What Can We Say About the Presidential Debate?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Although I wanted to write a column on the debate the day after, on Friday, as I usually do about some important social psychiatric event, I felt dazed and confused. What just happened, and why? Various psychiatric and neurological possibilities came to mind in regard to both sides. Yet, it also seemed that I probably should not publicly speculate more specifically about such possibilities because that would likely be a violation of the American Psychiatric Association’s ethical “Goldwater Rule” that prohibits using our knowledge to discuss any public figures publicly.

Days later, I still feel uncertain about what to write or present. Maybe the best I can do is to comment on the debate event itself. It reminded me of a couple’s therapy evaluation. A clinician asks questions to both parties, but at its most unresolvable, receives very different and contentious responses. The truth is hard to obtain. Were all the important questions asked?

It also reminds me of my cross-cultural work, the challenges of working with patients who come from different cultures than mine. Here, cultural humility is required, best conveyed by curiosity, respect, and dignity. What is less recognized is that such cultural differences can be political besides ethnic, religious, and other identity differences.¹

Perhaps the best that an evaluator can do in such a situation is to suggest follow-up individual evaluations. Yet, we have no requirement that our presidential candidates obtain an objective and complete general medical, neurological, or psychiatric evaluation, objective meaning not just a report from their own physician. I hope that happens voluntarily or from demands of each party.

On a larger system level, the follow-up on both sides reminded me some of gaslighting. Gaslighting is a form of psychological manipulation where the reality of what is seen is denied and distorted by those in control of the information and interpretation.

For now, then, the nomination process feels to me like a crisis in what is thought to be the Chinese conception: both a danger and an opportunity.

The danger is certainly to elect a President who may cause more harm than good. More than likely, our next president will have to be able to conduct complex discussions with adversary leaders. Besides the ethical admonition for our public silence about public figures, as psychiatrists we also have the ethical responsibility to speak out when danger to others seems clear enough. When an ethical conflict is apparent, do we choose personal confidentiality or public safety?

The opportunity is enough time to realistically reassure the public or to find new nomination options. In fact, that is reminiscent of what political parties did until the 1970s: choose their nominees at the conventions. There is also enough time to answer the mental health questions I posed last week which were generally ignored by the moderators.

This debate is personal, too. I am the age of the 2 current presidential nominees. I hope that I am able to see and accept—or have my loved ones and colleagues convince me—that I no longer am capable to do these columns and the related videos adequately. Age itself, though, is not the limitation. With age can come more wisdom from experience, but with age can also come related and irreversible debilitating medical problems, as well as denial of limitations. That complexity is what needs to try to be teased out as best as possible, one way or another in me, the presidential nominees, and all elders.

Somehow, and I know that is debatable, too, we in psychiatry must contribute to the presidential process with our expertise. Too much is at stake to not at least try.

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.

Reference

1. Haidt J. The Righteous Mind: Why Good People Are Divided By Politics and Religion. Vintage; 2013.