The Red Herring of the Candidates’ (Physical) Health

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The recent Pneumonia-gate peeled off yet another layer of dangerous absurdity in this presidential election. After Hillary’s fainting episode on 9/11, the media pounced on her health problems, legitimizing the voices of  Trump surrogates, trolls and other misguided souls who have already diagnosed Clinton with everything from aphasia to autism, with no evidence to support their conclusions.

The WaPo and NYT convened their editorial boards to issue official statements of concern over the candidates’ [plural] health, demanding that they make their health history public. There was not one demand, however, that the disclosed records include results of psychological and psychiatric evaluations — either because mental health is implicitly assumed to be part of a general health exam and/or because it is a taboo subject for several reasons, one of which is the very apparent but unmentionable character defect of the GOP candidate.

And it does appear to be the latter, given the insistence with which the media pursue Hillary’s real and imagined ailments, while essentially giving a pass to her opponent who openly derides the process by, among so many other things, offering a letter about his astonishingly excellent health that seems to be created, like much of his campaign and life, as a prank. (Sadly, it/they are not.)

This is just another example of how bizarre this presidential election is, and how its bizarreness is augmented and supported by the complicit mainstream media that chase the latest outrage and focus on issues of little significance, while remaining mum about the huuuge elephant in the room, that of Trump’s profoundly deficient character. This defect has been amply evidenced in his behavior, and documented, for decades, more thoroughly than that of any other American citizen.

Whatever physical ailments Hillary or any presidential candidate may have, they are either curable or manageable. Should the worst happen, we have a vice president and others down the chain of command ready to take on the executive role. Physical ailments certainly do not disqualify presidents from office, nor pose a risk for the country and the world. America has had several competent enough commanders-in-chief with serious physical ailments before.  But we have never had a president with such seriously disordered character as Trump — yet we are not talking about it. Because ethics.

Specifically, because of the well-meaning prohibition, applied to mental health professionals, against diagnosing strange people from a distance, also known in the U.S. as the Goldwater Rule.

Well, yes, we can talk Trump’s mental unhealth if we are lay people and/or use common vernacular that does not reference his defect directly but describes it in oblique and non-biding ways, through various pejorative terms if needed (like deplorable, or a chronic liar or thin-skinned bully, for example). Lay people can also use “expertly” language, calling the candidate a psychopath, for instance; but this will be accompanied by an understanding that lay people do not possess requisite knowledge and expertise to make such assessments matter. (To their credit, lay people often nail it.)

Meanwhile, those who do possess such knowledge and expertise are prohibited, or, more accurately, strongly discouraged from making such assessments, as the American Psychiatric Association recently reminded everyone.

This is madness. (Pun intended. I think.)

It has resulted in a most peculiar version of reality where those in-the-know cannot comment on what’s apparent and the subject of their expertise; and those who see the apparent, but don’t necessarily understand it, search confusedly for explanations which are not coming, as the experts are directed to remain mum. Thank heavens for the Internets, however, and common sense, which fill the knowledge gap somewhat.

There are obvious ethical and humane reasons for not diagnosing strange people from a distance, not the least of which is sparing the pain and stigma for subjects of such diagnoses, as well as avoiding diagnostic mistakes, which are far more common than most lay (and not) people realize. Psychiatric and psychological diagnosis is not an exact science.

Nevertheless, we do know, diagnostically speaking, some things about human beings and their psychological maladies, and this knowledge can be useful in helping us understand, and sometimes even predict to some degree, people’s general behavior.

The language of psychopathology, just like the language of physical health problems, can and should be disseminated and used freely in the public discourse when it’s warranted — i.e., when we are dealing with manifestations of mental unhealth and disorders. This language and the knowledge it conveys are not proprietary and an exclusive domain of the mental health professions. Our society can and should talk openly about depression, for example, or character disorders, learning (one hopes) more about them in the process. It is as much a matter of public health and safety as it is the case when dealing with physical body disorders.

When we encounter, for example, a person with symptoms of a dangerous physical disease, it would be helpful for people to know how the disease manifests and what its risks are, how to generally treat the affected person, and what to do to protect ourselves. Similarly, we need to stress public health education with respect to character disorders, some of which — specifically those that, like psychopathy and narcissism, severely impair a conscience — pose a clear danger to society.

Individuals who do not possess a functioning conscience (the main feature of psychopathy) and cover up this lack with a grandiose sense of their own importance and specialness, accompanied by entitlement, often aggrieved, and contempt for others (the main features of narcissism) tend to be inherently destructive. Their incurable character defect, known as narcissistic psychopathy (also, closely enough, malignant narcissism), is the most dangerous form of psychopathology known to humankind and the source of much, if not all, of human-made evil in the world.

The defect is found in genocidal tyrants, mass killers, religious leaders, and many CEOs alike. Their lack of conscience and their grandiosity that drive them to realize their main life objective — obtaining as much power and adulation for themselves as  possible, without any regard for interpersonal and social consequences  — guarantee to cause destruction on a small or large scale, depending on the reach of their influence. That much we know. There is, or should already be, no doubt about it. This knowledge is one obviously helpful aspect of (correct) diagnosis.

We also know that this character defect — which is NOT mental illness — is incurable and renders one so afflicted, particularly if in an advanced age, with little to no capacity of learning and change.

It is an extremely important piece of information when we consider such an individual for a leadership position, particularly in the area in which he has no previous experience. Hoping that the candidate will acquire knowledge and behaviors necessary for his duties is both foolish and dangerous, given what’s at stake. Again, recognizing this is helpful in disabusing such lingering, misguided hopes.

If there is one subset of the human population that should be kept away from positions of power, it is people with this character defect. Unfortunately, their pathology propels them to seek just such positions. And they hide behind what Hervey Cleckley called the mask of sanity so effectively that they can fool even experts.

This makes it especially important that we, as a society, implement protective measures which would stop these characterologically impaired individuals from finalizing their power-driven pursuits, since we know, or should already, about the inevitable exploitation and destruction that will ensue if we don’t.

One way to do so would be by employing psychological assessments to weed such people out of, say, presidential races.

We use various forms of psychological testing to determine job suitability for candidates in many different domains with lesser responsibilities — why not for the highest office where mental health and character are of utmost importance? It is reasonable to ask why is it necessary to need psychological assessments for job candidates in the restaurant business, for example, but not for the highest positions in the government?

Surely we can see that thoughtfulness, patience, and empathy, along with the capacity for guilt, critical self-reflection, and the ability to understand and strive to live according to the highest human values (a.k.a conscience) are more important in presidents than their cholesterol or blood sugar levels. Why then don’t we assess those former capacities as seriously as we do the latter? It is true that relevant psychological assessments would be more complicated than simple blood tests, but their results are far more important in this context.

Another aspect of the societal self-protective measures against destruction caused by conscience-impaired individuals is education. Polish psychiatrist Kazimierz Dabrowski warned that:

“[our] general inability to recognize the psychological type of [psychopaths] causes immense suffering, mass terror, violent oppression, genocide and the decay of civilization.” (source)

We have to do a better job educating the public about mental health and lack of it, paying special attention to character disorders which far too often not only go unrecognized as dangerous pathology, but are glamorized and championed as signs of successful adjustment to our society.

This education cannot take place if psychiatrists and psychologists are discouraged from offering their opinions and their debates are confined to academic and professional journals. Mental health experts must be given opportunities to openly and widely share their expertise with the public, and this is where the cooperation with the willing media is necessary.

One of the goals of such sharing would be demystification of psychiatric and psychological diagnoses which are complex, but in the general sense (i.e., outside of the privileged and confidential encounter with a patient in the doctor’s office) are not always best left exclusively to professionals. We too often forget that professionals, experts as they are, do not have a monopoly on describing and alleviating various forms of human mental suffering; and one could argue that a wider and greater understanding of these and related mental health issues could possibly lead to better health outcomes, in individuals and groups.

Of course the ethical prohibitions encapsulated in the Goldwater Rule do not apply to general discussions about mental disorders, but to diagnosing real people from a distance.

But it is difficult to have such general discussions while strenuously avoiding specific teachable examples whose presence looms large in our daily reality and collective consciousness. It is one of many reasons why the Goldwater Rule has been a subject of ongoing debate, this year more so than ever. The debate’s main arguments have been best summarized in The Ethics of APA’s Goldwater Rule by Jerome Kroll and Claire Pouncey.

The authors challenge the rule by, among other things, pointing out its unenforceability and showing its aspects that are inconsistent with reality-based practice. They also weigh the ethical prohibitions against ad hoc remote diagnoses issued  (usually) for media consumption and often without a good reason, against the professionals’ ethical duty to warn the public about individuals who pose danger to society, noting that:

For the individual moral agent choosing a course of action, the Goldwater Rule provides no direction, except to require that he prioritize the reputation of the profession.

Along the way, they bring up examples of professionals grappling with the Rule, one of which is a 2011 NYT editorial by psychiatrist Richard A. Friedman.

The subject of the editorial was the aftermath of Dominique Strauss-Kahn sexual assault scandal, during which, as Friedman writes, “a parade of psychiatrists stepped forward to offer their expert opinion in the news media.” Even though Kroll and Pouncey do not directly comment on this, the editorial is notable for its darkly ironic, in 2016, twist.

Friedman, who is supportive of the Goldwater Rule, says the following:

Of course, there are exceptions to all rules. Patient confidentiality is not absolute, for example: If a patient of mine told me he was thinking of killing someone, I would have an ethical and legal duty to violate confidentiality and warn both the person at risk and the police.

And one could reasonably argue that an exception should be made for psychiatric profiles of foreign political leaders, which United States intelligence services (and those of other countries) have been doing at least since World War II. An evaluation of Col. Muammar el-Qaddafi of Libya, for example, might well be in the national interest because it could help guide how we deal with this difficult figure.

Colonel Qaddafi’s ruthlessness, near-delusional grandiosity and love of absolute power all suggest a severe personality disorder called malignant narcissism. Because people with the disorder have a defect in moral conscience, they lack empathy, so there is no room to appeal to them on human terms. Instead, they are more likely to respond to the right mix of flattery, power and a credible threat of force.

Whether the foregoing diagnosis is correct or useful, I have no idea, but it is ethically defensible.

Despite what some of us might believe, though, none of our celebrities or politicians is likely to rise to the level of a national threat that justifies violation of the Goldwater rule.

It’s not sexy and probably won’t make headlines, but experts should just stick to the facts and educate the public, and leave the pleasure of diagnostic speculation to the amateurs.



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Updated, below, on 9/15/16.

This is a continuation of Kazimierz Dabrowski’s views of psychopathy, partially presented in the previous post. The text below comes from the same source:

Psychopathy: The greatest obstacle in the growth of personality and groups

Let us briefly review main characteristics of psychopathy in my approach.

Psychopathy is a structure based on primitive drives with a strong integrative force, and with intelligence in the service of those drives.

A psychopath is emotionally rigid and narrow. He has strong ambitions and significant talents, but they remain narrow and under the influence of primitive drives. He does not experience inner conflicts, but instead he creates external ones. He is not capable of empathy, and so he strives to gain control over others, or, before he can gain dominance, he submits to the control of others. He is usually deaf and blind to the problems of others, to their development and developmental difficulties. He relentlessly realizes his own goals. A psychopath exists on the level of primary integration and is emotionally stunted.

We can distinguish “small” and “big” psychopaths. We find the big ones among the most notorious world criminals, and among aggressive tyrants and dictators (e.g., Nero, Hitler), who do not hesitate to sacrifice others for their own goals. For a big psychopath, a person and a social group do not have any moral value. To him, rules of justice do not exist. Genocide or a concentration camp are not a moral problem for him, but a means to an end.

Small psychopaths are miniatures of the big ones. In general, they submit to big psychopaths in the right circumstances. A small psychopath looks for opportunities to realize his own interests, and to satisfy his desire to wreak havoc in society. A psychopath thinks that laws are to be broken and that they do not apply to him. He uses any circumstances to secure his position, money, and fortune, regardless of the consequences for others, without any consideration for ethical norms. Psychopaths do not know how to emotionally compare themselves with others, they cannot emotionally understand others, and they lack an empathic attitude.

Psychopaths are dynamic individuals, efficient, capable of making quick decisions, without hesitation or inhibition; they do not exhibit emotional or imaginational overexcitability, or intellectual overexcitability of a global character. They are usually incapable of retrospection, and their abilities for prospection are used to foster their narrow goals and ambitions. They do not apply self-control, are incapable of self-criticism, but show the capacity to skillfully control and realize their purposes, plans and programs. Thus they lack a multilevel inner psychic milieu; they lack multilevel emotional and instinctual functions. Therefore, as I said before, they do not understand the hierarchy of values in a global sense. They use an unconscious or semiconscious hierarchy of “values,” which are narrow, rigid and subsumed under their ambitions. (p. 123-124)

Dabrowski’s theoretical and clinical knowledge, which led him to formulate his groundbreaking yet not widely known Theory of Positive Disintegration in the first half of the 20th century, was years ahead of his time and still awaits proper recognition and dissemination. Many of his insights — for example, on the essential role of emotions, values, and crises in personality growth; on the crucial importance of empathy in development of individuals and societies; on the spectrum-like nature of mental disorders and mental health; and on the pernicious effects of psychopathy on the individual and group life — are just being independently “discovered” (if that) in American psychology today.

The fact that psychologists, and not only, re-invent the proverbial wheel is (or should be) an occasion to reflect about political nature of the scientific enterprise which is riddled with and crippled by social amnesia, and as such it fosters limited education among the professionals and so-called masses alike.

That limited education, among other reasons, is why we face the continuous and at least partially successful efforts to normalize psychopathy and mislead the public about it. This trend fits a society where human beings are the commodified instruments of profit-making whose well-being matters to the extent they serve that function, while corporations are accorded personhood and the markets are said to have inner lives.

The objectification and dehumanization of people that is a mark of psychopathy, and that goes hand in hand with fetishizing power and its signifiers, is also a feature of exploitative political systems, which are run, more often than not, by people with impaired or absent conscience (i.e., psychopaths, narcissists, and their ilk). And exploitative societies have psychological theories and officially disseminated knowledge that suit their needs, so it is little wonder that we are not being urgently (read: at all) educated about the dangers of conscience-based character defects like psychopathy and narcissism. On the contrary.

Under Nicholas Kristof’s The Black Eyes in Donald Trump’s Life, one astute commenter said the following (emphasis, in italics, mine):

Jeanie Diva , New York 1 day ago

We the people are the fault of all this. Trump had a TV show. People (not me) watched it. He was “cool”. He is a good snake oil salesman and knows exactly how to manipulate the press. Even Matt Lauer was sucked into his tornado.

That he got this far says everything about the people who support him. It also explains how we ended up with a do-nothing Congress. The fault is poor public education. We long ago stopped teaching people how to think critically. The level of knowledge of the average person is amazingly low. We spent billions on weapons and foreign aid to shore up our corporations, but we have been gutting education for over 50 years.

Stupid people do stupid things. Giving up on science, not reading widely, watching “reality” TV shows that aren’t at all real, following people like Snooky and Kim Kardashian — is this the action of educated, cultured, sophisticated people? Trump, while very wealthy, is an ignorant narcissist. As you can tell from reading comments here, many people do not know what a narcissist is. They don’t know what racism is, or bigotry. Who is to blame for that? Not Trump.

It’s easy to manipulate uneducated people — even those that went to college if all they learned was computer code. Trump is amazingly disgusting in a bold and obvious manner but millions are still duped by his facade. Hillary is flawed, but she isn’t dangerous, and besides, she comes with Bill, also not dangerous but very smart.

Jeanie Diva is right.

It is extremely difficult for normal people to understand what psychopathy and similar character defects (i.e., narcissism) are, as people with a conscience tend to project their conscience-based beliefs on the conscienceless, which only makes the exploitation by psychopaths (and narcissists and their ilk) easier. And it certainly does not help one bit that people who do, or should, understand the problem of psychopathy and related pathologies are not doing enough to educate the public about their dangers, or muddy the waters by offering their glamorized misinterpretations.

Dabrowski warned us, long decades ago, that

“[our] general inability to recognize the psychological type of [psychopaths] causes immense suffering, mass terror, violent oppression, genocide and the decay of civilization.” (source)

He was right about that, and about so many other things.

Meanwhile, the conscienceless continue their takeover of our world, as evidenced by Trump’s candidacy* — a fitting and logical culmination of the process, should he become elected.

*Read that story.


Tish, in the comments, asked for resources on dealing with psychopaths — here are some:

Society for the Scientific Study of Psychopathy

Aftermath: Surviving Psychopathy Foundation with excellent additional links

Psychopaths and Love — a great blog and resource by Adelyn Birch

Steve Becker’s Unmasking The Psychopath

Psychopathy Awareness blog by Claudia Moscovici



Psychopaths vs. Neurotics

It is hard to keep up with Trump’s insults and other expressions of his defective character, but a recent one stands out in particular for its educational value.

During a twittering temper tantrum late last month, Trump attempted to denigrate Mika Brzezinski by calling her a neurotic:

Tried watching low-rated @Morning_Joe this morning, unwatchable! @morningmika is off the wall, a neurotic and not very bright mess!

This prompted a chivalrous response from Mika’s co-host / insufferably pompous on-screen husband, Joe Scarborough: