Stop saying Donald Trump is mentally ill when what you mean is that he's a bad person

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The Goldwater Rule is one of the more obscure elements of psychiatric ethics. Put in place by the American Psychiatric Association (APA) in 1973, the rule simply states that a psychiatrist shouldn’t make public declarations about the mental health of a person they haven’t actually evaluated – say, for example, a celebrity or a political figure of interest.

“The rule is so named because of its association with an incident that took place during the 1964 presidential election,” the APA states. “During that election, Fact magazine published a survey in which they queried some 12,356 psychiatrists on whether candidate Senator Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency.”

Little wonder, then, that the APA has reportedly asked its members to remember the importance of abiding by the Goldwater Rule this week. Recent news has been awash with conspiracy theories about the psychiatric state of the new US President: 37 mental health experts signed a letter published in The New York Times on Monday stating that “the grave emotional instability indicated by [Donald] Trump’s speech and actions makes him incapable of serving safely as president”; a therapist wrote in Vox about the “insider view” on the debate her colleagues are having about Trump’s mental health; and The Atlantic ran a piece by a psychologist on the “mind of Donald Trump”, “drawing from well-validated concepts in the fields of personality, developmental, and social psychology”.

People just can’t wait to crack open that orange head and see what’s inside – especially if they’re mental health professionals.

You can see why Donald Trump makes for irresistible psychiatric fodder. His semi-literate 5am tweets about a former Miss Universe’s sex tapes; quotes like “If Ivanka weren’t my daughter, I’d be dating her” just screaming out for Freudian analysis; reports that one of the first things he asked an international foreign policy expert after becoming President was why the US couldn’t use nuclear weapons as a first response. All these remarks seem – to put it lightly – abnormal for a head of state. So is it the responsibility of psychiatrists to warn us all, before he acts on his words and does something really crazy?

No. No, it absolutely, definitely is not. And here’s why: we can’t keep conflating bad behaviour or reprehensible views with mental illness.

Every time we willingly blur the line between raging arsehole and mentally ill person, we do two very dangerous things: we increase stigma surrounding real psychiatric conditions, and we excuse people for their terrible behaviour on the basis that they had to have been “out of their minds” to think or act that way.

We make this mistake all the time. A mass murderer or a sadistic attacker is often described as “mentally unstable”, without any evidence at hand. Terrorist sympathisers, rapists, child abusers are routinely slapped with the label. “Probably schizophrenic” is a common layman’s diagnosis you’ll hear following one horrific tragedy or another, followed closely behind by “what looked like a bipolar episode”. And these terms creep into daily conversation as well: violent spouses “must have had something mentally wrong with them”; bullying bosses and Twitter trolls are dismissed as “clearly having psychological problems”.

When the only time we talk about schizophrenia, bipolar disorder or depression is when someone massacres their family or launches a vicious verbal attack on a stranger, then it’s very easy to see how stigma builds around psychiatric conditions which many reasonable, sensible, compassionate people live with their entire lives. It’s easy to see how we then read “I have depression” as “I could go off the rails any minute”, or “I’ve been diagnosed with bipolar disorder” with “I’m an obnoxious person who you don’t want to work in your office. Hire me at your peril.”

It’s also easy to see how we then stop holding people account for abuse, for cruelty, for prejudice and xenophobia. Rightly, we have courts of law which allow pleas of diminished responsibility when someone is gravely mentally ill and commits a crime. Twitter isn’t a court of law, and Donald Trump’s remarks about Muslims or actions surrounding his Mexican wall shouldn’t get to be waved away with a laugh and a shrug because he’s “mental”. They should be taken as seriously as the actions of anyone else who popular opinion has decided is sound of mind.

Put simply: sometimes, an arsehole is just an arsehole. In pop psychiatry, it’s especially important to remember that.