this is not normal

At Yale, Psychiatrists Cite Their ‘Duty to Warn’ About an Unfit President

In your guts, you know he’s nuts? Photo: Mandel Ngan/AFP/Getty Images

“Batty,” says Maureen Dowd. “Nut job,” offers Gail Collins. “Unhinged,” “delusional,” “deranged,” “sadistic,’ “sexual predator” — these are only a few of the labels slapped on Donald Trump by pundits, national-security chiefs, even U.S. senators.

Yet most members of one profession have been hiding in plain sight. Psychiatrists and psychologists operate under a norm — the so-called Goldwater Rule — that their professional organizations made up in 1973, forbidding them from diagnosing public figures they haven’t been able to evaluate in person. In the face of minimal trust at home and abroad in President Donald Trump’s stability and his tenuous grasp of reality, a group of eminent professionals are daring to depart from the party line and declaring exception to the rule.

The Hippocratic oath to First Do No Harm — sworn to Apollo the physician — has been turned into a self-serving hypocritical oath, charges Dr. John Gartner, a psychologist and former faculty member at Johns Hopkins Medical School. “The American Psychiatric Association looks out for the welfare of its members, to protect them from lawsuits. They’re not worrying about whether 300 million Americans are vulnerable to the life-and-death actions taken by this abnormal president.” And he and an increasing number of his colleagues are ready to declare that President Trump, whose actions are often described with neutral terms like “unprecedented,” is in fact dangerously ill. “Does Trump need to lie to my face for me to know he lies all the time?” asks Gartner. Now in private practice in New York City, he answers his own rhetorical question. “He does lie to my face — every night. I watch TV!”

This moment (which itself is “unprecedented”) led to an open town-hall meeting on Thursday, at Yale Medical School, to discuss the elephant in the room. Dr. Bandy X. Lee, a diminutive Yale psychiatry professor who organized the meeting, puts it this way: “The Goldwater Rule is not absolute. We have a ‘Duty to Warn,’ about a leader who is dangerous to the health and security of our patients.” She has formed a coalition by that name, and it now comprises almost 800 mental-health professionals who are “sufficiently alarmed that they feel the need to speak up about the mental-health status of the president.” Gartner has posted a similar petition on the web, and it has attracted 41,000 signatures, a high proportion of them from mental-health practitioners. Anyone can look it up and sign it.

Yale’s Dr. Bandy Lee. Photo: Robert A Lisak/Yale School of Medicine

“Duty to Warn” is a term with some history. In 1974, a trial known as the Tarasoff case established the law — now in force in 38 states — saying that if a patient is in imminent danger of physically hurting someone, his or her doctor may break confidentiality and alert the likely victim or call the police. As for the Goldwater Rule itself, it is essentially a gag order, part of the code of ethics of the American Psychiatric Association. It was created in the years after the 1964 presidential election, when the fiery conservative Barry Goldwater won the Republican nomination. (Goldwater ran on anti-communist rhetoric suggesting that he just might start a nuclear war, on the slogan “In Your Heart You Know He’s Right”; Lyndon Johnson’s counter-slogan was “In Your Guts You Know He’s Nuts.”) Press outlets, notably a magazine called Fact, asked psychiatrists and psychologists to diagnose Goldwater, and they did, enthusiastically and damningly. Goldwater sued Fact and won. The APA set down its rule a few years later.

It is only fair to point out that professional organizations governing mental-health practitioners still do not have a clean blotter. Only in 1968 was the Diagnostic and Statistical Manual of Mental Disorders rewritten, for its second edition, to drop the grievous classification of nonconformists, such as homosexuals, under “sociopathic personality disorder.” Two contract psychologists devised the CIA’s enhanced interrogation program, acknowledged by President George W. Bush. The American Psychological Association has admitted that key officials secretly “colluded with Department of Defense officials to loosen ethical guidelines” motivated by the wish to “curry favor with DoD.” Only in 2006 did the APA strictly prohibit psychiatrists from participating in “”enhanced interrogations.”

The event at Yale this week did not come about without controversy. It had been arranged jointly by Yale’s School of Medicine, Department of Psychiatry, and School of Public Health. All three dropped away before the big day. (Asked why, a spokesperson for the university says only, “Eminent psychiatrists were invited to speak about whether there are other ethical rules that override [the rule] in ordinary practice.”) The university upheld a commitment to free speech by giving Lee permission to hold an independent meeting in the auditorium of the medical school, but she was largely on her own. “I’m a pariah in my own department,” Dr. Lee confided to me before the event.

But she’s not one to back down. As a Korean-American girl growing up in gang territory in the Bronx, she saw kids caught in crossfire all the time. As an Asian girl in New York then, she recalls, “I didn’t belong anywhere, so I could go anywhere,” and so she did, secretly volunteering in Harlem as a tutor for homeless children. After Yale Medical School and her residency (through Harvard), she studied the anthropology of violence in East Africa. There she had a revelation: Tribal warfare wasn’t about gaining military superiority. “We know from violence studies that it’s inequality — the shame of powerlessness — that pushes people to resort to violence.” Years of working in maximum-security prisons have reinforced her belief that most inmates fight to preserve a sense of dignity and belonging. “Despite the fact that it destroys their chances in life, they continue to resort to violence in order to belong to a subculture where their status is defined by violence.”

Do Trump’s middle-class supporters see him as a strong man who promises to revive the status they have lost? I asked her. Is their sense of belonging tied to Trump? She agreed. “He is giving his fans a false sense of empowerment: ‘Make America great again, reject outsiders who will take your jobs.’ But instead of elevating their status with real solutions, he is exploiting their psychology.”

The Yale town meeting itself was, after the sponsoring departments pulled out, sparsely attended. It started late. Not many more than a dozen seats were filled, though about 60 viewers tuned in from around the country. (Harkness Auditorium holds 400.) But a special guest, via video monitor, piped in from his study in New York: Dr. Robert Jay Lifton, former Yale professor of psychiatry and author of the urtext about the ways Nazi doctors were perverted into killers. He’s 90. His full-lipped smile, evident at the start of his talk, went slack as he spoke.

He told the tiny audience he had an important concept to discuss: “malignant normality.” Lifton defines it as “arrangements put forward as being normal when in fact they are dangerous and destructive.” An extreme example on which he has done studies is that of German doctors who were assigned to Auschwitz. Their job was to be active in the mass killing. They were given perverted training to defeat their fears and shame and brainwash them into believing it was normal to gas Jews to death. (As, it’s worth noting, Syrian president Bashar al-Assad must do something similar to “normalize” the gassing of babies and women by their countrymen in his army.)

Dr. Judith Herman spoke next. She’s a renowned professor of psychiatry trained at Harvard and Cambridge and, after Trump’s election, she wrote a letter to President Obama expressing alarm at the symptoms of mental instability she saw in the president-elect. Was there some way to insist on a neuropsychiatric evaluation, she wrote, “before this man assumes the terrifying power of a U.S. president?” Only two of her colleagues were willing to co-sign the letter, which went viral and was read at the Women’s March on Washington.

Dr. James F. Gilligan, a senior clinical professor of psychiatry at NYU Medical School, was on next, and noted that, while speculative diagnoses of Trump have been made, one does not need a diagnosis to assess dangerousness. Anyone who doesn’t flatter him extravagantly is meant to be destroyed. He engages in exploitation and violation of the rights of others, and sometimes goes as far as sadism, with no evidence of remorse. “When you add all these elements,” Gilligan observed, “this is a class of people of whom Hitler is a member.” Only at the end did Gartner introduce a note of gallows humor. Imagine tomorrow’s grandparents, he suggested, stuck in a refugee camp in icy Idaho, trying to warm their hands over a fire while asked to explain it all to the grandkids. “Grandpa, you knew there was a dangerous man running our country — why didn’t you say something?

“Well, you see, in 1967 there was a lawsuit brought by a candidate for president called Barry Goldwater — “

“Wait, Grandpa — what’s a lawsuit?”

Chagrined, the grandfather tries to explain that a magazine had warned that Goldwater was unstable and had been sued.

“Wait, Grandpa — what’s a magazine?”

After the session ended, Lifton spoke to me, and I asked whether he sees Trump as an abnormal personality. “Trump creates his own extreme manipulation of reality,” he explained. “He insists that his spokesmen defend his false reality as normal. He then expects the rest of society to accept it — despite the lack of any evidence.” Lifton is unexpectedly insouciant when he speaks, and you can see it in the bushel of white hair that still flops over his forehead and ears, plus that half-lipped smile. I pressed him to interpret the angry meltdown that seized President Trump when he was told, after the fact, that his closest campaign cohort, Jeff Sessions, had recused himself from the Justice Department investigation of Trump’s Russian connections. “Trump’s version of reality did not include Sessions having done anything wrong,” he explained, “despite evidence of his reported contacts with the Russian ambassador.” Trump himself, he explained, cannot bear the humiliation of being exposed as wrong, and is “ultrasensitive” about the Russian connection. “He’s more than a little threatened by the idea of a full independent inquiry. A sudden influx of new information about his business holdings could create an explosive situation.”

Can our institutions that guarantee a separation of powers survive such a manipulative presidency? “Open institutions are still in effect, but he’s doing his best to ignore them and break them down,” says Lifton. “Trump is a person bent on authoritarian behavior.” He continued with a sobering quote from the contemporary poet Theodore Roethke: “In a dark time, the eye begins to see.”

At Yale, Psychiatrists Cite ‘Duty to Warn’ About Trump