through observation. While not a perfect vetting method, it will surely better inform those discussions with friends and co-workers and provide us all with a more thoughtful decision making process as we prepare to vote in November.
