Undeniably, the name calling was a newsworthy snapshot, a “gotcha,” moment, but it came at a most unfortunate time, perhaps intentionally by whoever leaked it, since the report appeared in the midst of two searing tragedies; the Vegas shooting of more than 500 country music lovers; and, Hurricane Maria’s savaging of Puerto Rico. Also, detrimental, from an optics perspective, it came at virtually the same time as publication of a new book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President,” by Brandy X. Lee,” (ISBN: 9781250179463.) Amazon claims it’s “the #1 bestseller in the United States Executive Government.”  Duh!

If you don’t want to pay $16.79 for your very own copy, or can’t expense it, the book’s description on Amazon’s site says it all:  “The consensus view of two dozen psychiatrists and psychologists [is] that Trump is dangerously mentally ill and that he presents a clear and present danger to the nation and our own mental health.”  Gratuitously, Amazon adds, “This is not normal.” In more ways than one, it’s most abnormal, and we’re not talking about Trump.

Is Trump, Goldwater comparison sensible or moronic? Tell us below

Breaking with the Goldwater rule, that psychiatrists not opine, clinically, about persons they haven’t examined, or treated, the authors assert a quasi-Tarasoff privilege to talk about the President, someone they’ve, likely, observed, closest, on T.V.  (See: Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14). The rule was named for Barry Goldwater, Jr., 1964 Republican presidential opponent of Lyndon B. Johnson who, successfully, portrayed Goldwater as a war mad, A-bomb-loving crazy.

Responding to a pre-election survey about Goldwater’s mental fitness for office, many psychiatrists reported that they saw Goldwater as normal, while others took the bait and labeled him: “paranoid,” "schizophrenic," "obsessive," "psychotic," and "narcissistic," according to an analysis of the rule’s origins in Psychology Today. (See: https://www.psychologytoday.com/blog/the-personality-analyst/201005/the-goldwater-rule.) The survey was first published in the election issue of the incongruously named Fact.

Following the ethical lapses of the looking-glass diagnoses of Goldwater, who wasn’t insane at all, the American Psychiatric Association imposed a ban on specific diagnoses of unexamined individuals. (The dead are exempted, for obvious reasons.) Consider, too, that psychosis, and other mental illnesses, can arise from underlying medical conditions; for example, arterial sclerosis, that require a secondary medical diagnosis, without which the first diagnosis is incomplete, and clinically inadequate, leading, potentially, to applications of non-salutary treatment(s).

Tarasoff held that a psychiatrist’s duty to warn others of imminent danger of grievous bodily harm, or death, from a patient, overcomes the otherwise, nearly, unbreakable privilege of psychiatrist-patient communications. Notwithstanding the inapplicability of Tarasoff, Trump’s inability to defend himself without submitting himself to a mental status examination, one that no one is required to undergo involuntarily, unless on a psychiatric hold, or by court order during pending legal proceedings, opens the door to many abuses.

There’s no good reason to change the Goldwater rule, now, just because Trump presents as different. Doing so hurts consumers of mental health services, and the profession, more than it does the President; and that’s sad, maybe even moronic.