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Rethinking the ‘Goldwater Rule’ in the Trump Era

Is it ever appropriate for mental health professionals to diagnose a politician from afar? Maybe.

"There are some mental illnesses," writes Richardson, "that are incurable and rarely treatable that would also make a person unqualified to be president. Imagine a sociopath, or someone with narcissistic personality disorder, for example." (Image: Trump on a psychiatrist’s couch is a composite image created for – the base image is a still shot from the movie "Annie Hall" (promotional/fair use))

Maybe it’s time America’s psychiatrists reconsider their Goldwater Rule.

The Goldwater Rule simply states that psychiatrists shouldn’t diagnose the mental health of a public figure unless they’ve personally examined the person. Naturally, if any public figures have sought mental health treatment, their doctors would be bound by confidentiality agreements.

In short, at present, if a public figure doesn’t wish to be diagnosed with a mental illness, or if they don’t want the diagnosis made public, then it will remain a secret.

In most cases, this is a good rule. After all, mental illness is still stigmatized.

One of our most successful presidents, Abraham Lincoln, famously suffered from severe depression, but he still did his job well. We wouldn’t want a modern, would-be Lincoln to face discrimination simply because his or her depression became public.

But there’s a circumstance in which I believe the Goldwater Rule is harmful.

There are some mental illnesses that are incurable and rarely treatable that would also make a person unqualified to be president. Imagine a sociopath, or someone with narcissistic personality disorder, for example.

People with narcissistic personality disorder rarely seek treatment, according to University of Kentucky psychologists Cristina Crego and Thomas Widiger.


If they do, it’s often because someone else forced them to do so, like a spouse who threatened to leave unless they went to therapy. But even if they show up regularly for their appointments, they may struggle to do the soul searching required in therapy.

The most hopeful response I’ve ever heard from a mental health professional about the prognosis of someone with narcissistic personality disorder is that maybe, with a lot of time and hard work in therapy, they might get a little bit better.

Narcissistic personality disorder is seriously debilitating, but often the person suffering from it believes that they’re fine and everyone else around them has the problem.

Imagine someone in the Oval Office whose biggest need every day is to feel important and loved by everyone around them, and who responds with rage when they perceive any sort of criticism.

This is a person who cannot do the business of the country or put the needs of the country first because his or her personal needs due to the disorder will rule their lives.

Given that there will be an entire opposing political party who does not like them, not to mention entire shows on television like Saturday Night Live devoted to making fun of them, no president will be loved by all. Every president must deal with criticism every single day.

What happens if the president feels slighted by a foreign leader? He or she could respond with sanctions, war, or even nukes.

Narcissists often don’t think the rules apply to them because they are special. They should be able to do what they want to get what they want. The U.S. president isn’t above the law, and it would be dangerous to elect someone who believes he or she is.

Given that such a person is never, ever likely to seek treatment, nor are they likely to allow a psychiatrist to make an assessment of their mental health public, that means that — should such a person be elected — there’s no way for psychiatrists to warn the public.

If the Goldwater Rule were rescinded, there’s certainly a danger that psychiatrists would publicly misdiagnose a public figure, or public figures with treatable mental illness would face unfair scrutiny.

Yet we must find a way to close the current loophole, which may protect someone mentally unfit for office from expert scrutiny.

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