Gracie Newman | Stanford University

Politicians have inarguably demanding careers. The stresses of the job are exacerbated by frequent travel, late nights, and constant criticism. They are perpetually amongst the most detested segments of the population; Aristophanes once wrote, “Characteristics of a popular politician: a horrible voice, bad breeding, and a vulgar manner.”

     To many Americans today, this depiction is represented best by Donald Trump. The president’s brash and unprecedented behavior has alarmed and offended citizens of across all demographics. There have been many angles by which activists have attempted to disqualify him from holding office - Trump has been described as arrogant, evil, idiotic, and dishonest. He is also frequently denounced as crazy. 

     These accusations carry heavier implications than might be initially evident. According to the National Alliance on Mental Illness, one in five adults are struggling with a diagnosable mental illness any given year. That amounts to about 43.8 people in the United States alone. In addition, half of all people will meet the DSM criteria for a mental illness at some point in their lifetime. Presumably, many of these people would prefer not to have their experiences and conditions equated with Donald Trump.

It has been widely suggested that legendary world leaders like Abraham Lincoln, and Winston Churchill, and Martin Luther King Jr. all struggled with mental illness. These assertions, however, are for the most part retrospective and ambiguous. American politicians often go to great lengths to conceal any potential medical issues lest they be interpreted as weakness. The accusations of Parkinson’s and Alzheimer’s disease leveled at Hillary Clinton by the right during the 2016 election exemplify the potency of the public’s concern on these topics.

The stigma surrounding psychiatric illness makes mental health problems an even more difficult subject to broach. Some of this may be due to the United States’ societal discomfort in dealing with mental health problems. The Norwegian Prime Minister Kjell Magne Bondevik took a leave of absence to deal with his depression in 1998 and was later re-elected. Thomas Eagleton, in contrast, was dropped as a U.S. Democratic vice presidential candidate in 1972 after it was publicized that he had been hospitalized for the same disease. Almost forty years later, there is still an undeniable cultural association in America between mental illness and character failings.

      Trump, of course, is not the first major politician to be accused of insanity. The clinical element is primarily what distinguishes these contemporary protestations from those of prior political eras. The recent social movement to acknowledge mental illnesses as genuine medical conditions has inadvertently created a mechanism with which people discredit political opponents using these diseases as pretext. Each claim that the president is a kook, a nutjob, or a lunatic has a more precise and serious suggestion behind it.

     Perhaps more directly problematic are those who attempt to diagnose the Commander In Chief with specific psychiatric illnesses. Many medical professionals, such as medical reporter Dr. Sanjay Gupta, warn against these “armchair diagnoses,” saying that they are ill-informed and risk perpetuating stigmatization to advance political agendas.

      Some psychiatrists, however, are also contributing their own diagnoses. This type of speculation is supposedly forbidden by American Psychiatric Association’s “Goldwater Rule,” which declared in 1973 that it is immoral for psychiatrists to give professional diagnostic opinions about public figures whom they have not examined in person or from whom they have obtained legal consent.

      Nevertheless, this emotional political era has inspired many psychiatrists to break with tradition. In October of last year, an association of mental health professionals, known collectively as Duty to Warn, marched to advocate for “Trump’s removal under the 25th Amendment on the grounds that he is psychologically unfit.” Such groups most commonly posit that the president has Narcissistic Personality Disorder or Antisocial Personality Disorder, which is more commonly known as sociopathy. Various other psychotic and mood disorders, such as Bipolar Disorder, have also been suggested.

     There have been more formal attempts to evaluate Trump’s mental competency as well. Last year, Democratic Rep. Zoe Lofgren of California, introduced a resolution in the House of Representatives asking the vice president and the cabinet to appoint both medical and psychiatric professionals to assess the president. The resolution asserted that, “President Donald J. Trump has exhibited an alarming pattern of behavior and speech causing concern that a mental disorder may have rendered him unfit and unable to fulfill his Constitutional duties." The legislation did receive much traction and did not come up for a vote.

 As early as the mid-nineties, President Jimmy Carter pushed for the establishment of a team of elite physicians who would regularly examine the chief politicians of the free world to confirm that their judgment wasn’t affected by any mental or neurological disabilities. In line with that thinking, psychiatrist Bandy Lee recently started advocating for compulsory, involuntary evaluation of Trump’s mental wellness.

The proposal to enforce obligatory psychiatric examinations for politicians is, to the least, a controversial one. There are moral and legal arguments on both sides of the discussion. (Ironically, these questions are all sprouting up as Republicans continue to attempt slashing down mental healthcare funding).

On one hand, high-ranking members of the executive branch, particularly the president, are responsible for wellbeing of all of hundreds

of millions of people. Trump holds the power to devastate the economy or start a nuclear war. As many worried Americans have pointed out, one of his irrational tweets could have catastrophic consequences. His incoherence, delusional assertions, and narcissistic self-reference make it hard to believe that Trump is the “very stable genius” he claims to be. Military officers and many federal employees are mandated to undergo psychiatric evaluations, and it is unclear why such standards would not be applied to any person assuming the most influential political position of the world’s most powerful country. Better safe than sorry, as it goes.

On the other hand, the suggestion that the diagnoses of a mental health condition automatically renders a candidate incapable is inimical to every anti-discrimination law that the U.S. has in place. The uproar about Trump’s psychological stability can be served to justify prejudice against those with mental illness, rendering them incapable and untrustworthy by proxy. Furthermore, it is a slippery slope to pathologizing any behavior with which one disagrees. This is not an improbable prediction, considering the extreme partisan divisions of American politics.

The profession of psychiatry itself is constantly evolving; at what point does somebody who is spiteful, vituperative, or irrational become mentally ill? There is evidence that even though mental illness is present across all cultures, the criteria and even expression of the same disease can differ significantly between societies. Who gets to decide what’s crazy?

Though most psychiatric professionals today look to the DSM-V for guidance, the interpretations of the diagnostic criteria can still vary depending on the doctor.  In a political era of rising populism, the extreme promises and bombastic dynamism of candidates complicates this issue further. Producing a panel of doctors that both Democrats and Republicans can agree on as an unbiased, objective committee would be challenging. If a president were to be declared mentally unfit for office, it would at best be a national embarrassment and at worst could undermine the United States’ international authority.

     There are a number of questions to consider that carry moral consequences. If a candidate does have a psychiatric disorder, should that preclude them from holding office? Are certain diseases more dangerous than others, and are these conceptions just? If a politician expresses minor symptoms of a mental illness that they have been diagnosed with, should they be removed from office? How does one objectively test to see if mental disorders are inhibiting somebody from making decisions? The philosophical roots of this debate lay in the dichotomous prioritization of either security or freedom, an issue the U.S. has struggled with since its founding.

           The underlying challenge is that both psychiatry and politics are nebulous and subjective fields. It is difficult to reach any mass consensus on what constitutes logic or sanity except for in the most egregious instances of ludicrousness. The deliberations about Trump’s psychological health brings up profound questions about America’s attitude towards mental illness, ones that country is not yet equipped to address.