Vol. 175 August 1, 2017 Trump Turmoil From a Medical Perspective

President Trump is not my patient.
I am not President Trump’s doctor.

Neither is Leonard L. Glass, MD, MPH, Board Certified psychiatrist and psychoanalyst, Associate Professor of Psychiatry Harvard Medical School, McLean Hospital Senior Attending Physician , medical ethicist, and Distinguished Life Fellow of the American Psychiatric Association (APA).

After clearly making those two statements above, Dr. Glass resigned his 40+ year membership in the APA because the APA recently reaffirmed and expanded its statement that it is unethical for any psychiatrist to make any statement about the mental state of public figures who they have NOT examined in person, i.e. who are not their “patient”.  It is called the Goldwater Rule and was  implemented by the APA Ethics Committee in 1964 after FACT Magazine lost a libel suit over their published poll of psychiatrists of the “mental state” of Senator Barry Goldwater as a candidate for president.  “Superimposing the time-honored doctor-patient relationship onto public, political discourse, where there is no doctor-patient relationship is intrusive, improper, and self-defeating”. (1)

HIPPA regulations about patient confidentiality aside for the moment, Dr. Glass feels that since orthopedic surgeons can explain to us the mechanics of an ACL tear and its treatment in a Patriots linebacker, and radiation therapists can give us chapter and verse about Senator Ted Kennedy’s positron treatment for brain cancer, forbidding an experienced professional observer of behavior to comment on the observed behavior of a public figure is ridiculous. He makes no pretense of “making a diagnosis”, and explicitly refrains from that.

Having stated that he disagrees with the APA Goldwater Rule, Dr. Glass goes on to give his insightful views of the observed behaviors, nay the copiously observed videotape and real-time audio behaviors, of a prominent public figure, President Trump. (Please notice the respect I am showing by not referring to him as “the Donald”.)

Dr. Glass first cites the US Army’s Field Manual for Leadership’s list of “criteria for leadership” as an objective means to evaluate capacity for effective leadership. The criteria are:
Trust
Discipline
Self-control
Judgment
Critical thinking
Self-awareness
Empathy.

Dr. Glass’s then offers his “plausible ways of understanding Trump’s aberrant behavior.”

  • “Trump’s continual boasting and proclamation of great confidence in his ability to solve complex problems suggest bluster and posturing to disguise insecurity.”
  • “His inability to tolerate divergent opinions and his lashing out impulsively at those who differ from him demonstrate an impulsivity that could interfere with processing important new data that runs contrary to his prior opinions.”
  • “His vindictiveness and ridicule of vulnerable groups [and individuals] point to a lack of empathy and compulsive need to prop up his self-worth at the expense of others.”
  • “His assertions of strength and power, paired with repeated complaints of being victimized, suggest fears of exposure as small and inadequate.”
  • “His numerous self-contradictions and shifts of position without acknowledgement of prior misjudgments betoken an erratic, unstable, and unreliable mind-set in which chaotic emotional needs are constantly swamping his capacity for deliberative, thoughtful problem-solving.”

Dr. Glass finishes with “These are psychological hypotheses aimed at helping us make sense of mercurial and aberrant behavior without getting into diagnosis .”

Now if you don’t consider President Trump’s behavior as aberrant, or at least as unusual, for a President, then you stopped reading this blog a while back.

One of the reasons I think that President Trump is so unusual was recently clarified for me by a couple of linguists interviewed on radio. They who have been studying his speeches for some time. “He speaks like people ordinarily do.” They mean that he is a bit rambling, sometimes quickly changes subjects, repeatedly emphases favorite or strongly held thoughts, and even injects profanity for effect. They go on to say that “ordinary language” is meant to be spoken, not read. It doesn’t necessarily read well as the written word. Understanding it often depends a lot on physical cues like voice modulation, facial expression, and body language. The linguists noted that his speech pattern is one way Trump has such an appeal for some. “He doesn’t talk like a politician.”

I am no fan of politick-speak, and I don’t consider myself to be an elitist (though at least one of my children would tell me that as a relatively affluent older white male, I fit the definition). But I do expect Presidents to speak like a President; with some eloquence, with some consistency of content and syntax, and hopefully with a greater vision than I have, so I can be inspired or challenged.

My late, sweet, gentle, very-short Irish Catholic mother-in-law’s most damning and infrequently-used dismissal of a person was “They’re ordinary”. I never thought that I would ever quote her in a blog, BUT ….

References:
1. “Let psychiatrists talk about Trump’s mental state,” Leonard L. Glass, Boston Globe, July 31, 2017, pg.A9.

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