Co-authored by Dee Mosbacher, M.D., Ph.D. and Nanette Gartrell, M.D.
Now that he has won the presidency, why wouldnt he just pivot and become more normal? Why would he say things in public that are destructive to him and the nation? Why stir things up unnecessarily? The chaos and incoherence are much worse than expected.
These are some of the questions and concerns that have been raised about President Trump by persons who are untrained in how mental impairment can manifest. Indeed, the vast array of healthy human behaviors makes it difficult for the ordinary person to detect disability other than in the most obvious cases. Further, the more impaired the individual, the more likely he or she is to deny pathological behavior and insist that it is by choice. In our culture, mental impairment, unlike other medical illnesses, still connotes a moral failureleading to its denial or use only in epithets. Yet it can afflict anyone, it is nonpartisan, and we can identify it through objective criteria.
The Goldwater rule, which specifies that psychiatrists cannot diagnose a public figure without a face-to-face evaluation, has contributed to the lack of discourse and education about Mr. Trump. An expansion of the rule by the American Psychiatric Association in March 2017 further compromised that possibility. Frequently overlooked is the fact that the Goldwater rule itself occurs under the ethical mandate to contribute to the betterment of public health, for which a professional may share with the public his or her expertise about psychiatric issues in general. As a result, mental health issues are continually marginalized, and misconceptions persist. It is commonly assumed, for example, that mental impairment will cancel out responsibility, when this occurs only rarely. Also, mental illness does not imply violence: most mentally ill individuals are not violent, and most violent individuals are not mentally ill. What is important, therefore, is not the diagnosis but the combination of particular symptoms and the context whether observed in a clinical setting or from afar when assessing dangerousness.
In the case of President Trump, it has been apparent for some time that his inability or unwillingness to distinguish fact from fiction, rageful responses to criticism, lack of impulse control, and wanton disregard for the rule of law indicate emotional impairment rather than deliberate choice. Such signs and symptoms may be tolerable in a variety of settings, but not when this individual has command of the nuclear arsenal. Fitness for duty evaluations are a common practice among forensic psychiatrists and other mental health professionals, who follow a standard assessment procedure while applying it to the duty in question. Although military personnel who are responsible for relaying nuclear orders must undergo rigorous mental health and medical evaluations that assess fitness for duty, no such requirement exists for their commander-in-chief.
At a time of increasing conflict abroad and worsening divisions at home, we believe it is time to remedy this situation. The 25th Amendment to the U.S. Constitution, which addresses presidential disability and succession, has never been invoked to evaluate whether a standing president is fit to serve. However, Congress has the ability to act within its provisions to create an independent, impartial panel of investigators to evaluate Mr. Trumps fitness to fulfill the duties of the presidency. Congress can pass legislation to ensure that future presidential and vice-presidential candidates are evaluated by this professional panel before the general election, and that the sitting president and vice-president are assessed on an annual basis.
Our specific recommendations are as follows:
Congress must act immediately. Congressional inaction has brought us to a crisis point: the nuclear arsenal rests in the hands of a president who shows symptoms of serious mental instability, with indications that they will likely escalate. This is an urgent matter of national and international security. We call on our elected officials to heed the warnings of thousands of mental health professionals who have requested an emergency evaluation of Mr. Trump. The world as we know it could cease to exist in a momentary, angry outburst.
Bandy X. Lee, M.D., M.Div., is a forensic psychiatrist on the faculty of Yale School of Medicine. In addition to her clinical work in correctional and public-sector settings, she served as Director of Research for the Center for the Study of Violence. She then co-founded Yales Violence and Health Study Group and leads an academic collaborators group for the World Health Organization. She has consulted with governments to set up violence prevention programs internationally and within the U.S., as well as helped to initiate reforms at New York Citys Rikers Island Correctional Center. She teaches at Yale Law School and Yale College. She published more than 100 peer-reviewed articles and chapters, edited eleven academic books, and authored a textbook on violence. Her latest publication will be a compendium of mental health expertise in the trade book, The Dangerous Case of Donald Trump.
Dee Mosbacher, M.D., Ph.D., is a psychiatrist and Academy Award-nominated documentary filmmaker who was formerly on the faculty of University of California, San Francisco. As a public-sector psychiatrist, Dr. Mosbacher specialized in the treatment of patients with severe mental illness. She served as San Mateo Countys Medical Director for Mental Health and Senior Psychiatrist at San Franciscos Progress Foundation. The Diane (Dee) Mosbacher and Woman Vision Papers are archived at the Sophia Smith Collection, Smith College. Dr. Mosbachers films are also contained within the Smithsonian National Museum of American History collection.
Nanette Gartrell, MD, is a psychiatrist, researcher, and writer who was formerly on the faculties of Harvard Medical School and University of California, San Francisco. Her 47 years of scientific investigations have focused primarily on sexual minority parent families. In the 1980s and 90s, Dr. Gartrell was the principal investigator of groundbreaking investigations into sexual misconduct by physicians that led to a clean-up of professional ethics codes and the criminalization of boundary violations. The Nanette K. Gartrell Papers are archived at the Sophia Smith Collection, Smith College.
Drs. Gartrell and Mosbacher are authors of the chapter: Hes Got the World in His Hands and His Finger on the Trigger: The Twenty- Fifth Amendment Solution, in The Dangerous Case of Donald Trump.
More:
What Mental Health Experts Can Say About The Presidency - HuffPost
- Fifth Amendment - The Text, Origins, and Meaning of the ... - April 26th, 2014 [April 26th, 2014]
- 5th Amendment - Revolutionary War and Beyond - April 26th, 2014 [April 26th, 2014]
- Fifth Amendment to the United States Constitution ... - April 26th, 2014 [April 26th, 2014]
- Justices suggest public employees' testimony is protected - April 29th, 2014 [April 29th, 2014]
- HST 330 fifth amendment presentation - Video - May 1st, 2014 [May 1st, 2014]
- Police not sure if Sioux City murder suspect invoked 5th Amendment rights - May 3rd, 2014 [May 3rd, 2014]
- Christie Ally Samson Refuses to Give Documents to Lawmakers - May 4th, 2014 [May 4th, 2014]
- House votes to hold ex-IRS official in contempt - May 8th, 2014 [May 8th, 2014]
- House votes to hold ex-IRS official Lois Lerner in contempt of Congress - May 8th, 2014 [May 8th, 2014]
- House holds Lois Lerner in contempt - May 8th, 2014 [May 8th, 2014]
- House votes to hold former IRS official in contempt - May 8th, 2014 [May 8th, 2014]
- Articles about Fifth Amendment - Los Angeles Times - May 9th, 2014 [May 9th, 2014]
- Former PA Chairman Samson Pleads Fifth - Video - May 9th, 2014 [May 9th, 2014]
- GOP-led House votes to hold former IRS official in contempt - May 12th, 2014 [May 12th, 2014]
- No plans to arrest Lois Lerner, John Boehner says - May 13th, 2014 [May 13th, 2014]
- Im not going to testify: Witness pleads Fifth Amendment during Bangor triple murder trial - May 13th, 2014 [May 13th, 2014]
- Attorney: Defense told Corso will take Fifth - May 16th, 2014 [May 16th, 2014]
- Spokane County workers use Fifth Amendment in back-dating case - Thu, 22 May 2014 PST - May 22nd, 2014 [May 22nd, 2014]
- Shawn Vestal: County permit clerical mishap raises eyebrows - Fri, 23 May 2014 PST - May 23rd, 2014 [May 23rd, 2014]
- Sexual abuse measure could lead to wrongful convictions, attorneys say - August 31st, 2014 [August 31st, 2014]
- 5th Amendment - Laws.com - August 31st, 2014 [August 31st, 2014]
- Wildstein takes the 5th - Video - August 31st, 2014 [August 31st, 2014]
- Fifth Amendment (United States Constitution ... - September 2nd, 2014 [September 2nd, 2014]
- New bill a powerful tool to imprison sex offenders - September 3rd, 2014 [September 3rd, 2014]
- Cristin Milioti in The Good Wife - Julianna Margulies - Video - September 4th, 2014 [September 4th, 2014]
- Kansas Supreme Court: Grand jury violated man's Fifth Amendment rights - September 6th, 2014 [September 6th, 2014]
- Attorney Gwendolyn Solomon Petitions United States Supreme Court to Review Tenth Circuits Decision in Case of the IRP6 - September 9th, 2014 [September 9th, 2014]
- Texas man's conviction overturned because of Fifth Amendment violation - September 10th, 2014 [September 10th, 2014]
- Cop Says 'You Must Be Doing Something Wrong if You Invoke Your Rights' (Video) - September 12th, 2014 [September 12th, 2014]
- Public be damned Litchfield latest example - September 14th, 2014 [September 14th, 2014]
- Volokh Conspiracy: What the posse comitatus case might mean for the future of the exclusionary rule - September 15th, 2014 [September 15th, 2014]
- Fifth Amendment - Video - September 15th, 2014 [September 15th, 2014]
- Top 5 Constitution-Related Searches at FindLaw.com - September 19th, 2014 [September 19th, 2014]
- The Fifth Amendment Eminent Domain - Video - September 19th, 2014 [September 19th, 2014]
- Apple And Google Will Force A Legal Battle Over The Privacy Of Your Passcode - September 20th, 2014 [September 20th, 2014]
- Civics- The Fifth Amendment (Sarah Hutchinson) - Video - September 20th, 2014 [September 20th, 2014]
- Google and Apple Wont Unlock Your Phone, But a Court Can Make You Do It - September 22nd, 2014 [September 22nd, 2014]
- GOP fumes over Lerner remarks - September 23rd, 2014 [September 23rd, 2014]
- Assistant to DeKalb CEO Ellis invokes 5th Amendment 30 times - September 23rd, 2014 [September 23rd, 2014]
- GOP fumes as Lois Lerner talks to press but snubs Congress - September 24th, 2014 [September 24th, 2014]
- Cry us a river, Lois Lerner - September 24th, 2014 [September 24th, 2014]
- Can You Go to Jail for Refusing to Testify? - September 25th, 2014 [September 25th, 2014]
- Fifth Amendment Projectb - Video - September 25th, 2014 [September 25th, 2014]
- The Commander Cody Band - Take The Fifth Amendment - 8/5/1977 - Convention Hall (Official) - Video - September 27th, 2014 [September 27th, 2014]
- Joey Gallo Takes The Fifth Amendment - Video - September 29th, 2014 [September 29th, 2014]
- Batavia High School teacher John Dryden retires from school district - October 3rd, 2014 [October 3rd, 2014]
- Batavia High School teacher John Dryden retires - October 4th, 2014 [October 4th, 2014]
- The Fifth Amendment Please Don't Leave Me Now - Video - October 6th, 2014 [October 6th, 2014]
- Man Denied Fifth Amendment While In Court Wearing Anti-Police Shirt, Still Won His Case (Video) - October 7th, 2014 [October 7th, 2014]
- Batavia teacher previously involved in Fifth Amendment dispute retires - October 7th, 2014 [October 7th, 2014]
- INFORMUCATE: THE FIFTH AMENDMENT - Video - October 8th, 2014 [October 8th, 2014]
- Fairholme Funds Appeals Fannie Mae and Freddie Mac Verdict - October 10th, 2014 [October 10th, 2014]
- Fresno Police Officer violated fifth amendment at a dui checkpoint. - Video - October 10th, 2014 [October 10th, 2014]
- Code cases: Police want phone access, but some pass - October 12th, 2014 [October 12th, 2014]
- Fresno Police Officer violated fifth amendment at a dui checkpoint. part 2 - Video - October 12th, 2014 [October 12th, 2014]
- Property Rights | Century Law Group - Video - October 20th, 2014 [October 20th, 2014]
- Agents questioned, Askar takes the Fifth in Trombetta hearing - October 21st, 2014 [October 21st, 2014]
- Scott and Crist have heated and personal final debate before November election - October 22nd, 2014 [October 22nd, 2014]
- Detective dodges questions about allegations made during rape investigation - October 25th, 2014 [October 25th, 2014]
- Disciplinary hearing for SB officer moved to later date - Video - October 27th, 2014 [October 27th, 2014]
- Judge Rules Suspect Can Be Required To Unlock Phone With Fingerprint - October 31st, 2014 [October 31st, 2014]
- Virginia judge: Police can demand a suspect unlock a phone with a fingerprint - October 31st, 2014 [October 31st, 2014]
- Court rules: Touch ID is not protected by the Fifth Amendment but Passcodes are - October 31st, 2014 [October 31st, 2014]
- Virginia Court: LEOs Can Force You To Provide Fingerprint To Unlock Your Phone - November 1st, 2014 [November 1st, 2014]
- Civil Rights and Civil Liberties - Fifth Amendment - Shh! The Right to Remain Silent - Video - November 1st, 2014 [November 1st, 2014]
- Your Fingerprints Belong To Us: Iphone Users Forfeit 5th Amendment - Video - November 2nd, 2014 [November 2nd, 2014]
- All Your Fingerprints Are Belong To Us: iPhone Users Forfeit Fifth Amendment - Video - November 2nd, 2014 [November 2nd, 2014]
- Log into Tax-News+ - November 4th, 2014 [November 4th, 2014]
- Editorial: Applying the Fifth Amendment in the era of smartphones - November 4th, 2014 [November 4th, 2014]
- Volokh Conspiracy: Virginia state trial court ruling on the Fifth Amendment and smart phones - November 4th, 2014 [November 4th, 2014]
- Fingerprints: iPhone Users Forfeit Fifth Amendment. - Video - November 4th, 2014 [November 4th, 2014]
- New ruling may affect police access to smartphones - Video - November 6th, 2014 [November 6th, 2014]
- Why the Constitution Can Protect Passwords But Not Fingerprint Scans - November 7th, 2014 [November 7th, 2014]
- Virginia state trial court ruling on the Fifth Amendment ... - November 7th, 2014 [November 7th, 2014]
- Is taking the fifth amendment a bad idea? - Video - November 7th, 2014 [November 7th, 2014]
- IT Security TV Show 4 November 2014 - iPhone Users Forfeit Fifth Amendment - Video - November 7th, 2014 [November 7th, 2014]
- the fifth amendment happy parody project song for connections - Video - November 8th, 2014 [November 8th, 2014]
- 13-year-olds murder conviction overturned - November 11th, 2014 [November 11th, 2014]
- Your Fifth Amendment Rights DO NOT Cover Biometrics - Video - November 11th, 2014 [November 11th, 2014]
- Philadelphia charter school officials pleaded Fifth 77 times - November 12th, 2014 [November 12th, 2014]