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A Short Essay on Mental Illness and the Presidency

2017-05-08

This is just thrown together off the top of my head, based on a thought I had while drinking tea on the porch.

 

The eventual subject of this essay is already obvious, but I will digress a bit if you will allow me.

Historically, there have been several instances of mental or physical/mental illness that adversely affected the operation of the Executive Branch of our government.

Arbitrarily starting at a hundred years ago, we have the example of Woodrow Wilson, a vastly learned and thoughtful man, who kept us out of WW I as long as possible so that we would have time to prepare.  The result was a spectacular victory spearheaded by our bravest young men, the end of a war that cost at least 11 million soldiers and 7 million civilians their lives (Google.)  Unfortunately, after the war and while touring the country to push a fatally flawed treaty in a hopeless attempt to get the Senate to agree to join the League of Nations Wilson suffered a disabling stroke that left him helpless for the rest of his presidency.  The stroke was dated October 2, 1919, although Wilson had numerous “mini-strokes” during September.   Wilson continued in office until March 20, 1921.

Wilson’s wife, a much younger woman who had taken over after his first wife died, took over the exercise of the executive power to the extent that she was able, with the assistance of Colonel House.  For the next  year and a half, Wilson’s illness was hidden from the press and the public.  Incredibly, Wilson thought he still had the vigor to serve a third term (which was legal in those days.)  News of the president’s stroke began to leak to the papers in February of 1920.  At that time, there was no legal mechanism to “retire” a president who had suffered a disabling illness but was till alive– and who refused to admit that he was, in fact, disabled.  The 25th Amendment, which provided clearer legal guidance, was not ratified until 1967.

President John F. Kennedy had Addison’s Disease and had to take replacement doses of cortisone to substitute for his body’s inability to produce this essential hormone.  Cortisone, especially in high doses, can cause psychotic symptoms, but there is no evidence that occurred in Kennedy’s case.  Instead, the more popular drugs of the time such as dextroamphetamine, barbituates, and other wonder drugs did un-noticed damage to his decision-making ability.  He was relatively young, however, and there is no evidence of psychic disturbance.

President Johnson, on the other hand, became increasingly paranoid during the latter part of his second term.  He was known to carry lists of people he felt were “against him.”  He also had, on paper, inaccurate or simply false data about the course of the war that he thought represented the true state of affairs.  It is fortunate for the country that he gave up and announced on national television that he was not running for another term

President Nixon is famous for his drunken late-night reveries in which he spun out his paranoid fantasies to trusted staff members.  From the time that Nixon fired his special prosecutor to the time he resigned, the executive office was simply paralyzed.  Nixon wandered about the White House late at night, drinking and delusional.  Shortly after he resigned, he suffered a life-threatening illness (phlebitis) partly due to his alcoholism and inactivity.  He never expressed any contrition or even admitted that he had committed a criminal act, and only apologized (after he was pardoned) for “not acting more decisively and more forthrightly in dealing with Watergate…”

Our current president, unlike any previous cases, was already showing florid signs of mental disorder even before he was elected.  A debate has grown up among mental health professionals over whether it is appropriate to actually come out and say that Don the Con is sick.  There is rule, called the Goldwater Rule, which was instituted among almost all mental health professional associations after the election of 1964, in which there was public speculation by some psychiatrists that Goldwater was “megalomaniac”, “paranoid”, “grossly psychotic”, and so on.  The psychiatrists were responding to a poll mailed to them by a muckraking journalist, Ralph Ginzburg, who later lost a libel suit by Goldwater– and had to pay the equivalent of half a million dollars in today’s money.

Because of the potential for “libel” and more importantly, to protect the patient’s privacy, the rule requires a mental health professional to personally examine a patient and get their express consent before publicly making any statements about that patient’s mental health or diagnosis.  Matters of general psychiatric interest to the public can be freely discussed, but one cannot speculate about a specific person’s mental health without examining them.

Unfortunately, this rule falls afoul of two other rules.  The first over-riding rule is the duty to warn.  This rule requires a mental health professional to warn potential victims of a dangerous patient if they have been informed of a threat or serious dangerous situations.  The usual scenario in which this rule comes in play is when a patient reveals in the course of therapy that they have violent intentions towards another person that the therapist knows.  In this case, the threat is that Don the Con will cause the deaths of thousands of Americans by taking away their health insurance.  There are other threats that he has made, but this is probably the most urgent.

The second over-riding rule is more complex.  It relates to the fact that Don the Con lies with such apparent facility.  This makes it necessary to interview or at least read the assessments of others who, we hope, will be more truthful about what he intends.  In addition, it is also informative to consider Don the Con’s past behavior as it has been recorded in the news media and by eyewitnesses.  Thus, the rule makes it essential to consult other sources rather than examining him directly.

Therefore, it is ethically appropriate to warn Don the Con’s potential victims (and there are many) of his diagnosis and the extent of his dangerousness to them.  Thus, making statements in a newspaper article about Don the Con are permissible, if they are qualified and do not simply repeat the obvious extent of paranoia, delusions, and narcissistic orientation– these signs are almost universal among politicians (although they are more extreme in this case) and do not readily translate into public disapproval.  What matters are his sociopathic behaviors and his threatening speech about those whom he perceives to be enemies.  It is not just the petty insults– it is the threats to use the powers of government to oppress those whom he believes to have disapproved of him.

Thus, we must state clearly that when Don the Con makes threats to use his presidential powers in unconstitutional ways this is unacceptable regardless of his mental health or lack of it.  Combined with his self-dealing and pervasive corruption, it is more than enough to justify impeachment, and after removal from office, criminal prosecution.  The twenty-five million dollar fine imposed on Don the Con in the Trump University case is not enough to make clear to him that he is violating the norms of society.  Sending him to jail and confiscating his wealth are the only fit remedies for his behavior.

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