Goldwater Violation

[Stagg737]

https://www.washingtonpost.com/nation/2021/06/18/ronny-jackson-biden-cognitive-test/

What's your point? Biden should be screened for neurocognitive decline just like Trump was (rightfully so) given their ages. Ron Jackson being a partisan jerk doesn't really change the idea that knowing if the president needs to be worked up for neurocognitive decline is probably a good idea.

To Trump acting? What benefit would anyone have from acting like a narcissist? See Matt Gaetz for an example of someone acting like a narcissist.

Do you honestly think he would have won the presidency in 2016 if he hadn't been so outrageous (act or not)? I don't. Seems like a pretty obvious benefit to me.

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[whopper]

What's your point? Biden should be screened for neurocognitive decline just like Trump was (rightfully so) given their ages. Ron Jackson being a partisan jerk doesn't really change the idea that knowing if the president needs to be worked up for neurocognitive decline is probably a good idea.



Do you honestly think he would have won the presidency in 2016 if he hadn't been so outrageous (act or not)? I don't. Seems like a pretty obvious benefit to me.

Neuro evaluations for president aren't really beneficial unless the person will score significantly low. Remember a MOCA is designed for the general population including people without a HS education. Simply seeing someone interact for several minutes can give more useful information vs a MOCA.

Obviously a president's job requires a good intellect. Kind of like demanding a neurocognitive evaluation for a physician. If the doctor can't practice that in and of itself is more coherent and important data.

 

[Stagg737]

Neuro evaluations for president aren't really beneficial unless the person will score significantly low. Remember a MOCA is designed for the general population including people without a HS education. Simply seeing someone interact for several minutes can give more useful information vs a MOCA.

Obviously a president's job requires a good intellect. Kind of like demanding a neurocognitive evaluation for a physician. If the doctor can't practice that in and of itself is more coherent and important data.

True, and it may not be necessary if those surrounding the individual are willing to step up when concerning behaviors or signs are noted, but how many people in any administration would be willing or capable of even doing so. The point is obviously not as a diagnostic tool, just a screening tool to assess whether a more thorough assessment would be necessary. I'd argue that this would be even more relevant to individuals in positions of significant influence like the president or physicians. If nothing else, it can provide that the individual does not need further workup and quash ridiculous claims.

 

[WisNeuro]

Neuro evaluations for president aren't really beneficial unless the person will score significantly low. Remember a MOCA is designed for the general population including people without a HS education. Simply seeing someone interact for several minutes can give more useful information vs a MOCA.

Obviously a president's job requires a good intellect. Kind of like demanding a neurocognitive evaluation for a physician. If the doctor can't practice that in and of itself is more coherent and important data.

Agreed. Also, many of us in the community would suggest a screener that you cannot get a copy of merely by googling it.

 

[ridethecliche]

I value freedom, and believe it should reign supreme.

My concerns are for the entropy of Medicine; things chipping away here. Chipping away there. Chipping away down low, up high, etc at the medical profession.

The bold runs counter to your argument, no?

Re entropy of medicine: This sounds like a weird fallacy, i.e. we should care about this and fix this because everything else is falling apart. Huh?

I dropped my APA membership. But I believe the organization that put themselves out there as declaring it unethical could still be the one to label and identify these moments.

I don't know, make a webpage "goldwater violations" and they simply list the people and why and when they sent a registered letter off for such violations. Whether it has any real consequences or not.

But I do worry as established institutions are crumbling around us this is one hole in the wall that could be patched to help the integrity of medicine as a whole.

So you cancelled your membership, yet you want them to exert more pressure to enforce a rule that was never fully vetted? Wouldn't this carry more weight if you actually joined them?

Re: established institutions crumbling.
This is another fallacy where you're harking back to an unspecified time in a similar way to the above.

The number of psychiatrists that incorrectly diagnosed Trump with NPD (any forensic psychiatrist worth their salt would know the correct diagnosis) was cringeworthy, for example. If you read the original Fact magazine article about Goldwater, the psychiatrists commenting make psychiatry seem like a joke. What is more of a joke, is that some psychiatrists believe the public is interested in what they have to say. They don't, unless it suits their own agenda.

A high schooler can tell you Trump is a textbook narcissist. You don’t need a MH professional. As to the denigration of medicine for not commenting on it. Are you living under a rock OP? Did you not see all the major journal editorials?

Ohhhh fight!

 

[Sushirolls]

There is conflict between my beliefs for freedom and and the propagation / support of institutions (such as medicine) that may bring with them restrictions and limitations. A frustrating thing to reconcile at times, but sometimes I don't, and embrace the duality of differing opinions depending on context of what hat I'm wearing.

APA was dropped due to going too far into being PAC and an organization that fails to limit mid levels.

I avoided further description of other crumbling institutions to hopefully keep this thread on track to the intended purpose: The intersection of professionalism and commentary on public figures by psychiatrists.

I support any form of consequence for goldwater violations, even if not by APA, and even if light and trivial. I believe this is a something worth drawing attention to and working towards.

At best it makes my trips to a barber easy, I simply say I can't comment on which have hot topic public person is getting people worked up. At worst a slippery slope logical fallacy could be that if encouraged, accepted, and becomes a norm, society may start to expect that we openly comment, That we become mandatory reporters of mental health. So simply walking down the streets of [pick your preferred city] and seeing a homeless person stumbling, shouting vagaries, you now get work to do in your off time when all you wanted to do was go to dinner with your family? This is just one of many hypothetical, catastrophic, slippery slope fallacy futures I could conjure up. Simply put, I believe it to be a good rule, and one that we should all strive to advocate for and enforce - even if trivially enforced.

 

[ridethecliche]

Is it really that you can't comment or that you can't give a professional opinion on the matter.

Saying, "yeah, some of this ish is just bonkers" is very different than saying "yeah, based on my medical knowledge, he's someone who has antsinpants disorder and needs to be hospitalized". A citizen is allowed to say that they find someone's behavior troubling.

 

[Mass Effect]

This kind of talk has important forensic implications, and some psychiatrists seem a little too comfortable with it.

I'm curious what "important forensic implications" does calling Trump a narcissist have? And yes, I am comfortable with it because I'm a damn good psychiatrist and the APA has no jurisdiction over what I do with my knowledge and thoughts.

The Goldwater rule I suppose is an ethical consideration, but it brings up questions about broader truths and the social meaning of mental illness.

What?

First of all, there’s a 25th amendment to the constitution that stipulates the medical examination and disability procedures (how to invoke basically a fitness for duty eval) regarding a sitting president. No one needs Joe Armchair MD a psychiatrist in Oklahoma to call in to Washington and ask “have you considered that the president might have a major neuro cognitive disorder? I was watching his speech on CNN and…” There is a medical staff in the White House. Now whether or not they are impartial is another question, but they’re there.

What?

On a somewhat separate note, it’s pretty stupid to announce that we’ve easily diagnosed someone after having watched news clips of them.

I'm not aware of anyone having done that. Seems every psychiatrist diagnosing Trump is doing so based on 30 years of speeches he's spoken, books he's written, his own words/actions, and the words of those who are intimately familiar with him.

And if a diagnosis can be thrown around, one that is supposed to take extensive psychiatric training to make, what is that diagnosis?

What?

Can anyone go to the DSM, read the criteria, and say “I or they or whoever has this?” It harkens back to Bob Spitzer and the DSM III when he was addressing the APA saying “Are clinicians even necessary anymore?” He meant that any untrained rater could simply follow an algorithm to make a diagnosis.

Welcome to medicine. It's a little more nuanced than what you've stated, but don't kid yourself that when the diagnosis is clear as day, it won't appear clear as day.

It’s also foolish to make a diagnosis like a personality disorder based on limited information about a person (or one or two evals). I will say with Trump we had whole books about his life and people that could talk about his past, so some of those trends could have been clearer. But don’t sell yourself short…when you are considering a personality disorder as a diagnosis, there’s a whole differential and criterion list that should be considered in detail (have these criteria all shown themselves persistently in several settings to impair social/occupational functioning or cause clinically significant distress etc).

Most of us here are board certified in this field so I doubt there's anyone who doesn't know that. With someone like Trump there is ample evidence on which to base the opinion.

 

[Mass Effect]

Do you honestly think he would have won the presidency in 2016 if he hadn't been so outrageous (act or not)? I don't. Seems like a pretty obvious benefit to me.

If you think that was an act....SMH. Just because someone is histrionic doesn't mean it's an act.

 

[Mass Effect]

There is conflict between my beliefs for freedom and and the propagation / support of institutions (such as medicine) that may bring with them restrictions and limitations. A frustrating thing to reconcile at times, but sometimes I don't, and embrace the duality of differing opinions depending on context of what hat I'm wearing.

I support any form of consequence for goldwater violations, even if not by APA, and even if light and trivial. I believe this is a something worth drawing attention to and working towards.

I think it's insincere to say you value freedom in any way, given your support of "any form of consequence for Goldwater violations".

Goldwater is a stupid concept that would be struck down in any court of law if it actually was a rule and not just a recommendation. It would make the APA a laughingstock which is likely why they've never pursued consequences for violators.

At best it makes my trips to a barber easy, I simply say I can't comment on which have hot topic public person is getting people worked up. At worst a slippery slope logical fallacy could be that if encouraged, accepted, and becomes a norm, society may start to expect that we openly comment, That we become mandatory reporters of mental health. So simply walking down the streets of [pick your preferred city] and seeing a homeless person stumbling, shouting vagaries, you now get work to do in your off time when all you wanted to do was go to dinner with your family? This is just one of many hypothetical, catastrophic, slippery slope fallacy futures I could conjure up. Simply put, I believe it to be a good rule, and one that we should all strive to advocate for and enforce - even if trivially enforced.

This is kinda ridiculous hyperbole.

 

[Alemo]

I'm curious what "important forensic implications" does calling Trump a narcissist have? And yes, I am comfortable with it because I'm a damn good psychiatrist and the APA has no jurisdiction over what I do with my knowledge and thoughts.



What?



What?



I'm not aware of anyone having done that. Seems every psychiatrist diagnosing Trump is doing so based on 30 years of speeches he's spoken, books he's written, his own words/actions, and the words of those who are intimately familiar with him.



What?



Welcome to medicine. It's a little more nuanced than what you've stated, but don't kid yourself that when the diagnosis is clear as day, it won't appear clear as day.



Most of us here are board certified in this field so I doubt there's anyone who doesn't know that. With someone like Trump there is ample evidence on which to base the opinion.

These are also not engaging replies (but it's cool that you sound like John Oliver). Thanks for your sincere "welcome to medicine." If you want to discuss the 25th amendment, fitness for duty, the conflict between our nosology and self-referential diagnostic criteria, I'd like to.

Re: my statement about forensic implications, it has nothing to do with Trump and narcissism per se, and everything to do with what a diagnosis means and how it is made. Forensic, as I understand the term, relates to questions that the legal system has about a science (psychiatry) and more broadly, public conceptions and representations of the field. I think personality structures and their more severe manifestations (personality disorders) need to be understood through personal examination of someone. Can they be understood or recognized in other ways? Sure, that's what I alluded to re Trump and the biographies and comments from close sources and relatives. Forensic specialists (and regular clinicians) can and do spend hundreds of hours reviewing police reports, jail records, collateral information, etc etc to form opinions.

But the point is, we should be hesitant to shoot our mouths off about this or that celebrity without having all the details. There's a lot of things that need to be ruled out. Is the world going to end if we do? No. Does it matter if you run afoul of the APA? I guess not. But you can be sure that the next time Bandy Lee is deposed or testifies in court, the cross-examining attorney is going to question and impugn the validity and method of her technique in the case at hand based on the idea that she so publicly diagnosed Trump "from afar." Does that concern you or Joe Psychiatrist MD in Oklahoma City? Probably not. Maybe it does. That's why I specified "forensic" implications, and didn't say "no psychiatrist should ever do something like this."

 

[Mass Effect]

These are also not engaging replies (but it's cool that you sound like John Oliver). Thanks for your sincere "welcome to medicine."

Seriously, what? How do I sound like John Oliver? My "welcome to medicine" was tongue-in-cheek, as in yes, lots of things in medicine are crystal clear and lots of psych disorders can be read in the DSM and self-diagnosed. That doesn't rule out other etiologies which is why I added that it's more nuanced than what you describe. But most times, it is what it appears to be. Someone comes in with self-described depression, do I rule out other things? Of course but 9 times out of 10, it's depression whether it's MDD or an adjustment d/o with depressed mood or whatever else, it's likely depression. Personality disorders aren't as straight forward, but your post taking on the philosophical "are clinicians even necessary?" needed a dose of reality. Yes clinicians are necessary, but not because we're the only people who can read the DSM and apply it. Nevertheless that line was not meant to be pissy so I will apologize for how it read.

Forensic, as I understand the term, relates to questions that the legal system has about a science (psychiatry) and more broadly, public conceptions and representations of the field

I have no idea what the above means. What do you mean about public conceptions and representations of the field? Forensic psychiatrists are involved in the legal system, doing evaluations, giving expert testimony and the like. It isn't about the legal system having questions about the science of psychiatry (well it is in a way, but only insofar as it applies to specific individuals; not the field in general). The psychiatrists in question are forensic psychiatrists. For a living, they give expert testimony, in many cases based only on chart review. This is considered standard as has been mentioned in this thread (the not having permission to do so isn't standard, but the case is also different), so no it isn't always based on specific evaluation.

I think personality structures and their more severe manifestations (personality disorders) need to be understood through personal examination of someone. Can they be understood or recognized in other ways? Sure, that's what I alluded to re Trump and the biographies and comments from close sources and relatives. Forensic specialists (and regular clinicians) can and do spend hundreds of hours reviewing police reports, jail records, collateral information, etc etc to form opinions

I don't disagree with you on either point. Personality disorders in most cases should be through personal examination of someone. I'm also on the record in saying that I don't think dx of personality disorders should be made after just one evaluation especially on an inpatient unit due to confounding factors. But as much or more information was available on Trump as any client in a forensic case so I don't think we can make an argument that any opinion is invalid only because the clinician never met him one on one.

But you can be sure that the next time Bandy Lee is deposed or testifies in court, the cross-examining attorney is going to question and impugn the validity and method of her technique in the case at hand based on the idea that she so publicly diagnosed Trump "from afar."

And any attorney worth his salt is going to stand up and say hogwash with a capital H. She didn't diagnose Trump "from afar" except maybe in the literal meaning of the word as it applies to physical distance. But all of Trump's antics were on public display for over 3 decades, not just in news reports but in his own words during speeches, interviews, books he's written, game shows he's hosted, the books of others. To suggest that the diagnosis shouldn't be made because after 30 years of him being in everyone's face, a 60 minute eval would be more accurate is weak and not scientifically sound.

The argument against making these diagnoses is that we don't want to politicize psychiatry which will only further stigmatize it. We don't want psych evals to be invoked in political elections with the prize of an "all clear" meaning that you're a suitable candidate for office. We want to normalize seeing a psychiatrist, regardless of getting an "all clear" or not. It shouldn't be a way to weed out impaired people since the majority of people with a psych diagnosis are fully capable of doing their jobs, whatever that job may be. That's the argument, not some outdated rule that was never sound to begin with. That and as Splik said, we have to be careful not to make a joke of ourselves if we get the diagnosis wrong.

Does that concern you or Joe Psychiatrist MD in Oklahoma City? Probably not. Maybe it does. That's why I specified "forensic" implications, and didn't say "no psychiatrist should ever do something like this."

I don't know what that means. I'm not seeing any forensic implications here.

 

[Stagg737]

If you think that was an act....SMH. Just because someone is histrionic doesn't mean it's an act.

I never said I thought it was an act. Just pointed out that this idea was irrelevant to the argument of whether his behavior and persona were relevant to him winning the 2016 election. Which I absolutely believe it was.

 

[Stagg737]

It shouldn't be a way to weed out impaired people since the majority of people with a psych diagnosis are fully capable of doing their jobs, whatever that job may be.

But this is exactly what was being done by the group who went in front of congress and testified that they had diagnosed Trump with a PD and stated, on record, that he should be removed from office because his diagnosis impaired his ability to lead. We can argue whether that is a true statement or not, but that is how their "evaluations" are being used. This also does the complete opposite of destigmatizing psychiatry and reinforces the (incorrect) idea that psychiatrists can make diagnoses and control the career/life of individuals who are not their patients. The original Goldwater Rule prevented that, but still allowed us to give commentary without stating diagnoses. The "updated" rule is ridiculous imo and does act as a muzzle for silencing psychiatrists, but the original premise of not making diagnoses to avoid inappropriate politicization of psychiatry and mental illness is still valid.

 

[Mass Effect]

But this is exactly what was being done by the group who went in front of congress and testified that they had diagnosed Trump with a PD and stated, on record, that he should be removed from office because his diagnosis impaired his ability to lead

Yes, I know. I'm saying the criticism against them should be based on that concept, not on some silly, outdated recommendation or some book they wrote or speech they gave about Trump.

But I disagree with your premise that this means psychiatrists can control your life. When you put yourself on full display, you welcome all opinions of your conduct and character and a psychiatrist commenting on that is not them controlling your life.

 

[LimpSpatula]

I never said I thought it was an act. Just pointed out that this idea was irrelevant to the argument of whether his behavior and persona were relevant to him winning the 2016 election. Which I absolutely believe it was.

White nationalism =! Narcissism. If you’re saying that his unapologetically small loan of million dollars type traits stroked that nationalism, fine. But lets not pretend charisma had anything to do with him getting elected.

 

[Stagg737]

But I disagree with your premise that this means psychiatrists can control your life. When you put yourself on full display, you welcome all opinions of your conduct and character and a psychiatrist commenting on that is not them controlling your life.

I mean, we can control some peoples lives, but that's irrelevant to this point. Like I stated, the idea that we control the average Joe's life is wrong, social media and the general media have far more influence than we ever will. The point is that people will see this and believe that we're trying to control their lives resulting in further distrust of our field and patients not seeking help when needed. Before you call out a strawman, I already see this regularly and is part of why I dislike outpatient so much. Trying to be a salesman for treatment gets tiring, even when it's just a small portion of the patients.

White nationalism =! Narcissism. If you’re saying that his unapologetically small loan of million dollars type traits stroked that nationalism, fine. But lets not pretend charisma had anything to do with him getting elected.

Who said anything about charisma? I think people here are extrapolating and twisting my statements to interpretations that just aren't true. I was mostly referring to his persona that he's a powerful guy that gets things done and won't tolerate the BS of politicians while stoking the fear of the 'other' and that he will be the great protector of American culture (MAGA) is what played a huge role. If you think that played no role then you're either detached/ignorant of huges portions of the population or lived under a rock from 2014 to 2016.

 

[LimpSpatula]

Who said anything about charisma? I think people here are extrapolating and twisting my statements to interpretations that just aren't true. I was mostly referring to his persona that he's a powerful guy that gets things done and won't tolerate the BS of politicians while stoking the fear of the 'other' and that he will be the great protector of American culture (MAGA) is what played a huge role. If you think that played no role then you're either detached/ignorant of huges portions of the population or lived under a rock from 2014 to 2016.

I think the only thing that got him elected was white nationalism. I’m not twisting your words. You’re trying to make narcissism and white nationalism a nexus.

 

[Stagg737]

I think the only thing that got him elected was white nationalism. I’m not twisting your words. You’re trying to make narcissism and white nationalism a nexus.

I'm really not. If you can't get that then I don't think there's a point in discussing it further.

 

[Mass Effect]

I mean, we can control some peoples lives, but that's irrelevant to this point. Like I stated, the idea that we control the average Joe's life is wrong, social media and the general media have far more influence than we ever will. The point is that people will see this and believe that we're trying to control their lives resulting in further distrust of our field and patients not seeking help when needed. Before you call out a strawman, I already see this regularly and is part of why I dislike outpatient so much. Trying to be a salesman for treatment gets tiring, even when it's just a small portion of the patients.

I legitimately have no idea what you're talking about. People will see what? They'll see us saying that Charlie Sheen had a mental health breakdown and suddenly they won't trust us? What? What are you seeing regularly and why are you trying to be a salesman?

 

[birchswing]

Wasn't there a fairly famous psychiatrist who diagnosed Joaquin Phoenix with something when he was in character for the movie I'm Still Here? It was a mockumentary in which he stayed in character in public. I can't remember who diagnosed him. I mean a lot of people thought his downfall was real, but I vaguely remember there was a psychiatrist in particular who commented on it.

 

[Stagg737]

I legitimately have no idea what you're talking about. People will see what? They'll see us saying that Charlie Sheen had a mental health breakdown and suddenly they won't trust us? What? What are you seeing regularly and why are you trying to be a salesman?

I'm confused why you're not understanding what people are saying, but I'll try and clarify. People see that someone in the public eye can be "assessed" and diagnosed by Dr. Random Doctor and that this can be taken seriously by those in power (congress in the example we've been using) and used to potentially end their career. It does the opposite of destigmatizing psychiatry and reinforces the (incorrect) idea that psychiatrists can make diagnoses and control the career/life of individuals who are not their patients. It's not that they suddenly won't trust us, it just furthers the distrust that already exists.

I was saying I regularly see patients for consults or evals and they don't want to talk to me d/t lack of trust. They'll say things like "I don't want any medications that are going to mess with my mind" or be afraid that things they tell me are going to cause problems in their lives (legal, loss of job, insurance coverage, etc). I have to do a lot of education and reassurance with too many patients that what they tell me isn't going to be used against them in their careers or other matters. Many of these individuals are fairly reasonable and not excessively paranoid. Maybe this is just d/t the clinics I've worked in, but I felt like a salesman/ambassador for the field too much during my outpatient year. Instances where psychiatrists start crusades to have people removed from office or other career issues based on PD diagnoses made from afar does nothing to help this and only reinforces the already evident distrust of the MH field by much of the general population.

You may disagree with much of that, but it was a non-insignificant part of my outpatient year and a big reason I got so burned out with outpatient.

 

[Mass Effect]

I'm confused why you're not understanding what people are saying, but I'll try and clarify.

I don't understand because it seems your posts are a mix of saying exactly what I already said (and presenting it as a new argument) or parsing down a complex issue to a simplistic dilemma.

People see that someone in the public eye can be "assessed" and diagnosed by Dr. Random Doctor and that this can be taken seriously by those in power (congress in the example we've been using) and used to potentially end their career. It does the opposite of destigmatizing psychiatry and reinforces the (incorrect) idea that psychiatrists can make diagnoses and control the career/life of individuals who are not their patients. It's not that they suddenly won't trust us, it just furthers the distrust that already exists

I already said this above. "The argument against making these diagnoses is that we don't want to politicize psychiatry which will only further stigmatize it. We don't want psych evals to be invoked in political elections with the prize of an "all clear" meaning that you're a suitable candidate for office. We want to normalize seeing a psychiatrist, regardless of getting an "all clear" or not. It shouldn't be a way to weed out impaired people since the majority of people with a psych diagnosis are fully capable of doing their jobs, whatever that job may be."

I was saying I regularly see patients for consults or evals and they don't want to talk to me d/t lack of trust. They'll say things like "I don't want any medications that are going to mess with my mind" or be afraid that things they tell me are going to cause problems in their lives (legal, loss of job, insurance coverage, etc). I have to do a lot of education and reassurance with too many patients that what they tell me isn't going to be used against them in their careers or other matters. Many of these individuals are fairly reasonable and not excessively paranoid. Maybe this is just d/t the clinics I've worked in, but I felt like a salesman/ambassador for the field too much during my outpatient year

This is not because some psychiatrist somewhere diagnosed a celebrity. That's a very simplistic way of looking at a very nuanced situation. For one, the patients are right - psych problems DO cause problems in a number of ways. They cause legal issues, are used in child custody cases, can result in professional consequences, can affect insurance coverage. You can do all the education and reassurance in the world but it doesn't erase facts and we shouldn't hide that from patients. The answer to that is also not to waste energy on stupid things like Goldwater, but instead to tackle real, legit reasons that people are afraid of talking to us. That's what stuns me. People are up in arms over Bandy Lee when the field of psychiatry has had a problem long before she arrived on the scene and the problem was not exacerbated by her or any of the people she was working with. The field's problems lie in the issues I said above.

Instances where psychiatrists start crusades to have people removed from office or other career issues based on PD diagnoses made from afar does nothing to help this and only reinforces the already evident distrust of the MH field by much of the general population

Again, already said by me. See above.

 

[Stagg737]

I was just clarifying what I've repeated 3 times. We do agree on some points, but apparently that was missed the first couple times I stated it.

The answer to that is also not to waste energy on stupid things like Goldwater, but instead to tackle real, legit reasons that people are afraid of talking to us. That's what stuns me. People are up in arms over Bandy Lee when the field of psychiatry has had a problem long before she arrived on the scene and the problem was not exacerbated by her or any of the people she was working with. The field's problems lie in the issues I said above.

You don't have to believe me, but I have had couple of patients flat out refuse to talk to me because of that situation. I do educate patients when something could affect their job or or custody/legal issues when it's relevant (which it is usually not), but there's no way that most patients I'm seeing because their PCP referred them to me for depression or anxiety should be as resistant as they can be or nearly as frequently as I experienced last year.

Yes, the problem has existed long before this and there are far worse things the field did that legitimately should sow some distrust. But saying that the whole Bandy Lee led situation did not have an effect is something I cannot agree with based on my clinical experiences.

 

[<L>]

Seems we're veering off topic here. I don't think anyone thinks Goldwater could ever be considered illegal or worthy of police action. The discussion is about ethics and professional consequences.

Sounds like a job for...

 

[<L>]

All this talk about Trump yet not enough people are asking whether or not *Bandy Lee* is a narcissist... smh.

Really the whole debate on here misses the point. I've had not one but two Grand Rounds speakers come thru my institution to talk about her and the ethics of it , but basically her whole deal is her belief that attention-seeking credentialed professionals going on TV and telling the public "You see all that behavior from Trump that you've been seeing for years. It's actually BAD. You didn't realize that it's bad when you voted for him, but you don't have my academic credentials. I work for YALE!" and believing that this would somehow be persuading to Trump-voting yokels who love his behavior.

Sure.......

Fascinating that the solution that Bandy Lee proposes involves giving Bandy Lee a book deal and more media attention.

 

[LimpSpatula]

All this talk about Trump yet not enough people are asking whether or not *Bandy Lee* is a narcissist... smh.

Really the whole debate on here misses the point. I've had not one but two Grand Rounds speakers come thru my institution to talk about her and the ethics of it , but basically her whole deal is her belief that attention-seeking credentialed professionals going on TV and telling the public "You see all that behavior from Trump that you've been seeing for years. It's actually BAD. You didn't realize that it's bad when you voted for him, but you don't have my academic credentials. I work for YALE!" and believing that this would somehow be persuading to Trump-voting yokels who love his behavior.

Sure.......

Fascinating that the solution that Bandy Lee proposes involves giving Bandy Lee a book deal and more media attention.

They’re both grifters, nothing more. Trump is no more dangerous than the next US President. All he did was expose how weak and feeble minded people are. He’s not some mastermind. I love the argument of “well maybe the next President will be smarter and be able to pull off a legit conspiracy”, as if Congress and Big Business isn’t a cesspool of sociopaths.

 

[Trismegistus4]

I haven't read Bandy Lee's book, but I think people are missing the point. Everyone seems to be assuming Lee proposed a syllogism:

• People with narcissistic personality disorder shouldn't be allowed to be President.
• Donald Trump has narcissistic personality disorder.
• Therefore, Donald Trump shouldn't be allowed to be President.

But based on what I understand of her comments, this is not the case. She didn't claim to diagnose him with a clear-cut DSM diagnosis, nor claim that persons with that DSM diagnosis can't be President. Instead, she claimed to be able to deduce all kinds of things about him by secondhand observation, and claimed that those things could predict that he would do all kinds of dangerous things, like kill a bunch of people or get a bunch of people killed. Then, when something happened that resulted in people dying (COVID,) she retconned it into her "prediction" in a case of confirmation bias.

And this is exactly what the psychiatrists whose comments about Barry Goldwater were published in Fact magazine in 1964 did, the publication of which led to the Goldwater rule. We forget now that that was the heyday of psychoanalysis, when psychiatrists thought they could make all kinds of deep inferences about a person based on seemingly, to the layman, insignificant external clues, and trace them back to childhood family dynamics. "Based on the fact that this person stands with his left toe pointed ten degrees farther laterally than his right toe and clears his throat before every time he speaks, we can clearly see that he suffers from delusions of grandeur stemming from the fact that his mother didn't change his diaper in a timely fashion when was progressing from the oral to the anal stage" and other such nonsense. This was considered embarrassing to the field of psychiatry, and rightly so.

 

[ridethecliche]

Free Britney amirite?

 

[Mass Effect]

All this talk about Trump yet not enough people are asking whether or not *Bandy Lee* is a narcissist... smh.

Really the whole debate on here misses the point. I've had not one but two Grand Rounds speakers come thru my institution to talk about her and the ethics of it , but basically her whole deal is her belief that attention-seeking credentialed professionals going on TV and telling the public "You see all that behavior from Trump that you've been seeing for years. It's actually BAD. You didn't realize that it's bad when you voted for him, but you don't have my academic credentials. I work for YALE!" and believing that this would somehow be persuading to Trump-voting yokels who love his behavior.

Sure.......

Fascinating that the solution that Bandy Lee proposes involves giving Bandy Lee a book deal and more media attention.

We don't talk about Bandy Lee because no one cares about her pathology and most people don't know enough about her to comment on her pathology. I sure don't. I didn't even read her book. My argument is strictly about this outdated rule in the first place.

 

[Mass Effect]

I haven't read Bandy Lee's book, but I think people are missing the point. Everyone seems to be assuming Lee proposed a syllogism:

• People with narcissistic personality disorder shouldn't be allowed to be President.
• Donald Trump has narcissistic personality disorder.
• Therefore, Donald Trump shouldn't be allowed to be President.

But based on what I understand of her comments, this is not the case. She didn't claim to diagnose him with a clear-cut DSM diagnosis, nor claim that persons with that DSM diagnosis can't be President. Instead, she claimed to be able to deduce all kinds of things about him by secondhand observation, and claimed that those things could predict that he would do all kinds of dangerous things, like kill a bunch of people or get a bunch of people killed. Then, when something happened that resulted in people dying (COVID,) she retconned it into her "prediction" in a case of confirmation bias.

And this is exactly what the psychiatrists whose comments about Barry Goldwater were published in Fact magazine in 1964 did, the publication of which led to the Goldwater rule. We forget now that that was the heyday of psychoanalysis, when psychiatrists thought they could make all kinds of deep inferences about a person based on seemingly, to the layman, insignificant external clues, and trace them back to childhood family dynamics. "Based on the fact that this person stands with his left toe pointed ten degrees farther laterally than his right toe and clears his throat before every time he speaks, we can clearly see that he suffers from delusions of grandeur stemming from the fact that his mother didn't change his diaper in a timely fashion when was progressing from the oral to the anal stage" and other such nonsense. This was considered embarrassing to the field of psychiatry, and rightly so.

The defense of a rule to muzzle professionals due to the fear that someone will wander far from the reservation and give us a bad name is cult-like behavior. I did not give up my rights to become a doctor. If doctors can argue against vaccines and masks based on hogwash, I can sure as hell give my professional opinion on the behavior of a man who has been in the spotlight as himself longer than I've been alive.

 

[LimpSpatula]

The defense of a rule to muzzle professionals due to the fear that someone will wander far from the reservation and give us a bad name is cult-like behavior. I did not give up my rights to become a doctor. If doctors can argue against vaccines and masks based on hogwash, I can sure as hell give my professional opinion on the behavior of a man who has been in the spotlight as himself longer than I've been alive.

 

[Trismegistus4]

The defense of a rule to muzzle professionals due to the fear that someone will wander far from the reservation and give us a bad name is cult-like behavior. I did not give up my rights to become a doctor. If doctors can argue against vaccines and masks based on hogwash, I can sure as hell give my professional opinion on the behavior of a man who has been in the spotlight as himself longer than I've been alive.

You can call Donald Trump a narcissist all you want, but claiming that you have an official duty to warn because you can gaze into your magical psychiatric crystal ball and predict that not only is he going to get a bunch of people killed, but also he poses a danger to "our survival as a species" (which she literally said) is not a legitimate professional opinion.

 

[WisNeuro]

You can call Donald Trump a narcissist all you want, but claiming that you have an official duty to warn because you can gaze into your magical psychiatric crystal ball and predict that not only is he going to get a bunch of people killed, but also he poses a danger to "our survival as a species" (which she literally said) is not a legitimate professional opinion.

If we're still using forensic work as a comparison, I'd say that at least 10%, easily, of the "professional opinions" I see in reports are far from what would be considered professional, or based in any empirical reality of the issue in question.

 

[Mass Effect]

You can call Donald Trump a narcissist all you want, but claiming that you have an official duty to warn because you can gaze into your magical psychiatric crystal ball and predict that not only is he going to get a bunch of people killed, but also he poses a danger to "our survival as a species" (which she literally said) is not a legitimate professional opinion.

Why isn't it? None of us can predict with absolute certainty what another individual will do, I'll give you that. But we try to predict all the time. Every time we hold a patient involuntarily, every time we fill out disability paperwork, every time we fill out FMLA, we are making a prediction based on our knowledge of an individual and our knowledge of mental illness. And yes, as an expert of human behavior and more important, human pathology, I can gaze into a magical psychiatric crystal ball and say that someone with his character pathology should not in the White House. Have no problem doing that and calling it a legitimate professional opinion, which it most certainly is.

 

[<L>]

If we're still using forensic work as a comparison, I'd say that at least 10%, easily, of the "professional opinions" I see in reports are far from what would be considered professional, or based in any empirical reality of the issue in question.

Depends on who's paying you to give it.

 

[<L>]

Why isn't it? None of us can predict with absolute certainty what another individual will do, I'll give you that. But we try to predict all the time. Every time we hold a patient involuntarily, every time we fill out disability paperwork, every time we fill out FMLA, we are making a prediction based on our knowledge of an individual and our knowledge of mental illness. And yes, as an expert of human behavior and more important, human pathology, I can gaze into a magical psychiatric crystal ball and say that someone with his character pathology should not in the White House. Have no problem doing that and calling it a legitimate professional opinion, which it most certainly is.

I mean, you and I can call it a "professional opinion" as psychiatrists but it's really no more or less valid than my wife's "professional opinion" of Trump as a high school social studies teacher.

In truth, I'd trust the latter more given some of the civics education failures I've seen from medical professionals I work with posted onto facebook.

 

[Trismegistus4]

I mean, you and I can call it a "professional opinion" as psychiatrists but it's really no more or less valid than my wife's "professional opinion" of Trump as a high school social studies teacher.

In truth, I'd trust the latter more given some of the civics education failures I've seen from medical professionals I work with posted onto facebook.

Psychiatrists: Goldwater is a deranged Nazi who's going to get us all killed!
APA: Psychiatrists shouldn't offer a professional opinion about an individual unless they have conducted an examination and have been granted authorization to do so.
Psychiatrists: OK, I see the wisdom in that. After all, we turned out to be wrong about Goldwater.
<40 years later>
Bandy Lee and associates: Trump is a deranged Nazi who's going to get us all killed!
Psychiatrists: What's the difference between that and the statements made about Barry Goldwater?
Bandy Lee and associates: This time it's true!

 

[Mass Effect]

I mean, you and I can call it a "professional opinion" as psychiatrists but it's really no more or less valid than my wife's "professional opinion" of Trump as a high school social studies teacher.

In truth, I'd trust the latter more given some of the civics education failures I've seen from medical professionals I work with posted onto facebook.

Has nothing to do with civics and I vehemently disagree with your assertion that a psychiatrist's opinion of human behavior is considered as valid as a teacher's. If you really believe that, then maybe all hospitals should hire teachers to supervise those pesky NPs. But I suspect you don't actually believe it. You're just being hyperbolic rather than arguing the point. If we've fallen that much as a profession that it's wrong to call us experts in studying someone's behavior and formulating an opinion based on 30-40 years of interviews, stunts, television shows, books, and debates, then God help us going forward.

 

[Mass Effect]

Psychiatrists: Goldwater is a deranged Nazi who's going to get us all killed!
APA: Psychiatrists shouldn't offer a professional opinion about an individual unless they have conducted an examination and have been granted authorization to do so.
Psychiatrists: OK, I see the wisdom in that. After all, we turned out to be wrong about Goldwater.
<40 years later>
Bandy Lee and associates: Trump is a deranged Nazi who's going to get us all killed!
Psychiatrists: What's the difference between that and the statements made about Barry Goldwater?
Bandy Lee and associates: This time it's true!

The above is what we call theater.

 

[splik]

Psychiatrists: Goldwater is a deranged Nazi who's going to get us all killed!
APA: Psychiatrists shouldn't offer a professional opinion about an individual unless they have conducted an examination and have been granted authorization to do so.
Psychiatrists: OK, I see the wisdom in that. After all, we turned out to be wrong about Goldwater.
<40 years later>
Bandy Lee and associates: Trump is a deranged Nazi who's going to get us all killed!
Psychiatrists: What's the difference between that and the statements made about Barry Goldwater?
Bandy Lee and associates: This time it's true!

No psychiatrist said Goldwater was a Nazi. He was a lifelong member of the NAACP, supported integration before it became law, and denounced and banned support of the KKK. Unlike Trump who had a long history of anti-black racism and who called white supremacists “very fine people” and never denounced the support of extremist and terrorist white supremacist groups instead telling them to “stand back and stand by”.

Nobody said they were wrong about Goldwater. He never became president and so never had the power to bring us to nuclear war. Some psychiatrists opined (their opinion actively solicited) at the time that he was unfit for various psychobabble reasons, but it was all about concerns about his advocacy for using nuclear weapons (leading to far fetched psychoanalytic interpretations as to why). We will never know whether he would have started a nuclear war but based on his statements there are good reasons to think he would have used them.

bandy lee et al didn’t have their opinions solicited initially, they gave them anyway, arguing they had a “duty to warn”. Very different to the Goldwater issue of Fact magazine where they surveyed all the psychiatrists in the country for their opinions on Goldwater.

The APA intervened in the Goldwater issue because thousands of psychiatrists responded and it was an embarrassment for the profession. It is harder to argue that one or a handful of individuals, because of their opinions, bring the whole of psychiatry into disrepute. But when you had over 2000 of the 12000 psychiatrists back them providing their opinions including some pretty out there psychodynamic interpretations, that was too big to ignore. It is no accident that it wasn’t until 1973 (9 years later) that the Goldwater rule came into being. This was at a time when the very validity of psychiatric diagnoses were being challenged and the field as a whole under threat. This was the same time that homosexuality was removed from DSM-II, the Rosenhan study exposed psychiatrists could not tell the sane from the insane, and the US-UK diagnostic study highlighted huge problems in the application of psychiatric diagnosis in clinical practice. It was also during a time when the psychodynamic heyday of psychiatry was in decline and psychiatry was seeking medical respectability. This was Something that was not helped by psychiatrists opining that Goldwater’s love of nukes was because he never got over his father being Jewish and other far flung pronouncements.

 

[WisNeuro]

Depends on who's paying you to give it.

Not if you're doing it with integrity.

 

[Trismegistus4]

No psychiatrist said Goldwater was a Nazi. He was a lifelong member of the NAACP, supported integration before it became law, and denounced and banned support of the KKK. Unlike Trump who had a long history of anti-black racism and who called white supremacists “very fine people” and never denounced the support of extremist and terrorist white supremacist groups instead telling them to “stand back and stand by”.

You can actually read the entire article in a window in this Vox article. Some highlights:

• “I believe Goldwater has the same pathological make-up as Hitler, Castro, Stalin and other known schizophrenic leaders.”
• "He appeals to all of the delinquent tendencies in the citizens of the United States: bigotry, hatred, doing away with the income tax, etc. Hitler used the same psychological advantage with the German people."
• "If Goldwater wins the Presidency, both you and I will be among the first into the concentration camps."
• "Gentlemen, I have a bumper sticker on my car which reads REMEMBER MUNICH."
• "Goldwater's expressed wish that he go to the Berchtesgaden region, Hitler's old resting place, to rest after his campaign is enough to convince me of his strong identification with the authoritarianism of Hitler, if not identification with Hitler himself, and all that this implies."
• "Goldwater reminds me in his psychological make-up and political success of Hitler."
• "Since his nomination, I find myself increasingly thinking of the early 1930s and the rise of another intemperate, impulsive, counterfeit figure of a masculine man, namely, Adolf Hitler."

And my favorite:

• "He is a mass-murderer at heart and a suicide. He is amoral and immoral. A dangerous Lunatic! P.S.: Any psychiatrist who does not agree with the above is himself psychologically unfit to be a psychiatrist."

There were many other similar comments, including ones lamenting his following in the "racially bigoted" South and bemoaning his attitude toward Negroes.

Gee, where have I heard all that before?

The APA intervened in the Goldwater issue because thousands of psychiatrists responded and it was an embarrassment for the profession. It is harder to argue that one or a handful of individuals, because of their opinions, bring the whole of psychiatry into disrepute. But when you had over 2000 of the 12000 psychiatrists back them providing their opinions including some pretty out there psychodynamic interpretations, that was too big to ignore. It is no accident that it wasn’t until 1973 (9 years later) that the Goldwater rule came into being.

It's also worth noting that Goldwater sued Fact magazine and won.

 

[LimpSpatula]

You can actually read the entire article in a window in this Vox article. Some highlights:

• “I believe Goldwater has the same pathological make-up as Hitler, Castro, Stalin and other known schizophrenic leaders.”
• "He appeals to all of the delinquent tendencies in the citizens of the United States: bigotry, hatred, doing away with the income tax, etc. Hitler used the same psychological advantage with the German people."
• "If Goldwater wins the Presidency, both you and I will be among the first into the concentration camps."
• "Gentlemen, I have a bumper sticker on my car which reads REMEMBER MUNICH."
• "Goldwater's expressed wish that he go to the Berchtesgaden region, Hitler's old resting place, to rest after his campaign is enough to convince me of his strong identification with the authoritarianism of Hitler, if not identification with Hitler himself, and all that this implies."
• "Goldwater reminds me in his psychological make-up and political success of Hitler."
• "Since his nomination, I find myself increasingly thinking of the early 1930s and the rise of another intemperate, impulsive, counterfeit figure of a masculine man, namely, Adolf Hitler."

And my favorite:

• "He is a mass-murderer at heart and a suicide. He is amoral and immoral. A dangerous Lunatic! P.S.: Any psychiatrist who does not agree with the above is himself psychologically unfit to be a psychiatrist."

There were many other similar comments, including ones lamenting his following in the "racially bigoted" South and bemoaning his attitude toward Negroes.

Gee, where have I heard all that before?



It's also worth noting that Goldwater sued Fact magazine and won.

Psychiatry’s ugly past aside, those comments highlight the arrogance of doctors as a whole during that era. How embarrassing they are. It’s why big business and the government cut them out of the game. And now the patients are starting to cut us out. Greed is a hellavu thing.

 

[birchswing]

Now that it seems some of you are comfortable discussing him medically, what drug or problem would make you sniff incessantly when giving relatively sedate speeches and debate performances that was/is not present when doing high-energy, over-the-top rallies? I've heard people suggest cocaine, but the outcome seemed to be the opposite. He was sniffing every time he was more sedate and serious. And it disappeared when he let loose.

 

[reca]

the Rosenhan study exposed psychiatrists could not tell the sane from the insane

The Rosenhan study absolutely changed the course of mental health in America but it exposed nothing. There is significant evidence to suggest that the study was never actually carried out the way Rosenhan claimed it was. See here: On the troubling trail of psychiatry’s pseudopatients stunt

 

[whopper]

I think some people who don't like the Goldwater Rule are losing perspective that we are in a healing profession. We only are supposed to make comments when we know what we're talking about and virtually almost all the time this pertains to an individual it was after a thorough evaluation. We are not in a position where we are supposed to make spot-judgments on public officials.

What this has to do with us being a "healing profession" is we only get to do this, virtually all the time, only on patients. Hardly ever do we get an in-depth ability to evaluate someone who isn't a patient. One of the only exceptions is in a forensic evaluation. Any physician trying to do something outside the area of the medical context of psychiatric treatment (or any field of medicine for that matter) is acting outside their usual area.


Several several times in forensic psychiatric history, psychiatrists made statements or judgments that turned out to be false, misleading, and completely outside of their expertise. E.g. James Grigson testified several times that he recommended a court to go forward with an execution based on his (less than) expert opinion. The APA even inserted itself into his cases saying he had no evidenced-based data to back up his statements.

Several people think psychiatrists have an ability to read people's minds, or perform acts literally on the supernatural. We do not. Actions done by Bandy Lee used to be done by psychiatrists claiming to be metaphysical masters of the mind, are in violation of our profession and I mentioned above there is evidence to back they were self-serving (paid to do a book? Went on the TV talk circuit where you get paid?), and she had no evidence that met with the standard of care. Evaluations based on tweets and soundbites is not appropriate.

If she wanted to do it the right way she could've written letters stating to various high-level branches of government recommending the President get evaluated and cited evidence to back up her concern.

Everything she did was already public knowledge. It's not like she was unlocking a door opening knowledge no one could've figured out for themselves. It was already on the table that the then-President was showing clear signs of issues just as Biden is showing some and his critics do the same.

Psychiatrists are not masters of the mind. We are masters in the medical specialty of healing mental illness. Psychologists are masters of the mind.

 

[Mass Effect]

I think some people who don't like the Goldwater Rule are losing perspective that we are in a healing profession. We only are supposed to make comments when we know what we're talking about and virtually almost all the time this pertains to an individual it was after a thorough evaluation. We are not in a position where we are supposed to make spot-judgments on public officials.

Real talk: what makes you think you'd be any better at formulating Trump after a 60 minute (or heck even a 90 minute) intake than after 30 years of information? No one made any spot judgments that I've seen. If you've seen spot judgments, let me know.

What this has to do with us being a "healing profession" is we only get to do this, virtually all the time, only on patients. Hardly ever do we get an in-depth ability to evaluate someone who isn't a patient.

Not only the entire profession of forensic psychiatry (which you mentioned) but also any of us who do consultative work would challenge that.

Several several times in forensic psychiatric history, psychiatrists made statements or judgments that turned out to be false, misleading, and completely outside of their expertise. E.g. James Grigson testified several times that he recommended a court to go forward with an execution based on his (less than) expert opinion. The APA even inserted itself into his cases saying he had no evidenced-based data to back up his statements.

True but I fail to see how that's relevant. Psychiatrists are wrong with their own patients, that isn't exclusive to Goldwater violations.

Several people think psychiatrists have an ability to read people's minds, or perform acts literally on the supernatural. We do not. Actions done by Bandy Lee used to be done by psychiatrists claiming to be metaphysical masters of the mind,

Completely disagree with this. There is zero correlation between Lee's actions and supernatural or metaphysical relevance. This is a scare tactic based on your interpretation and not backed up by objective evidence.

are in violation of our profession and I mentioned above there is evidence to back they were self-serving (paid to do a book? Went on the TV talk circuit where you get paid?), and she had no evidence that met with the standard of care. Evaluations based on tweets and soundbites is not appropriate.

I doubt the evaluations were based just on tweets and soundbites. There's a literal wealth of information on this man, from his own mouth and the mouths of those who know him best. Anyone claiming that somehow a 60 minute intake would be more appropriate because you'd come to a different conclusion is spouting BS.

If she wanted to do it the right way she could've written letters stating to various high-level branches of government recommending the President get evaluated and cited evidence to back up her concern.

That's much worse in my view. Stating her opinion is one thing. IT's an opinion based on her expertise. But I can see an argument against it stating that we shouldn't use psychiatry to penalize our political enemies. But recommending a psych eval opens a whole new can of worms and does worse for the field than her just stating her opinion.

Everything she did was already public knowledge. It's not like she was unlocking a door opening knowledge no one could've figured out for themselves. It was already on the table that the then-President was showing clear signs of issues just as Biden is showing some and his critics do the same.

Then what's the problem?

 

[whopper]

A 60 minute talk wouldn't likely give enough ammo for an evaluation of the kind needed for a sitting president.
Bandy Lee's evaluation offered no professional insight into the person more so than anyone of average intelligence offering their opinion reading various media bites. So what's the problem? You don't see it prima-facie? (on the surface?) That a doctor is publishing a book, going on the talk-circuit based on no real substance and in violation of professional standards? (So then should psychiatrists be making what they claim to be professional judgments on anyone based on little data?)

30 years of data without an evaluation that meets standards within our field? Again a prima facie-needs no explanation. If opinions were professional based on prior data without a recent evaluation.....there's no need to even go here.

Consultative work-hey challenge if you'd like. People offering consultative work saying their training gives them something that the training is not designed to do can certainly debate it all they want. That's up to you and the person that hires you. Leave me out of it. I would though challenge specific cases where doctors make claims that do not meet a Daubert standard as happened time and time again in our own field.

Scare tactic? Prima Facie again. Lee based much of her evaluation on tweets. She's basing her arguments that she has professional level insight on a person where she doesn't have professional level insight hence the accusation she's trying to use the misleading mystique of psychiatry.

 

[Mass Effect]

A 60 minute talk wouldn't likely give enough ammo for an evaluation of the kind needed for a sitting president.
Bandy Lee's evaluation offered no professional insight into the person more so than anyone of average intelligence offering their opinion reading various media bites. So what's the problem? You don't see it prima-facie? (on the surface?) That a doctor is publishing a book, going on the talk-circuit based on no real substance and in violation of professional standards? (So then should psychiatrists be making what they claim to be professional judgments on anyone based on little data?)

Except it's not "little data"? And it's also not a violation of professional standards. It's a violation of a recommendation by a toothless organization that pretends to have more power than it does. Just because we're psychiatrists, we didn't sign away our rights to act as private citizens with expertise in the area of psychology and the mind. If a neurologist wanted to comment on how someone walks or if a pulmonologist wanted to comment on a candidate's smoking or use of oxygen, would that be just as deplorable? My guess is no and it shouldn't either. I think treating psychiatry differently is what makes it stigmatized. In our quest to protect our profession, we've created standards for ourselves that actually stigmatize it even more.

30 years of data without an evaluation that meets standards within our field? Again a prima facie-needs no explanation. If opinions were professional based on prior data without a recent evaluation.....there's no need to even go here.

What is missing from the 30 years of data that you think you could get from a formal evaluation?

Consultative work-hey challenge if you'd like. People offering consultative work saying their training gives them something that the training is not designed to do can certainly debate it all they want. That's up to you and the person that hires you. Leave me out of it. I would though challenge specific cases where doctors make claims that do not meet a Daubert standard as happened time and time again in our own field.

The heart of consultation is not owning the patient. They are not your patient. Your "client" is the primary.

Scare tactic? Prima Facie again. Lee based much of her evaluation on tweets.

Did she say that? I know little about her, but I seem to remember she was basing her opinion on everything -- including interviews, articles, TV shows, books (his and others about him), family members, and his own goofy performances for 30 years. Hardly just on tweets.

She's basing her arguments that she has professional level insight on a person where she doesn't have professional level insight hence the accusation she's trying to use the misleading mystique of psychiatry.

I fail to see how she's using the "misleading mystique of psychiatry". Are you really going to say you can't form a professional opinion on Trump? Because I think that's laughable and flies in the face of what forensic psychology and psychiatry has managed to do for decades.