The Politicization of Psychiatry

“Given the numerous historical antecedents, it is likely that—probably sooner rather than later—politics would get in the way of such clinical assessments.“

In 1961, Dr. Thomas Szasz published his book The Myth of Mental Illness. This helped to give rise to the anti-psychiatry movement, which, for decades, was associated with figures from the Left (most notably, Michel Foucault). However, today, this skepticism about the merits of psychiatry is perhaps more readily associated with fringe groups, such as Scientologists.

Although contemporary defenders of anti-psychiatry may make some bizarre claims, The Myth of Mental Illness, itself, was not especially outrageous. Szasz’s argument was straightforward: There is no objective criteria to separate the normal from the pathological when it comes to mental health. Consequently, psychiatry easily lends itself to abuse by political actors, who are eager to justify their actions by appealing to psychiatric labels. In Szasz’s words, “…Today, when Medicine and the State are allied, people accept therapeutic justifications for state-sanctioned coercion. This is how, some two hundred years ago, psychiatry became an arm of the coercive apparatus of the state. And this is why today all of medicine threatens to become transformed from personal therapy into political tyranny.”

Szasz’s position is too extreme. In psychiatry, diagnostic criteria may not be as robust as in, say, cardiology; nevertheless, it is still possible to differentiate between a psychotic and a normal person, and, thankfully, this allows for more efficient treatment of those struggling with mental disorders. As psychiatry becomes increasingly intertwined with neuroscience, psychiatrists ever more understand the biological correlates of mental illness. As such, Szasz’s critique is outdated; there are now more objective criteria to diagnose patients with particular mental illnesses.

With that said, in its historical context, Szasz’s position is perfectly understandable. By 1959, Soviet premier Nikita Khrushchev was saying things like this: “Can there be diseases, nervous disorders among certain people in Communist society? Evidently yes. If that is so, then there will also be offenses that are characteristic for people with abnormal minds…To those who might start calling for opposition to Communism on this basis, we can say that…clearly the mental state of such people is not normal.” In other words, if one did not like Communism, he was, therefore, insane and ought to be in the madhouse. Indeed, for the next 30 years, Soviet psychiatrists were complicit in this kind of abuse and, in turn, invented a bizarre mental illness: sluggish schizophrenia. According to this diagnosis, the patient would not necessarily show any symptoms, but his anti-Communist political leanings were taken as an indication that—later on—psychotic symptoms would appear. With this diagnosis, hundreds of political dissidents were involuntarily confined for decades.

As the United States becomes increasingly polarized, is it too much of a stretch to think that the members of that commission would inevitably use their white coats as protective cloaks when they put psychiatric diagnostic labels on presidents they simply do not like?

This was typical of totalitarian regimes, such as the Soviet Union. But the United States has not been a stranger to the political abuse of psychiatry either. In the Antebellum South, Dr. Samuel Cartwright believed that disobedient slaves were suffering from “drapetomania,” allegedly a clinical condition whose main feature was “the absconding from service” and was caused by white masters’ neglect in disciplining and caring for slaves.

But even in more recent times, there has occasionally been the temptation to use psychiatry as a way to score points against political opponents. For example, at the time of the 1964 presidential election, Fact magazine published an article in which many psychiatrists freely attacked Republican nominee Senator Barry Goldwater by declaring him unfit for office, even though none of those psychiatrists had ever conducted a clinical interview with the candidate. In the article, Goldwater was described as schizophrenic, manic, immature, cowardly, lunatic, and even a dangerous, latent homosexual.

The American Psychiatric Association immediately realized the irresponsible way psychiatrists could leverage their medical expertise to score political points. Soon after, the so-called Goldwater Rule was issued, and this forbade psychiatrists from weighing-in on the mental health of any public figures they had not personally examined. 

Yet, as a result of President Donald Trump’s election in 2016, some psychiatrists are now challenging the Goldwater Rule, arguing that President Trump is dangerously unfit for office because he is allegedly mentally unstable. Their arguments, which are compiled in the book The Dangerous Case of Donald Trump, are not much better than the cheap talking points that were leveled against Senator Goldwater in 1964: President Trump has “daddy issues”; he admires brutal dictators; he is a bully. 

Unfortunately, these psychiatrists have paved the way for the further politicization of psychiatry. The latest development concerns House Speaker Nancy Pelosi’s pitch of a bill based on the 25th Amendment to the Constitution. As USA Today reports, this bill “would set up a 16-member bipartisan commission comprised of doctors and former administration officials to conduct a medical exam of the president and evaluate the fitness of the president for office.”

At first glance, this might seem like a reasonable further contribution to a system of checks and balances, in which a bipartisan commission oversees a president’s health status and fitness for office based on scientific criteria. The bipartisan commission would likely establish with precision whether or not a president who has been recently diagnosed with, say, diabetes or heart disease is fit for an office that requires such strenuous work. A blood pressure of 185 mmHG or a glucose level of 180 mg/dL can hardly be interpreted politically.

Yet, in this context, Szasz’s work once again gains some relevance. What about mental illness? Can alleged symptoms of Narcissistic Personality Disorder (the mental illness most frequently attributed to President Trump) be interpreted objectively, without any political bias? That is a much tougher call. Given the numerous historical antecedents, it is likely that—probably sooner rather than later—politics would get in the way of such clinical assessments. As the United States becomes increasingly polarized, is it too much of a stretch to think that the members of that commission would inevitably use their white coats as protective cloaks when they put psychiatric diagnostic labels on presidents they simply do not like?

Perhaps President Trump is incorrect to say that the Pelosi pitch is simply a cynical ploy “to replace Joe Biden with Kamala Harris. The Dems want that to happen fast because Sleepy Joe is out of it!!!” However, in a country that is increasingly reliant on psychotherapy and antidepressants, psychiatrists have become too powerful. To grant these individuals the power to decide whether or not a president is fit for office may actually be the opposite of an optimal system of checks and balances. Even worse, it would hamper the decades-long effort of psychiatry to rid itself of its history of political abuse.

Dr. Gabriel Andrade is a university professor. His twitter is @gandrade80