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25th April 2017, 09:18 AM | #321 |
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Mostly because none of us are in any position to accurately assess the mental state of Donald Trump. The point is that "backseat doctoring" is wrong whether it's speculating about Clinton's supposed dementia or Trump's supposed "dangerousness." The personal opinion of a doctor that has not treated the subject is irrelevant and shouldn't be publicly stated as a professional opinion.
There's also the question of which mental illnesses should disqualify a president. In fact, there is no list of mental illnesses that would disqualify someone from office. The only qualifications for the office are clearly spelled out in the Constitution. A mentally ill person can certainly be (has been?) elected. The only recourse then is for the VP to invoke Section 4 of the 25th Amendment. You allege NPD. Is NPD disqualifying? Why? Isn't it possible for someone with NPD to be high-functioning, mostly rational and successful? Another issue involved here is that we are stigmatizing all mental illness as making someone unqualified to be President. That's simply not the case. According to this paper, a good chunk of our past leaders have exhibited signs of mental illness. If you accept the Yale panel's analysis of Trump then this paper should be right up your alley. |
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25th April 2017, 09:20 AM | #322 |
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An elected official is not employee even if it makes sense for the IRS to classify them as such. They are not a polysci institution and are not there to answer our political science questions.
ETA, from a philosophical or polysci perspective we might conclude elected officials are employees, but the fact they get a W-2 won't matter. |
25th April 2017, 09:29 AM | #323 |
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25th April 2017, 09:34 AM | #324 |
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I think we disagree about what "sufficient evidence" is. I don't think observing a person during public appearances is sufficient evidence to make a valid diagnosis. These shrinks have no idea what Trump is like in his private life and have never even spoken to Trump personally or professionally. Rendering a professional opinion in this manner goes against their own professional standards of practice and ethics, making such an opinion worthless.
As for the public right to know about the President's mental/medical state, I think it's sufficient that those who work with him every day -the VP and the Cabinet- can make that judgement call on our behalf. ETA: Further than that: How does the public know when a professional is rendering a valid medical opinion or simply making a political attack under the guise of professionalism? |
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25th April 2017, 10:21 AM | #325 |
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25th April 2017, 10:22 AM | #326 |
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25th April 2017, 10:24 AM | #327 |
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25th April 2017, 10:28 AM | #328 |
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Technically that's an analogy fail. Rabies is diagnosed by a viral culture.
However, certain raccoon behaviors and the prevalence of rabies in the area in raccoons would indicate if rabies vaccine was warranted for a person that had had contact with said raccoon but the raccoon was not available for testing. So we could indeed make a presumptive diagnosis of rabies in a raccoon based on it's behavior alone without an in-person exam. |
25th April 2017, 10:29 AM | #329 |
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25th April 2017, 10:31 AM | #330 |
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25th April 2017, 10:32 AM | #331 |
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25th April 2017, 10:33 AM | #332 |
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I still want to know how one unseats a hypothetical mental president when no-one's allowed to posit that he's mental?
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25th April 2017, 10:38 AM | #333 |
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25th April 2017, 10:39 AM | #334 |
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That wold depend on your definition of "declare" said diagnosis. You're essentially saying if it walks/talks/looks like a duck you can only say it is exhibiting the appearance of a duck. I disagree.
Look at it a different way. You develop an hypothesis. You define the methodology (observation) of testing your hypothesis. You carry out said observations. You conclude your hypothesis was correct. You make predictions about Trump's future behavior based on the hypothesis. Your predictions are correct. You've pretty much proved your case in as much as science 'proves' anything. See the Goldwater rule. |
25th April 2017, 10:40 AM | #335 |
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25th April 2017, 10:51 AM | #336 |
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Not a satisfactory one. It very much seems like opening a box with the crowbar that's in the box. How does one decide that a president is psychologically unfit for office if, as has been stated, merely observing his behaviour is insufficient to begin an investigation? There must come a point at which someone's allowed to say 'Er, he's gone a bit mad, do you think we'd better do something about it' and to not have that statement invalidated with 'the doctor hasn't examined the patient, there can be no suggestion that anything is wrong with the president and to do so would be unethical' |
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25th April 2017, 10:54 AM | #337 |
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25th April 2017, 10:59 AM | #338 |
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Surely, you are professional enough to admit that your opinion of Trump's mental state, having not personally interviewed/examined him, is not worth anything in the context of coming to an actual diagnosis and that doing so publicly would be ethically wrong. Similarly, these psychiatrists are wrong.
Again, the reason why it's wrong is simple: How does the public differentiate between a profession rendering a professional opinion or a disgruntled private citizen with a medical degree using the veneer of "professionalism" to make a political attack? |
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25th April 2017, 11:07 AM | #339 |
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This is exactly what the 25th Amendment allows for. The VP does not need an MD evaluation in order to make his own judgement and seek concurrence from the cabinet. There doesn't have to be a diagnosis.
No one has said that "merely observing his behaviour is insufficient to begin an investigation." Clearly, the VP can "begin an investigation" based on his own observations. What has been said is that a psychiatrist (or any other medical professional) should not render a professional opinion without examining the patient themselves. At the very least, if they do render a professional opinion, it shouldn't be given much weight. |
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25th April 2017, 11:10 AM | #340 |
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All of us are in a position to observe Trump's behavior and to compare it to the description of narcissistic personality disorder, but apparently not all of us are willing to do that objectively. If "Clinton's supposed dementia" can be documented with 1/100th as much evidence, then that absolutely would be an issue in judging her fitness for office, so if any qualified psychiatrist can make that case, then I would have expected them to do so.
I do believe the Goldwater Rule serves a useful purpose, and I definitely don't like the idea of just dropping it. But there are such things as ethical and moral dilemmas that aren't easily solved by rules. These psychiatrists are well aware of the professional risk they're taking by speaking out. Before accusing them of being partisan hacks, can you take an objective look at other possible motives for taking that risk? Disqualifying from what, and successful at what? President of the Trump Organization? The star of the Apprentice? Demagogue politician? Or President of the United States? |
25th April 2017, 11:12 AM | #341 |
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At the very least, one would need access to their medical chart which would have notes of previous clinical interviews, psych testing results, etc. I agree that an in person examination may not be strictly necessary, but certainly you need more than watching him on TV.
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25th April 2017, 11:13 AM | #342 |
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OK, time to get real: What changes, after this announcement?
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25th April 2017, 11:16 AM | #343 |
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An untrained, lay observer's opinion counts and cannot be disregarded as merely politically motivated, however a slew of highly trained mental health professionals can be safely disregarded and impugned with accusations of being politically motivated. Well, I'm up to speed now, at least.
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25th April 2017, 11:27 AM | #344 |
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I wouldn't expect them to do that. How can I, John Q Public, tell if they are rendering their opinion because they genuinely think she has dementia or because they are trying to smear her? Am I just supposed to rely on their professionalism and good-nature? I'm not naive enough for that, I'm afraid. Unfortunately, too many people would assume they are acting in good faith when they may not be. I think that's a dangerous situation.
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That dilemma is the reason why it's wrong for psychiatrists to use the gravitas of their position in society to make public statements about the mental health of politicians they haven't even reviewed medical records about.
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25th April 2017, 11:48 AM | #345 |
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25th April 2017, 11:53 AM | #346 |
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It can be regarded however you like. If the President challenges, then Congress has to vote on the matter. It would be hard to pull off such a move on purely political grounds. However, if the President was obviously unstable, it would be much easier to convince Congress to remove him.
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For me, the opinion of the "slew of highly trained mental health professionals," has to be judged in light of the fact that: 1)They haven't examined Trump themselves -they haven't even reviewed his medical records; 2)They are acting outside the bounds of their profession's standards of practice and ethics and 3)There is the possibility that they are using their position as experts to make a political attack. Those three factors are enough for me to take their opinion with a grain of salt. YMMV |
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25th April 2017, 11:54 AM | #347 |
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25th April 2017, 12:01 PM | #348 |
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You keep asserting this falsehood while never answering the key question this poses: which tests or exams would one do in-person to improve on the accuracy of the diagnosis?
There is no better method in psychiatry for making a diagnosis than observation of the patient in his real-life interactions. |
25th April 2017, 12:03 PM | #349 |
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25th April 2017, 12:06 PM | #350 |
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How do you decide in other areas where professional opinion intersects with politics, such as the dangers of smoking, the AIDS epidemic, climate change, vaccinations, and various socio-economic issues? Everyone is allowed to speak, but professionals carry more weight, and if they disagree then John Q. Public has to sort it out somehow. My preference is weighing the arguments against the evidence.
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25th April 2017, 12:09 PM | #351 |
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A review of relevant medical records, personal clinical interview, interview with family members and close associates and a psychological test or two would be a good start.
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25th April 2017, 12:23 PM | #352 |
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25th April 2017, 12:24 PM | #353 |
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The reason why stems from the nature of a personality disorder. There are classic behaviors one exhibits when one has a pathologic narcissistic personality disorder.
Trump displays these behaviors consistently and predictably. Just observing him throughout the campaign process was sufficient to make said diagnosis. The fact he continues to display the same classic behaviors only adds more proof to the pudding. This is a classic straw man. "This guy", as in a number of psychologists and psychiatrists who have made public statements? The APA is a professional association. It's not a regulating body. Like most of these professional organizations they have position papers.
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There's a World Psychiatric Association, American Academy of Child and Adolescent Psychiatry (AACAP), The American Association of Chairs of Departments of Psychiatry (AACDP), American Association for Geriatric Psychiatry, American Association of Directors of Psychiatric Residency Training (AADPRT), American Board of Psychiatry and Neurology (ABPN), American College of Neuropsychopharmacology (ACNP), The Association of Women Psychiatrists (AWP), and more. You all really need to stop acting like the APA is a regulating body or a body that sets practice standards. The APA has opinion positions on practice standards. No one is held to those standards as a matter of law. If one harms a patient, the fact one didn't follow an accepted standard can have an influence on a court decision. It would never be the sole reason a provider lost his/her credentials. For example, I am allowed by law to prescribe outside the FDA approval for a drug as long as the drug is approved for the market. That's a clear-cut example where one can act outside of a practice standard provided one can justify one's actions. The ignorance in this thread about the significance of an APA position on this matter is a Dunning Kruger effect indeed. |
25th April 2017, 12:24 PM | #354 |
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I think there is a difference between scientists informing political debate and psychiatrists evaluating the medical state of political figures.
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25th April 2017, 12:24 PM | #355 |
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25th April 2017, 12:28 PM | #356 |
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25th April 2017, 12:32 PM | #357 |
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25th April 2017, 12:33 PM | #358 |
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25th April 2017, 12:49 PM | #359 |
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25th April 2017, 12:50 PM | #360 |
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And yet: More than a few prestigious psychiatrists disagree with the APA position in this circumstance.
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First, the issue is psychiatrist against psychiatrist, let's get that straight. Second, let's look at the difference between the Goldwater case and the Trump case. In the Trump case he displays classic symptoms of a well defined personality disorder. In the Goldwater case, it was Freudian based opinions, something no longer held valid in the US (I understand some countries in Europe still consider Freud valid).
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The HuffPo article is excellent for understanding the issues of the day that led to the Goldwater rule, and for seeing how they do not apply to Trump today. |
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