The year was 1964, and after losing in a landslide, the candidate, Sen. Barry Goldwater of Arizona, sued the publisher of Fact magazine, which had published the survey, winning $75,000 in damages.
But doctors attacked the survey, too, for its unsupported clinical language and obvious partisanship. In 1973, the American Psychiatric Association adopted what became known as the Goldwater Rule, declaring it unethical for any psychiatrist to diagnose a public figure’s condition “unless he or she has conducted an examination and has been granted proper authorization for such a statement.”
Enter Donald Trump.
The 2016 Republican nominee’s incendiary, stream-of-consciousness pronouncements have strained that agreement to the breaking point, exposing divisions in the field over whether such restraint is appropriate today.
Psychiatrists and psychologists have publicly flouted the Goldwater Rule, tagging Trump with an assortment of personality problems, including grandiosity, a lack of empathy, and “malignant narcissism.” The clinical insults are flying so thick that this month, the psychiatric association reiterated that breaking the Goldwater Rule “is irresponsible, potentially stigmatizing, and definitely unethical.”
Putting a psychiatric label on a candidate they oppose can be a “seemingly irresistible tool for some in the field,” said Dr. Paul Appelbaum, a professor of psychiatry, medicine and law at Columbia University who disapproves of the practice. “This year, perhaps more than most, they’re persuaded they’re saving the nation from a terrible fate.”
William Doherty, a psychologist at the University of Minnesota, believes exactly that. In June, Doherty posted an online manifesto against “Trumpism” that has been signed by more than 2,200 mental health specialists.
“Yes, for me this is an exception,” Doherty said. “What we have here is a threat to democracy itself.”
Supporters of the Goldwater Rule have cited three main rationales for adhering to it: Most diagnoses made from a distance turn out to be wrong; the labels themselves can cause real harm to the person and family members; and the practice undermines the field’s credibility, particularly its commitment to confidentiality. Not to mention, others say, that it could expose a left-leaning bias in the field.
But the psychoanalyzing of public figures by commentators, columnists and pop psychologists has a bipartisan history. Concerns about grandiosity and narcissism dogged Lyndon B. Johnson’s presidency. Suspicions of a deepening paranoia clouded the end of Richard Nixon’s. Accusations of manipulation, deceit and a sense of entitlement have trailed the Clintons for years, prompting speculation about deeper personality problems.
Trump himself has recently tried to turn the tables, accusing Hillary Clinton of being “unstable” and “unhinged.”
While the vast majority of therapists’ comments remain focused on Trump, some in the profession say that if public psychoanalyzing is going to be done, it should be directed at both candidates.
“Do those things rise to a diagnosable level? I sure don’t know,” said Don Sizemore, a family therapist in Lexington, Kentucky. “But if we’re diagnosing him, we should be doing the same for her.”
Yet history cautions against the armchair analysis of either one. Psychiatrists point to Goldwater himself as a prime example of getting it wrong. By the time he died in 1998, Goldwater was regarded as “one of his party’s most respected elder statesmen,” The Washington Post said in its obituary.
In the wake of the Monica Lewinsky scandal, many people longed for a diagnosis to explain or denounce President Bill Clinton’s behavior, said Dr. Nada Stotland, a psychiatrist at Rush Medical College in Chicago. “I remember getting all these media calls asking if he was a narcissist or a sex addict,” she said. “Well, sex addiction wasn’t a recognized disorder at the time. And if it had been, was the behavior then not his fault? I ended up dancing around these questions, because this idea that we should go around, willy-nilly, putting diagnoses on people is just wrong.”
But those using clinical language to describe Trump’s behavior contend that this presidential election is vastly different, for a big reason: The proliferation of social media comments and video clips, which afford direct, unscripted access to candidates, was simply not available in previous races. The depth of that material creates a public persona complete enough to analyze on its own merits, they say.
Doherty said he and the therapists who signed his manifesto were not diagnosing Trump’s personal traits, but his public persona. The manifesto characterizes “Trumpism” as reinventing history, never apologizing, demeaning critics and inciting violence. “One can talk about his public behavior without knowing whether he is fully that way with his children, his wife, his friends,” Doherty said.
Dr. Steven Buser, a psychiatrist who with his colleague, Dr. Leonard Cruz, coedited a new book, “A Clear and Present Danger: Narcissism in the Era of Donald Trump,” stressed, “We are careful not to make a clinical diagnosis here, to say that Donald Trump has narcissistic personality disorder.” The contributing writers include psychiatrists and psychologists, but Buser said, “We are focused on the image he projects, on TV, in tweets, in quotes.”
Appelbaum calls this distinction a convenient splitting of hairs. “It takes a skilled therapist months, sometimes longer, seeing a person regularly and asking probing questions to make a determination of whether a disorder is present,” Appelbaum said.
The stigma of mental vulnerability is especially damaging in politics. In the 1972 presidential race, Sen. Thomas F. Eagleton of Missouri withdrew as George McGovern’s running mate after 18 days — at McGovern’s request — in the wake of revelations that he had undergone psychiatric counseling and electroshock therapy. In 1988, the Democratic nominee, Michael S. Dukakis, released his medical records to counter rumors that he had undergone psychiatric treatment. He had not.
During his libel trial, Goldwater was mystified by some of the psychiatrists’ comments about his personality, including one calling him an “anal character.” “I don’t know what an anal character would be,” he testified, according to news accounts. “I tried to look it up in the dictionary, but couldn’t find it.”
He took particular exception to a psychiatrist’s comment that he was “a counterfeit figure of a masculine man.” Such a charge “weighs several tons, and the effect is rather depressing,” he said.
If there are exceptions to the Goldwater Rule, psychiatrists apparently cannot agree on them. More distant historical figures tend to be fair game; “Lincoln’s Melancholy,” a book by Joshua Wolf Shenk making the case that Lincoln had suffered from depression, was well received.
Leaders of hostile nations may or may not qualify, depending on who is judging. A psychiatrist who provided a personality assessment of Saddam Hussein at the request of the George W. Bush administration was criticized by some in the psychiatric community, but not formally censured.
Retired politicians fall into a gray area. Therapists have penned books on George W. Bush, as well as Bill Clinton. Not all of their colleagues approve.
But in an era when private moments and comments are increasingly available for public consumption, some argue that the Goldwater Rule is due for an update.
“There’s another perspective on this altogether,” said John D. Mayer, a University of New Hampshire psychologist who has written widely on the rule. “The ethicists who wrote the rule have been entirely focused on the negative side of commentaries. But there’s a positive, adaptive side to every personality trait.
“If you call someone deceitful, whether Clinton or Trump,” Mayer said of this year’s nominees, “it needs to be said that, for a good politician, there are reasons you can’t always say everything you know, or exactly what you think.”