Platt Perspective on Business and Technology

Donald Trump and the stress testing of the American system of government 2

Posted in social networking and business by Timothy Platt on February 24, 2017

This is my seventh installment to a now-ongoing if still occasional series of postings in which I seek to address politics in the United States as it has become, starting with the nominations process leading up to the 2016 presidential elections (see Social Networking and Business 2, posting 244 and loosely following.)

I am also very explicitly offering this posting as a direct continuation of an immediately related, Part 1 stress test posting that I first wrote to go live to this blog a few days ago. My goal here is to continue its line of discussion from essentially where I left off on it there.

As a matter of offering at least a brief continuity of narrative overlap here, I focused on two fundamental areas of interest and concern in that earlier posting, that we all face as we observe – and endure the Trump presidency. The first of those issues is captured in the essentially unavoidable to ignore fact that:

• Donald Trump as the president of the United States, follows the exact same approach to agreement and dissent now, that he always has. He takes even the slightest possibility of disagreement with himself, and on even just his most off the cuff comments, half formed thoughts or posturing as if they constituted a dire, existential threat to his very being – and certainly to his sense of self-worth. He exists, as such in his own self-defined and self-imposed, and his own rigidly enforced and maintained epistemic bubble. And it is a bubble that endures without the requirement of thoughtful analysis or reflection that would more normally be at least implied from the word epistemic itself, with that coming from the Greek root word epistēmē (ἐπιστήμη), meaning knowledge. Donald Trump’s epistemic bubble is designed to block and prevent any real self-reflection or self-knowledge; any such insight would essentially of necessity remain unattainable, absent any possibility of any considered alternatives, and regarding any issues.
• And congruent with this issue if nothing else, and as the second signally important issue raised in my February 20 posting that I would make note of here, is the question of now-president Trump’s mental health and his capacity to in fact effectively fulfill his duties of office as president.

I began addressing that second issue in my just cited sixth series installment and will focus on more fully addressing it here in this posting, referring back to the first of the above two bullet-pointed issues as it becomes crucially important in this mental health context too.

More specifically, I wrote in my earlier posting of the catch-22 that mental health professionals now find themselves in as a result of the enactment of Section 7.3 of the American Psychiatric Association (APA)’s code of ethics: the colloquially named Goldwater rule. Psychiatrists, and I add professionally trained and licensed mental health professionals in general are for the most part barred on ethical practice grounds, from offering specific mental health diagnoses of individual public figures, or of individuals in general who they have not specifically, personally met with and professionally assessed for this. And then they cannot divulge what they do find if they get to make such assessments, at least publically, without violating clinician/patient confidentiality agreements and requirements – except when and if they are required to do so under law as for example might arise if they are required to testify in a court of law. And I wrote then of how mental health professionals have begun challenging the edges of this restriction, at the very least, by offering more general statements concerning types of mental health diagnoses – that are not explicitly being offered as individualized diagnoses of any one individual (e.g. our current sitting president), but that would be impossible not to specifically see as being directed towards him. I wrote that on February 19 to go live the next day, and looking back at the flow of news surrounding the Trump presidency, cracks were already forming in the directed and individualized distant-diagnoses protection that the Goldwater rule was intended to enforce. Some clinicians were already beginning to at least mutter in that direction. I write this on February 23, 2017 and those cracks have widened – and at least a few widely peer-respected mental health clinicians are now starting to very publically, overtly set that rule aside in order to discuss Donald Trump as a specific diagnosable individual.

One line of argument used when this rule was first established and as a basis for it, was that the Goldwater detractors were making more ad hoc assessments than would ever be professionally used or even condoned now, and certainly with today’s professional diagnostic rigor as is currently available. Basic functional and diagnostic mental health conditions and syndromes have now been rigorously formally defined and in essentially universally held terms, and with all such diagnostic standards based on carefully conducted clinical studies. The core reference work that contains this flow of carefully developed and organized diagnostic knowledge is the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), that first came out in 2013 for this most recently updated version, and that now constitutes the primary resource in place for offering clear, unambiguous, replicably consistent and clinically validated diagnostic findings. And clinicians are now starting to cite its rigor, and the very ubiquity of their range of opportunity to observe Donald Trump as offering sufficient basis for their arriving at professionally meaningful diagnoses as to the state of his mental health. This is all new territory, and it is uncertain as to how professional organizations such as the APA will respond to what amounts to explicit and intentional violation of its formal code of ethics by its members, and particularly in such a high profile political context. But setting that set of possible outcomes within the profession aside for now, the Goldwater rule has for an increasing number of mental health professionals, become a more dubious resource, and one that might be overlooked or even ignored in attempts to meet what they have come to see as a greater perceived societal need. Professional psychiatrists, and I add psychologists and others are now speaking out and publically offering explicit diagnostic assessments as to the current state of Donald Trump’s mental health.

But let’s step back from that and consider the process that the Goldwater rules would allow if adhered to. And let’s consider that complex of issues in terms of a single question and its possible answers:

• Would Trump even allow a mental health professional to evaluate him, and even just under circumstances that would legally demand complete confidentiality on their part?

I would have to assume that any realistic answer to that would have to be no, and particularly given the first of the two carry-over issues that I raised in Part 6 of this series and that I repeated, rephrased above. Donald Trump is unable to endure even a hint of dissent from his assessment as to how many people publically attended his open air inauguration and in spite of all photographic evidence and from all sources that would contradict his claims and beliefs there. This is, or at least should be a very minor and even a very forgettable issue, but president Trump cannot let go of it, attacking any and all who would attempt to violate the received wisdom of his epistemic bubble on this or any other matter. How likely is it that he would allow in a licensed mental health professional who might challenge his very mental competency and the entirety of that bubble and everything that it contains and consists of?

Let’s consider a possible historical parallel here, with the reign of King George III of the United Kingdom. George III came to be seen as the mad king – and in all fairness his overt hallucinations and other mental health manifestations probably trace in their essential entirely to his suffering from a familial genetic disease: a form of porphyria. Efforts were made to treat and if possible cure him, and a legion of physicians was brought in, in an attempt to achieve that goal. But George III was the King, so no lesser being was or could be allowed to speak to him without his permission, let alone ask him any questions. When the King did not want to hear from someone he simply ignored them – and many of these physician attempts went essentially entirely ignored. No one can make a diagnosis or offer a meaningfully relevant treatment if they cannot find out anything at all about the patient who they would treat. That held then, in those primitive days of mental health assessment and treatment and it still applies now.

King George III did in fact have one physician who for whatever reason he did allow to speak with him – but not actually ask any questions. That was a man by the name of Francis Willis, who found himself in the King’s presence at a point in time when George III was going into one of his periodic remissions – as occur for those suffering from the condition that he had.

Willis was richly rewarded for his presumed success, and was paid the then fortune of over one thousand pounds at least once for his effort. The King even had a special commemorative coin struck that bore Willis’ image on it as a token of his appreciation. His Willis era remission ended and his overt symptoms returned again of course, but that is another story. My primary point here is that neither earlier era physicians nor modern day mental health professionals can automatically impose their will or their diagnostic skills on a resistant King George III, or upon an at least as equally resistant Donald Trump, US president. And George III was at least self-aware enough to realize that he had real problems.

And this brings me to the question of the 25th amendment to the US constitution and its critically important Section 4, and of the constitutionally stated process by which a sitting United States president might formally be declared as being unable to perform his duties of office. This brings me to the completely untested-for-mental-health issues process, by which a sitting president might be required to at least temporarily step aside from serving in office and with the vice president taking offer as acting president – until the elected president is somehow formally found mentally capable of functioning in office again.

I am going to continue this narrative in a next series installment in another four days or so, and with that set of issues. And then, as promised in Part 6 of this series, I will at least briefly look into a number of presidential succession issues as might be illuminated by the stories of specific prior US presidents, and by relevant points of American history. And as a part of that, I will also consider the issues of impeachment as that enters this narrative at least as significantly as Section 4’s determination of incapacitation issues do. And as a part of all of that, I will at least briefly discuss the gray area challenge of determining precisely what it means to be capable or incapable of carrying out the duties of office, and of being declared incapacitated to a degree that would surpass such a functionality threshold. Ultimately, any attempt to even temporarily remove a sitting US president, and certainly against their will, is going to hinge on what this means and both as a matter of general principle and as a matter of actual here-and-now political will and follow-through. Ultimately, even impeachment and removal from office for the commission of “high crimes and misdemeanors” would bring up issues of capacity to actually serve in office and certainly as political decisions have to be made in the US Congress, and acted upon. So the issues that I would turn to next in this series have essentially across the board implications and I add complications here.

Meanwhile, you can find this and related postings at Social Networking and Business 2, and also see that directory’s Page 1.

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