Is psychiatric treatment an option for a candidate?

Is psychiatric treatment an option for a candidate?

Published Tuesday, October 25, 2016

David Letterman, who has taken a centrist approach to politics for his entire career, took an unusual step in an interview quoted in the Oct. 8 New York Times where he made the following statement about Donald Trump: “If you see somebody who’s not behaving like any other human you’ve known, that means something. They need an appointment with a psychiatrist. They need a diagnosis and they need a prescription.”

While I have written four op-eds for this newspaper in the past year relating to Donald Trump, I have been very careful not to suggest that Mr. Trump needs a psychiatric appointment or a prescription and I have never offered a diagnosis although dozens of my colleagues have privately offered me rather definitive ideas and thoughts about diagnosis and recommendations for treatment.

Why I have not been more forthcoming and why I will not offer a diagnosis or a treatment recommendation in this column is simple: to do so would be a violation of a professional code of ethics and a basic principle which has come to be known as the “Goldwater Rule.”

During the 1964 presidential campaign between Barry Goldwater and Lyndon Johnson, the editors of Fact magazine asked 12,356 psychiatrists one simple question: whether they believed Barry Goldwater was psychologically fit to serve as president of the United States. Many of the comments were highly critical of Goldwater and some described him as “psychotic, a megalomaniac, and a paranoid schizophrenic.”

These comments were considered extremely unprofessional and eventuated in the American Psychiatric Association ethics annotation known as the Goldwater Rule passed by the APA in 1973 which stated: “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.”

All of this got me to thinking back to the 1972 presidential election when Thomas Eagleton was forced to withdraw as the vice presidential running mate of George McGovern because he had been hospitalized on three occasions and treated for depression in the 1960s. Though asked to leave the presidential ticket, Eagleton’s psychiatric treatment proved to be highly effective and he was subsequently elected to the Senate in 1974 and in 1980 and served with great distinction.

In particular, Mr. Eagleton took a leading role in legislation to halt the United States’ bombing of Cambodia in 1973. In the Senate, Eagleton was active in matters dealing with foreign relations, intelligence, defense, education, health care and the environment.

He was instrumental in the Senate’s passage of the Clean Air Act and the Clean Water Act, and sponsored the amendment that effectively ended American involvement in the Vietnam War.

This all occurred long after his diagnosed illness and treatment for which he had been removed from the democratic ticket in 1972. He chose not to run for the Senate again in l986. However, in 1987, Eagleton returned to Missouri as an attorney, political commentator, and professor at Washington University in St. Louis, where until his death he was professor of public affairs. Throughout his Washington University career, Eagleton authored three books and taught courses in economics with the former chairman of the Council of Economic Advisers.

I think it is fair to say that he continued to be a highly functioning and very active, involved and contributing member of society at many levels and was even the chief negotiator for a coalition that lured the Los Angeles Rams football team to St. Louis in 1995.

It may be ironic that on July 23, 1996 Eagleton delivered a warm introductory speech for George McGovern during a promotional tour for McGovern’s book, “Terry: My Daughter’s Life-and-Death Struggle with Alcoholism.” Finally, following Eagleton’s death, in a telephone interview, McGovern said he erred in removing Eagleton. He said Democrats could have won the election if he had kept Eagleton on the ticket.

All of this leads me to muse on what would have happened had Donald Trump sought professional help from a psychiatrist rather than from a series of professional consultants and advisers with the goal of helping to “even him out,” diminish his obvious lack of self-control, perhaps improve his judgment and ability to concentrate, focus and listen thoughtfully to others without the need to constantly interrupt, reduce his emotional outbursts, impatience and emotional lability, help him sleep through the night so that his now infamous 3 a.m. tweets would never occur again, helped him to become more coherent in his emotional and intellectual responses, and even diminish his apparent, but inappropriate, sexual remarks and behavior.

My guess is that he would simply by virtue of having sought professional, psychiatric help, still in 2016 be considered no longer qualified to be a candidate for president of the United States.

To me it is a bitter irony that never having sought psychiatric care or ever been treated for a psychiatric illness Trump became the Republican candidate for president — and perhaps might still be elected our president — despite all of these troublesome behaviors which dozens of non-psychiatric journalists have repeatedly diagnosed as manifestations of a mental illness. However, if these behaviors had been significantly ameliorated by medical treatment, Trump would then sadly be considered by many “unfit to serve” simply by virtue of having “come out!”

It has been almost half a century since Eagleton was forced to leave the ticket because of a past history of mental illness despite a successful treatment evidenced by a highly successful life from 1972 when he was dropped from the ticket until his death in 2007.

We have changed as a society in so many ways and are far more tolerant, accepting and even protective of lifestyle experiences and choices that would have been totally unacceptable to the majority of Americans in 1964. How sad that so much prejudice and stigma still exists with regard to mental illness and psychiatric treatment which would still make it impossible for even those men and women who have been successfully treated for a mental illness to be considered as a presidential candidate today.

Dr. John S. Tamerin lives and practices psychiatry in Greenwich. He is a clinical associate professor of psychiatry at the Cornell/Weill School of Medicine.