General Discussion

To get a doctor’s take on the issue, MDLinx reached out to multiple neurologists and other doctors for their insights. Many of HCPs, however, replied saying that they felt uncomfortable or unequipped to comment on Trump’s health.

The first thing one notices about the text itself is the title The Dangerous Case of Donald Trump. It is ambiguous but not innocent. When a doctor speaks of a case, the term references a clinical case in which a person becomes a patient, with a history, symptoms, laboratory findings, medical conditions, and a life lived in a community, but here in the title of the book sits one of the key disputed points: the psychiatrist has to deny that Mr. Trump's case is one of a patient while simultaneously providing a diagnosis that is claimed not to be a diagnosis; otherwise, all the Hippocratic and legal, medical, and ethics-related problems arise: confidentiality, privacy, respect, beneficence, nonmaleficence, and some sort of mutual contract. So, if he is not a patient, which he is not, in what sense is he a “case,” and why is the term used in the title of the book? It is left unclear, purposely, I assume. If there was any doubt that convening a conference that assesses the mental health of a president and publishing a book of the papers given at the conference sticks a finger in the eye of the APA leadership, then the labeling of President Trump as a case throws down the gauntlet.

There are three sections to this book. The first, entitled “The Trump Phenomenon,” takes up questions of diagnoses. The second section, entitled “The Trump Dilemma,” should really be titled “The Psychiatrists' Dilemma.” Trump has no dilemma; psychiatry does. This section discusses the problem that psychiatry has in deciding what stance to take about his dangerousness, especially in light of the Goldwater Rule. The third section, “The Trump Effect,” examines the impact of his personality and policies on various segments of the population (often white middle-class citizens in therapy) and on the psychiatric profession.

However, our appreciation for the courage and effort to take on the APA ethics police and the Trump lobby should not cause us to overlook some of the weaknesses in arguments, logic, perspective, and evidence. I recognize the pressures to get this book out in a timely fashion, but an index would have been helpful. It is difficult to go back and forth and see what several of the authors had to say about narcissism or dangerousness or the Goldwater Rule. On a more substantial note, there is too often a lack of critical thinking about concepts and causality, which seriously weakens the credibility of what the authors wish to get across. For example, there are too many outdated and simplistic assumptions about the psychodynamics of narcissism. The reader is told that persons are narcissistic to hide their shame or overcompensate for their inadequacies; they stifle their conscience and their compassion. I do not know if any of these generalizations are true of Mr. Trump, nor do I have confidence that if I asked him directly, I would get a trustworthy answer. It does not help the advancement of our field to proffer rote explanations, and it certainly does not help to use such arguments in trying to persuade anyone to view the situation differently.

Moving on, the lack of critical thinking and the presence of inexact comparisons are distressing. Is it helpful to call Presidents Clinton and Kennedy narcissists, because they are said by some to be womanizers? How many women does one have to be casually involved with to be a womanizer? Is it the number or quality of relationships that supports such a label? Would the APA come down on psychiatrists as heavily if they called a political figure they had not personally examined a womanizer rather than a narcissist? Are there reasons, other than narcissism, to consider why an individual might be a womanizer?

https://jaapl.org/content/46/2/267

As you know, it can be challenging to diagnose a patient with a health condition when they are not, in fact, your patient, and when they haven’t visited you in your office or talked to you during a telehealth or face-to-face appointment. It can be even harder to make a medical evaluation based on secondhand information, social media feeds, or news reports.

https://www.mdlinx.com/article/doctors-react-to-claims-that-trump-is-sundowning/4rPDR0lIEHfW8euPL4EZNS