If you are clinician trained and educated in the practice of diagnosis, what can you say about the chaos and pathology you observe, say, in a U.S. leader, or in the functioning of the White House as an organization? Nothing. Can you write or blog about the evident narcissism and proclivities towards confabulation immediately observable in a U.S. leader’s behavior and statements? Not at all. This is because of the Goldwater Rule, the proscription against clinicians diagnosing politicians who have not been subject to a formal, structured interview in your office. The Goldwater Rule was established by the American Psychiatric Association to head off reductive, politically motivated pathologization of Barry Goldwater during the 1964 presidential campaign. Many abide by this self-imposed gag rule, especially if they wish to avoid the perception that they are “getting political” and if they want their blog postings to be published and remain accessible to readers.
But there is a problem with the Goldwater Rule. Namely, clinical interviews are not perfect assessment tools, because a client, or U.S. leader, can behave one way in your office, and a totally different way in their professional life and in his or her intimate and public relationships. In some ways, the way a person acts and speaks in public during the pursuit of his or her daily duties and tasks reveals a great deal about who they are, how they view themselves and how they view and treat others. For example, what would it say if a Commander in Chief demonstrated a repeated pattern of rewarding those who kowtow and flatter him and of punishing and publicly humiliating those who fail to issue obsequious platitudes? With the advents of the 24-hour news cycle and social media, a wealth of data is now available in public comments, speeches, tweets, and other forms of communication to analyze and interpret, and yes, diagnose, from one’s couch or at one’s office. As the news quotes and reacts to the latest tweet storm from a President, clinicians would also able to analyze and opine on the ongoing “characterological EEG” (Stephen Ducat, 2017) conveniently broadcast in a readily accessible text. But it would be verboten to do so.
It has been pointed out that if a leader’s personality traits were really so toxic or pathological, why do they not seem to cause him significant suffering, and why has he been “successful” (if celebrity, and apparent wealth, but not four bankruptcies, are the primary criteria of this quality). Stephen Ducat rebuts this perspective handily by pointing out the ego-syntonic nature of personality disorders. That is, that “the behavior of such patients is untroublingly congruent with how they want to see themselves. This is especially the case with narcissism” (Ducat, 2018, p. 3). This is to say that the narcissistic individual does suffer distress, but their pain is camouflaged by their primary preoccupations of an incessant pursuit of admiration (“it’s all about him, all of the time”) and a continuous war against those who dare to doubt his or her obvious greatness. For example, narcissistic President “would never seek treatment for his character—not because he doesn't suffer, but because he locates that suffering in the failures of others to affirm his most grandiose self-image” (Ducat, 2017).
Trouble is, if clinicians in this hypothetical scenario read the Twitter storms with increasing alarm, and continued to see ample evidence on daily news broadcasts of this type of pathology, their wings would be clipped, their mouths muzzled, by the Goldwater Rule. No self-respecting, professional website, or blog, would allow the circumvention of that rule, or allow themselves to be tainted by someone trying to diagnose, for example, a sitting President. The great irony is that while those perfectly positioned to critique a dysfunctional White House (organizational psychologists and systems consultants, for example) or diagnose a mad king in the Oval Office (psychiatrists, and licensed therapists, clinical psychologists, social workers, etc.) would be silenced, a crazed ignoramus could bray on, in unfettered torrents of wholly fallacious tweets deemed “official White House statements.” While clinicians remained bound and gagged, the innumerable caravan of sycophantic toadies would run interference and protect an aggrieved manchild from the consequences of his own ignorance and incompetence. If someone gestures to an amazing capacity for telling falsehoods, the court of the mad king would protest that he “tells it like it is” and merely defends the American people from the “very dishonest” free press, who are the enemy of the people, not a pillar of democracy as the Founding Fathers suggested. In this hypothetical scenario, the chief’s total lack of discipline, focus and morality would be flipped into an impressive ability to “do anything” with impunity, even get away with an extramarital affair with, say, a porn star, and deny it, or fire a cabinet member by tweet. The ability to get away with anything could even become a central component to this hypothetical leader’s brand (Ducat, 2017).
It’s a good thing that this is all pretend, and we don’t face a situation like that in America today. And in the scenario of a mad king, with our Constitutional separation of powers, and checks and balances, surely the legislative branch would rise to the occasion and hold such a leader accountable. Surely Congress would reign him or her in, in the democracy that we all know and love.
Kyle D. Killian, PhD is author of Interracial Couples, Intimacy & Therapy: Crossing Racial Borders from Columbia University Press.
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