Clinician Activists Grapple with 25th Amendment and Trump’s Mental Health

Clinician Activists Grapple with 25th Amendment and Trump’s Mental Health

Mulling over President Trump’s mental health has become a national preoccupation, with commentators from Morning Joe co-host Mika Brzezinski to politicians like Connecticut Democratic Senator Chris Murphy all eager to weigh in on the issue. But one group of activists hope that their words will hold a little more weight and speed up Trump’s departure from the White House.

Duty to Warn, a group of mental health professionals, has called for Trump’s removal from office under the 25th Amendment. The group argues that Trump exhibits many of the traits of malignant narcissism—a condition characterized by high levels of selfishness, grandiosity, paranoia, antisocial personality, and sadism, all which make him unfit to govern.

However, the group’s stance is controversial. An American Psychiatric Association guideline known as the “Goldwater Rule” states that it is unethical for a clinician to offer a professional opinion about the mental health of someone they haven’t diagnosed in person and without the patient’s consent. During Barry Goldwater’s 1964 bid for the presidency, a Fact Magazine poll found that nearly 1,200 psychiatrists believed that Goldwater was unfit for the job.

While the APA acknowledges that the legal concept of “duty to warn” (which varies by state) requires a psychiatrist to disregard confidentiality when he or she has reason to believe a patient is a threat, “it does not apply if there is no physician-patient relationship.”

But psychologist John Gartner, the head of Duty to Warn, cites numerous reports about Trump’s alarming behavior, including comments from the president’s inner circle, as evidence that there are clear warning signs that Trump is unfit. Trump’s longtime friend and adviser Tom Barrack has found his behavior shocking; Senator Bob Corker of Tennessee has doubted his stability; and Secretary of State Rex Tillerson reportedly called Trump a “moron” after he expressed a desire to expand the country’s nuclear arsenal.

The German psychoanalyst Erich Fromm coined the term “malignant narcissism” to describe leaders like Adolf Hitler and Josef Stalin. According to Gartner, “when personalities [exhibiting this condition] achieve power, they become dramatically worse.” He believes that Trump is deteriorating psychologically, which means that he could make a rash decision, such as launching nuclear weapons. “Knowing that Donald Trump meets all criteria for malignant narcissism is actually a matter of national security,” Gartner said at an October Duty to Warn town hall meeting in Washington.

Gartner supports two pending bills: the Oversight Commission on Presidential Capacity (OCPC) Act and the Restricting First Use of Nuclear Weapons Act. The OCPC Act, introduced by Democratic Representative Jamie Raskin of Maryland, calls for Congress to establish an 11-person committee of physicians, psychiatrists, and former high-ranking members of the executive branch (such as a president, vice president, secretary of state, or attorney general) to determine whether a president is “unable to discharge the powers and duties of his office” under Section 4 of the 25th Amendment. Each party would appoint five committee members, who would then select an 11th person to chair the commission. Raskin, a constitutional lawyer, says he wishes that the congressional body described in the 25th Amendment had been established “50 years ago.”

Democratic Representative Ted Lieu of California introduced the nuclear weapons bill, which aims to prevent the president from launching a “first-use nuclear strike”—meaning a strike against a country that has not already attacked the United States with nuclear weapons first—unless Congress has made a declaration of war explicitly authorizing the strike.

However, Gartner’s decision to launch two political action committees, the Duty to Warn PAC and super PAC, which he plans to use to support social media campaigns to target local and state voters, has raised eyebrows. Raskin was named Duty to Warn’s “Legislator of the Year” at an October kickoff event in Washington, and received a $1,000 check from the group. Gartner says that the group intends to support candidates who say they will vote for bills that could restrict Trump’s access to nuclear codes, or lead to his removal from office under the 25th Amendment.

Gartner is adamant that his activism is not motivated by partisan politics, or any interest in only electing Democrats. If a Republican candidate for Congress pledges to support Raskin’s or Lieu’s bills, Gartner said he would “support that person double.” Asked about the Duty to Warn PACs, Raskin says, “They’re definitely supporting the legislation and trying to bring attention generally to the 25th Amendment.”

Prior to setting up Duty to Warn, Gartner says he had never been politically active. “It’s so obvious what we’re doing and why we’re doing this,” Gartner tells The American Prospect. “I’m doing it because as a psychologist, I see this person as a murderous madman.”

However, some doctors do not agree with Gartner’s moves. Psychiatrist Allen Frances, author of Twilight of American Sanity, a recent book about the Trump age, calls Trump the “most dangerous man on earth” and agrees that his access to the nuclear codes should be restricted.

But Frances says that while the danger Trump poses is obvious, diagnosing his behavior is a “distraction” and stigmatizes the mentally ill. He adds that while Duty to Warn’s diagnosis is a prelude to a call to invoke the 25th Amendment to remove Trump, that “will never happen politically.”

Raskin suggests that mental illnesses do not automatically disqualify someone from being able to execute the powers of the office. Abraham Lincoln, who many historians believe suffered from clinical depression, was “one of our greatest presidents,” he says. Yet even without a formal diagnosis, Raskin thinks there is a strong case for Trump’s removal. “The question isn’t does he have this or that … disorder,” Raskin says. “The question is simply: Would a citizen think [a president] is dangerously unfit to execute the powers and duties of office?” He adds, “Mental health professionals, psychiatrists, and psychologists have every bit as much right as any other citizen to opine about that.”