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

[Bob001]

.....
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.

But Trump's motivations matter. I probably wouldn't agree with the extreme right-wing about much of anything, but I recognize that Cruz, Pence etc. are capable of absorbing facts and shaping their decisions accordingly. I don't think those guys would ever ask "Why do we have nuclear weapons if we don't use them?," as Trump has reliably been quoted. It is Trump's basic disconnection from reality -- as revealed in his countless lies, exaggerations and threats, and his extreme ignorance -- that are most disturbing, and are the result of his psychiatric issues, not policy disputes.

 

[Skeptic Ginger]

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....

I think Trump's cognitive decline would be considered 'mild' were he getting a medical evaluation. There is no reason a POTUS with mild cognitive decline should worry anyone. If it progressed, that would be a different story.

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. [snip]

It is my opinion you are ignoring blatantly obvious evidence.

...
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?

If you think Clinton had a pathology and Trump doesn't, I can only conclude you are filtering your observations through a partisan lens.

Why do you think so many professionals are weighing in that Trump has a pathology? Do you think his obsession with himself is just an eccentricity?

Even top members in the GOP are calling Trump bat **** crazy.

 

[Skeptic Ginger]

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.

I am not aware of such a reporting law or responsibility. If you find one I'd be interested in reading it.

 

[blutoski]

I am not aware of such a reporting law or responsibility. If you find one I'd be interested in reading it.

Do you mean you're not aware of any law like that in any jurisdiction? I can describe the local versions here in DC as pertaining to psychiatry. I can locate the list of criteria for BC MDs. As you can imagine, if a person is diagnosed as floridly psychotic, it's not "discretionary" for the MD to decide whether the pt can walk out of emerg or not. There's an established protocol. MDs who fail are at risk of losing their license (there are some high profile cases in Canada recently about this)

There are other criteria, for various different conditions as well. For example, GPs and Opticians are required to report knowledge of a legally blind person who admits to driving - my diabetic aunt was reported by her GP when her retinas became too damaged.

Or is this specifically about DC?

 

[blutoski]

I think Trump's cognitive decline would be considered 'mild' were he getting a medical evaluation. There is no reason a POTUS with mild cognitive decline should worry anyone. If it progressed, that would be a different story.

It will progress, because it's almost certainly due to his age.

Many (perhaps the majority - perhaps all) politicians are narcissists, it's never been a barrier to performance. Dementia, on the other hand, has a historical precedent for justifying expedited retirements &c.

It is my opinion you are ignoring blatantly obvious evidence.

If you think Clinton had a pathology and Trump doesn't, I can only conclude you are filtering your observations through a partisan lens.

Why do you think so many professionals are weighing in that Trump has a pathology? Do you think his obsession with himself is just an eccentricity?

I think an alternative answer is: because people let their political opinions bias their judgement (I think you concede this as a possibility immediately above?), and he is a very polarizing politician that raises emotions in an unprecedented scale.

Even top members in the GOP are calling Trump bat **** crazy.

It's entirely possible, sure. Dunno, I'm not a doctor. I'm sure their opinions are as uninformed as mine.

 

[blutoski]

I repeat, Trump is our employee. We are entitled to judge his fitness for his job.

This, I agree with. The procedure should be to advocate for him to get a psychiatric exam. I'm all for it.

 

[blutoski]

But Trump's motivations matter. I probably wouldn't agree with the extreme right-wing about much of anything, but I recognize that Cruz, Pence etc. are capable of absorbing facts and shaping their decisions accordingly. I don't think those guys would ever ask "Why do we have nuclear weapons if we don't use them?," as Trump has reliably been quoted. It is Trump's basic disconnection from reality -- as revealed in his countless lies, exaggerations and threats, and his extreme ignorance -- that are most disturbing, and are the result of his psychiatric issues, not policy disputes.

I don't think we can conclude that. He's also noticeably the only one in that list who is not a professional politician. It's possible his ignorance about managing a government originates in his complete lack of experience in such a role.

Ignorant and misinformed is not a mental illness.

 

[blutoski]

Do you mean you're not aware of any law like that in any jurisdiction? I can describe the local versions here in DC as pertaining to psychiatry. I can locate the list of criteria for BC MDs. As you can imagine, if a person is diagnosed as floridly psychotic, it's not "discretionary" for the MD to decide whether the pt can walk out of emerg or not. There's an established protocol. MDs who fail are at risk of losing their license (there are some high profile cases in Canada recently about this)

There are other criteria, for various different conditions as well. For example, GPs and Opticians are required to report knowledge of a legally blind person who admits to driving - my diabetic aunt was reported by her GP when her retinas became too damaged.

Or is this specifically about DC?

Just following up on your request, here's the BC College's primer on the [Duty to Report]

So, examples include a mandatory requirement to report, say, child abuse. Need to report all deaths. There's a list of reportable contagious illnesses. Injuries from a motor vehicle accident.

I'll dig a bit more, there are special clauses in the BC Mental Health Act regarding what is mandatory for involuntary status, and reporting to the health district / slash / police.

 

[Jodie]

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.

Respectfully, you may be right, but without actually evaluating the man in person you can't make a definitive diagnosis any better than I or anyone else can who doesn't personally have contact with him.

 

[Skeptic Ginger]

Do you mean you're not aware of any law like that in any jurisdiction? I can describe the local versions here in DC as pertaining to psychiatry. I can locate the list of criteria for BC MDs. As you can imagine, if a person is diagnosed as floridly psychotic, it's not "discretionary" for the MD to decide whether the pt can walk out of emerg or not. There's an established protocol. MDs who fail are at risk of losing their license (there are some high profile cases in Canada recently about this)

There are other criteria, for various different conditions as well. For example, GPs and Opticians are required to report knowledge of a legally blind person who admits to driving - my diabetic aunt was reported by her GP when her retinas became too damaged.

Or is this specifically about DC?

I've never seen a law requiring a medical provider to report a diagnosed mental illness in a legislator. In this state such a report would be serious a violation of confidentiality. If one has evidence of child abuse, sexual abuse, or a crime (I once reported welfare fraud) then reporting is mandatory. But reporting someone's mental illness, we are prohibited by law from telling anyone not involved in the patient's care.

So if you know of any law in Canada or the US, I'd be interested in reading it.

 

[Skeptic Ginger]

It will progress, because it's almost certainly due to his age.

Many (perhaps the majority - perhaps all) politicians are narcissists, it's never been a barrier to performance. Dementia, on the other hand, has a historical precedent for justifying expedited retirements &c.

I think an alternative answer is: because people let their political opinions bias their judgement (I think you concede this as a possibility immediately above?), and he is a very polarizing politician that raises emotions in an unprecedented scale.

It's entirely possible, sure. Dunno, I'm not a doctor. I'm sure their opinions are as uninformed as mine.

While personality qualities like narcissism do fall on a continuum, Trump's clearly crosses the line into pathology.

I don't need to argue my opinion, many other professionals share it, and the evidence Trump meets the diagnostic criteria is overwhelming.

 

[Skeptic Ginger]

Just following up on your request, here's the BC College's primer on the [Duty to Report]

So, examples include a mandatory requirement to report, say, child abuse. Need to report all deaths. There's a list of reportable contagious illnesses. Injuries from a motor vehicle accident.

I'll dig a bit more, there are special clauses in the BC Mental Health Act regarding what is mandatory for involuntary status, and reporting to the health district / slash / police.

I'll have to look that over.

 

[Skeptic Ginger]

Respectfully, you may be right, but without actually evaluating the man in person you can't make a definitive diagnosis any better than I or anyone else can who doesn't personally have contact with him.

I respect your opinion but don't share it. No one yet in this thread has been able to describe just what would be gained from an in-person exam that we don't already have overwhelming evidence of.

It's a knee-jerk response, "always must see patient in person". It doesn't allow for exceptions, two of which have been discussed in the thread. One is in forensic procedures where someone might profile a suspect or report on a person who refuses an evaluation. And the second one is Trump where the amount of evidence available is more than sufficient to draw a diagnostic conclusion.

 

[blutoski]

I'll have to look that over.

I hope the concept isn't controversial - Duty to Warn regarding a person with mental illness in a sensitive occupation is explicitly cited by the Yale University profs as justification for going public with their concerns.

The debate is whether this is a qualifying situation, if their concerns are not based on a diagnosis obtained through their profession's accepted practice.

 

[blutoski]

While personality qualities like narcissism do fall on a continuum, Trump's clearly crosses the line into pathology.

I don't need to argue my opinion, many other professionals share it, and the evidence Trump meets the diagnostic criteria is overwhelming.

And other professionals disagree - they have good reasons, IMO (specifically, where's the life consequences?) and I mainly disagree that they actually have this evidence. Their cited evidence is not sufficient in my opinion, having been obtained through an unreliable method.

 

[Skeptic Ginger]

I hope the concept isn't controversial

Of course not.

- Duty to Warn regarding a person with mental illness in a sensitive occupation is explicitly cited by the Yale University profs as justification for going public with their concerns.

But those professionals are not using information about Trump that is confidential, so there is a difference.

The debate is whether this is a qualifying situation, if their concerns are not based on a diagnosis obtained through their profession's accepted practice.

That and the laws in this state on confidentiality of mental illness information appear to differ from that in BC.

If I thought a patient was going to commit a crime, like get a gun and shoot someone, or if I thought a surgeon was practicing under the influence, I would have a duty to warn. But it's a bit more gray when it comes to legislators, which is why I need time to look at the details on your link.

 

[blutoski]

I've never seen a law requiring a medical provider to report a diagnosed mental illness in a legislator.

The Duty to Warn is not a list of occupations that are reportworthy. It's a high level "if there's a danger to self or the public" qualification. Politicians aren't special in that regard, and I think it's actually taken for granted within government operations that mentally ill politicians who are genuinely dangerous need to be identified and either treated or forced to resign.

There's actually some documentation of the increased formal White House psychiatric monitoring of Lyndon B. Johnson, as he was becoming unstable during the expansion of the Vietnam War. They were genuinely worried he'd crack and be useless in a domestic or defense crisis.

In this state such a report would be serious a violation of confidentiality.

Duty to Warn legally protects the MD from confidentiality breach charges - arguably, that's the purpose of the legislation.

If one has evidence of child abuse, sexual abuse, or a crime (I once reported welfare fraud) then reporting is mandatory. But reporting someone's mental illness, we are prohibited by law from telling anyone not involved in the patient's care.

So if you know of any law in Canada or the US, I'd be interested in reading it.

This site lists which US states have psychiatric mandatory/permissive Duty to Report legislation.

[MENTAL HEALTH PROFESSIONALS’ DUTY TO WARN]

Washington is a Mandatory Duty to Warn state, which means that not only is there no conflict with patient confidentiality, a psychiatrist who neglected this responsibility could be criminally liable.

DC is Permissive, which means in DC a psychiatrist is protected from privacy violations if they report a potentially dangerous diagnosed patient in good faith, but they don't have to report.

Basically, what I was trying to clarify is that there's no "Catch-22" for the scenario where an actual in-person exam produces a diagnosis, the MD can report it to the appropriate authorities without concern of conflicting with patient confidentiality.

 

[Ron_Tomkins]

You know, what depresses me the most about this, is that everything that's going on right now in the United States is almost a carbon copy of the exact situation that happened when Chavez became President.

He too, was a controversial figure that no one ever considered would run for President, let alone win.

He too, won by a landslide.

He too was received with immense backlash from the media, which he accused of being biased against him, launching a never ending conflict between him and the media, which he constantly disqualified.

And now, this: People, in their desperation, are trying to get "experts" to say publicly that he's clinically insane.

Well, let me tell you: You're wasting your time. I've lived this whole **** and I know how it ends: And it doesn't end with the guy in power getting impeached.



Yes, I'm aware the United States is a very different country from Venezuela. But some patterns of behavior never change.

 

[blutoski]

Of course not.

But those professionals are not using information about Trump that is confidential, so there is a difference.

Their diagnosis would be confidential.
I think that's the reason they cite the Duty to Warn, as they appreciate they would be publicly revealing a medical condition. They believe it is justified based on the danger.

That and the laws in this state on confidentiality of mental illness information appear to differ from that in BC.

If I thought a patient was going to commit a crime, like get a gun and shoot someone, or if I thought a surgeon was practicing under the influence, I would have a duty to warn. But it's a bit more gray when it comes to legislators, which is why I need time to look at the details on your link.

I'd recommend looking at the one I just posted instead, the American one. It shows that WA is a mandatory reporting state, and reporting to the appropriate authorities indemnifies the psychiatrist from any penalty for breach of confidentiality.

 

[xjx388]

The Duty to Warn is not a list of occupations that are reportworthy. It's a high level "if there's a danger to self or the public" qualification. Politicians aren't special in that regard, and I think it's actually taken for granted within government operations that mentally ill politicians who are genuinely dangerous need to be identified and either treated or forced to resign.

There's actually some documentation of the increased formal White House psychiatric monitoring of Lyndon B. Johnson, as he was becoming unstable during the expansion of the Vietnam War. They were genuinely worried he'd crack and be useless in a domestic or defense crisis.





Duty to Warn legally protects the MD from confidentiality breach charges - arguably, that's the purpose of the legislation.





This site lists which US states have psychiatric mandatory/permissive Duty to Report legislation.

[MENTAL HEALTH PROFESSIONALS’ DUTY TO WARN]

Washington is a Mandatory Duty to Warn state, which means that not only is there no conflict with patient confidentiality, a psychiatrist who neglected this responsibility could be criminally liable.

DC is Permissive, which means in DC a psychiatrist is protected from privacy violations if they report a potentially dangerous diagnosed patient in good faith, but they don't have to report.

Basically, what I was trying to clarify is that there's no "Catch-22" for the scenario where an actual in-person exam produces a diagnosis, the MD can report it to the appropriate authorities without concern of conflicting with patient confidentiality.

Not only that, a duty to warn only applies when there is an imminent threat: a patient makes a specific threat towards a person or the public. In Trump's case, what's the specific threat? Funny how no one can tell us that despite the mountain of "evidence" that leads them to warn us about his dangerousness...


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