Donald Trump has 'dangerous mental illness', say psychiatry experts at Yale conferenc

[Giordano]

Sure I do. The first scenario is an actual medical encounter where the doctor examines and treats the patient using sound medical science. The second scenario is not a medical encounter, therefore, there is no valid medical information being generated and no valid medical science being practiced. I would like to know if SG gets that difference.

Lawyers and accountants don't have the same ethical and legal restrictions as doctors do. Lawsuits are public record as are tax suits and liens. There is no medical information that is public record because it's recognize as very personal and intimate. Funny, then, how we don't require Presidents to submit extensive financial and legal records. Since we don't require candidates to submit any other confidential documents, why would we start doing so with something as intimate as their medical records?

I fail to see the distinction you see:

Lawyers are free to form legal conclusions and to discuss their conclusions quite openly based on information and "facts" that go way beyond, or have nothing to do with, what is available in official public records of law suits, taxes, etc. How many discussions by lawyers have you seen on TV relating to the constitutionality or legal ethics of a President's actions based on information that has never been adjudicated in court or presented under oath? The vast bulk of the information used by these lawyers to form their viewpoints is obtained from "the news" rather than from from any official source or from a professional relationship with a client (and of course discussing the latter would be unethical). Trump hints that he might fire Mueller- a firestorm of legal opinions follows in the total absence of any official action by Trump.

Of ours the more detailed (including insider) information a lawyer has the more accurate their legal opinion is likely to be.

As I see it he same exact situation applies to medical doctors. A doctor can strongly suspect that someone is heavily hemorrhaging based on television footage. Certainly seeing that individual as a patient would help confirm such a diagnosis but the situation is not quite as black or white as you imply. It would be quite reasonable for a doctor, after viewing a video, to state publicly "Gee I think that person is hemorrhaging- in my opinion they should go to an ER."

As with physical medicine a professional needs to communicate the limitations of their diagnosis/viewpoint when providing it. I have no problem if a psychiatrist states on Fox News that "I am a psychiatrist and I think that Trump's is mentally ill" if they make it clear that view is based "only" on public information. Further, medical people have to make diagnoses based on what information they have- the accuracy of a diagnosis increases with the more information they have- there is no magic line where suddenly a diagnosis is definitive. Let's say a psychiatrist gets to talk to Trump in a medical office for an hour- is that now enough for a legitimate right to make a (private) diagnosis? Or two hours? In many ways Trump's publicly documented behavior provides a very rich and valuable resource for judging his metal and emotional stability, better as others have pointed out, than an office visit when he might be on his best behavior. In fact I am certain that many people have been diagnosed as mentally ill based on documented facts and testimony by others, rather than based on their cautious and scripted behavior during an interview with the psychiatrist.

 

[Skeptic Ginger]

No need, I remember that it was simply a cite of the state law that allows you to practice medicine. You would need to cite something more detailed about the FP APRN scope of practice. [snipped ]

Your memory is poor, it included citations discussing why/how family practice includes basic psychiatric diagnoses and treatment.

This is more Dunning Kruger, BTW. You seem to think you know a lot about family practice but your posts say you don't.

Yes, one of the professors who signed on to this mockery of medicine. Why should we accept the words of a professional who doesn't follow professional standards?

Uh, maybe because he's a professor of psychiatry (at Harvard IIRC).

 

[phiwum]

I fail to see the distinction you see:

Lawyers are free to form legal conclusions and to discuss their conclusions quite openly based on information and "facts" that go way beyond, or have nothing to do with, what is available in official public records of law suits, taxes, etc. How many discussions by lawyers have you seen on TV relating to the constitutionality or legal ethics of a President's actions based on information that has never been adjudicated in court or presented under oath? The vast bulk of the information used by these lawyers to form their viewpoints is obtained from "the news" rather than from from any official source or from a professional relationship with a client (and of course discussing the latter would be unethical). Trump hints that he might fire Mueller- a firestorm of legal opinions follows in the total absence of any official action by Trump.

Of ours the more detailed (including insider) information a lawyer has the more accurate their legal opinion is likely to be.

As I see it he same exact situation applies to medical doctors. A doctor can strongly suspect that someone is heavily hemorrhaging based on television footage. Certainly seeing that individual as a patient would help confirm such a diagnosis but the situation is not quite as black or white as you imply. It would be quite reasonable for a doctor, after viewing a video, to state publicly "Gee I think that person is hemorrhaging- in my opinion they should go to an ER."

As with physical medicine a professional needs to communicate the limitations of their diagnosis/viewpoint when providing it. I have no problem if a psychiatrist states on Fox News that "I am a psychiatrist and I think that Trump's is mentally ill" if they make it clear that view is based "only" on public information. Further, medical people have to make diagnoses based on what information they have- the accuracy of a diagnosis increases with the more information they have- there is no magic line where suddenly a diagnosis is definitive. Let's say a psychiatrist gets to talk to Trump in a medical office for an hour- is that now enough for a legitimate right to make a (private) diagnosis? Or two hours? In many ways Trump's publicly documented behavior provides a very rich and valuable resource for judging his metal and emotional stability, better as others have pointed out, than an office visit when he might be on his best behavior. In fact I am certain that many people have been diagnosed as mentally ill based on documented facts and testimony by others, rather than based on their cautious and scripted behavior during an interview with the psychiatrist.

Medical professionals are bound by HIPAA. Attorneys are bound by other laws and rules. The analogy doesn't work.

Sent from my SM-G950U using Tapatalk

 

[Skeptic Ginger]

... I have no problem if a psychiatrist states on Fox News that "I am a psychiatrist and I think that Trump's is mentally ill" if they make it clear that view is based "only" on public information.

With Trump, this is a given and it's been stated over and over by the experts involved that Trump's public behavior is what we are all going by.

... Let's say a psychiatrist gets to talk to Trump in a medical office for an hour- is that now enough for a legitimate right to make a (private) diagnosis?

If you are asking is this now a matter of confidentiality, then pretty much, yes because at that point you could no longer say your assessment was based on publicly available information.

Which brings up a catch 22 if a professional wanted to discuss Trump's mental status as a matter of public safety and interest. If said provider did diagnose Trump with an in-person evaluation, said provider could not then discuss the situation publicly.

....In fact I am certain that many people have been diagnosed as mentally ill based on documented facts and testimony by others, rather than based on their cautious and scripted behavior during an interview with the psychiatrist.

Absolutely.

 

[Skeptic Ginger]

Medical professionals are bound by HIPAA. Attorneys are bound by other laws and rules. The analogy doesn't work.

So what? The principles are the same, maybe a few rules differ. If I see evidence of child or sexual abuse I am obligated to report it. A lawyer is only obligated to report crimes that are about to or likely to happen but not anything the client says about crimes they committed.

But both professions are bound by rules governing information they obtain during the work they are doing.

 

[xjx388]

I fail to see the distinction you see:

Lawyers are free to form legal conclusions and to discuss their conclusions quite openly based on information and "facts" that go way beyond, or have nothing to do with, what is available in official public records of law suits, taxes, etc.

Lawyers are not bound by any ethical code forbidding them from discussing the legal matters of public figures. Legal information is not protected by law in the same way medical information is.

How many discussions by lawyers have you seen on TV relating to the constitutionality or legal ethics of a President's actions based on information that has never been adjudicated in court or presented under oath?

They are discussing matters which are public record.

The vast bulk of the information used by these lawyers to form their viewpoints is obtained from "the news" rather than from from any official source or from a professional relationship with a client (and of course discussing the latter would be unethical). Trump hints that he might fire Mueller- a firestorm of legal opinions follows in the total absence of any official action by Trump.

Trump takes a public action and the pundits talk about it. Yes, this is perfectly fine and does not violate any ethical codes or laws.

Of ours the more detailed (including insider) information a lawyer has the more accurate their legal opinion is likely to be.

As I see it he same exact situation applies to medical doctors. A doctor can strongly suspect that someone is heavily hemorrhaging based on television footage. Certainly seeing that individual as a patient would help confirm such a diagnosis but the situation is not quite as black or white as you imply. It would be quite reasonable for a doctor, after viewing a video, to state publicly "Gee I think that person is hemorrhaging- in my opinion they should go to an ER."

You are not describing a diagnosis. Anyone can see massive bleeding and say, "Hey, maybe you should go to the ER." A diagnosis would be, "The hemorrhaging is the result of cocaine abuse." You would agree that a doctor observing from the street does not have enough information to definitively say that, yes?

As with physical medicine a professional needs to communicate the limitations of their diagnosis/viewpoint when providing it. I have no problem if a psychiatrist states on Fox News that "I am a psychiatrist and I think that Trump's is mentally ill" if they make it clear that view is based "only" on public information.

The APA disagrees with you. And all doctors are ethically proscribed from commenting directly about public figures.

Further, medical people have to make diagnoses based on what information they have- the accuracy of a diagnosis increases with the more information they have- there is no magic line where suddenly a diagnosis is definitive. Let's say a psychiatrist gets to talk to Trump in a medical office for an hour- is that now enough for a legitimate right to make a (private) diagnosis? Or two hours?

It would be a hell of a lot more accurate than someone who has never even met the dude.

In many ways Trump's publicly documented behavior provides a very rich and valuable resource for judging his metal and emotional stability, better as others have pointed out, than an office visit when he might be on his best behavior. In fact I am certain that many people have been diagnosed as mentally ill based on documented facts and testimony by others, rather than based on their cautious and scripted behavior during an interview with the psychiatrist.

You are free to point those cases out but I think you are wrong. No one is diagnosed with anything until they have been properly examined by a qualified professional. Psychiatrists are trained to work around patients who are putting on a show.

 

[Emily's Cat]

@Emily's Cat:

I'll add you to the list with Bob and xjx388 of the people in the thread that don't understand the concept of information you obtain in the line of work and that which you do not.

I really love how knowledgeable you are. I mean, here you are, an ARNP specializing in family practice and infectious disease control, with as much knowledge of mental health diagnosis and treatment as a board certified Psychologist or Psychiatrist, and a complete understanding of medical facility management, and an incredible depth of knowledge about health insurance, third-party payers, business associates, and all things related.

For someone who bandies about 'Dunning-Kruger' as your insult of choice, you sure don't seem to have a grasp on the set of things that you may not be an expert on.

 

[Emily's Cat]

I understand this issue and how it is often part of the criteria that are evaluated by mental health professionals attempting to diagnose mental illness. Essentially if a mental or emotional "condition" is not interfering with the ability of the individual to function in society then it is not necessarily an illness. This is of course from the perspective of the relationship of the healthcare provider to their patient: there is nothing to "cure" if their patient is doing just fine as is. Sort of defines the distinction between eccentric versus crazy (speaking informally).

However this is not the only criterion for a legitimate diagnosis of mental illness. Mental illness can include conditions that represent threats to others in society. A deranged serial killer may be very successful both in their day job and in their "hobby" and thus from their own perspective are functioning very well, but I doubt that their "success" would preclude a diagnosis of mental illness. They may have had the same mental illness from childhood and may have begun killing people as soon as they were old enough to do so.

I understand you are bringing this point up as a caution ("weakens the reliability...") but I wanted to flesh out the other perspective. And again- I am not making an "actual diagnosis." I am simply stating what I suspect a very large number of people also conclude from Trump's behavior. In fact whether he is clinically crazy is not all that important to me (I don't believe "crazy" is even used as an official term anymore). But he is "crazy" in the popularly accepted sense of the word, which is sufficient to make him a very dangerous man as POTUS.

I don't have any problem at all with identifying Trump as a horrible jerk, who really shouldn't have managed to win the presidency, and who really probably shouldn't be in charge of the country. "Crazy" or not, he's simple not professional and presidential. Seriously, at a minimum someone needs to change the password on his twitter account, or take away his damned phone!

I'd be perfectly happy to see him removed from office for legitimate reasons. But I don't condone the approach being used here. I have a significant number of ethical concerns about the precedent being set.

 

[Emily's Cat]

Again @Emily's Cat: if you look back in the thread I posted citations how and why diagnosing something like a narcissistic personality disorder was well within the scope of practice of a family nurse practitioner. That is basic family practice, not specialty practice.

We treat the whole person, you can't approach any patient with limited tunnel vision. That would be ridiculous. In addition, the NP is often the first to see a patient with disorders that require specialty care. If you didn't recognize a fairly simple psychiatric condition, that would be pretty incompetent for family practice.

BTW, I love it that people who obviously don't know **** about nurse practitioners think they know what my scope of practice is. I'm pretty sure after more than three decades as an NP, I know what my scope of practice is.

1) Narcissistic Personality Disorder doesn't appear to be considered a "simple psychiatric condition". By all accounts, it's one of the more complex personality disorders.

2) The NP is certainly often the first to see a patient with a disorder that requires specialty care. But the NP is not making the diagnosis of that disorder, the NP refers the patient to the specialist... because it requires specialty care.

3) I respect your knowledge in your field. I also respect the regulations in the state of Washington which require an NP to have specialty training certified by an appropriate body in order to provide mental health services within their practice. That's a certification that you have freely admitted that you do not have.

For goodness sakes, I know a ton of incredibly skilled and knowledgeable underwriters with decades of experience producing composite rates for insurance sales... but they're still not qualified to opine on the sufficiency of the rate development, nor are they allowed to submit rate filings on behalf of their company!

Knowing a lot about your field does not mean that you know anything at all about someone else's field.

 

[Emily's Cat]

That's it exactly. Nothing he does outside a psychiatrist's office matters. He could stand on New York's Fifth Avenue and shoot someone - then bash their head in and start eating their brains - and nobody would be qualified to say that he is crazy.

Feel free to say he's crazy. Crazy isn't a diagnosis.

A Layperson can give their uninformed opinion that the crazy person is schizophrenic to their heart's content - they're not qualified to make that diagnosis, and their opinion carries no authority.

But a medical professional should not use their medical authority in order to make a diagnosis on incomplete information and without appropriate practice standards. Hell, if a board certified psychiatrist wants to refer to Trump as 'crazy' I have no objection to that! But if they want to say that Trump has NPD, then they damned well better have evaluated him and controlled for other potential causes of his observed behavior.

 

[Emily's Cat]

Your memory is poor, it included citations discussing why/how family practice includes basic psychiatric diagnoses and treatment.

The problem is that you've made the mistake of assuming that personality disorders fall into the category of 'simple' and 'basic' diagnoses.

 

[Jodie]

Early onset Alzheimer's begins before the age of 65. On average, early onset would be a lot further along in a 70 yr old.

Regardless, Trump's narcissistic behavior is not new. For example, he has for decades surrounded himself with pictures of himself like those displayed at Mir-a-lago. You can go back years and you'll see the same narcissism symptoms.

I don't think that is necessarily a symptom of narcissistic personality disorder.

 

[Skeptic Ginger]

I don't think that is necessarily a symptom of narcissistic personality disorder.

Are you talking about Trump's history of self-adulation? The Trump photos are one example, not the full range of evidence.

Are you in the same camp as blutoski's psychiatrist wife who thinks Trump has more dementia than narcissism?

I respectfully disagree and frankly think any professionals that can't see Trump's pathologic narcissism are not looking at all the evidence.

I do think his vocabulary suggests mild cognitive decline. Evidence has been in the news reports that he used to be much more articulate. But that's not his main issue.

 

[Craig B]

This letter to the First Minister of Scotland does little to ease doubts about Trump's mental state.

 

[xjx388]

I respectfully disagree and frankly think any professionals that can't see Trump's pathologic narcissism are not looking at all the evidence.

Or, you know, they admit they haven't examined/interviewed him personally so they may not have all the evidence. Most providers, thank The Maker, understand the limitations of diagnosis from afar.

 

[blutoski]

Are you talking about Trump's history of self-adulation? The Trump photos are one example, not the full range of evidence.

Are you in the same camp as blutoski's psychiatrist wife who thinks Trump has more dementia than narcissism?

Just to clarify: I'm not sure she said "more" dementia than narcissism. Granted, both have a continuum, but diagnoses are binary. (he has X or he doesn't) Her opinion was that the evidence was more convincing for dementia than NPD.

Further clarification: it's not about whether he's narcissistic (he obviously is), but whether he qualifies for Narcissistic Personality Disorder.

An analogy is depression. Depressed people don't necessarily have clinical depression, but we can all observe they're depressed if they show the signs. The former is a colloquially described emotion we are all qualified to identify; the latter is a medical diagnosis that requires a professional examination.

And secondly, in the grand scheme of things, even if a psychiatrist were to determine that he has both narcissism and dementia, that narcissism is not a cause for alarm, as it is a personality descriptor. (As opposed to Narcissistic Personality Disorder). Dementia, on the other hand, is a flat our alarm bell for anybody in an executive leadership position, very obviously so where nukes are involved. I don't know this for a fact, but I'd be shocked if dementia that impacts an essential services occupation is not mandatory reportable in DC.

I respectfully disagree and frankly think any professionals that can't see Trump's pathologic narcissism are not looking at all the evidence.

I do think his vocabulary suggests mild cognitive decline. Evidence has been in the news reports that he used to be much more articulate. But that's not his main issue.

In terms of qualifications for office, my understanding is that cognitive decline from senescence is more important than the cluster Bs (PDs) and probably more important than most other psychiatric diagnoses as well. Again, clinical depression comes to mind. I seem to recall that Kennedy had recurring clinical depression, but the medical diagnosis did not disqualify him for office, and thank the Random Quanta. Another that comes to mind is Churchill, who admits to being periodically disabled by severe clinical depression.

So, to this extent, it's a tempest in a teapot. Other political candidates fit the description, they're not disqualified (IMO, Hillary Clinton is a better fit for NPD, as she has failed to achieve her goals - a key diagnostic feature of NPD) so why the interest in this guy?

 

[blutoski]

I really love how knowledgeable you are. I mean, here you are, an ARNP specializing in family practice and infectious disease control, with as much knowledge of mental health diagnosis and treatment as a board certified Psychologist or Psychiatrist, and a complete understanding of medical facility management, and an incredible depth of knowledge about health insurance, third-party payers, business associates, and all things related.

For someone who bandies about 'Dunning-Kruger' as your insult of choice, you sure don't seem to have a grasp on the set of things that you may not be an expert on.

And even if she did, it's not her call, to be frank.

An easy way to confirm qualifications would be to fire off an email to the appropriate certification authority and ask:

• does a person with this certification have the qualifications to diagnose NPD ?
• if so, can they do it through media, or is an in-person structured interview necessary ?

If the answer is 'no' then it's Burzynski zone, where normally Skeptics voice disapproval.

 

[blutoski]

Which brings up a catch 22 if a professional wanted to discuss Trump's mental status as a matter of public safety and interest. If said provider did diagnose Trump with an in-person evaluation, said provider could not then discuss the situation publicly.

I'm not sure there's a catch 22. It would shock me if a legitimate and impacting diagnosis in a sensitive occupation doesn't have mandatory reporting in DC.

No, it won't be "public" in the sense of 'tabloid news,' but the appropriate (public) authorities would be engaged in such a way to protect patient privacy, even if that's somebody in the West Wing, which is obviously suboptimal.

 

[Bob001]

.....
You are not describing a diagnosis. Anyone can see massive bleeding and say, "Hey, maybe you should go to the ER." A diagnosis would be, "The hemorrhaging is the result of cocaine abuse." You would agree that a doctor observing from the street does not have enough information to definitively say that, yes?
.....

What you don't seem willing to accept is that psychiatric illness is largely determined by the subject's thinking and behavior. For someone who is severely disturbed, the shrink might not even care much what the subject says about himself vs. what the shrink observes, and what his family, neighbors, victims, police etc. say about him. There is plenty of incontrovertible evidence of Trump's thinking and behavior. A detailed examination might be required to determine where he went off the rails and how to treat him medically. But that's different from observing what's wrong by looking at what's in front of you and assessing how it may affect his performance in office. I repeat, Trump is our employee. We are entitled to judge his fitness for his job.

 

[xjx388]

What you don't seem willing to accept is that psychiatric illness is largely determined by the subject's thinking and behavior.

I realize that. I also realize that illness is diagnosed by analyzing a patient's thinking and behavior in a clinical setting. What you and others are advocating here is distance diagnosis by people who have never met or spoken to the subject and may be acting out of a political or personal bias -and then passing this off as a genuine expert opinion and accurate diagnosis.

For someone who is severely disturbed, the shrink might not even care much what the subject says about himself vs. what the shrink observes, and what his family, neighbors, victims, police etc. say about him. There is plenty of incontrovertible evidence of Trump's thinking and behavior. A detailed examination might be required to determine where he went off the rails and how to treat him medically. But that's different from observing what's wrong by looking at what's in front of you and assessing how it may affect his performance in office. I repeat, Trump is our employee. We are entitled to judge his fitness for his job.

You and I don't need an expert opinion to judge his fitness for the job. I'm pretty sure we are agreed that he really shouldn't be President. Did you need to hear the psychiatric diagnosis to come to this conclusion? I seriously doubt you thought Trump was qualified to be President until these docs spoke up.