I had a conversation with a group of PGY2/3 resident psychiatrists about a year ago about Trump. They were all engaging in their pet theories about Trump. It was a fun informal dinner with friends, so nothing professionally problematic.
What did disturb me was not a single person in the room knew anything about the Goldwater Rule or what it was. I, the only non-MD, had to explain the history and consequences. I was kind of shocked something like this was not talked about in their ethics training.
My first thought was "oh god I'm sorry you had to be the only non-MD at a dinner with a bunch of residents". Surprising to me those residents didn't know the Goldwater Rule. I assumed every psychiatrist learned about it very early on, since duty to warn is important.
It irked me quite a bit that basic observations of the human condition like "poor memory" were conflated, I think intentionally in this case, with delivering dementia diagnoses. Though it's mostly just a matter of running political interference here, the assumption that everyday statements about personality or behavior either must come in the form a diagnostic entities or are somehow concealing medical implications is not a good turn in the discourse. I've seen similar non sequiturs with psychiatric conditions; Alice says that Bob has been anxious lately, and Carol interjects that anxiety disorders are serious conditions that can't be diagnosed by laypeople. The expectation that psychiatrists can or should provide assessments of public figures when plain observation of their public actions is pretty adequate to assess capacity contributes to this kind of nosological imperialism.
Well said, I agree. The public can notice for themselves "this guy's memory is too shaky for my liking" or "this guy's personality is offensive to me" or whatever, without the need for professional validation. I hadn't seen the Times article. I'm not following the real-time discussion of either candidates' health on anything more than a superficial level, in part because there is so much hearsay and because it won't be too long before the issues in question are settled one way or another. Not worth it for me to follow under a microscope.
I absolutely love this defence of the Goldwater rule, Martin. Much needed - if not for maintaining the professional standing of psychiatry, then at least for common sense. And beautifully written, too :)
I'm not familiar with her book and didn't follow that whole story so I don't know the details. But I don't think publicly diagnosing people without their consent is appropriate. IMO whether you're a psychiatrist or psychologist doesn't really matter.
I’ll admit to only skimming this. But I think you’re correct; I don’t see any reason to assume that psychiatrists are less tribal, less susceptible to confirmation bias and so forth, or less human, than other humans.
I’m a longtime disliker of Donald Trump, going back to when he was a Democrat. But I don’t need the blessing of a psychiatrist to draw conclusions about the man whose utterances are more heavily documented than any public figure in modern history. I’d rather have the psychiatric profession trying to maintain its integrity than have a psychiatrist break the Goldwater rule to reinforce what i already believe.
Arguably, it’s a little narcissistic (in the non clinical sense) to ask psychiatrists to do that, and a little narcissistic of a psychiatrist to feel the calling to break that rule. At least in part because we all know that no criticism of Donald Trump means anything to his apologists.
Thank you for this illuminating history and reflection. I smiled in appreciative agreement at your comment, "Personally, I think any psychiatrist criticizing a public figure under the guise of “duty to warn” has come down with an unfortunate case of grandiose-hero-savior-syndrome."
Thank you for a balanced and professional overview of this topic. I was unfamiliar with the Goldwater Rule but it seems to take an authoritative and sensible approach. I am not a psychologist or psychiatrist or anything psych (though my wife occasionally claims I am psychic!). For me, the non-expert, the clincher is your point about how can you make any determination without an examination? Thumbs up!
I am so impressed with the compassion, as well as the clarity, with which you dealt with these issues. You focused on the ethical issues from the clinician's perspective, which of course makes sense. However, you were kind enough not to dwell on voters' susceptibility to claims by authority figures, whether or not made in good faith.
I'd like to add that I found your discussion of a Borderline vs Bipolar diagnosis based on similar presentation to be extremely edifying.
1) Thank you for addressing the issues! I was in 7th grade at the time and my friends & I were very much anti-Goldwater because all of our parents and teachers —in “history & civics classes” —were discussing all of the issues and they were all upper middle class liberals or “country club Republicans.
2) Of course Trump far worse / more dangerous than Goldwater and even Goldwater seemed to have “mellowed” in someways later years as compared with his 1964 version. (As maybe a side issue, of course I remember the famous “daisy” commercial and Goldwater’s slogans about “extremism”.)
3) Once an adult, I always thought that the Goldwater Rule should have led to a “work around” where psych opinions based upon hypotheticals could have been the basis for “fitness” opinions coupled with disclaimers about “opinion given without a subject’s exact medical history and direct exam and so may be in invalid as to them specific person. I think opinions should have been allowed also based upon psych classification elements a la “DSM”.
4) NOW: I think EVERY candidate should be required to undergo a panel exam with a balanced /agreed upon panel chosen by the AMA and the APA based upon both interviews, full neuropsych and physical exams for differential diagnosis, MMPI, criminal and civil, tax, credit bureau, medical and psych and medication records, IRS, school records, national security checks, financial records and conflict of interest checks, military records, bankruptcy checks, social media surveillance and polygraphs required.
5) Any candidate refusing is out and all applications /process for Presidential candidates should be executed under “penalty of perjury” and yearly updates should be required. (And no Montreal or “Mini-Mental” screening exams are adequate.)
6) Over the past 50-60 years any candidate for “police academies”, bar admission, many other kinds of employment and appointments for positions of trust have to undergo similar scrutiny.
7) My background /current involvements—in addition to being an artist & photographer /writer, entrepreneur— lawyer since 1981 with primary specialty in workers’ compensation defense and risk management representing insurance companies, multi-national corporations, municipalities*, hospitals, self insured associations, etc.
The issues of “fitness for duties”, as well as of causation for symptoms, (and accidents and injuries), diagnoses, conditions, their permanence and whether symptoms and conditions were impairments permanently or impairments at all, and credibility of workers’ comp. claimants and their doctor expert witnesses were always issues.
* And their various departments such as police, fire, seaport, transit, etc.
I get where you're coming from, but I think these kinds of requirements would be counterproductive. Just consider all of the new opportunities for corruption and rule-bending, not to mention debates over what things should or shouldn't be tested. One of my main points is that we're better off allowing millions of people (many of whom have seen the candidates speak and interact for quite a while) decide based on what they see with their own eyes whether or not a candidate is fit for duty.
Again, thanks for your discussion of the Goldwater rule. Do you disagree with the idea that it's a scandal for Presidential candidates not to be vetted when the majority of high level executive and Government positions --and even lower-level government positions are vetted- would not dare hire these days without comprehensive vetting.
I don't think it is a scandal. Maybe in some societies with different traditions, culture, population, etc, that kind of "vetting" might work. But I think our political system runs on the idea that, generally speaking, if you're running for elected office, it's the voters' opinion that matters. Consider that the Constitution itself has few qualifications for holding elected office, whether executive or legislative. The Framers themselves could well have put in various additional qualifications, but didn't (perhaps because they foresaw these problems? I don't know but would be interesting to learn more about).
Requirements this extensive run the risk of discrimination against people with significant medical history who are nevertheless fit for their duty. And it gives people with aspirations to these offices substantial incentive to conceal their problems rather than seek treatment that would leave a record. This is already the case for people with high ambitions; forcing review of medical records would greatly worsen the problem.
Thanks for your comments; Yours, mine and everyone else’s are all part of the .”marketplace of ideas”.
But in light of the fact that lesser officers, employments, positions all require extensive background checks, it seems bizarre not to require it for the most powerful political and executive job in the world.
Or are you advocating for no background checks for anyone and everyone?
I'm advocating for awareness of the perverse incentives that are created by intrusions into medical and psychiatric histories. I also think people overweight the value of such information in evaluating fitness. Besides the externality of treatment aversion, more information is not always better, and sometimes it results in worse decsions.
If I'm not mistaken, what you're advocating goes well beyond a typical background check. The list of tests and checks you supplied honestly looks like throwing examination spaghetti at the wall. I do not believe that police officers and candidates to the bar have their medication histories examined, are subject to review by a panel of AMA and APA experts, or are forced to take (worse than pointless) polygraph tests. I'm not aware of any office that requires this degree of intrusive screening.
Hi, and thanks for writing. No time right now to answer in detail: Superbowl Sunday!. But your comment re: “medication” caught ny eye.
For example, I know for a fact that in 2022 that the TSA—the Federal guys that examine luggage, among other airport duties—not only asked about meds in general, but also called out candidates for taking certain meds and required not only secondary meduxal exams about certain meds, but also some meds might disqualify a candidate from the get go.
(I can even post a redacted version; i. e., no names or addresses, of their forms to show you what I mean. [Forms from 2022 from a closed case of a lawyer I know so the info back then was authentic.])
It is astounding to me that many people object to knowing more about their Presidential candidates and Presidents.
I couldn't find anything about the TSA and medical requirements: https://jobs.tsa.gov/Resources/BackgroundRequirements.pdf Although if there are objections to specific medications that interfere with job performance or pose special risks given the nature of a job (hard to envision for a luggage checker but could be the case) that's different from what's you've proposed.
I do know that *pilots* face a lot of strictures re: mental health conditions and medications. Regardless what you think of it, it leads to the problem I referenced initially: they are unwilling to seek help lest they lose their jobs and consequently pose more, not less of a danger: https://archive.ph/7Ev0e
In a country where millions no longer trust experts or scientific authority, I think your suggestion will not fly. As Dr Greenwald says, qualified practitioners disagree all the time on diagnoses, so I wouldn't be in favor of this either.
No problem that our opinions differ in some ways: it's called "the marketplace of ideas". But do you disagree that it's a scandal that candidates for President are not vetted?
The very use of the word “vet” means there's some superior dispassionate authority that is capable of making error free judgments. The quality of the process depends entirely upon the body making the judgment. Also, realize that the whole field of psychiatry is focused on mental illness, and there's very little research done on psyches that function "well-enough."
I would rather leave the process as a traditional job of the press, and the oppo research that is done by rivals. Then candidates have to answer for what gets dug up about them. I also very much approve of releasing tax returns for the last 10 years.
As the doc said, we see enough of these guys on tape to get a sense of their personalities.
Also, I tend to be a natural small "c" conservative— distrustful of sweeping change.
I think the comment on police academies sort of misses the point. Sure, it would be possible to screen for psychopathy (or low empathy on the ASPD spectrum) or even the dark tetrad. It might even be possible to devise a version of the IAT which isn't prone to false positives, with test-takers obtaining wildly different results on different days.
But this wouldn't solve the problem of police brutality in America or deaths in custody. Most police brutality incidents happen for two reasons. First, barring a few extreme indicators (end spectrum ASPD, an adult version of Richard Tremblay's chronic physical aggression), it's impossible to assess how any given individual will react to being given power and authority over others. Second, it's impossible to gauge how well an individual will cope with the stress conditions of life-threatening situations.
It might be possible to do something about the latter. Decades ago a British science programme called QED ran a filmed test using go karting to measure testosterone biasing in adrenal responses. Five women and five men participated in the test. Those with very high testosterone had extreme adrenal responses which predicted dangerously high speeds with accompanying crashes. Those with low testosterone didn't go anywhere near as fast. One of the best performers on this test and another measuring spatial acuity, was a woman whose chosen profession was test pilot. With a go karting course designed to both simulate greatly increased danger, and increased competitive pressure (with a minimum benchmark) it might be possible to screen out the extremes, with very high testosterone types likely to take risks and make grievous errors in life-threatening situations and very low testosterone types are another type of liability, likely to get themselves, their partners and innocent civilians killed in life-threatening situations, through a lack of swift and decisive action.
Screening out psychopaths would be a very good idea. Psychopaths operate in two way, directly and indirectly. Directly is obvious. Indirectly is through the construction of social camouflage by changing social dynamics. There is great literature both surrounding corporate psychopaths and in the promotion of male rape myths, which shows that psychopaths change their social environments in order to 'normalise' their behaviour. Psychopaths can be high functioning, but they make terrible leaders and managers. In the standard team set-up a manager will try to balance two competing teams, so that only teamwork and hard work can be the decisive factor. Psychopaths have a pathological preference for creating 'A' and 'B' teams, the elites and losers, and then proceed to get the 'A' team to bully the 'B' as a means of practising their preferred aberrant behaviour.
There have been a few instances in the US where explicit racism has been proven to a legal standard at a social level. This is almost certainly the result of psychopathic individual infiltrating the command layer. There is an unfortunate tendency amongst emergency room workers, charity workers and police officers to acquire an institutionalised form of 'victim-blaming', arising from frustration with the daily grind of people who won't or don't help themselves. It's highly likely that under these circumstances a charismatic manipulative psychopath would be able to metastasize generalised contempt for people based upon their socio-economic circumstances into explicit racism, especially when the community being served is in one of the 2% of American districts where 50% of all American violent crime occurs. However, to the psychopath the racism is only instrumental, a form of social camouflage constructed in order to indulge their pathological inclinations.
Police brutality in America generally doesn't occur because of racism, although strong correlation has been shown for lower levels of statistically inappropriate escalation of force like physical manhandling, use of handcuffs, and restraining the individual prone, usually because both parties expect the interaction to go badly and often because some officers have a far greater fear of a more drastic uncontrolled escalation, with likely career-altering and reputation damaging implications. For every George Floyd there is a Tony Timpa. For every Black kid shoot with a toy gun in America one can find a White kids who was shot in the exact same circumstances. Screening on the basis of political basis or educational background really won't help because the exact same social dynamic of contempt/disgust 'victim-blaming' is to be found amongst strongly liberal occupations, even amongst those with the highest proclivity towards public service (people don't go into ER medicine for the money).
America will only change when wealthier White Americans realise it could happen to them, and does- although most victims of crime and the most heavily policed are invariably the poor.
Generally, population level IAT research shows that the UK has lower implicit bias levels than the US. The NHS is quasi-religious in its public service ethic, with huge amounts of respect and admiration given to those who serve in a medical capacity. If it happens here, then you can bet your bottom dollar its happening in America.
There is hugely cited paper from 2015 which looks at structural racism and implicit bias amongst American healthcare workers. It really misses the point. With a strong liberal bias for these occupations, lower ingroup and resulting implicit bias, implicit bias should be lower than for the general population. But it's not. Why? Because the bias is acquired. It's masking SES disgust/contempt- the externalised frustration of those who work with societies poorest, those who not only cannot help themselves, but quite often won't. Better training is required. Despair, chronic demoralisation and the resulting nihilistic self-destructiveness is a dark well from which it's very difficult to summon the energy to climb out of.
I am in private practice, I appreciate this post. Years ago when Trump was first elected, patient after patient came in crying about the results. I am not exaggerating, they were in tears. I was taken aback that anyone would think this was an appropriate venue for a political discussion. I can't remember how I handled it then. But I still remember it.
If Biden wants to convince us that he is truly able to do his job why not simply show up in person at the White House press briefings and answer questions from the press? If he is competent performing that task without a teleprompter in such a setting we would immediately see it and our concerns about his mental acuity would be lessened. Then repeat every week until the election. That he refuses to take that simple step simply underscores the severity of his problem.
Hi, and thanks for writing. No tine right now to answer in detail: Superbowl Sunday!. But your comment re: “medication” caught ny eye.
For example, I know for a fact that in 2022 that the TSA—the Federal guys that examine luggage, among other airport duties—not only asked about meds in general, but also called out candidates for taking certain meds and required not only secondary meduxal exams about certain meds, but also some meds might disqualify a candidate from the get go.
(I can even post a redacted version; i. e., no names or addresses, of their forms to show you what I mean. [Forms from 2022 from a closed case of a lawyer I know so the info back then was authentic.])
It is astounding to me that many people object to knowing more about their Presidential candidates and Presidents.
If that is what they are trying to do, it is reprehensible. I do not know, but now am alarmed enough to want to check it out. That should never be touted as a normal and non-criminal lifestyle choice.
"Does, say, ADHD or narcissistic personality disorder necessarily disqualify someone from leadership?"
If we're going to disqualify politicians on the basis of narcissism then we won't have any politicians. (This is not a joke.)
If we take "narcissism" broadly, including its positive and negative aspects, and not in a narrow DSM sense, then yeah you're probably right.
I had a conversation with a group of PGY2/3 resident psychiatrists about a year ago about Trump. They were all engaging in their pet theories about Trump. It was a fun informal dinner with friends, so nothing professionally problematic.
What did disturb me was not a single person in the room knew anything about the Goldwater Rule or what it was. I, the only non-MD, had to explain the history and consequences. I was kind of shocked something like this was not talked about in their ethics training.
My first thought was "oh god I'm sorry you had to be the only non-MD at a dinner with a bunch of residents". Surprising to me those residents didn't know the Goldwater Rule. I assumed every psychiatrist learned about it very early on, since duty to warn is important.
I wonder if you saw this piece in the NYT today? https://archive.ph/FY8e7
It irked me quite a bit that basic observations of the human condition like "poor memory" were conflated, I think intentionally in this case, with delivering dementia diagnoses. Though it's mostly just a matter of running political interference here, the assumption that everyday statements about personality or behavior either must come in the form a diagnostic entities or are somehow concealing medical implications is not a good turn in the discourse. I've seen similar non sequiturs with psychiatric conditions; Alice says that Bob has been anxious lately, and Carol interjects that anxiety disorders are serious conditions that can't be diagnosed by laypeople. The expectation that psychiatrists can or should provide assessments of public figures when plain observation of their public actions is pretty adequate to assess capacity contributes to this kind of nosological imperialism.
Well said, I agree. The public can notice for themselves "this guy's memory is too shaky for my liking" or "this guy's personality is offensive to me" or whatever, without the need for professional validation. I hadn't seen the Times article. I'm not following the real-time discussion of either candidates' health on anything more than a superficial level, in part because there is so much hearsay and because it won't be too long before the issues in question are settled one way or another. Not worth it for me to follow under a microscope.
I have seen people refer to Hur's description of Biden as a "finding."
Hardly. Only a judge or jury can make a finding after both sides have presented evidence and witnesses have been cross examined.
I absolutely love this defence of the Goldwater rule, Martin. Much needed - if not for maintaining the professional standing of psychiatry, then at least for common sense. And beautifully written, too :)
This is a great exploration of the issues involved.
Great article explaining all the issues! My question is did Mary Trump violate the Goldwater Rule when she diagnosed Trump as a high-functioning sociopath? https://www.cbc.ca/news/world/trump-niece-book-1.5646052
I'm not familiar with her book and didn't follow that whole story so I don't know the details. But I don't think publicly diagnosing people without their consent is appropriate. IMO whether you're a psychiatrist or psychologist doesn't really matter.
I’ll admit to only skimming this. But I think you’re correct; I don’t see any reason to assume that psychiatrists are less tribal, less susceptible to confirmation bias and so forth, or less human, than other humans.
I’m a longtime disliker of Donald Trump, going back to when he was a Democrat. But I don’t need the blessing of a psychiatrist to draw conclusions about the man whose utterances are more heavily documented than any public figure in modern history. I’d rather have the psychiatric profession trying to maintain its integrity than have a psychiatrist break the Goldwater rule to reinforce what i already believe.
Arguably, it’s a little narcissistic (in the non clinical sense) to ask psychiatrists to do that, and a little narcissistic of a psychiatrist to feel the calling to break that rule. At least in part because we all know that no criticism of Donald Trump means anything to his apologists.
Thank you for this illuminating history and reflection. I smiled in appreciative agreement at your comment, "Personally, I think any psychiatrist criticizing a public figure under the guise of “duty to warn” has come down with an unfortunate case of grandiose-hero-savior-syndrome."
Thank you for a balanced and professional overview of this topic. I was unfamiliar with the Goldwater Rule but it seems to take an authoritative and sensible approach. I am not a psychologist or psychiatrist or anything psych (though my wife occasionally claims I am psychic!). For me, the non-expert, the clincher is your point about how can you make any determination without an examination? Thumbs up!
I am so impressed with the compassion, as well as the clarity, with which you dealt with these issues. You focused on the ethical issues from the clinician's perspective, which of course makes sense. However, you were kind enough not to dwell on voters' susceptibility to claims by authority figures, whether or not made in good faith.
I'd like to add that I found your discussion of a Borderline vs Bipolar diagnosis based on similar presentation to be extremely edifying.
1) Thank you for addressing the issues! I was in 7th grade at the time and my friends & I were very much anti-Goldwater because all of our parents and teachers —in “history & civics classes” —were discussing all of the issues and they were all upper middle class liberals or “country club Republicans.
2) Of course Trump far worse / more dangerous than Goldwater and even Goldwater seemed to have “mellowed” in someways later years as compared with his 1964 version. (As maybe a side issue, of course I remember the famous “daisy” commercial and Goldwater’s slogans about “extremism”.)
3) Once an adult, I always thought that the Goldwater Rule should have led to a “work around” where psych opinions based upon hypotheticals could have been the basis for “fitness” opinions coupled with disclaimers about “opinion given without a subject’s exact medical history and direct exam and so may be in invalid as to them specific person. I think opinions should have been allowed also based upon psych classification elements a la “DSM”.
4) NOW: I think EVERY candidate should be required to undergo a panel exam with a balanced /agreed upon panel chosen by the AMA and the APA based upon both interviews, full neuropsych and physical exams for differential diagnosis, MMPI, criminal and civil, tax, credit bureau, medical and psych and medication records, IRS, school records, national security checks, financial records and conflict of interest checks, military records, bankruptcy checks, social media surveillance and polygraphs required.
5) Any candidate refusing is out and all applications /process for Presidential candidates should be executed under “penalty of perjury” and yearly updates should be required. (And no Montreal or “Mini-Mental” screening exams are adequate.)
6) Over the past 50-60 years any candidate for “police academies”, bar admission, many other kinds of employment and appointments for positions of trust have to undergo similar scrutiny.
7) My background /current involvements—in addition to being an artist & photographer /writer, entrepreneur— lawyer since 1981 with primary specialty in workers’ compensation defense and risk management representing insurance companies, multi-national corporations, municipalities*, hospitals, self insured associations, etc.
The issues of “fitness for duties”, as well as of causation for symptoms, (and accidents and injuries), diagnoses, conditions, their permanence and whether symptoms and conditions were impairments permanently or impairments at all, and credibility of workers’ comp. claimants and their doctor expert witnesses were always issues.
* And their various departments such as police, fire, seaport, transit, etc.
I get where you're coming from, but I think these kinds of requirements would be counterproductive. Just consider all of the new opportunities for corruption and rule-bending, not to mention debates over what things should or shouldn't be tested. One of my main points is that we're better off allowing millions of people (many of whom have seen the candidates speak and interact for quite a while) decide based on what they see with their own eyes whether or not a candidate is fit for duty.
Again, thanks for your discussion of the Goldwater rule. Do you disagree with the idea that it's a scandal for Presidential candidates not to be vetted when the majority of high level executive and Government positions --and even lower-level government positions are vetted- would not dare hire these days without comprehensive vetting.
I don't think it is a scandal. Maybe in some societies with different traditions, culture, population, etc, that kind of "vetting" might work. But I think our political system runs on the idea that, generally speaking, if you're running for elected office, it's the voters' opinion that matters. Consider that the Constitution itself has few qualifications for holding elected office, whether executive or legislative. The Framers themselves could well have put in various additional qualifications, but didn't (perhaps because they foresaw these problems? I don't know but would be interesting to learn more about).
Requirements this extensive run the risk of discrimination against people with significant medical history who are nevertheless fit for their duty. And it gives people with aspirations to these offices substantial incentive to conceal their problems rather than seek treatment that would leave a record. This is already the case for people with high ambitions; forcing review of medical records would greatly worsen the problem.
Thanks for your comments; Yours, mine and everyone else’s are all part of the .”marketplace of ideas”.
But in light of the fact that lesser officers, employments, positions all require extensive background checks, it seems bizarre not to require it for the most powerful political and executive job in the world.
Or are you advocating for no background checks for anyone and everyone?
I'm advocating for awareness of the perverse incentives that are created by intrusions into medical and psychiatric histories. I also think people overweight the value of such information in evaluating fitness. Besides the externality of treatment aversion, more information is not always better, and sometimes it results in worse decsions.
If I'm not mistaken, what you're advocating goes well beyond a typical background check. The list of tests and checks you supplied honestly looks like throwing examination spaghetti at the wall. I do not believe that police officers and candidates to the bar have their medication histories examined, are subject to review by a panel of AMA and APA experts, or are forced to take (worse than pointless) polygraph tests. I'm not aware of any office that requires this degree of intrusive screening.
Hi, and thanks for writing. No time right now to answer in detail: Superbowl Sunday!. But your comment re: “medication” caught ny eye.
For example, I know for a fact that in 2022 that the TSA—the Federal guys that examine luggage, among other airport duties—not only asked about meds in general, but also called out candidates for taking certain meds and required not only secondary meduxal exams about certain meds, but also some meds might disqualify a candidate from the get go.
(I can even post a redacted version; i. e., no names or addresses, of their forms to show you what I mean. [Forms from 2022 from a closed case of a lawyer I know so the info back then was authentic.])
It is astounding to me that many people object to knowing more about their Presidential candidates and Presidents.
I couldn't find anything about the TSA and medical requirements: https://jobs.tsa.gov/Resources/BackgroundRequirements.pdf Although if there are objections to specific medications that interfere with job performance or pose special risks given the nature of a job (hard to envision for a luggage checker but could be the case) that's different from what's you've proposed.
I do know that *pilots* face a lot of strictures re: mental health conditions and medications. Regardless what you think of it, it leads to the problem I referenced initially: they are unwilling to seek help lest they lose their jobs and consequently pose more, not less of a danger: https://archive.ph/7Ev0e
In a country where millions no longer trust experts or scientific authority, I think your suggestion will not fly. As Dr Greenwald says, qualified practitioners disagree all the time on diagnoses, so I wouldn't be in favor of this either.
> In a country where millions no longer trust experts or scientific authority,
As well they shouldn't. Our experts and "scientific" authorities have repeatedly shown themselves to be completely untrustworthy.
No problem that our opinions differ in some ways: it's called "the marketplace of ideas". But do you disagree that it's a scandal that candidates for President are not vetted?
The very use of the word “vet” means there's some superior dispassionate authority that is capable of making error free judgments. The quality of the process depends entirely upon the body making the judgment. Also, realize that the whole field of psychiatry is focused on mental illness, and there's very little research done on psyches that function "well-enough."
I would rather leave the process as a traditional job of the press, and the oppo research that is done by rivals. Then candidates have to answer for what gets dug up about them. I also very much approve of releasing tax returns for the last 10 years.
As the doc said, we see enough of these guys on tape to get a sense of their personalities.
Also, I tend to be a natural small "c" conservative— distrustful of sweeping change.
I think the comment on police academies sort of misses the point. Sure, it would be possible to screen for psychopathy (or low empathy on the ASPD spectrum) or even the dark tetrad. It might even be possible to devise a version of the IAT which isn't prone to false positives, with test-takers obtaining wildly different results on different days.
But this wouldn't solve the problem of police brutality in America or deaths in custody. Most police brutality incidents happen for two reasons. First, barring a few extreme indicators (end spectrum ASPD, an adult version of Richard Tremblay's chronic physical aggression), it's impossible to assess how any given individual will react to being given power and authority over others. Second, it's impossible to gauge how well an individual will cope with the stress conditions of life-threatening situations.
It might be possible to do something about the latter. Decades ago a British science programme called QED ran a filmed test using go karting to measure testosterone biasing in adrenal responses. Five women and five men participated in the test. Those with very high testosterone had extreme adrenal responses which predicted dangerously high speeds with accompanying crashes. Those with low testosterone didn't go anywhere near as fast. One of the best performers on this test and another measuring spatial acuity, was a woman whose chosen profession was test pilot. With a go karting course designed to both simulate greatly increased danger, and increased competitive pressure (with a minimum benchmark) it might be possible to screen out the extremes, with very high testosterone types likely to take risks and make grievous errors in life-threatening situations and very low testosterone types are another type of liability, likely to get themselves, their partners and innocent civilians killed in life-threatening situations, through a lack of swift and decisive action.
Screening out psychopaths would be a very good idea. Psychopaths operate in two way, directly and indirectly. Directly is obvious. Indirectly is through the construction of social camouflage by changing social dynamics. There is great literature both surrounding corporate psychopaths and in the promotion of male rape myths, which shows that psychopaths change their social environments in order to 'normalise' their behaviour. Psychopaths can be high functioning, but they make terrible leaders and managers. In the standard team set-up a manager will try to balance two competing teams, so that only teamwork and hard work can be the decisive factor. Psychopaths have a pathological preference for creating 'A' and 'B' teams, the elites and losers, and then proceed to get the 'A' team to bully the 'B' as a means of practising their preferred aberrant behaviour.
There have been a few instances in the US where explicit racism has been proven to a legal standard at a social level. This is almost certainly the result of psychopathic individual infiltrating the command layer. There is an unfortunate tendency amongst emergency room workers, charity workers and police officers to acquire an institutionalised form of 'victim-blaming', arising from frustration with the daily grind of people who won't or don't help themselves. It's highly likely that under these circumstances a charismatic manipulative psychopath would be able to metastasize generalised contempt for people based upon their socio-economic circumstances into explicit racism, especially when the community being served is in one of the 2% of American districts where 50% of all American violent crime occurs. However, to the psychopath the racism is only instrumental, a form of social camouflage constructed in order to indulge their pathological inclinations.
Police brutality in America generally doesn't occur because of racism, although strong correlation has been shown for lower levels of statistically inappropriate escalation of force like physical manhandling, use of handcuffs, and restraining the individual prone, usually because both parties expect the interaction to go badly and often because some officers have a far greater fear of a more drastic uncontrolled escalation, with likely career-altering and reputation damaging implications. For every George Floyd there is a Tony Timpa. For every Black kid shoot with a toy gun in America one can find a White kids who was shot in the exact same circumstances. Screening on the basis of political basis or educational background really won't help because the exact same social dynamic of contempt/disgust 'victim-blaming' is to be found amongst strongly liberal occupations, even amongst those with the highest proclivity towards public service (people don't go into ER medicine for the money).
America will only change when wealthier White Americans realise it could happen to them, and does- although most victims of crime and the most heavily policed are invariably the poor.
https://www.manchesterworld.uk/news/manchester-university-ae-deprived-3814491
Generally, population level IAT research shows that the UK has lower implicit bias levels than the US. The NHS is quasi-religious in its public service ethic, with huge amounts of respect and admiration given to those who serve in a medical capacity. If it happens here, then you can bet your bottom dollar its happening in America.
There is hugely cited paper from 2015 which looks at structural racism and implicit bias amongst American healthcare workers. It really misses the point. With a strong liberal bias for these occupations, lower ingroup and resulting implicit bias, implicit bias should be lower than for the general population. But it's not. Why? Because the bias is acquired. It's masking SES disgust/contempt- the externalised frustration of those who work with societies poorest, those who not only cannot help themselves, but quite often won't. Better training is required. Despair, chronic demoralisation and the resulting nihilistic self-destructiveness is a dark well from which it's very difficult to summon the energy to climb out of.
Frankly, given that by now even psychologists barely even bother to keep up the pretense that psychology is scientific (https://www.experimental-history.com/p/im-so-sorry-for-psychologys-loss), I think psychology should be legally reclassified as a religion.
I am in private practice, I appreciate this post. Years ago when Trump was first elected, patient after patient came in crying about the results. I am not exaggerating, they were in tears. I was taken aback that anyone would think this was an appropriate venue for a political discussion. I can't remember how I handled it then. But I still remember it.
A little too late on the perception as a "captured constituency" front I think, applies to physicians more broadly though.
If Biden wants to convince us that he is truly able to do his job why not simply show up in person at the White House press briefings and answer questions from the press? If he is competent performing that task without a teleprompter in such a setting we would immediately see it and our concerns about his mental acuity would be lessened. Then repeat every week until the election. That he refuses to take that simple step simply underscores the severity of his problem.
Hi, and thanks for writing. No tine right now to answer in detail: Superbowl Sunday!. But your comment re: “medication” caught ny eye.
For example, I know for a fact that in 2022 that the TSA—the Federal guys that examine luggage, among other airport duties—not only asked about meds in general, but also called out candidates for taking certain meds and required not only secondary meduxal exams about certain meds, but also some meds might disqualify a candidate from the get go.
(I can even post a redacted version; i. e., no names or addresses, of their forms to show you what I mean. [Forms from 2022 from a closed case of a lawyer I know so the info back then was authentic.])
It is astounding to me that many people object to knowing more about their Presidential candidates and Presidents.
Isn't this the same APA that periodically tries to get pedophilia reclassified as a sexual orientation?
If that is what they are trying to do, it is reprehensible. I do not know, but now am alarmed enough to want to check it out. That should never be touted as a normal and non-criminal lifestyle choice.