As the plethora of comments in a Psychiatric Times article by Dr. Ronald Pies indicate, there are heated opinions about whether President Donald Trump has a mental disorder and whether mental health professionals should be making diagnoses about someone they have never even met (a violation of the Goldwater Rule).
Various diagnoses have been imputed to explain this President’s behavior during his first weeks in office. Narcissistic personality disorder (NPD) seems to be the most common. A variation of NPD, malignant narcissism, has also been suggested. Others have invoked ADD, sociopathy, and even hyperthymic temperament.
A diversity of viewpoints shouldn't be surprising. For one thing, it can be argued that a psychiatric diagnosis from afar is really a reflection of one's opinion of President Trump's politics. But to consider only one domain—public behavior—is to miss essential elements in clinical work, ie, private behavior, subjective reactions, and an interpersonal interaction with an mental health expert. That’s why a diagnosis imposed on any public figure without a personal assessment is inadequate, unreliable, and invalid.
And there is another risk to accepting the practice of psychiatric diagnosis from afar. Every public figure would be vulnerable to public diagnosis. And isn’t fear that psychiatrists can read minds one reason why the public has feared us in the past?
A public diagnosis also lends itself to political propaganda, as we saw in such totalitarian countries as the Soviet Union. Inaccurate diagnoses that justified hospitalization of political dissidents was common. We American psychiatrists led the successful campaign to help stop that practice in the Soviet Union back in the 1970s.
What is important about any public figure’s behavior is the consequence of the behavior—not any diagnoses we make from afar. And in the case of the behavior of Donald Trump or any US President, the good of the people, the country, and the world, are ultimately at stake.