The past few weeks or reporting have been fraught with callous speculation about President Trump’s mental health. The New York Times has been especially active in promoting this argument, and several of their regular columnists have done so viciously. Charles Blow, for example, called Trump “mentally small“ and seems to imply that he is a “mentally unstable simpleton.” Meanwhile, The Times’ “Mental Health” topic section has been saturated with Trump speculation, which sits equal among discussions about anorexia and patient abuse. Other liberal outlets from CNN to Huffington Post have been taking this line, too.
From the outset, this is really just speculation. Very few psychiatrists have weighed in on the issue, because the American Psychiatric Association, via the Goldwater Rule, has deemed giving an opinion on a current president’s mental health unethical without a personal evaluation. The APA made clear that the rule still stands, days after the Trump speculation began. Nonetheless, to quell debate, Trump asked for a mental fitness evaluation and passed it. This wasn’t enough for some, including NYT columnist Gail Collins. She concludes that the test would have missed his “terrible attention deficit disorder and rampaging narcissism.” Yet for all of this dramatic extrapolation, there is no sound evidence that Trump has any mental illness.
Speculation about Trump’s mental state isn’t new, but its recent revival largely centers around the work of psychiatrist Bandy Lee. She edited a controversial book titled, “The Dangerous Case of Donald Trump,” which is validated by its authorship of 27 psychiatrists. You’d think that would make for a compelling, scientific case, but they seem hardly unbiased. The book contains lines such as, “absolute tyranny is DT’s wet dream,” and, “The Trump administration … may sta[g]e a fake terrorist attack.” The authors repeatedly compare Trump to Hitler, too.
Clearly, then, this is not just a random sample of 27 psychiatrists. It’s people who are applying their trade to invalidate somebody they already disagree with in a manner inconsistent with prevailing psychiatric guidelines. That cannot be called a professional opinion.
I’m not commenting on Trump’s actual mental fitness nor on anything he has done. He is not, however, “prima facie mentally ill.” To give that sort of pseudo-diagnosis and then to reach for the 25th Amendment is to sidestep important debates about the role of psychiatry in politics, the definition of mental illness and, more basically, the ethicality of Trump’s actions.
In fact, some are using this psychiatric argument in a way that undermines political debate. Psychiatrist Allen Frances is one of them. In his “Twilight of American Sanity,” he argues that Trump supporters are crazy, not the man himself. In doing so, he writes very condescendingly of them: “[You] must first gain [their] trust as a precondition for exploring the fears, feelings, fancies, stressors, legitimate beefs and experiences that have made the false beliefs so believable.”
Surely, some of the beliefs of Trump supporters are demonstrably false, as is the case with climate science denial. Yet other matters, like immigration, economic policy and abortion, are more subjective. You do not have to be mentally ill to hold conservative views on these issues. I struggle to see a difference between this and an entirely ad hominem approach to discussion: Assume incorrectness from perceived personality traits.
On the whole, Frances claims that Trump’s behavior is reflective of our own faults. What I find truly worrying, though, is that our feckless speculation and labeling has revealed an underlying lack of concern for those struggling with mental illness. At present, many are using the accusations of a few psychiatrists as a blank check to make comments about Trump’s purported mental instability.
Except there probably isn’t mental instability. More clearly, there’s at least no distinct mental health issue and hence no clear target for this line of attack. Trump’s assailants are therefore just moving from his negative characteristics to random and general diagnoses in an offensive and inaccurate way. It’s not hard to see that.
When a journalist unfoundedly calls someone a mentally unstable simpleton, he has created an association between mental illness and idiocy. When he says that a person is mentally small, he attributes weakness to mental illness. Blow is creating a negative portrait of Trump, littering imprecise adjectives about his mental state amongst a barrage of insults. These words are not being used clinically. They are selected to make Trump sound unhinged, without diagnosis, assigning terms to him on the basis of whatever sounds most damaging.
There are two main reasons this is wrong:
The first is immediate. People with some sort of actual mental health issue have surely come across this kind of reporting, which teems with inaccurate accusations and extrapolations about the state of someone’s mental health. To have terms about mental health thrown around in such a way may reaffirm to those people that the public does not really understand the issue. Worse yet, because the terms are used in a clearly negative way, it stigmatizes people who suffer from mental illness. That stigma has often been perpetuated shamelessly, for example when, in a cartoon, The Washington Post depicted Trump wearing a straitjacket in a padded room. The National Mental Health Alliance specifically warns against the potential damage of cartoonish depictions of mental illness.
Mental health disorders already tend to make people feel guilty or worthless. The last thing we should want is to make matters worse. Moreover, when journalists jump from suspicion of mental illness to accusations of complete incompetence, they’ve made a visible overreach that could impact the self-esteem of people dealing with mental health disorders.
The second reason this matters is social. At present, the effect of stigma on people with mental health disorders is huge, with only 25 percent believing, “that people are caring and sympathetic to persons with mental illness.” Research has demonstrated this to be an important reason why the majority of adults with a mental illness do not receive professional treatment. For scale, the U.S. has one of the most pervasive mental health crises of any country on earth. Most importantly, suicide is the 10th leading cause of death in the United States, and 90 percent of people who commit suicide have a mental illness of some sort.
We don’t need any more stigma against mental illness. The Trump speculation has promoted it widely.
Lastly, I want to say that this is not just a journalistic problem. In fact, people who deal with mental health issues are liable to promote this stigma too; I don’t want to assume anything about the mental health of the journalists against Trump. What’s clear, though, is that something about how we talk about mental illness is causing feelings of shame and inadequacy. It’s the only way this global crisis can remain hidden. To ameliorate that, we need to reshape public attitudes about mental health.
Language counts. To that end, I want to point out where I’ve made a mistake in publicly discussing mental health. In an article where I discussed my struggle with anxiety, I concluded: “Those who are lucky enough to recover find that instead of gaining freedom, they’ve entered into a new prison. They never quite regain ownership of themselves, because they view the depth of their anxiety’s effect with the same dismissive stance we’ve taken towards its breadth.”
There, I claimed that the return of anxiety might be due to someone’s dismissive stance. The problem I now see, though, is that one’s struggle with mental illness cannot be attributed to their faults. That’s not to say people with mental health problems can’t handle themselves. Rather, this problem is so painful for so many people, and it’s not getting much better on a national scale. We need to better consider why that is and what we can do about it. Blaming anyone suffering from it – or negatively stereotyping them – will not make matters better.
Contact Noah Louis-Ferdinand at nlouisfe ‘at’ stanford.edu.