My Illinois Neighbor: Rod Blagojevich

I'm from Chicago. I live a few blocks from where I was born and a few blocks in the other direction from where Barack Obama and his family live until they move to the White House. But no sooner did I begin to bask in the proximity of this history-making leader of the free world than I found myself cringing instead because of Rod Blagojevich. Unfortunately, the behaviors of which our Illinois governor has been accused (as of this writing, he has not been convicted) break no new ground in Illinois. Should Blagojevich go to prison, he could room with his immediate predecessor.

I can't explain my state's tradition. Which is fortunate, because that is not what this column is about. It's about another question I can't answer. If Blagojevich is guilty of the crimes of which he has been accused, including the attempt to extort money to sell a seat in the Senate of the United States, why did he do it? Within days after his arrest, I was getting media calls asking to explain. The Associated Press reporter had heard the term“ delusions of grandeur” bandied about, and people could not understand how, apparently, a man of gubernatorial stature could boast that he was perfectly aware his communications were being monitored and then repeatedly incriminate himself during those communications. They were saying that behavior that irrational must be the result of some psychiatric condition. The AP reporter wanted my opinion.

When Barry Goldwater, a “hawk,” ran for president of the United States, some psychiatrists took it upon themselves to proclaim that he had a mental illness. As a result, our ethics code came to include the“ Goldwater Rule”: it is unethical for a psychiatrist to diagnose a public figure or other individual he or she has never seen. I could have told the reporter that and ended the conversation. However, one of the major missions of APA is to familiarize the public with and educate the public about psychiatry. Some people still think psychiatrists are weird; why miss an opportunity, if only to be quoted saying something sensible—or even something thought provoking? So what is this sensible and provocative remark I'm going to make?

First of all, so that things would be perfectly clear, I reminded the reporter of the Goldwater Rule. I told her that psychiatric disorders could cloud people's judgment or make them feel invulnerable to the usual consequences of their actions. However, I said, it is also true that people often do things they know perfectly well are dangerous, and say or do things that contradict one another: “I love my wife.... I am having an affair.”

This explanation gave me the opportunity to demonstrate that psychiatrists do not automatically pathologize all human foibles. I told her that if there were real reason to worry about Gov. Blagojevich's mental health, he should have a complete evaluation, not an impressionistic diagnosis. That gave me the opportunity to remind her, and her readers, should she choose to quote me, that psychiatrists are physicians and that it requires expertise and care to make a psychiatric assessment.

I summed it all up by making those points explicit. I pointed out a paradox. Some people accuse psychiatrists of devising a DSM category for any undesirable behavior, unusual idea, bad habit, or unpleasant mood. Many people are under the completely mistaken impression that vicious criminals often get off scot free with the help of psychiatrists who attribute their heinous acts to psychiatric pathology. At the same time, every time somebody commits a terrible crime or engages in ultimately forbidden and ultimately self-defeating behavior—sex with an intern in the Oval Office, for example—people ask us to make a psychiatric diagnosis.

I don't know whether the reporter quoted from our discussion. Experience teaches me that it is unlikely that my preferred comment will be quoted (the only way to accomplish that is to say the same thing over and over), but also unlikely that my comments will be misused. I hope I left the reporter with the impression that psychiatrists have sensible and interesting things to say, that we do not make snap judgments about public figures, that we take the art and science of diagnosis seriously, and that we don't claim to understand all human behavior. Yes, I am a psychiatrist from Illinois. But no—I don't have a diagnosis for Rod Blagojevich. ▪