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• The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President Thomas Dunne Books (New York, NY), 2017

1. The dangerous case of Donald Trump : 27 psychiatrists and mental health experts assess a president LCCN 2017028497 Type of material Book Main title The dangerous case of Donald Trump : 27 psychiatrists and mental health experts assess a president / edited by Bandy X. Lee, M.D., M.Div. Edition First edition. Published/Produced New York : Thomas Dunne Books, St. Martin's Press, 2017. Description xix, 360 pages ; 24 cm ISBN 9781250179456 (hardcover) CALL NUMBER E913.3 .D36 2017 CABIN BRANCH Copy 1 Request in Jefferson or Adams Building Reading Rooms - STORED OFFSITE

• Yale - https://medicine.yale.edu/psychiatry/people/bandy_lee.profile

  Bandy X. Lee, MD, MDiv
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  BIOGRAPHY
  Dr. Bandy Lee is an internationally recognized expert on violence. Trained in medicine and psychiatry at Yale and Harvard Universities, and in medical anthropology as a fellow of the National Institute of Mental Health, she is currently on the faculty of Yale School of Medicine’s Law and Psychiatry Division. She served as Director of Research for the Center for the Study of Violence (Harvard, U. Penn., N.Y.U., and Yale), co-founded Yale’s Violence and Health Study Group (MacMillan Center for International Studies), and leads a project group for the World Health Organization’s Violence Prevention Alliance. She has consulted with the governments of Ireland and France, as well as California, Connecticut, Massachusetts, and New York on violence prevention programming in prisons and in the community. She played a key role in initiating reforms at Rikers Island, New York City’s correctional facility known for extreme levels of violence. She has been teaching students studying to be public defenders and to become asylum attorneys at Yale Law School since 2003, and a Global Health Studies course of her design, “Violence: Causes and Cures,” since 2013. She has served as consultant to the World Health Organization Violence and Injury Prevention department, UNESCO, and other United Nations bodies, and as speaker to the World Economic Forum. Her interests are in global health approaches to violence prevention and multisectoral collaboration.

  EDUCATION & TRAINING
  MDiv Yale Divinity School (1995)
  MD Yale University School of Medicine (1994)
  Intern Bellevue Hospital Center
  Resident Massachusetts General Hospital
  Chief Resident Massachusetts General Hospital
  Research Fellow Harvard Medical School

  RESEARCH INTERESTS
  Criminal Psychology; Humanities; International Agencies; Public Health; Social Justice; Violence; Global Health; Legal Cases; Psychiatry and Psychology; Phenomena and Processes; Anthropology, Education, Sociology and Social Phenomena

  RESEARCH SUMMARY
  Formulating the multiple, interlinked determinants of violence, by exploring the interaction between biological, psychological, social, and environmental processes for effective prevention.

  Specialized Terms: Violence Prevention, Public Health Approaches, Interdisciplinary and Multisectorial Collaborations, Behavioral Violence, Structural Violence, Social Justice, Global Health, Peace Promotion, and Creative Studies.

  SELECTED PUBLICATIONS
  Kaaya SF, Lee B, Smith-Fawzi MC, Mbwambo JK, Msamanga GI. Validity and calibration of the Kiswahili version of the Hopkins Symptom Checklist–25 amongst HIV-positive antenatal clinic attendees in Dar es Salaam, Tanzania. Acta Psychiatrica Scandinavica 106:9-19, 2002.
  Lee B, Gilligan J. The pharmacological treatment of violent youth. Annals of the New York Academy of Sciences 1036:356-381, 2004.
  Gilligan J, Lee B. Beyond the prison paradigm: From provoking violence to preventing it by creating ‘anti-prisons’ (residential colleges and therapeutic communities). Annals of the New York Academy of Sciences 1036:300-324, 2004.
  Lee B, Gilligan J. The Resolve to Stop the Violence Project: Transforming an in-house culture of violence through a jail-based programme. Journal of Public Health 27:149-155, 2005.
  Gilligan J, Lee B. The Resolve to Stop the Violence Project: Reducing violent recidivism in the community through a jail-based initiative. Journal of Public Health 27:143-148, 2005.
  Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting depressive disorder with the Hopkins Symptom Checklist–25 in Tanzania. International Journal of Social Psychiatry 54:7-20, 2008.
  Kaaya SF, Lee B, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting depressive disorder with a 19-item local instrument in Tanzania. International Journal of Social Psychiatry 54:21-33, 2008.
  Lee B, Young JL. Building a global health ethic without doing further violence. American Journal of Bioethics 12:59-60, 2012.
  Lee B, Leckman JF, Mbwambo JKK. Violence and health: Current perspectives of the WHO Violence Prevention Alliance. Aggression and Violent Behavior 19:609-615, 2014.
  Lee B, Wexler BE, Gilligan J. Political correlates of violent death rates in the U.S., 1900-2010: Longitudinal and cross-sectional analyses. Aggression and Violent Behavior 19:721-728, 2014.
  Lee B, Marotta PL, Blay-Tofey M, Wang W, de Bourmont S. Economic correlates of violent death rates in forty countries, 1962-2008: A cross-typological analysis. Aggression and Violent Behavior 19:729-737, 2014.
  Lee B., Prabhu M. A reflection on the madness in prisons. Stanford Law and Policy Review 26: 253-268, 2015.
  Lee B, Leckman JF, Khoshnood K. Violence, health, and South-North collaborations: Furthering an interdisciplinary agenda. Social Science and Medicine 146:236-242, 2015.
  Blay-Tofey M., Lee B. Preventing gender-based violence engendered by conflict: The case of Côte d’Ivoire. Social Science and Medicine, 146:341-347, 2015.
  Bouloudnine R, Lee B, Rowe M. In the midst of a mental healthcare crisis: How psychiatrists can better advocate for their clients. Journal of Health Systems and Policy Research 2:15-20, 2015.
  Lee B, Donnelly PD, Cohen L, Garg S. Violence, health, and the 2030 Agenda: Merging evidence and implementation. Journal of Public Health Policy 37S:1-12, 2016.
  Lee B, Gilligan J, Kaaya SF, Schuder KK. Violence and health: Implications of the 2030 Agenda for South-North collaborations. International Journal of Public Health 61:861-862, 2016.
  Lee B, Kjaerulf F, Turner S, Cohen L, Donnelly PD, Muggah R, Davis‎‎ R, Realini A, Kieselbach B, Snyder MacGregor L, Waller I, Gordon R, Moloney-Kitts M, Lee G, Gilligan J. Transforming our world: Implementing the 2030 Agenda through Sustainable Development Goal Indicators. Journal of Public Health Policy 37S:13-31, 2016.
  Kjaerulf F, Lee B, Cohen L, Donnelly P, Turner S, Davies R, Realini A, Moloney-Kitts M, Gordon R, Lee G, Gilligan J. The 2030 Agenda for Sustainable Development—A golden opportunity for global violence prevention. International Journal of Public Health 61:863-864, 2016.
  Gilligan J, Lee B, Garg S, Blay-Tofey M, and Luo A. A case for studying country regimes in the public health model of violence. Journal of Public Health Policy 37S:133-144, 2016.
  Uwizeye G, Lee B, Krill T. Health system re-design following sexual violence during the genocide in Rwanda. International Journal of Public Health 61:959-960, 2016.
  Mikton CR, Tanaka M, Tomlinson M, Streiner DL, Tonmyr L, Lee B, Fisher J, Hegadoren J, Pim JE, Wang SJS, MacMillan HL. Global research priorities for interpersonal violence prevention: A modified Delphi study. Bulletin of the World Health Organization 95:36-48, 2017.
  Khoshnood K, Lee B, Marin C. Health effects of war on civilians. In Wiist WH, White SK (eds.), Preventing War and Promoting Peace: A Guide for Health Professionals. Cambridge, U.K.: Cambridge University Press, 2017.
  Lee B, Lee G. Violence and health. In Callan H (ed.), International Encyclopedia of Anthropology. New York: John Wiley & Sons, 2018.
  Lee B, Young JL. Clinicians’ need for an ecological approach to violence reduction. AMA Journal of Ethics 20:472-479, 2018.
  Adlam J, Kluttig T, Lee B (eds.). Violent States and Creative States: From the Global to the Individual. Vol. 1: Structural Violence and Creative Structures. London: Jessica Kingsley, 2018.
  Lee B, Kluttig T, Adlam J (eds.). Violent States and Creative States: From the Global to the Individual. Vol. 2: Human Violence and Creative Humanity. London: Jessica Kingsley, 2018.
  Lee B. Violence: An Interdisciplinary Approach to Causes, Consequences, and Cures. New York: Wiley-Blackwell, 2019.

  CLINICAL INTERESTS
  Adult
  Dangerous Behavior
  Mental Health
  Prisoners
  Refugees
  Safety
  Global Health
  Substance-Related Disorders
  Harm Reduction
  Interdisciplinary Studies
  Anthropology, Medical
  PATIENT CARE
  Accepts new patients? No
  Referrals: Not Applicable

Donald Trump Is Dangerous, Psychiatrists Must Speak Out
Judith Herman and Bandy Lee
The Report, from U.S. News & World Report. (Jan. 25, 2018):
Copyright: COPYRIGHT 2018 U.S. News and World Report, L.P.
http://www.usnews.com/news/the-report
Full Text:
Psychiatrists have a moral obligation to speak out about President Donald Trump's dangerous behavior.

By Judith Herman, Bandy Lee

It doesn't take a psychiatrist to notice that our president is mentally compromised. Nevertheless, by speaking out, we lend support and dignity to our fellow citizens who are justifiably alarmed by the president's furious tirades, conspiracy fantasies, aversion to facts and attraction to violence. We can lend a hand in helping the public to understand behaviors that are unusual and alarming, but which can all too easily be rationalized and normalized. Currently, the president's apologists are attempting to assuage the public's concerns by reporting that he passed a simple screening test for dementia during his physical exam. But unless we wish to set the bar exceedingly low, the fact that he is able to draw a clock or identify a picture of a lion does not establish his mental fitness for office.

OPINION: [(https://www.usnews.com/opinion/op-ed/articles/2018-01-11/politicizing-donald-trumps-mental-health-is-dangerous) Politicizing Donald Trump's Mental Health Is Dangerous]

Soon after the presidential election of 2016, alarmed by the apparent mental instability of the president-elect, we both separately circulated letters expressing our concern among some of our professional colleagues. Most declined to sign. A number of people admitted they were afraid of some undefined form of retaliation -- so quickly had a climate of fear taken hold. Others cited matters of principle. Psychiatry, we were warned, should stay out of politics; otherwise, the profession could end up being ethically compromised. The example most frequently cited was that of psychiatrists in the Soviet Union who collaborated with the secret police to diagnose dissidents as mentally ill.

This was a serious consideration. Indeed, we need not look beyond our own borders for examples of ethics violations committed by professionals who became entangled in politics. We have recently witnessed the disgrace of an entire professional organization, the American Psychological Association, whose leadership, in collusion with governmental officials, rewrote its ethical guidelines to give cover to a secret government interrogation program and to excuse military psychologists who designed and implemented methods of torture. The association's membership did not approve this change and tried to reverse it, but they were unsuccessful until the matter became a public scandal.

By contrast, the American Psychiatric Association took a strong and principled stand against any form of participation in interrogation or torture. Thus, our own recent history illustrates how important it is for leaders in the professions to stand firm against ethical violations, and to resist succumbing to the argument that exceptional political circumstances, such as "the war on terror," demand exceptions to basic ethical codes.

SEE: [(https://www.usnews.com/opinion/cartoons/2017/02/01/cartoons-on-president-donald-trump) Cartoons on President Donald Trump]

If we are mindful of the dangers of politicizing the professions, then certainly we must heed the so-called "Goldwater rule," or Section 7.3 of the American Psychiatric Association code of ethics, which states: "it is unethical for a psychiatrist to offer a professional opinion [on a public figure] unless he or she has conducted an examination and has been granted proper authorization for such a statement." This "rule" is really nothing more than an affirmation of the ordinary norms of clinical practice. Evaluation of patients requires a full examination. Formulating a credible diagnosis is not possible when applied to public figures at a distance. We have no quarrel with this principle.

However, two months into this new administration, in March 2017, without debate among the membership, the American Psychiatric Association suddenly extended the "Goldwater rule" to prohibit any form of commentary on public figures. This seems highly questionable to us. It appears that our psychiatric association is not immune to the kind of politically pressured acquiescence we have seen in the past with its psychological counterpart. Numerous members have resigned, and the APA has been flooded with letters of protest, and yet rather than respond to its members' request not to modify a rule without consulting them, it has "doubled down" in a recent statement on January 9, 2018. Defenders of this rule of silence have been reduced to unilateral decree and argument by insult, a sure sign that their position is indefensible.

The public trust is violated if the profession fails in its duty to warn when a person who holds the power of life and death over us all shows clear signs of dangerous mental impairment. We should pause if professionals are asked to remain silent when they have seen enough evidence to sound alarm in any other situation. In a democracy, should not the president be subject to the same standards of practice as any other person when it comes to dangerousness? Does he not deserve the same medical standard of care?

There are those who still hold out hope that this president can be "managed" by members of his cabinet. Our professional experience would suggest, rather, that his dangerousness is likely to increase. Assessing dangerousness is different from making a diagnosis. Signs of dangerousness secondary to mental disorder can become apparent without a full diagnostic interview, and can be detected from a distance. The psychiatrist is expected to err, if at all, on the side of safety when the risk of inaction is too great. Only one person need be in danger of harm by the impaired individual, and the threshold for containment is even lower if the individual has access to weapons (not to mention nuclear weapons).

PHOTOS: [(https://www.usnews.com/news/the-report/photos/2017/01/16/photos-the-big-picture-january-2018) The Big Picture -- January 2018]

Physicians are guided by the Declaration of Geneva and the American Medical Association's Principles of Medical Ethics. The former confirms the physician's dedication to the humanitarian goals of medicine, while the latter defines honorable behavior for the physician. The physician's responsibility is first and foremost to the patient, but it extends as well to society. When a person poses a danger because of mental disturbance, psychiatrists are mandated to report, to incapacitate and to take steps to protect the public.

Because we believe that this president is dangerous, we have been speaking out publicly and encouraging our fellow mental health professionals to speak out. How can we be sure that this is morally permissible? We would argue that the key question is whether, as professionals, we are engaging in collusion with state abuses of power, or in resistance to them. If we are asked to cooperate with state programs that violate human rights, then regardless of the purported justification, any involvement can only corrupt, and the only appropriate ethical stance is to refuse participation of any sort. If, on the other hand, we perceive that state power is being abused by an executive who seems to be mentally unstable, then we may certainly speak out, not only as citizens, but also, we would argue, as professionals who have an ethical and moral responsibility to educate the public. Thousands of professionals have already joined us, and we call on our professional organization to reconsider its rule of silence.

Source Citation (MLA 8th Edition)
Herman, Judith, and Bandy Lee. "Donald Trump Is Dangerous, Psychiatrists Must Speak Out." The Report, from U.S. News & World Report, 25 Jan. 2018. General OneFile, http://link.galegroup.com/apps/doc/A525076635/ITOF?u=schlager&sid=ITOF&xid=ebc63d40. Accessed 23 Apr. 2018.

Gale Document Number: GALE|A525076635

The Myth of Donald Trump's Mental Illness: Don't medicalize political judgments
Jacob Sullum
Reason. 50.1 (May 2018): p64+.
Copyright: COPYRIGHT 2018 Reason Foundation
http://reason.com/about
Full Text:
IS THE PRESIDENT of the United States mentally ill, or is he just an asshole? That is the puzzle posed by The Dangerous Case of Donald Trump:27 Psychiatrists and Mental Health Experts Assess a President. The question would have amused Thomas Szasz, the late psychiatric iconoclast whose legacy is considered in a new essay collection edited by Jeffrey Schaler, Henry Zvi Lothane, and Richard Vatz.

Szasz, who died in 2012 at the age of 92, spent his career calling attention to the ways in which "the myth of mental illness" (the title of his best-known book) muddles our thinking about troublesome people and problematic conduct. The sweeping, creeping medicalization of thought and behavior that Szasz decried is epitomized by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which is where "mental health experts" look when trying to diagnose Trump (or anyone else).

The most promising label mentioned by the contributors to The Dangerous Case of Donald Trump, edited by Yale psychiatrist Bandy Lee, is "narcissistic personality disorder." According to the DSM-5, the latest edition of that psychiatric bible, the symptoms of this condition include grandiosity, attention seeking, self-centeredness, "exaggerated self-appraisal," condescension, feelings of entitlement, lack of empathy, and relationships that are "largely superficial and exist to serve self-esteem regulation."

That seems like a pretty accurate summary of the president's personality. But what is gained by calling this collection of traits a "mental disorder" (and implicitly a disease, since psychiatrists are medical doctors)? Diagnosing Trump is a rhetorical trick that allows his opponents to medicalize questions about his competence, temperament, and policies, giving experts like Lee special authority to render political judgments that are supposedly beyond the ken of laymen.

"Possibly the oddest experience in my career as a psychiatrist has been to find that the only people not allowed to speak about an issue are those who know the most about it," Lee writes in the introduction. "How can I, as a medical and mental health researcher, remain a bystander in the face of one of the greatest emergencies of our time, when I have been called to step in everywhere else?"

Lee is alluding to the "Goldwater rule," which bars members of the American Psychiatric Association (APA) from diagnosing at a distance public figures whom they have not personally examined. It is so named because it was created in response to psychiatric critiques of 1964 Republican presidential nominee Barry Goldwater--in particular, a Fact article in which APA members described the candidate as "a dangerous lunatic," a repressed homosexual, a self-hating half-Jew, a paranoid schizophrenic, and "a mass-murderer at heart," just like "Hitler, Castro, Stalin and other known schizophrenic leaders."

Lee says she objects not to the Goldwater rule itself but to an excessively broad interpretation of it that prohibits psychiatrists from bringing their expertise to bear on an orange-haired menace who poses an existential threat to humanity. The truth that she and her colleagues are capable of revealing, she says, "could be the key to future human survival."

And time is running out. "As more time passes," Lee told Newsweek in January, "we come closer to the greatest risk of danger, one that could even mean the extinction of the human species. This is not hyperbole. This is the reality." Furthermore, she told The New York Times, people are clamoring to hear what she and her colleagues have to say. "The level of concern by the public is now enormous," she said. "They're telling us to speak more loudly and clearly and not to stop until something is done, because they are terrified."

Other contributors to Lee's book are equally breathless. They say Trump is "the most dangerous man in the world," an extreme sociopath whose presidency will "most likely be catastrophic," "a profoundly evil man exhibiting malignant narcissism," and "an American Hitler" with "the power to reduce the unprecedentedly destructive world wars and genocides of the twentieth century to minor footnotes in the history of human violence."

If you are not a fan of Trump but doubt that he is on the verge of killing us all, or if you view his antics as more funny than terrifying, Lee and her allies have a ready response: Where is your medical degree? Where did you acquire the mental health expertise that is necessary to read the president's mind and see the deadly danger lurking there?

Szasz's response to this sort of wild speculation and grandiose pretension was notably different from the APA's. That organization saw its members slapping psychiatric labels on a politician they'd never met and said, essentially, "Cut it out. You are making us look bad." According to the Goldwater rule, "it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement."

Szasz showed that the unethical conduct the APA condemned, which gave value judgments a pseudoscientific veneer, was fundamentally similar to the professional practices the APA endorsed. Psychiatric diagnoses, which equate things people say and do with diseases, are inherently subjective, cannot be verified by biological tests, and tell us nothing about etiology. Even if a psychiatrist talked to Trump at length and had him complete a battery of questionnaires before concluding that he suffers from narcissistic personality disorder, the diagnosis would not tell us anything important that we don't already know.

Richard Vatz, co-editor of Thomas S. Szasz: The Man and His Ideas, sees little evidence that Americans have taken to heart the renegade psychiatrist's point that mental illness is a metaphor and should not be taken literally. He notes that politicians and pundits still routinely cite mental illness as an explanation for outrageous acts of violence, even though it explains nothing, and describe drug addiction as a disease, which they take to be the enlightened and scientific view.

"The rhetorical refuge of attributing unusually horrible acts or simply unusual actions to mental illness has not noticeably abated since Szasz first questioned the existence of 'mental illness' over a half century ago," writes Vatz, a professor of political rhetoric and communication at Towson University. "The responsibility-denying rhetoric of mental illness, steeped in mystification and self-serving explanations of the difficult-to-explain, will perhaps forever successfully endure."

Such rhetoric is appealing because it is useful, even when it makes little sense. Consider civil commitment of sex offenders, which is authorized by about 20 states and the federal government. Under these laws, sex offenders who have completed their prison sentences can be confined indefinitely in "treatment centers." The Supreme Court approved that policy based on the premise that certain sex offenders suffer from "a volitional impairment rendering them dangerous beyond their control."

The theory is puzzling on its face, since these very same offenders were punished with prison terms based on the assumption that they could and should have controlled themselves. Stranger still, the mental illness that supposedly impairs their volition is defined by legislators rather than psychiatrists, and in some states it seems to be incurable, since the prisonerscum-patients are almost never deemed well enough to be released. Supporters of civil commitment for sex offenders are untroubled by these contradictions, because the rhetoric of mental illness facilitates preventive detention of people they fear and detest.

The insanity defense, by contrast, offends most people because they don't like the results. Three-quarters of Americans thought justice was not served by the 1982 acquittal of would-be presidential assassin John Hinckley, according to an ABC News poll conducted at the time. The case, which Vatz mentions and Szasz frequently discussed, inspired legislation that made it substantially harder to successfully mount an insanity defense in federal court.

Hinckley, who received a primary diagnosis of schizotypal personality disorder in 1982, ended up spending more than three decades in a mental hospital. The judge who ordered his release in 2016 said his mental illnesses "have been in full and sustained remission for well over 20 years, perhaps more than 27 years," which suggests that punitive considerations (or fear of a public backlash) unofficially played a role in his continued confinement.

Vatz also points to criticism of the DSM's ever-expanding scope, which already encompasses something like half the population and may one day cover us all. He notes that "Szasz used to write particularly derisively of those who would argue only that mental illness was overdiagnosed: that mental illness was a major problem, just not as widespread as most people thought." Yet even that relatively mild critique of psychiatry has radical implications: If mental illness is not whatever psychiatrists say it is, what exactly is it?

Psychiatry's diagnostic difficulties are in fact fundamental, as recognized by no less an authority than Allen Frances, who chaired the committee that edited the fourth edition of the DSM. "Psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests," Frances noted in a 2013 Annals of Internal Medicine article. "Psychiatric diagnosis is facing a renewed crisis of confidence caused by diagnostic inflation. The boundaries of psychiatry are easily expanded because no bright line separates patients who are simply worried from those with mild mental disorders." Or as Frances put it more pithily in a 2011 interview with the psychotherapist Gary Greenberg, "There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it."

That is not a minor problem that can be tweaked by another revision of the DSM. "I agree completely with Schaler and Szasz that mental disorders are not diseases and that treating them as such can sometimes have noxious legal consequences," Frances wrote in a 2012 Cato Unbound debate that also featured Vatz's co-editor Jeffrey Schaler. "Mental disorders are constructs, nothing more but also nothing less." Frances thinks some of these constructs reflect impairments of rationality and self-control that may justify coercive intervention. "Schizophrenia is certainly not a disease," he wrote, "but equally it is not a myth."

The DSM-5 describes schizophrenia as "a severe and chronic mental disorder characterized by disturbances in thought, perception and behavior." The symptoms may include delusions, hallucinations, disorganized speech, flat affect, and "grossly disorganized or catatonic behavior." But what psychiatrists call schizophrenia, which is said to affect about 1 percent of the population, may "turn out to be many different things," as Trinity College Dublin psychologist Simon McCarthy-Jones recently observed in The Conversation, an online forum for academics and scientists.

Some of those things may involve measurable neurological defects. "It is important to remember," Vatz writes, "that a small percentage of people labeled (diagnosed) as schizophrenic... are brain diseased and cognitively incompetent. These people generally show signs of disease during an autopsy."

The possibility that some people who receive a diagnosis of schizophrenia have brain diseases--a point that Szasz conceded--does not mean that schizophrenia is a brain disease, let alone that all the other mental illnesses cataloged by the DSM are. To the contrary, a condition ceases to be a mental illness once an underlying biological cause for it can be identified. That is what happened with "general paresis of the insane," which moved from the province of psychiatrists to that of neurologists after it was understood to be a consequence of brain damage caused by syphilis. Neurological conditions such as multiple sclerosis, Alzheimer's disease, and Parkinson's disease likewise are not considered mental illnesses.

Still, if some people diagnosed with schizophrenia have brain diseases that make them "cognitively incompetent," that disability might justify a legal process that allows others to make decisions on their behalf, just as it might in the case of someone with Alzheimer's. A verifiable brain disease certainly seems like a firmer basis for limiting someone's freedom than speculation about a mental disorder that may or may not have a neurological component.

The libertarian writer David Ramsay Steele, who also contributed an essay to Thomas S. Szasz: The Man and His Ideas, agrees with Szasz that there is no such thing as mental illness if the phrase is taken literally. But he argues that "today the most popular unpacking of 'mental illness' by far is 'unidentified brain illness with mental symptoms,' and there is nothing incoherent about that." Steele challenges the close connection that Szasz drew between a belief in the reality of mental illness and the justification for psychiatric coercion. He notes that people with bona fide brain diseases are not typically treated against their will and that people with psychiatric diagnoses, including schizophrenia, are capable of making rational choices and do not necessarily pose a danger to others. To justify coercion, in other words, something more than a diagnosis is needed, whether the condition is a scientifically validated neurological disease or a mental disorder said to be caused by a "chemical imbalance" no one has managed to measure.

Likewise with judgments about Donald Trump's fitness for office. "The issue we are raising is not whether Trump is mentally ill," New York University psychiatrist James Gilligan writes in Lee's collection. "It is whether he is dangerous. Dangerousness is not a psychiatric diagnosis." The president could be mentally ill but not dangerous, Gilligan says, and he could be dangerous but not mentally ill.

Allen Frances draws a similar distinction. Trump "is definitely unstable," he told The New York Times in January, right after the president declared himself "a very stable genius" on Twitter. "He is definitely impulsive. He is world-class narcissistic not just for our day but for the ages. You can't say enough about how incompetent and unqualified he is to be leader of the free world. But that does not make him mentally ill."

Gilligan and Frances may be right or they may be wrong, but the fact that they have medical degrees does not make them especially credible, because these are not medical conclusions. They are political conclusions.

Voters knew what they were getting with this president, and almost half of them decided to give hima shot anyway. Trump provides daily ammunition to those who think that was a mistake. But if they want to persuade others, they will have to put down the DSM and pick up a newspaper.

JACOB SULLUM

JACOB SULLUM is a senior editor at Reason and a nationally syndicated columnist.

The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, edited by Bandy Lee, St. Martin's Press, 360 pages, $27.99

Thomas S. Szasz: The Man and His Ideas, edited by Jeffrey A. Schaler, Henry Zvi Lothane, and Richard E. Vatz, Routledge, 215 pages, $52

Source Citation (MLA 8th Edition)
Sullum, Jacob. "The Myth of Donald Trump's Mental Illness: Don't medicalize political judgments." Reason, May 2018, p. 64+. General OneFile, http://link.galegroup.com/apps/doc/A534376611/ITOF?u=schlager&sid=ITOF&xid=2f2a1937. Accessed 23 Apr. 2018.

Gale Document Number: GALE|A534376611
Lee, Bandy X.: THE DANGEROUS CASE OF DONALD TRUMP
Kirkus Reviews. (Sept. 15, 2017):
Copyright: COPYRIGHT 2017 Kirkus Media LLC
http://www.kirkusreviews.com/
Full Text:
Lee, Bandy X. THE DANGEROUS CASE OF DONALD TRUMP Dunne/St. Martin's (Adult Nonfiction) $27.99 10, 3 ISBN: 978-1-250-17945-6

Mental health professionals and others make the case that Donald Trump is mentally ill, dangerous, or both.Editor Lee (Law and Psychiatry/Yale School of Medicine) asked for and received submissions for this book within a three-week period, and several of them show signs of being written in haste. Many of the contributors are psychologists or psychiatrists in private practice; others include journalist Gail Sheehy, Tony Schwartz, the co-author of Trump's The Art of the Deal, and attorney and "political junkie" James A. Herb, who filed a petition in the Palm Beach County Circuit Court to determine Trump's mental incapacity in October 2016, "based on the fact that Trump's apparent lack of mental capacity to function could impact me and possibly the whole world." The volume makes no attempt to avoid bias; it's aimed strictly at demonstrating that Trump shouldn't be in office (admittedly a view held by tens of millions of other Americans) and that a panel of mental health professionals should be established to determine his lack of fitness. At the heart of many of the essays is the increasingly controversial 1973 "Goldwater rule" implemented by the American Psychiatric Association, which states that psychiatrists shouldn't diagnose public figures without personally examining them. Also frequently cited is the Tarasoff decision made by California in 1976, which states that psychiatrists should speak out when they know that "an individual is dangerous to another person or persons." Some of the essays border on self-parody: one author argues seriously that "post-Trump stress disorder" ought to be considered "as serious as PTSD." Read collectively, the essays become repetitious: the contributors lean on the same definitions of narcissism and paranoia and cite the same tweets and passages from speeches, most of which will already be familiar to readers. As with most anti-Trump books, this one will shore up the opinions of those already convinced of his lack of fitness for the job but won't change the minds of his supporters, the vast majority of whom won't read it.

Source Citation (MLA 8th Edition)
"Lee, Bandy X.: THE DANGEROUS CASE OF DONALD TRUMP." Kirkus Reviews, 15 Sept. 2017. General OneFile, http://link.galegroup.com/apps/doc/A504217688/ITOF?u=schlager&sid=ITOF&xid=7e2c454e. Accessed 23 Apr. 2018.

Gale Document Number: GALE|A504217688

Related Resources
'You Can't Separate Trump's Mental Health From His Voters': Q&A With Mental Health Expert Dr. Bandy Lee
Albawaba.com. (Feb. 4, 2018): News:
Copyright: COPYRIGHT 2018 SyndiGate Media Inc.
http://www.albawaba.com/
Full Text:
Donald Trump's mental health is commonly deemed dangerous

But in voting for him, the U.S. may have a larger problem

Dr. Lee clams Trump's health reflects a larger instabiltiy within the American people

There may be a dangerous 'symbiosis' between Trump and his base

By Ty Joplin

It is common to think U.S. President Donald Trump's mental health is in shambles. The most fringe sects of society concoct theories about Trump's mental deterioration, drawing evidence from the explosive book "Fire and Fury: Inside the Trump White House" that details Trump forgetting his friends' names and faces. The theory goes that Trump is senile and is breaking down in front of the American people.

Most others think Trump is just an unhinged person both mentally and morally--calling Mexicans rapists, bragging about sexual assault, and threatening nuclear war with North Korea via Twitter rant. The New York Times' recent op-ed sums it up well, asking: "Is Trump Crazy Like a Fox or Plain Old Crazy?" No matter the answer, many aren't losing sleep over the fact that their president doesn't follow standard 'presidential' protocol of being diplomatic or level-headed.

However to some, Trump's state of mind is a burgeoning state of emergency. Mental Health experts have been sounding alarms regarding his mental health, and one expert in particular has become the face of this movement. Dr. Bandy Lee is an assistant professor at the Yale University School of Medicine. She edited a book questioning Trump's health, "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President."

However, there is a massive part of the story missing: what fuels Trump's rash behavior? This is less tangible, but potentially much more dangerous.

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Dr. Bandy Lee

If Trump as U.S. President is a reflection of American political consciousness, does calling his reported lack of empathy/turns to aggression/lack of central planning also reflect these same characteristics on the american people?

In other words, to what extent does calling this representative mentally dangerous extend to those who voted for him, in part, because of his strongman tendencies that are now being called dangerous?

"Yes and no.

Certainly a general state of poor public mental health has led to the country's electing an impaired leader. Healthy individuals are generally repelled, not drawn to, pathology, whereas less healthy individuals might find violence and destructiveness, for example, very compelling.

On the other hand, the everyday person is not greatly exposed to pathologies, either, and would likely interpret what they are seeing in terms of what they know: variations of the normal, which is usually wide and varied--and so a lot is also missed. It may take a specialist to recognize abnormality, or signs of pathology, especially when they are subtle.

The particular traits that Mr. Trump has, furthermore, can be confusing: a lack of control can be seen as honesty, tendencies to go into attack mode can be seen as strength (whereas they more often arise from profound feelings of weakness and inadequacy), and the intense desire to 'sense' others in order to overpower them by deceiving and manipulating them can be mistaken for empathy (whereas in fact it is the opposite of empathy, since the goal is to cheat, or to promise one thing and then bring the opposite).

Those who are most subject to this kind of luring and predation are often the most vulnerable, who have been victimized in the past--'the forgotten men and women'--and the magnitude of the deception may conspire with psychological protection mechanisms against pain to avoid seeing the truth, sometimes at all cost."

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(Dr. Lee then goes into exactly how Trump 'feeds' his base)

"This explains the undying devotion of some members of his 'base', regardless of the policies that are revealed (for example, his billionaire cabinet that is greater than any "swamp" in history, a tax reform that essentially steals from the poor to give to the rich, or repeated attempts at healthcare reform that would only take away from those who have little).

All Mr. Trump needs to do is to give out the most meager evidence--crumbs--that he is "working for them," and they will desperately gather them as proof that they were correct about him. Mental health professionals who are familiar with these patterns may attempt to educate and to warn the public, but it is an uphill battle (note that I have received death threats). Realization of reality is too painful at the moment, and difficult because of widespread corruption and exploitation of this social-psychological dynamic.

The best we can do in such a situation is to try to remove the pathogen (the pathology-causing agent) as soon as possible to allow for healing and recovery. It is a truly heartbreaking situation, and his greatest supporters are victims, not necessarily those we should fault."

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(Rami Khoury/Al Bawaba)

In voting for him though, Trump's base could have actually been empowering themselves by putting a brute in power that speaks to their anger directly and in a way no other politician would dare do.

In this sense, their anger incentivizes Trump to continue being rash and aggressive because that's what his voters want to see. So do you think they are truly powerless or do they maintain a more terrifying power that is shown through a kind of rage?

In other words, who do you think is truly more mentally unwell in this feedback loop?

"There is absolutely an element of this, a 'symbiosis' that consists of mutual confirmation and support of pathology.

Offender- and victimhood can manifest as two sides of the same coin in both the president and his "base,' and there are many dynamics underlying it. I describe his supporters as victims because they are genuinely loyal to the president, precisely for his hypnosis and deception (he claims to serve some historic 'America' and 'traditional' notions such as policing through force, the military, and Christianity).

He thrives on their adoration, and in turn gives them what they emotionally need: authority and 'power' (in quotes because it is not true power) they can identify with, a feeling of superiority against an 'out group' that they can exclude and oppress (as an antidote to their own sense of inferiority), and an avenue for ventilating their anger and grievances.

The drive to satisfy their frustration and rage supersedes any reasoned thought of self-interest, and as long as the 'leader' is in position, they will offer their blind allegiance, even if it practically hurts them and worsens the conditions that enraged them in the first place.

It is a very destructive course with a universally damaging outcome for all those involved, which is why we do not count it among the wide range of normal, healthy behavior (which brings thriving and enhances life) but count it as disease (which brings damage, destruction, and death)."

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(Dr. Lee details how this goes beyond ideology and party affiliation)

"A crucial component of societal unfolding of this course is an impaired, destructive leader gaining power. It should not be mistaken for a political movement or ideology, as it is the institution of a diseased mind in a leadership position, supported by his like-minded base and a silent or complicit majority, that gives rise to the situation--almost regardless of ideology.

It should be noted here that most mental impairments are not destructive toward others in this way; usually, it is the afflicted individual who suffers, but also may develop strengths from overcoming that suffering such as compassion and empathy, which are desirable leadership qualities. Most destructive and violent individuals, in fact, do not suffer from a diagnosable mental illness, and most mentally ill individuals are more likely to be victims than perpetrators of violence.

Destructive individuals like those I outline above are common in society, but usually society contains them in jails and prisons. When the state of societal mental health is poor, society begins to revere, rather than scorn, them for their qualities."

A member of the Ku Klux Klan (KKK) during the Unite the Right rally (AFP/FILE)

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(Dr. Lee then concludes her thoughts on the general mental health of the U.S.)

"It is important that you have said what you did because the two--Trump's mental health and his voter base--are not separable.

You must note: mental instability in the leader and poor mental health of the public create a malignant symbiosis, and Mr. Trump himself would not be dangerous if he were not in this feedback loop.

Also, mental impairment and criminal-mindedness are not mutually exclusive, either, but create an even more dangerous situation. Stating that Mr. Trump is mentally unstable does not exonerate him from wrongdoing, and it does not solve the problem. In fact, my work in violence prevention over the last twenty years can be said to be devoted to improving public mental health, precisely because I have been concerned about its decline, mainly through conditions of increasing inequality.

As I note in the book, 'The Dangerous Case of Donald Trump,' we are speaking about the larger context that gave rise to his presidency, as well as the greater population that he has affected by virtue of his position. The ascendancy of such an impaired individual speaks to the nation's general state of public mental health, certainly, and the general population will remain long after he is gone (and has worsened their condition).

Nevertheless, it does not negate the fact that he is very unstable and yet in charge of a nuclear arsenal that could put an end to the human species--and this is the most immediate emergency."

[c] 2000 - 2018 Al Bawaba (www.albawaba.com) Provided by SyndiGate Media Inc. ( Syndigate.info ).

Source Citation (MLA 8th Edition)
"'You Can't Separate Trump's Mental Health From His Voters': Q&A With Mental Health Expert Dr. Bandy Lee." Albawaba.com, 4 Feb. 2018. General OneFile, http://link.galegroup.com/apps/doc/A526183605/ITOF?u=schlager&sid=ITOF&xid=90c6023f. Accessed 23 Apr. 2018.

Gale Document Number: GALE|A526183605

Herman, Judith, and Bandy Lee. "Donald Trump Is Dangerous, Psychiatrists Must Speak Out." The Report, from U.S. News & World Report, 25 Jan. 2018. General OneFile, http://link.galegroup.com/apps/doc/A525076635/ITOF?u=schlager&sid=ITOF&xid=ebc63d40. Accessed 23 Apr. 2018. Sullum, Jacob. "The Myth of Donald Trump's Mental Illness: Don't medicalize political judgments." Reason, May 2018, p. 64+. General OneFile, http://link.galegroup.com/apps/doc/A534376611/ITOF?u=schlager&sid=ITOF&xid=2f2a1937. Accessed 23 Apr. 2018. "Lee, Bandy X.: THE DANGEROUS CASE OF DONALD TRUMP." Kirkus Reviews, 15 Sept. 2017. General OneFile, http://link.galegroup.com/apps/doc/A504217688/ITOF?u=schlager&sid=ITOF&xid=7e2c454e. Accessed 23 Apr. 2018. "'You Can't Separate Trump's Mental Health From His Voters': Q&A With Mental Health Expert Dr. Bandy Lee." Albawaba.com, 4 Feb. 2018. General OneFile, http://link.galegroup.com/apps/doc/A526183605/ITOF?u=schlager&sid=ITOF&xid=90c6023f. Accessed 23 Apr. 2018.

• New Yorker
  https://www.newyorker.com/news/news-desk/diagnosing-donald-trump
  Word count: 1346

  Diagnosing Donald Trump, and His Voters

  By Masha GessenOctober 6, 2017

  In the new book “The Dangerous Case of Donald Trump,” mental-health experts unpack the mortal danger of the President’s mind.Photograph by Brendan Smialowski / AFP / Getty
  The question is not whether the President is crazy but whether he is crazy like a fox or crazy like crazy. And, if there is someone who can know the difference, should this person, or this group of people, say something—or would that be crazy (or unethical, or undemocratic)?

  Jay Rosen, a media scholar at New York University, has been arguing for months that “many things Trump does are best explained by Narcissistic Personality Disorder,” and that journalists should start saying so. In March, the Times published a letter by the psychiatrists Robert Jay Lifton and Judith L. Herman, who stated that Trump’s “repeated failure to distinguish between reality and fantasy, and his outbursts of rage when his fantasies are contradicted” suggest that, “faced with crisis, President Trump will lack the judgment to respond rationally.” Herman, who is a professor at Harvard Medical School, also co-authored an earlier letter to President Obama, in November, urging him to find a way to subject President-elect Trump to a neuropsychiatric evaluation.

  Lifton and Herman are possibly the greatest living American thinkers in the field of mental health. Lifton, who trained both as a psychiatrist and a psychoanalyst, is also a psychohistorian; he has written on survivors of the atomic bombs dropped on Japan, on Nazi doctors, and on other expressions of what he calls “an extreme century” (the one before this one). Herman, who has done pioneering research on trauma, has written most eloquently on the near-impossibility of speaking about the unimaginable—and now that Donald Trump is, unimaginably, President, she has been speaking out in favor of speaking up. Herman and Lifton have now written introductory articles to a collection called “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.” It is edited by Bandy X. Lee, a psychiatrist at the Yale School of Medicine who, earlier this year, convened a conference called Duty to Warn.

  Contributors to the book entertain the possibility of applying a variety of diagnoses and descriptions to the President. Philip Zimbardo, who is best known for his Stanford Prison Experiment, and his co-author, Rosemary Sword, propose that Trump is an “extreme present hedonist.” He may also be a sociopath, a malignant narcissist, borderline, on the bipolar spectrum, a hypomanic, suffering from delusional disorder, or cognitively impaired. None of these conditions is a novelty in the Oval Office. Lyndon Johnson was bipolar, and John F. Kennedy and Bill Clinton might have been characterized as “extreme present hedonists,” narcissists, and hypomanics. Richard Nixon was, in addition to his narcissism, a sociopath who suffered from delusions, and Ronald Reagan’s noticeable cognitive decline began no later than his second term. Different authors suggest that America “dodged the bullet” with Reagan, that Nixon’s malignant insanity was exposed in time, and that Clinton’s afflictions might have propelled him to Presidential success, just as similar traits can aid the success of entrepreneurs. (Steve Jobs comes up.)

  Behind the obvious political leanings of the authors lurks a conceptual problem. Definitions of mental illness are mutable; they vary from culture to culture and change with time. The Diagnostic and Statistical Manual of Mental Disorders is edited every few years to reflect changes in norms: some conditions stop being viewed as pathologies, while others are elevated from mere idiosyncrasies to the status of illness. In a footnote to her introduction, Herman acknowledges the psychiatric profession’s “ignominious history” of misogyny and homophobia, but this is misleading: the problem wasn’t so much that psychiatrists were homophobic but that homosexuality fell so far outside the social norm as to virtually preclude the possibility of a happy, healthy life.

  Political leadership is not the norm. I once saw Alexander Esenin-Volpin, one of the founders of the Soviet dissident movement, receive his medical documents, dating back to his hospitalizations decades earlier. His diagnosis of mental illness was based explicitly on his expressed belief that protest could overturn the Soviet regime. Esenin-Volpin laughed with delight when he read the document. It was funny. It was also accurate: the idea that the protest of a few intellectuals could bring down the Soviet regime was insane. Esenin-Volpin, in fact, struggled with mental-health issues throughout his life. He was also a visionary.

  No one of sound mind would suspect Trump of being a visionary. But is there an objective, value-free way to draw the very subjective and generally value-laden distinction between vision and insanity? More to the point, is there a way to avert the danger posed by Trump’s craziness that won’t set us on the path of policing the thinking of democratically elected leaders? Zimbardo suggests that there should be a vetting process for Presidential candidates, akin to psychological tests used for “positions ranging from department store sales clerk to high-level executive.” Craig Malkin, a lecturer at Harvard Medical School and the author of “Rethinking Narcissism,” suggests relying on “people already trained to provide functional and risk assessment based entirely on observation—forensic psychiatrists and psychologists as well as ‘profilers’ groomed by the CIA, the FBI, and various law enforcement agencies.” This is a positively terrifying idea. As Mark Joseph Stern wrote in Slate in response to last December’s calls for the Electoral College to un-elect Trump, it “only made sense if you assumed as a starting point that America would never hold another presidential election.”

  Psychiatrists who contributed to “The Dangerous Case of Donald Trump” are moved by the sense that they have a special knowledge they need to communicate to the public. But Trump is not their patient. The phrase “duty to warn,” which refers to a psychiatrist’s obligation to break patient confidentiality in case of danger to a third party, cannot apply to them literally. As professionals, these psychiatrists have a kind of optics that may allow them to pick out signs of danger in Trump’s behavior or statements, but, at the same time, they are analyzing what we all see: the President’s persistent, blatant lies (there is some disagreement among contributors on whether he knows he is lying or is, in fact, delusional); his contradictory statements; his inability to hold a thought; his aggression; his lack of empathy. None of this is secret, special knowledge—it is all known to the people who voted for him. We might ask what’s wrong with them rather than what’s wrong with him.

  VIDEO FROM THE NEW YORKER
  James Comey on His Infamous Dinner with Trump

  Thomas Singer, a psychiatrist and Jungian psychoanalyst from San Francisco, suggests that the election reflects “a woundedness at the core of the American group Self,” with Trump offering protection from further injury and even a cure for the wound. The conversation turns, as it must, from diagnosing the President to diagnosing the people who voted for him. That has the effect of making Trump appear normal—in the sense that, psychologically, he is offering his voters what they want and need.

  Knowing what we know about Trump and what psychiatrists know about aggression, impulse control, and predictive behavior, we are all in mortal danger. He is the man with his finger on the nuclear button. Contributors to “The Dangerous Case of Donald Trump” ask whether this creates a “duty to warn.” But the real question is, Should democracy allow a plurality of citizens to place the lives of an entire country in the hands of a madman? Crazy as this idea is, it’s not a question psychiatrists can answer.

  Masha Gessen, a staff writer, has written several books, including, most recently, “The Future Is History: How Totalitarianism Reclaimed Russia,” which won the National Book Award in 2017.Read more »

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