Should Trump be put on a mental health hold?
“A few days ago, Salon published an interview with psychiatrist Bandy Lee, who argued that Nancy Pelosi should put President Trump on an involuntary 72-hour mental health hold after he ordered a drone strike in Iraq. While there are plenty of reasons to see Trump’s presidency as a problem, this is the wrong approach to solving it. Mental health holds are a delicate tool designed to help those in dire need of treatment; weaponizing them for political purposes wouldn’t just be ineffective; it would make a mockery of the psychiatric profession and the people we care for.
Gone are the days when anyone could rid themselves of an inheritance-grubbing nephew, a wife with lackluster domestic skills, or an unpopular world leader by dropping them off at the local insane asylum. Checks and balances put into place in the 1960s now lay out specific criteria that must be met for a person to be hospitalized against their will, and routine court hearings ensure that a patient’s fate does not lie entirely in the hands of a cheating spouse or a political foe.
Just having a diagnosis of a mental illness isn’t enough to be put on an involuntary hold—depending on the jurisdiction, that mental illness has to either confer a risk of harm or an inability to take care of one’s basic needs. A person could be put on such a hold if they posed a threat to others because of their mental illness, but not by a citizen’s petition or Nancy Pelosi. The Speaker of the House would have to call someone certified to place such a hold, either a trained mental health professional or a law enforcement officer.
And mental health holds don’t just make troublesome people go away. They allow authorities to bring someone to a facility against their will for an evaluation. The president has his own team of medical experts, so it’s unclear what an outside evaluation would get him, but nonetheless, after the hold was placed, he could be brought to an outside psychiatric facility or local emergency department. The Secret Service would have to secure the location first, disrupting care for the hundreds of patients whose lives depend on those services that day.
Once the president arrived, he would be seen by a team of mental health professionals on what will undoubtedly be one of the most perplexing shifts of their careers. The psychiatrist, trained in diagnosing schizophrenia and providing psychotherapy to patients with depression, would now be tasked with evaluating whether the president’s foreign policy strategy was a result of some previously undiagnosed mental illness. Getting information from collateral sources is an important piece of risk-assessment work; the physician would want to talk to the Secretary of State, the National Security Advisor, and other military experts to complete their evaluation. This could take years.
At some point, the president would attend a hearing to argue his case: He is not suffering from a mental illness that makes him an imminent threat to others. The free public defender usually assigned to patients would undoubtedly be replaced by a highly compensated expert legal team led by Rudy Giuliani. It’s hard to imagine what judge would extend Trump’s hold for further hospitalization.
If it were extended, to what end? No medication has been shown to mitigate the risk of a president continuing attacks in the Middle East. The most good that could come out of this process would be Trump getting first-hand exposure to people suffering from mental illness, substance use problems, and homelessness, and the fact that they would confiscate his phone upon arrival—tweeting would be a memory.
Being the leader of a nation requires constantly weighing people’s safety and well-being in the balance. Every drone strike, every war, every rescue and recovery operation puts lives in danger. There is an argument to be made that the President’s recent strike on Iraq was rash, poorly coordinated, and based on thin evidence of an imminent threat. Poor judgment, sure. But borne of mental illness? Trump knew who his target was and what he had done, and many Republicans support his decision. It’s not as though he thought General Soleimani had been sneaking into the White House and poisoning his food.
Trump may not be overtly delusional, but he’s exhibited some disagreeable personality traits: an inflated sense of self-importance, a refusal to seek or abide by the input of advisors, impulsive decision-making, and a fragile, petulant ego. But these are not symptoms of mental illness. They more closely fit the pattern of narcissism, and there are narcissists among us in any profession that calls for the belief that you are capable of extraordinary things: neurosurgeons, Navy SEALs, tech entrepreneurs. It’s practically a job requirement for being president.
Trump is far from the first in his position to exhibit such traits. You’d have to be something of a narcissist to believe you could and should be the leader of the free world. If not for the perks of power, prestige, and the company of important people, being President of the United States isn’t a very appealing job. Anyone who watched the West Wing knows it’s stressful, never-ending work that takes over your life and the lives of your family. You trade your privacy and much of your earning potential to have your golf habits scrutinized by millions and be mocked regularly on Saturday Night Live.
To many, Trump is an unlikeable character who has made disastrous decisions from a position of extreme power he is not qualified to have. He is one of many reckless, thoughtless, self-centered people in the world who is quick to put his own desires above the needs of others. People like that may make bad friends and unfit leaders, but it doesn’t make them mentally ill.
When people act in extreme and harmful ways that are incomprehensible to us, we search for explanations. But filing their motives away under the vernacular catch-all of “crazy” taints the public’s perceptions of what mental illness really is. It’s not mass shooters and power-hungry dictators; it’s generally good people with hard lives doing their best to just get by. It’s your co-worker who was absent all last week because of his untreated depression; it’s the homeless man mumbling to his voices because they are all the family he has left; it’s the woman who relapsed during a manic episode because she couldn’t afford to refill her meds. Categorizing Trump as mentally ill because you don’t like his politics is an insult to the mentally ill.
As physicians, we have the power to do dangerous things to people to heal them. A surgeon can amputate a person’s limb to keep an infection from spreading. An anesthesiologist can paralyze a patient and control their breathing. A psychiatrist can suspend someone’s civil liberties to get them into treatment. It may be tempting for physicians to bend the rules and leverage these capabilities to stop their opponents, political or personal. But if we do, we will also be guilty of abusing the power people have entrusted to our position for centuries.”