Tuesday, January 23, 2018

Can Trump prove his sanity?

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Since Donald Trump took over the United States presidency a year ago, doubts over his mental stability and his very sanity have been mounting. With the release of Michael Wolff's book Fire and Fury: Inside the Trump White House, which claims to offer a behind-the-scenes look at the president's dysfunctional administration, those doubts seem to have taken on a new salience and urgency.

But, beyond claiming on Twitter that he is a "very stable genius," what could Trump actually do to prove that he is psychologically fit for what, by some definitions, is the world's highest office?

There is no clear physical test for mental illness. Even if Trump were subjected to a battery of blood tests and brain scans, the results would most likely prove nothing. The vast majority of people with psychosis would have normal results. Likewise, an abnormal test wouldn't necessarily imply impaired mental capacity: a person can retain their intelligence, even after losing a significant amount of their brain.

For example, a recent study showed that all but four of 54 children who underwent a hemispherectomy, in which half the brain is removed to treat severe and intractable epilepsy, showed the same or even improved intellectual capacity. So Trump could literally have half a brain, and it still wouldn't prove that he was mentally ill.

Another approach to determining Trump's mental fitness would be to have psychiatrists examine him and share their findings. But, however unbiased the psychiatrists were, such assessments would ultimately be subjective. As any trial judge or criminal lawyer can attest, for every psychological expert produced by the defense in a legal case, prosecutors can produce one to argue the opposite.

Consider the case of Anders Breivik, who killed 77 people in Norway in 2011. At his trial, two teams of court-appointed psychiatrists disagreed with each other over whether he was insane. If psychiatrists can't agree on whether a mass murderer is insane, what hope is there that they could agree about Trump?

In any case, Trump seems to have no interest in bringing in experts. Instead, he has pursued his own - and, from a psychiatric perspective, ill-advised - strategy for rebutting questions about his sanity.

One of Trump's go-to defenses has been that he is highly intelligent - or, as he put it recently on Twitter, "like, really smart." But, even if true, this, too, proves nothing. Many highly intelligent people suffer from mental illness.

In fact, studies have shown that the populations of countries with higher average IQs suffer higher rates of suicide. And suicide rates at the prestigious universities of Oxford and Cambridge are in line with average suicide rates for university-age people, highlighting again that being smart - or even smart and privileged - does not immunize a person against mental illness.

Trump also claims that he is too successful to be mentally ill. But Howard Hughes's success as a film producer and airline owner made him one of the richest Americans to emerge during the first half of the twentieth century. He also set several world airspeed records. Yet he suffered from severe obsessive-compulsive disorder, and he died suffering from extreme malnutrition and possible drug addiction.

Likewise, John Paul Getty, the US-born industrialist who was the world's richest person during his time, was so obsessively frugal and paranoid that, when his grandson was kidnapped, he negotiated down the ransom demand, even after the kidnappers sent him a lock of his grandson's hair and one of his ears.

Trump's third key defense is to turn allegations about his sanity against his accusers and political opponents. That tactic is not new. In the Soviet Union - and, many argue, in China today - political dissidents would be committed to psychiatric care, precisely to discredit them. Russia actually withdrew from the World Psychiatric Association for most of the 1980s, in order to avoid being expelled for such practices.

As an experiment led by David Rosenhan of Stanford University in the 1970s demonstrated, a label of mental illness can be difficult to remove. Healthy volunteers invented a hallucination, in order to find out whether the psychiatric system could distinguish genuine mental illness.

The volunteers ended up being admitted to psychiatric institutions, where they behaved normally and claimed no symptoms. But, with the psychotic label already affixed to their files, whatever they did was assumed to be a symptom of their insanity. At best, they would be declared to be "in remission."

Rosenhan's experiment suggests that questions about Trump's mental health might never go away, no matter what steps he takes to change his detractors' minds. Even if he stops ranting on Twitter or speaking in convoluted and incoherent sentences, at best he will be viewed as being "in remission."

Modern psychiatrists would argue that they have taken to heart the lessons of the Rosenhan experiment, and now make diagnoses much more cautiously and rigorously. Yet irresponsible political uses of psychiatric medicine still abound. To name one example, the British government recently attempted to recruit National Health Service mental-health professionals to report those suspected of being psychiatrically vulnerable to extremist ideology.

In the original Rosenhan experiment, the only people who reliably recognized that the "impostor patients" were, in fact, mentally healthy were their fellow psychiatric inmates. By this logic, perhaps we are asking the wrong people to assess Trump's sanity. In any case, if Trump's detractors hope to drive him from office, they will need more than armchair psychiatry.

Raj Persaud and Peter Bruggen are psychiatrists based in London

-----------Raj Persaud and Peter Bruggen

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