What Can and Should Psychiatrists Say About the Presidential Races in the United States and Elsewhere?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

As our country’s presidential nominations fall into place, all seems quiet on the psychiatric front in the United States. Surely, our American Psychiatric Association’s “Goldwater Rule” has something to do with that, as it tries to all but eliminate any psychiatrist comment about a public figure. This ethical prohibition was even tightened in the first year of President Trump’s administration. Nevertheless, the extreme silence may also reflect something else, say some learned helplessness.

Internationally, there are scores of countries having major elections. A group of psychiatrists just recently extended the warning against psychiatric labelling of politicians internationally.¹ This widespread social challenge of leadership thereby also calls for worldwide social psychiatric reflection and response.

Whether you agree with the Goldwater Rule or not, what then does that rule seem to publicly allow to be discussed? That allowance seems to be the administrative policies of a given administration. What may be unique here in the United States is that we may have the likely potential nominees of both parties with a real presidential track record to consider. For example, back in 2019 I discussed the environmental policies of the Trump administration without any reflections about him personally.²

As a citizen, I am concerned about all that a President influences, especially the risks of public harm. However, as a psychiatrist, I am particularly concerned about mental health. In that regard, here is some of what I am particularly concerned about and would ask each nominee:

• How would you work to reduce the public mental health concern over the ever-rising prevalence of mental disorders in this country?
• What would you do to reduce the social determinants of mental health and what I call the social psychopathologies, such as racism, anti-Semitism, Islamophobia, sexism, cultish thinking, gun violence, war, and the like?
• Knowing that sometimes certain mental disturbances are helpful for certain societal situations,³ such as the depression of President Lincoln and his ensuing empathy for the disenfranchised, do you think that all who run for President should have a mental health evaluation by a neutral expert?
• Given the limitations of our current medications, would you want psychedelics legalized, and why?
• What are your views about having a national single payer health system?
• Given that humiliation can lead to revenge, do you think it is important to treat others, even those you strongly disagree with, with dignity?
• Given that the internet offers previously unavailable opportunities to humiliate and bully others, how should this internet harm be controlled?
• What would you do to reduce the epidemic rates of burnout in physicians?

If answers do not emerge from the nominees or in the media coverage, I would search for what is already on record that would help answer these questions. Since Section 7 of my APA’s ethical principles emphasizes improving the mental health of communities, silence only implicitly condones the socially influenced mental harm that already exists.

Certainly, the world has known many destructive leaders. Finding those who have the vision and practical skills to enhance the well-being of their own citizens as well as others is such a daunting and complex challenge, but our psychiatric expertise can contribute to successful leadership, if only we participate in the process.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Mahdanian A, Rosen A, Jureidini J, Puras D. A call to avoid psychiatric labelling in a historic election year. Lancet Psychiatry. January 23, 2024. Accessed January 25, 2024. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00009-9/fulltext

2. Van Susteren L, Moffic HS. The Age of Thanatos: Environmental Consequences of the Trump Presidency. In: Lee B, eds. The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess President. Thomas Dunne Books; 2019.

3. Ghaemi N. A First-Rate Madness: Uncovering the Links Between Leadership and MentalIllness. Penguin Books Reprint; 2012.