This month, the American Psychoanalytic Association told its roughly 3,500 members a decades-old rule against speculating on the mental health of some public figures does not apply to their members — and yup, this rule change indeed has something to do with the aggressively Freudian president in the White House.
According to Scientific American, one of the association's past presidents, Dr. Prudence Gourguechon, said the rule change was motivated by "belief in the value of psychoanalytic knowledge in explaining human behaviour. We don't want to prohibit our members from using their knowledge responsibly."
The rule change was in part necessary since President Donald Trump's "behaviour is so different from anything we've seen before," Gourguechon added.
Professional restrictions on diagnosing the mental health of public figures, which opponents refer to as a "gag rule," has long been a matter of contention within the mental health field — but it's become a particularly tense debate as of late. No wonder, given Trump's tendency to go to war with his own staff and allies over perceived slights, rambling Twitter threats and that time this week he demanded the Boy Scouts pledge him their loyalty.
Within the American Psychiatric Association, the much larger organisation that claims a membership of over 37,000, the prohibition is sometimes called the "Goldwater Rule." (An unscientific and extremely controversial 1964 poll of 2,417 psychiatrists found half thought Republican nominee Barry Goldwater was mentally unfit to be president, weighing in with descriptions like "paranoid" and "grossly psychotic.") While violating the rule can only result in associational sanctions like being kicked out of the APA, not revocation of medical degrees or licenses to practice, it's still a powerful deterrent.
Prominent psychiatrist Dr. Leonard Glass published an editorial in Psychiatric Times this month resigning from the latter APA, saying the rule had grown more draconian this year with a new interpretation"that comments about a public figure's affect and behaviour constituted an unethical professional opinion."
Glass wrote tighter restrictions on statements by psychiatrists "made a fundamental error conflating a 'professional opinion' that one might provide in a clinical setting and be the basis for a treatment plan with the 'opinion of a professional' who is making an observation in a non-clinical context, in the public domain." When he raised the distinction with the APA, he wrote, he came away with the impression the association thought its members "must be muzzled to protect the profession."
The American Psychoanalytic Association may not have the clout of the American Psychiatric Association, but it is respected. It's not calling for reckless abandon, either: Gourguechon told the Atlantic it would be unethical for a psychiatrist to "guess what's going on in somebody's mind," but that offering general insights like whether particular presidential behaviours were "impulsive" are fine.
Trump is almost certainly such a significant outlier that some of his behaviours need to be weighed in on by professional mental health experts. Just listen to the guy speak for five minutes, and it becomes very hard not to think there's something deeply wrong going on in there.
But there's also grounds to wonder if relaxing a rule designed to prevent the political weaponization of a medical discipline could have consequences long beyond the current moment. We do live in an age of Dr. Phils, massive stigmatization of mental health issues and politicians quite eager to call their opponents insane.
Trump's "psychological motivations are too obvious to be interesting, and analysing them will not halt his headlong power grab," the Duke University School of Medicine's Dr. Allen Frances, one of the authors of the criteria on narcissistic personality disorder, wrote in the New York Times in February. "The antidote to a dystopic Trumpean dark age is political, not psychological."