Gagged by Goldwater

As I write this at the turn of the year, hospitals are overflowing, and our medical system is about to collapse. Yet the approaching loss of a half million lives in the United States from COVID-19 was entirely preventable. For me, the disastrous mismanagement of the pandemic was always more a mental health issue—of the head of state. So is the reckless discrediting of a normal election, the violence in the streets that have now flowed into the Capitol, and the near destruction of our democracy. This was all foreseen by mental health experts² and may have been prevented had the discussion about the president’s dangerous psychology not been quashed by a single mental health organization: the American Psychiatric Association (APA).

Having spent most of my career as a specialist in violence prevention applying psychiatric principles to public health, I could see the vast psychological influence³ Trump would have on society. I was deeply concerned that silencing experts would enable the spread of mental pathology alongside an inability on the part of government to apply correct interventions, both of which would ultimately result in immense suffering and societal damage. 

An alarming event in March 2017 prompted me to act: the APA’s revival of the obscure Goldwater rule, a guideline that prohibited the psychiatric diagnosis of a public figure without personal examination and consent. The APA expanded this “rule” to prohibit psychiatrists from publicly commenting on any objective aspect of a public figure and stipulated no emergency exception. In other words, the APA turned this antiquated guideline into a gag order that superseded all our primary professional responsibilities. Using the Goldwater rule to privilege a powerful public figure above an entire society’s right to have the best available knowledge to protect itself seemed to me the first sign of authoritarianism.

So, I assembled other prominent mental health professionals, first to an ethics conference at Yale School of Medicine and then through the bestselling public-service book The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.⁴ More than fifty members of the U.S. Congress eventually met with us. They said: “If you continue to do your part and educate the public on medical matters, we will be able to do our part and act politically.” By January 2018, we had raised the matter of the president’s mental health to the number-one topic of national conversation. 

Then the APA intervened. They made a public statement⁵ denouncing our work as “unethical” and moved to discredit our efforts. 

In a damning letter to the editor⁶ in the New England Journal of Medicine, past president of the APA Dr. Jeffrey A Lieberman wrote, “Psychiatry has made too many past missteps to engage in political partisanship disguised as patriotism… I believe that Pouncey and Lee and her coauthors are acting in good faith and are convinced they are fulfilling a moral obligation. But I believe this is a misguided and dangerous morality.” The New York Times joined in by publishing an editorial⁷ chastising psychiatrists who would speak up, as well as a lengthy op-ed⁸ penned by Lieberman.  

It did not seem to matter that all the core tenets of medical ethics pointed to our professional obligation to protect public health, above and beyond any etiquette we owed a public figure. A widespread and ongoing misinformation campaign had launched to discourage the media from giving voice to mental health experts.

For example, when our growing group of concerned mental health professionals—now called World Mental Health Coalition (WMHC)—invited more than fifty news organizations to a large interdisciplinary conference⁹ on the president’s overall fitness for his job, more than half of them declined to report on the event, citing the Goldwater rule. 

We watched the media comply with the APA suppression by routinely supplanting mental health experts with political pundits. The resulting fog of misinterpretation seemed as destructive as the gutting of institutions, the replacement of career personnel with unqualified flatterers, the catering to a president’s emotional needs at the expense of public good, and ultimately, the use of presidential powers solely for the expansion of personal power. Without expert input to explain the abnormal behavior of public figures, the dangers we had anticipated were minimized and pathology was normalized, inducing a “malignant normality.”

Despite the obstacles, we continued to perform our professional duty. When Special Counsel Robert Mueller released the findings of his investigation, we did our own analysis.¹⁰ Mueller’s report may not have been enough to indict a president, but it gave us the perfect information for a mental capacity, or “fitness,” evaluation: abundant, high-quality reports from coworkers and close associates under sworn testimony, which are valued over a personal interview. Top mental health experts from around the country formed an independent panel, then by standardized assessment, we concluded that Donald Trump did not meet any of the criteria for fitness. In fact, lacking even the most basic mental capacity for rational decision-making, he was unfit for any job, let alone president. We offered the president a chance to interview with us—to demonstrate his fitness—but he did not respond. Therefore, we published our conclusions with recommendations¹¹ that: (a) the president’s access to the nuclear codes be removed and (b) his war-making powers be curtailed. But without means to garner significant public attention, our message was largely ignored. 

Then, in late September 2019, everything changed. A whistleblower revealed¹² that the president had allegedly abused his powers and the governmental purse to help his own reelection campaign. This led to the Speaker of the House finally announcing an impeachment inquiry.

The WMHC had long encouraged impeachment, but for it to proceed nearly three years into the president’s incessantly scandalous term—a protracted window that allowed him to swell maximally in his false sense of omnipotence and impunity—was potentially dangerous. Our knowledge of human psychopathology provided us a blueprint for understanding and anticipating the actions that would most incite potentially aggressive and violent responses out of Trump. We were concerned that without guardrails, Trump’s psychology suggested he would retaliate, possibly invoking presidential martial powers. So, we released new public statements and submitted letters to Congress warning them of the dire implications of the president’s impairment and recommending psychological containment strategies before it was too late.

In early October 2019, Drs. Stephen Soldz and Edwin Fisher and I, along with more than two hundred fifty mental health professionals, sent an urgent letter to Congress.¹³ Three days later, Donald Trump ordered the withdrawal of troops from northern Syria, causing the massacre of our Kurdish allies. 

In early December 2019, Drs. John Zinner and Jerrold Post and I, this time along with over eight hundred mental health professionals, sent another warning.¹⁴ A month later, Trump ordered the assassination of a top Iranian general, Qassim Soleimani, to the surprise of even military officials, bringing us to the brink of war with Iran.

WMHC then issued our most urgent warning, but the House proceeded with its vote and handed over the articles to the Senate. As a result, the House’s impeachment efforts only enraged the president, and when the Senate acquitted him in a sham trial, his destructive impulses went uncontained, enabling his triumphal State of the Union address and his vengeful firing spree of those who lawfully testified against him.

Our final warning to Congress was delivered less than two weeks before the first United States case of COVID-19 in January 2020. Suddenly, the danger we were warning against turned into an unprecedented domestic threat. Not only had Donald Trump, out of pathological envy of his predecessor, defunded the Centers for Disease Control and Prevention (CDC) and dismantled the pandemic response teams that had been lauded throughout the world, he had also fired the CDC’s team in China, whose job was to detect and contain the very kind of respiratory infectious disease we faced with COVID-19. With a deadly pandemic arising just when the president most believed himself immune to prosecution, the number of infections and deaths in the United States quickly surpassed China’s and then every other country on the planet.

Had the House of Representatives held on to the articles of impeachment a month longer, removal may have been more likely, as more of Trump’s malfeasance came to light. Instead, the now-acquitted, apparently invincible president jubilantly declared the pandemic another “hoax” by the Democrats. He psychologically recruited his base into his alternative reality and resisted necessary actions such as widespread testing and tracing as well as isolating and mask-wearing—our only recourses. The result was that the U.S.—in spite of all its wealth, resources, concentration of experts, and military might, and much to the surprise and pity of the entire world—became the global epicenter of the pandemic. And there was no going back. A central pathology of Donald Trump is that he can neither admit an error nor take responsibility for his actions. Instead, he turned defiance of public health measures into a fight for freedom.

In early February 2020, I issued statements that control of “the mental health pandemic” was vital for effective control of the viral pandemic. In late March 2020, the World Mental Health Coalition issued a “Prescription for Survival,”¹⁵ stating that the president’s removal, or at least removal of influence, was critical to containing the U.S. death toll. We issued “Refills” or “Urgent Updates” in August, November, and December 2020, when eighty-five million Americans were planning to travel over the holidays, despite the raging pandemic that was claiming three thousand lives per day. At the time of this writing, one in one thousand Americans are already dead—five times the global average—and the death toll is projected to be a half million by the end of February 2021. 

Just as WMHC predicted earlier consequences for not instituting containment of the president’s psychology, we anticipated this lethal mishandling of the pandemic, exactly as it would happen, before it happened. I published a “blow-by-blow account”¹⁶ of our predictions and efforts to raise the alarm in August 2020. Further, our mental capacity evaluation assessed that almost all final deaths from COVID-19 would be attributable to the president’s mental state—and not the characteristics of the virus—which has been confirmed by a large Columbia University study.¹⁷

Our work has never stopped: over the summer, we also published Our Documents¹⁸, containing over three hundred pages of our letters, petitions, and conference transcripts. In October, I published a guide for healing the country, Profile of a Nation: Trump’s Mind, America’s Soul,¹⁹ a complete psychological analysis of Donald Trump in the context of his followers and the nation, in which I anticipated the post-election turmoil. We held a town hall series, which included an emergency reunion of speakers²⁰ from our major interdisciplinary conference, along with special guests John Dean and Dr. Noam Chomsky. In late September 2020, more than one hundred senior mental health professionals went on video record²¹ to declare Donald Trump too psychologically dangerous and mentally unfit for the presidency or candidacy for reelection. Finally, after the election, to explain the psychological upheavals we expected, I started my short, daily videos, A Psychological Take on the News. 

All those who accidentally came across our material would tell us they could not fathom how we were not a greater part of the national conversation. Mental health professionals could have brought the knowledge necessary for politicians to act when the public was still on board. One of the greatest travesties, I believe, has been the silencing of relevant expertise.²² The people are empowered for self-government only when they have access to knowledge. Experts, in turn, have an obligation to society that far exceeds a mere technical role. One would have thought a mental health association such as the American Psychiatric Association would help and not harm²³ a nation’s health, but they were too busy getting on the new, lucrative bandwagon²⁴ where mental impairment is the same as mental health, criminality the same as good intentions, and corruption and exploitation the same as political success. 

Still, they cannot subvert the truth. No amount of distortion and deception can change the fact that human life is precious, and our care for that life paramount. In other words, no special interest is worthier than the nurturance of human health and the safeguarding of human survival. This was the reason the World Medical Association instituted the Declaration of Geneva in 1948.²⁵ This universal pledge for all health professionals—established in response to the experience of physician collusion under Nazism—emphasizes that we speak up in contexts of injustice and especially not collude with destructive governments. The APA may have won for now, but humanity endures, and history will have its verdict. ■