Paula Joan Caplan (July 7, 1947 - July 21, 2021)

First published May 8, 2020, at https://www.madinamerica.com/2020/05/presidents-fitness-can-professionals-help-decide/ [new material added here is in square brackets below]

 

Even before Donald Trump became President of the United States, speculations about whether he was fit to serve were rampant. Although it is beside the point, much time and heated debate consisted of questions such as, "Is he mentally ill?" and "Which kindof mental illness does he have?" In our psychiatrized nation, such discussions have widely been heard as meaning: "Trump is mentally ill, and that makes him unfit to serve as President."

 

Most readers of Mad in America know that both the overarching category of "mental illness" and the hundreds of alleged subcategories listed in psychiatric classification systems have no scientific basis and are not useful in helping people who are suffering or stopping those who make other people suffer. I addressed this in an article I wrote fairly early in the debate, called "The Truth about Trump and Psychiatric Diagnosis."

 

Most readers of Mad in America also have a healthy skepticism about what—or whether—professionals have anything to contribute to the benefitting of society. So the question is whether that skepticism applies to determining whether Trump or any President is fit to serve in that office. I think that, for once, it does not, but I have a very specific reason for saying this.

 

The 25th Amendment to the United States Constitution was supposed to provide for the removal of an unfit President. It was "proposed by Congress and ratified by the states in the aftermath of the assassination of President John F. Kennedy" and "provides the procedures for replacing the president or vice president in the event of death, removal, resignation, or incapacitation." However,  the devil is in the details, and the Amendment turns out to be woefully inadequate. Why? Because Section 4 provides that:

 

Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

 

However, even if that happened in Trump's case, the Amendment provides that if the President just declares in writing that "no such inability exists," he continues in his office unless the Congress determines by two-thirds vote of both Houses that the President is unable to discharge the powers and duties of the office. It's not hard to imagine that with the current Senate, that would be unlikely to happen, given the Senate's utter failure to act after the House of Representatives impeached the President.

Congressman Jamin Raskin (D-MD), a brilliant Constitutional law scholar, has tried to draft legislation that would get around the highly political nature of the process as it is described in the Amendment. He aimed to create a mechanism for determining fitness to serve by creating a Commission for that purpose. In correspondence with me (Sept. 4, 2017), he explained the further wish to avoid making the process solely "psychiatric or medical," because then, "people will say the decision has been medicalized or psychologized when it is properly a public policy question."

 

His idea was to constitute a Commission with a mix of public policy, medical, and psychiatric professionals. Since fitness to serve can be affected by such physical impairments as those caused by strokes and comas, it makes sense to include medical personnel who are not psychiatrists. The legislation he proposed was HR 1987 from the 115th Congress, to which 70 members of the House of Representatives signed on, all Democrats.

 

I sent Congressman Raskin a proposal in which I strongly argued against including mental health professionals who would likely focus on psychiatric diagnosis. I pointed out not only that such diagnoses are unscientific but also that many people who have been given such labels have done great work and done no harm.  I then pointed out that some psychologists and educators can offer information and tools that are directly relevant to fitness to serve.

 

In fact, it strikes me as quite simple: Determination of fitness to serve should be based on whether the office-holder can carry out the crucial elements of the job. Professionals who are trained in developing and administering reliable, valid achievement tests and tests of memory and abstract thinking—primarily some psychologists and educators—could play crucial roles in such a Commission.

 

Here are excerpts from what I wrote to the Congressman on January 4, 2018, and which still applies. I have added slight clarifications in square brackets.

If you have [psychiatrists] on the Commission, whatever they say will not be scientific, not empirically demonstrable, and thus open to accusations that the process is improperly political. Where there is no science (there is none in psychiatric diagnosis), there is only opinion, and opinion is always highly susceptible to bias of many kinds.
The Commission ought to include a neuropsychologist, since they are trained to give standardized memory tests, and memory is of course an essential component of fitness to serve.  The Commission should arrange to have [chosen or] constructed the relevant tests of fitness, which are in many ways achievement tests — tests of knowledge about the Constitution ([a] book being published tomorrow includes…that someone tried to discuss the Constitution with Trump and got as far as the 4th Amendment before he changed the subject, so this is a timely way to point out the usefulness of the approach I suggest), how a bill becomes a law, geography, political systems globally, and tests of memory and of the understanding of abstract concepts including but not limited to cause-effect relationships.
The tests described in (2) have a parallel in the achievement tests a person applying for U.S. citizenship needs to take. As you said, the Constitution does not include requirements as in (2), but those become relevant once the question of fitness to serve is raised.
Various people throw around the term "mental" as in "mental impairment." It is essential to distinguish between two kinds of "mental impairment": There is emotional impairment [or difference] (e.g., absence of empathy and compassion, believing oneself to be Jesus Christ [if one is not]), and there is cognitive impairment (e.g., dementia, reading disability, math disability, inability to form or comprehend abstract concepts). Just a note: Trump may be suffering from both lifelong cognitive impairment (one of his professors from Wharton called him the dumbest student he ever had) and perhaps now, some dementia. [T]he way he slurred "United States" recently is not explained by dry mouth as was suggested. He could be having small strokes. That's why a neurologist as well as a neuropsychologist would be good to have on the Commission.
If you left out Trump's name and just told anyone some things he has said and done, they would assign labels such as "bully," "whopping sense of entitlement," "power-hungry," "stunning lack of empathy and compassion" [and "thug," "criminal," or "evildoer]. These are more than adequate to explain a huge amount of what we see in him. Ask people what they think calling him "mentally ill" would add. What does it explain that is relevant to fitness to serve as President? Saying he is unfit to serve because of being mentally ill is causing huge offense to people who have psychiatric labels, and that may well come close to 1/3 of the U.S. population. Abraham Lincoln would have been diagnosed as mentally ill. A psychiatric label is orthogonal to the matter of fitness to serve.
The kinds of tests described in (2) are exquisitely specific, jargon-free, and inarguably relevant to fitness to serve.

Congressman Raskin, in a May 6, 2020 email to me, said that if he were to rewrite the legislation today, he would include Governors and a neurologist. He noted: "All of the events we are living through reconfirm for me that the critical concept under Section 4 of the 25th Amendment is 'dangerous unfitness' to discharge the powers and duties of office."

 

Despite all of the above, many psychiatrists and psychologists have claimed that they have "special expertise" and extensive training that qualify them to judge Trump to be mentally unfit and dangerous to this nation's "public health." Their position is that they have a "duty to warn" that justifies their ignoring of the Goldwater Rule, https://www.madinamerica.com/2020/04/muzzled-psychiatry-time-crisis/ which prohibits the giving of professional opinions of anyone the therapist has not evaluated in person.

 

Of course, given that psychiatric diagnoses are not valid, the Goldwater Rule by all rights should specify that no one should ever give anyone a psychiatric diagnosis. But the rule refers to more than just diagnosis, so the professionals who claim special expertise—who tend to vary among themselves, and some of whom vacillate between saying he is mentally ill and saying diagnosis is beside the point [their leader, Yale psychiatrist Bandy Lee, has been quoted in a recent article in a publication that is opposed to psychiatric diagnosis https://www.madinamerica.com/2020/04/muzzled-psychiatry-time-crisis/ as saying that diagnosis is beside the point, when in fact she sometimes says that but has vigorously promoted a book she edited and a film about the book in which her chosen authors say that he is mentally ill, and some even claim to know he should be diagnosed with specific, but various, labels] —should stop claiming that they must speak out because of that alleged expertise.

 

For psychiatrists, psychologists, social workers, and other therapists to claim that they are essential for warning people that Trump is dangerous is to claim special expertise and insight to which they are not entitled, and it simultaneously demeans the judgment of nonprofessionals and helps strengthen the power of their guilds.

 

The fact is that, as longtime expert on dangerousness Dr. James Gilligan has said, the only good predictor of dangerous behavior is past commission of dangerous acts, and as Dr. Gilligan pointed out in a press conference at the National Press Club in February, 2018, Trump himself has acknowledged his own dangerous behavior, including but by no means limited to his sexual assaults.

My middle-school grandchildren observed this with no help from any professional or anyone older than they. There is, then, a role for some professionals in trying to remove unfit officials from office, but it is not the one that some would like us to believe.

by Paula J. Caplan
 
It's easy to lose sight of major tragedies in a world filled with them. That makes it essential to personalize suffering, to connect it to our own experiences. Any parent who has dropped off their child for the first day of daycare or preschool and found the child's anguish and even fear painful to see can only begin to imagine how it is for both refugee parents and children whom the United States government has torn from each other and kept separate for months…or longer.
 
During the Iran hostage period, newscaster Walter Cronkite never let the nation forget what was happening: Each night, he announced the number of days that had passed since the start of the Iran hostage crisis. In contrast, while uncounted and even uncountable numbers of children of refugees are being held in isolation from their parents in the United States, warehoused as punishment for the parents' search for a better life or their desperate flight from dangers in their home countries, these tragedies go off media people's radar and out of the minds and hearts of the public except on rare occasions. We shouldn't have to wait for another refugee child to die to keep these horrors in front of us.
 
I couldn't get out of my head the images of these children and could not stop imagining them wondering, "Where are my parents? Don't they love me? Will I ever see them again? Who are these people who come in here and speak in a language I don't understand Why doesn't anyone hug me? Why is it freezing in here? Why do I have to sleep on this hard floor with only a thin cover? Why do they stick needles in me with medicine that makes me feel awful? [Some of the children have been injected with psychiatric drugs.] What did I do wrong?"
 
I began by contacting Veterans For Peace Former National President Mike Ferner and VFP Cofounder and current Maine VFP Chapter President Doug Rawlings, whose encouragement and assistance helped lead to the creation of a coalition aiming to keep the current horrors about the children constantly before the public.
 
On Human Rights Day, December 10, 2018, a dozen human rights and violence/trauma organizations and more than three dozen individuals working in these fields issued a press release called "Who's Keeping Track? A Call for Continuous Media Attention on the Separation of Children from Refugee Parents." The crux of the release was a call for major U.S. news media outlets to dramatize the growing number of days these separations have lasted by asking them to follow Cronkite's example, announcing every day how many days have passed since the first children (as far as can be determined) were taken from their refugee parents. Also included in the release was a link to a petition where all can endorse the call: https://www.thepetitionsite.com/takeaction/387/953/389/
 
Our coalition recognizes that this seems to be a small step, but every day that the public forgets these horrors is another day the children and parents suffer, another day the government gets away with continuing the nightmare and in fact increasing these separations. Furthermore, stories about Cronkite's daily announcements by Washington Post columnist Ellen Goodman and Public Radio International (at 11:58) show how powerful they were. 
 
When no media response was forthcoming, the coalition created the howlonghavethechildrenbeengone.com website, which displays a clock ticking the seconds away, with this message: 
"This clock shows the amount of time passed since the first child -- as far as can be confirmed -- was separated from their refugee parent(s) on April 6, 2018. Undoubtedly, these punitive separations had been going on even before then. Please watch the clock, and put yourself in the position of such a child -- and then of their parent -- and vividly picture what it is like, one second at a time, to be going through what they are experiencing." 
 
The coalition's members hope that viewers will imagine how profoundly it affects the children to wonder why this has happened, whether their parents allowed it to happen, whether their parents love them, why no one speaks to them in their language, why it is so cold where they are warehoused, why no one hugs them, and why – for some – they are injected with drugs that make them feel horrible and/or sexually abused.
 
The website will remain up until the practice ends.
 
Veterans for Peace was the first organization to sign on to the initiative, and the other original signatory entities were the Association for Women in Psychology; Foundation for Excellence in Mental Health Care; Institute on Violence, Abuse, and Trauma; International Museum of Human Rights at San Diego; National Association for Rights Protection and Advocacy; National Partnership to End Interpersonal Violence; National Latinx Psychological Association; Psychoanalysis for Social Responsibility, Section IX of Division 39, American Psychological Association; Psychologists for Social Responsibility; and Psychotherapy Action Network. Subsequent endorsers are Eve Ensler's V-Day Project, Robert Shetterly's Americans Who Tell the Truth, ChildUSA, and the Academy on Violence and Abuse.
 
The press release included our statement that in the past year, "to the best of our knowledge, 2,667 babies and children were separated from their refugee parents for an average of 83 days each, though recent news is that the number may well be twice that high. Of those, 140 are yet to be reunited and 30 will not be returned to their parents.  The trauma and emotional devastation and damage to these children, as well as to their parents, are unconscionable and in some cases will be irreparable. One lawsuit already filed even alleges children were injected with powerful, dangerous psychiatric drugs."  
 
Still worse, the actual number of separated children may never be known, due to a combination of the government's covering up of the facts and shockingly irresponsibly poor record-keeping. https://www.pbs.org/newshour/nation/why-we-may-never-know-the-true-number-of-family-separations?fbclid=IwAR109-vcygENzMlQqOPRfys66Nxs_WAjuM1Xgm94BpY90XJ11d7XE-7W__g
 
Recognizing the impossibility of learning when the practice actually began, the coalition's clock starts from April 6, 2018, when U.S. Attorney General Jeff Sessions initiated what was called a "zero tolerance" policy and directed U.S. Attorneys to prosecute for illegal entry all those apprehended along the Southwest border. Part of the policy of prosecution was to separate parents from their children, and it has emerged that government agencies failed even to record the movements and locations of some children and some parents, making their reunification virtually impossible.
-
Leaders of the National Disability Rights Network, whose Protection & Advocacy (P&A) members are among the few people allowed entrance to places where these children are being held, said in a December 18, 2018, press release that after visiting more than 25 facilities in eight states, they had "identified children with a wide variety of disabilities (Intellectual/Developmental, Psychiatric, and Deaf) and unmet needs." They warned that problems identified in these facilities included "drugging, lack of education and treatment." They reported that during some of their monitoring visits, staff at the facilities "have stated that there are no children with disabilities in the facility, yet [the P&As] could see children who appear to have disabilities during the visits."  They called the treatment in at least some facilities "in question" and noted that their distance from potential sponsors and/or family affects "both their bond with caring adults and also their family's ability to monitor their conditions of confinement."
 
Other problems the P&As noted were "lack of reasonable accommodation for children with disabilities, …little evidence of treatment for children with disabilities of all sorts," poor and inconsistent provision of education, and isolation of children from the community.
 
When a source who requested anonymity was asked why some among the relatively small numbers professionals and activists who are allowed to enter the children's holding facilities have not videotaped the conditions and made them public, their response was that that would likely lead to still further restrictions on who would be allowed access.
 
 "The welfare of these children has too quickly passed largely out of view of the public. We urge the media to move quickly to ensure ongoing media coverage of this massive human tragedy," said Sandi Capuano Morrison, CEO of the Institute on Violence, Abuse, and Trauma.  
 
A Democracy Now! Interview with a coalition representative is at https://www.democracynow.org/2018/12/19/mental_health_experts_rights_groups_call

 
 

Originally published 02/20/2017 10:34 pm ET @ http://www.huffingtonpost.com/entry/58abb3b0e4b0417c4066c22b

Once you know a crucial fact about what gets called mental illness, the debate about whether or not President Donald J. Trump is mentally ill disappears, and what is left is what really matters. What really matters is that President Trump apparently has no desire to change behavior that has been described as totally self-absorbed, self-referential, misogynist, racist, xenophobic, and otherwise abusive.

It’s ironic that the arguments on both sides of the debate about whether or not Trump is mentally ill are based on the one “alternative fact”: that deciding who is mentally ill is a science. That could not be farther from the truth.

Those who are arguably the world’s most powerful psychiatrists — those who periodically create and publish a new edition of the psychiatric handbook called the Diagnostic and Statistical Manual of Mental Disorders (DSM) — typically acknowledge that the foundational premise of the entire book, that it is possible to define “mental illness” in an adequate, appropriate, and useful way, is wrong. In each edition of the DSM, the new set of arbiters tries to create a definition of “mental illness,” since the book consists of hundreds of alleged categories and subcategories of mental illness and thus depends on their getting that primary definition right. Each time, they have acknowledged their failure to do so. Even Allen Frances, who oversaw creation of the DSM edition that held sway from 1994 to 2013, famously called psychiatric diagnosis “bullshit” (cited in Gary Greenberg’s excellent Book of Woe from his article in Wired based on his interview with the psychiatrist).

As far as I can tell, no one else weighing in on the debate about the President has served on a DSM Task Force...and then felt they had to withdraw because of what they had learned. I spent two years as an insider on Allen Frances’s Task Force, where I learned that — despite what is widely assumed to be true — psychiatric diagnostic categories are not scientifically derived but are constructed, made up by the handful of people with the most power in the DSM hierarchy. When Frances in various media currently gives the impression that he is uniquely qualified to judge President Trump because he wrote the criteria for Narcissistic Personality Disorder (NPD), the label that many therapists have recently applied to him, Frances neglected to note that the criteria for NPD change with every edition. Frances changed them somewhat from the DSM edition that came before his, and the NPD criteria in the edition subsequent to his — the currently in use DSM-5 — differ from his. These changes reflect the moving-target nature of this label.

The changes over time in how NPD is defined are important, because to debate about whether or not the President has NPD is to reify misguidedly and harmfully the notion that there is a scientific way to find out. I resigned from the DSM-IV Task Force because I could not participate in the creation of a book that would be marketed as scientific when I knew that it was not — and that would garner more than $100 million for its publisher, the American Psychiatric Association, and help Big Pharma earn billions of dollars for psychiatric drugs marketed as curing the ever-growing number of manufactured categories.

Some people try to prove that Trump does not have NPD on the grounds that his self-centeredness and so on do not cause him to suffer; but even that argument is irrelevant, because no version of NPD has specified that in order to “qualify” for this label, one has to be suffering because of its features.

Do people suffer and deserve help to alleviate that suffering? Of course, they do, and that is the subject of many books and other articles. But the research about how that is best done — what behavior, feelings, and/or thoughts can be changed — and what cannot is a side issue for our purposes here, because there is not a shred of evidence that President Trump wants to change. Remember that old joke: “How many therapists does it take to change a light bulb?” “One. But the lightbulb really has to want to change.”

There is great debate among therapists about whether or not any personality disorders belong in the manual of mental illnesses, since it is an arbitrary decision left to each individual therapist whether or not a particular patient’s personality is extreme enough to qualify as a disorder. To engage in the attempt to decide whether or not President Trump has NPD is to act as though that label is clearly a description of a mental illness, however one defines “mental illness.”

Some believe that if they were to prove that the President is mentally ill, it would be easier to turf him out of office. But it was morally wrong that Senator Thomas Eagleton was removed as George McGovern’s vice presidential running mate in 1972 when it became publicly known that he had suffered from bouts of depression and had been hospitalized for that reason, because what should have mattered for him and should matter for all elected officials is how well they can do their jobs. Eagleton had been a great Senator. Whether or not one believes that Trump is doing his current job well depends partly on whether or not you share his views of the world, partly on whether or not he is truthful with the people of this nation (many Presidents have not been), and partly on how he manages his various tasks.

At this crucial time in our nation’s history, the last thing we need is to let debates about whether or not the President is mentally ill divert us from deciding whether or not he is doing his job, whether or not we like what he is doing, and whether or not what he is doing is dangerous or evil.

———————————————
Author’s note: I am the author of They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, which is my insider’s description of the process of creating the book that is called the psychiatrist’s “Bible” and is used to determine who is mentally ill. I am editor of Bias in Psychiatric Diagnosis and have written many articles and book chapters about psychiatric diagnosis, which I would be happy for people to read.
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Originally published February 8, 2017 at 5:08 p.m. ET at http://www.huffingtonpost.com/entry/589b943fe4b02bbb1816c2b5?timestamp=1486591713158

Thanks to writer/performer/activist Eve Ensler, Valentine’s Day has become a time to advocate for women. However, what has been starkly missing from the tsunami of media stories about and petitions protesting a vast array of Trump administration actions and projected actions has been anything about violence against women. Senator Jeff Sessions, soon to become Attorney General of the United States, voted against funding for the Violence Against Women Act, and President Donald Trump reportedly plans to ignore and even punish women, men, and children who are victims of violence by eliminating the funding of the Violence Against Women Act. And in light of the combination of the President’s history of treatment of women and his continual expressions of respect for Russia, the Russian parliament’s recent, overwhelming vote to decriminalize domestic violence eerily resonates with these portents.

Media coverage of frightening budget cuts Trump plans for other programs has been generous, but media coverage of the plan to wipe out funding for services to victims of family violence has been sparse to nonexistent, reflecting the often hidden nature of the latter. It is ironic that such violence is comprised of one set of phenomena that could accurately be called a part of what Trump refers to as “American carnage.”

Chances are, domestic violence victims were disproportionately absent from the recent, remarkable Women’s Marches, because typical effects of violence on victims include impaired mobility in the world, reduced finances, and emotional paralysis due to fear of inciting the anger of the perpetrators. Few abusive men want their women victims to march for women’s rights.

Reports from reliable media reveal that President Trump has been working closely with the Heritage Foundation, a conservative think tank, and is likely to follow its proposals for budget cuts that would include eliminating — not reducing — funding for the Violence Against Women Act (VAWA), which then-Senator Joe Biden shepherded to passage in 1994. Already, what used to be the White House’s online fact sheet about the VAWA has vanished from https://www.whitehouse.gov/sites/default/files/docs/vawa_factsheet.pdf, where that URL now yields only this message: “Thank you for your interest in this subject. STAY TUNED AS WE CONTINUE TO UPDATE WHITEHOUSE.GOV.”

Eliminating VAWA funding would disproportionately deprive poor women, immigrant women, women from racialized groups — and many women who are disabled due to abuse — of ways to escape from further violence. Tragically ironic, given President Trump’s apparent focus on reducing costs, is that the VAWA has saved both the nation as a whole and individual states enormous amounts of money. According to the National Network to End Domestic Violence, “In its first six years alone, VAWA saved taxpayers at least $12.6 billion in net averted social costs,” and in a recent study of a single state, Kentucky, “civil protection orders saved an average of $85 million a year.” http://nnedv.org/policy/issues/vawa.html As for savings in human costs, within the Department of Justice, actions funded by the VAWA addressed to domestic violence, sexual assault, dating violence, and stalking have led to dramatic increases in reporting of violence by both women and men, and the numbers of deaths due to intimate partner violence has decreased since 1994 by 34% for women and 57% for men, while non-fatal domestic violence has decreased by 67%.

In spite of these gains, these kinds of violence continue at epidemic levels. In light of President Trump’s focus on saving money and saving jobs, it is important that the costs of intimate partner violence exceed $8.3 billion a year, that victims of intimate partner violence lose a total of 8 million days of paid work yearly, and between 21 and 60% of such victims lose their jobs for causes that stem from that abuse. http://psycnet.apa.org/journals/ocp/12/2/136/ And because, according to the World Health Organization, victims of abuse are more likely than other people to become addicted to alcohol, tobacco, or drugs, this increases the human and the financial costs of such violence. http://apps.who.int/iris/bitstream/10665/85239/1/9789241564625_eng.pdf?ua=1

According to the National Coalition Against Domestic Violence, http://www.ncadv.org/learn-more/statistics, intimate partner violence accounts for 15% of all violent crime. In one year, more than 10 million women and men are physically abused by an intimate partner in the U.S., 1/3 of women and 1/4 of men have been victims of some physical violence by an intimate partner, and for severe physical violence, the figures are 1/5 of women and 1/7 of men. These kinds of violence increase rates of suicidal behavior. Domestic violence hotlines receive an average of more than 20,000 phone calls a day. One-fifth of women have been raped, and 1 in 15 children are exposed to intimate partner violence annually, with 90% of those children being eyewitnesses.

Because of the physical injuries and psychological suffering from which so many of these victims of violence suffer, as well as from their intimidation into silence by their abusers, it is up to the rest of us to speak up loudly and unceasingly to stop the infliction of violence-by-budget-cuts on those who have already been harmed and those who will be in the future. A small but important Valentine gift the Trump administration could give would be to get the facts about violence against women back up on the White House’s website. A greater gift would be for the President and Congress to show real heart and publicly and proudly commit to fully funding the VAWA.

Please note: Reports from reliable media mentioned above include http://www.newsweek.com/donald-trump-violence-against-women-federal-funding-budget-cuts-544710 and to http://thehill.com/policy/finance/314991-trump-team-prepares-dramatic-cuts, among others.

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