On the 25th Amendment and Donald Trump: Don’t Weaponize Psychiatry

In the past four years, claims were repeatedly made about the mental health of President Trump and his psychological fitness to govern. As an APA member who follows the Goldwater Rule, I cannot ethically comment in a public, professional capacity on the mental health status of public figures—nor do I wish to.

Also, having served on the committees that worked on DSM-5, DSM-5-TR, and the World Health Organization’s ICD-11 and tried to narrow diagnosis, I’m a believer in the importance of diagnosis. However, I also believe psychiatrists should do less diagnosing, not more. That includes a narrow use of psychiatric diagnoses, primarily for the purposes of treating patients.

Some of my professional colleagues, however, do not feel similarly constrained. They have publicly expressed outrage over the president’s behavior over the last four years, couched in terms like “narcissistic personality” and “psychopathology.” Their “diagnosing” further intensified after the Capitol riots as they called for invoking the 25th Amendment of the U.S. Constitution to remove Mr. Trump from office.

As a concerned U.S. citizen, I believe Mr. Trump was unfit for the office he held (full disclosure: I did not vote for him—twice). As a psychiatrist and psychoanalyst who has not examined him, however, I don’t know that the recent crisis had anything to do with his having a psychiatric diagnosis.

“Psychopathology,” for example, is just our profession’s jargon word that does not specify an actual diagnosis. And, in the corporate world, one rarely sees anyone lose a leadership position, let alone be psychiatrically hospitalized, for meeting diagnostic criteria of “narcissistic personality.” In other words, just because you think someone is “crazy” and you don’t like that person, it doesn’t mean the person should lose his or her job.

However, it is true that psychiatry, since its inception, has been used to harm people who should not be considered patients at all. For example, our profession, without much evidence but with much social sanction, began classifying gay people as ill in the 19th century. It continued to do so until the last third of the 20th century when APA removed “homosexuality” from DSM-II in 1973 and WHO followed suit in 1990. Before that, and sadly still in some places in the United States and other parts of the world today, mental health professionals offer to “cure” a normal form of sexual expression.

Psychiatry has also been misused for obvious political purposes. In the former Soviet Union, political dissidents “diagnosed” with “sluggish schizophrenia” were locked away in psychiatric hospitals. In Communist China today, followers of the Falun Gong movement, trade union activists, human rights workers, and others have been sent to psychiatric facilities for political rehabilitation, rather than actual mental health treatment.

Mr. Trump’s bad behavior was on display for years. One did not have to be a psychiatrist to see that there was something wrong with his judgment. His sabotaging of the Georgia elections and losing the Republican Senate majority were just one recent example. However, using the language of psychiatry—and presumably engaging a psychiatrist or two to perform a 25th Amendment psychiatric examination—to fast-track the sidelining of a sitting president, no matter how incompetent, is another example of weaponizing psychiatry and politicizing our field.

Doing so would have been bad for psychiatry, as it would only reinforce existing negative stereotypes about mental health issues. It would also have set a bad precedent for future political crises as it might be seen as another way to quickly bypass more legitimate and legal means, like impeachment, to remove an incompetent official.

In the end, fortunately, the 25th Amendment was not evoked, and Mr. Trump was impeached by the House of Representatives for his actions, not his mental state. In other words, the political system worked without any help from psychiatry. Which, in my opinion, is how it should be. ■