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Saturday, September 09, 2017

Base Motives

The Republican base really puts the base in base.


jimf said...

Saturday, September 9, 2017
A Conversation with Psychiatrist Lance Dodes about Donald Trump and Sociopathy

Dr. Lance Dodes is the guest on this week's episode of The Chauncey DeVega Show.
He is assistant clinical professor of psychiatry at Harvard Medical School
(retired) and a psychoanalyst (Training and Supervising Analyst Emeritus
at the Boston Psychoanalytic Society and Institute).

Dr. Dodes is a signatory to a nationally discussed letter which was published
in The New York Times which warned the public about the dangers posed by
Donald Trump's mental health. He also has contributed a chapter on
Donald Trump and sociopathy in the forthcoming book
_The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental
Health Experts Assess a President_.

During this episode of The Chauncey DeVega Show, Dr. Dodes and Chauncey
discuss how clinicians have a "duty to warn" the American people (and the world)
about Donald Trump's mental health problems. Dr. Dodes also clarifies
the common misunderstandings surrounding the so-called "Goldwater Rule".
And Dr. Dodes shares his thoughts about how he believes that Donald Trump
is a sociopath and a megalomaniac not unlike other tyrants which we
have seen throughout human history.

jimf said...

Dodes' remarks about the Goldwater Rule are interesting:

DeVega: The concerns about [Trump's] mental health are obvious.
Very easy for laypeople to try to diagnose from afar, and
I also understand that you have that sort of informal
Goldwater Rule. . .

Dodes: Yeah, the Goldwater Rule. . .

DeVega: Yeah, and I mean, it's funny how that's thrown around, because
it's an informal guide, it's not a rule, right?

Dodes: It is really a rule of the American Psychiatric Association,
which people sort of associate with mental-health providers, but
actually, although it does represent most psychiatrists, that is
a subset of all the people in the country who are professionals in
mental health. For example, the APA's version of the Goldwater Rule
is **not** subscribed to by any of the other major mental agencies,
including my own, the American Psychoanalytic Association, and also
it's not subscribed to by the American Psychological Association
or the National Association of Social Workers, and there are a couple
of others. Nobody has the extremely rigid view of the APA -- for
good reason, because the APA's view, first of all it's unconstitutional,
because it prohibits free speech; but aside from that, it's unethical
to have the rule as they have it. There is no such rule -- first of
all, it's not an ethical question, it's a mistake to call it an
ethical question. Uh, psychiatry is a branch of medicine. And
medical ethics are very clear. Medical ethics have only to do with
two things: one, proper treatment of the patient; and two, proper
research. So the second is not relevant here. But proper treatment
of patients is a very good idea. That's where ethics comes in.
You don't go into a, you know, into doing an operation without
knowing what you're doing, or being drunk. But the concerns that the
APA is expressing about things like confidentiality and getting the
permission of the person before you talk about them simply don't
apply unless the person is your patient. Donald Trump is not
anybody's patient. So there is no confidentiality rule. There is
simply nothing, it's not an ethical matter. And, in fact, no other
branch of medicine has this rule. You know, if your favorite
linebacker goes down with a tear to his A[nterior]C[ruciate]L[igament]
in the football game, the next thing you'll see is on somebody's newscast
that they will have some orthopedist come on and talk about ACL
injuries and they'll talk about the prognosis and how long it will
take, and what kind of treatment there might be, and so forth and so
on, and every other medical specialty feels free, and they should
feel free, to speak out about public figures, because it's a public
service, it's something that when in psychiatry is called "duty to warn".
But in this case it's more than warning -- simply informing the
public. That's part of our duty, it's part of our job. And it's
useful to the public. So, when you gag the people who actually
know the best about these things, then you leave the public, as
you started by saying, with uninformed lay opinions, some of which
may be accurate, but they're still -- it would be nice to get them
confirmed by people who actually know what they're talking about.
There is no ethical question. The Goldwater Rule was not an
ethical question.

jimf said...

So you might ask, why do they have it?
The reason they have it they've been very clear about if you just
listen to them. They're protecting themselves. They themselves --
the president of the APA Maria Oquendo and some of these other people --
say, "it makes psychiatry look bad", the way we looked bad in the
original Goldwater issue in 1964. It makes the field look bad.
It makes us look stupid. You can find the quotes -- they basically
say that. So that's their reason -- they don't want to look bad,
they don't want to be embarrassed by somebody saying something stupid.
But that's not an ethics question. That's a guild question -- that's
protecting their reputation. And the other reasons which they gave,
which are just made up -- things like "it would be insulting to people
who have mental problems", which is ridiculous. Nobody's mixing up
somebody who's a sociopath like Donald Trump with somebody who has
anxiety or depression or even a known illness like schizophrenia.
No one's going to make that mistake. We all know what we're talking
about, and everybody knows that in the country. So that never had
any meaning. And, needless to say, most of us in the field care a
great deal about folks who have emotional problems, so we're not -- we're
the last people who would try to mock them. And the APA is doing a
great disservice by trying to gag people. . .