Tuesday, January 24, 2012

Newt the Borderpath: Making the Case that Psychiatry is Not Allowed to Make

Picking up where we left off ...

Thanks to “the Goldwater Rule” embedded into the code of ethics of the American Psychiatric Association, it is unethical for psychiatrists to “offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

The rule was the direct outcome of more than a thousand psychiatrists venturing negative (totally un)professional opinions about 1964 Republican Presidential candidate Barry Goldwater in response to a Fact magazine survey.

The rule effectively precludes psychiatrists from publicly stating the obvious, namely that current Republican Presidential front-runner Newt Gingrinch is “a walking-talking DSM-IV Axis II, Cluster B special, displaying a suite of bizarre behaviors distributed along at least three diagnoses, including borderline personality disorder, narcissism, and antisocial personality disorder.”

Of all the crazy things, the framers of the Goldwater Rule almost certainly never envisioned the bizarre possibility of one of its own reaching exactly the opposite conclusion, namely how Newt’s abundant character flaws might actually make him a better President. This happened last week when psychiatrist Keith Ablow scribbled an over-the-top commentary to that effect on Fox News. The gist of his thesis was that the cold-blooded indifference Newt displayed in dumping his first two wives is precisely the quality required of our next President in being “direct and unsparing with the Congress, the American people and our allies.”

Ironically, any psychiatrist jumping in to refute Ablow’s nonsense can only do so at the risk of incurring disciplinary action by the APA. Okay, we know the dangers of judging people we have never met, but what about public figures we may know better than members of our own family? Clearly, the public interest demands critical evaluation from the psychiatric profession.

With Newt Gingrich, it turns out, the exercise is as easy as shooting fish in a barrel. To focus on just one incident:

In 1995, Newt Gingrich as House Speaker initiated a 22-day federal government shutdown. In the midst of the crisis, Gingrich attributed his hardline stance to a perceived “snub” from President Clinton, who purportedly did not talk to him during a flight on Air Force One to Israel for the funeral of assassinated Prime Minister Yitzhak Rabin.

I’m not sure which is worse: A man putting millions of Americans in jeopardy as a result over his own damaged ego, in total disregard for their concerns, or expecting his victims (the American public) to identify with his pain. It turns out that Clinton had photos of the two talking on the trip.

In an op-ed piece in the Feb 25, 2011 Washington Post, Gingrich recast his outrageous conduct as a stand on principle, blaming President Clinton for vetoing a Republican budget and the “liberal media” for misreporting the issue, claiming that the short-term pain of the shutdown set the stage for later budget deals.

“So, we faced a choice,” he wrote. “We could cave in and be accepted by the Washington establishment, or we could stand firm for a balanced budget for the American people.”

There really is no issue here: The only thing that psychiatrists should be arguing about is which diagnostic category to stick Newt in. Three of the Cluster B personality disorders come immediately to mind - narcissism, borderline, and antisocial - with some element of paranoia thrown in. But as psychiatrists and psychologists are quick to point out, personal pathology is far more fluid and subtle, not amenable to diagnostic boxes.

So let’s dispense with choosing between this diagnosis or that diagnosis and going with a bit of each. This is the approach Barbara Oakley took in her 2007 book “Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed and My Sister Stole My Mother's Boyfriend,” which has received considerable play on this blog.

As you recall, Dr Oakley characterized certain individuals as “successfully sinister,” your classic Machiavellians - charismatic and ruthless - out for themselves at the expense of anyone unfortunate enough to happen to breathe the same air. Her Machiavellian poster boy is Chairman Mao, whom she describes as “the perfect borderpath,” exhibiting  clear elements of borderline and psycho/sociopathy (plus generous helpings of narcissism and paranoia).

In the chaos of China, to the considerable detriment of a quarter of the world’s population, Mao was able to exploit his pathology to attain a position of absolute power for more than three decades. In a democracy, a borderpath is inclined to reach a more modest pinnacle. To quote from one of my earlier pieces:

In politics, says Dr Oakley, an American-born Mao might have become a populist demagogue in the 1930s Huey Long mold (I will leave the obvious contemporary examples to others) ...

Do you detect an obvious contemporary example? With the stakes much higher? Pity that psychiatry can’t talk about it.


Grace-WorkinProgress said...

No way to fight crazy without looking a little crazy yourself so what do you do? Lay low and hope the storm will pass?

herb said...


Your topic brings to mind a question whose time may have come and one which I’ve recently posed to my discussion group, “Should candidates for public office be subjected to drug, mental etc. testing as would be a candidate for employment in the private sector or special government departments?”


John McManamy said...

Hey, Herb. Interesting point. It won't happen, of course, but it shouldn't stop the public from demanding disclosure. Under pressure from Newt, Romney disclosed his taxes. Anything that calls into question a candidate's fitness for high office and how their decisions may be influenced needs to be thoroughly examined.

Physical health, tax returns, marriage infidelities, it's all on the table. So should mental health - especially mental health. This is not dog catcher these people are running for. The next President has the power to wreck the economy and drive all but the top 1% into poverty, not to mention start a nuclear war and destroy the environment and thus abort future generations.

We've had a lot of commentary on how all but one or two of the Republican candidates are batshit crazy and we need to hear a lot more, preferably from people who are qualified in this area.

Anonymous said...

i'm not sure what to make of this article...

i'm just passing thru, but felt i needed to comment. i was too young, but you seem a bit older than me. do you remember the thomas eagelton fiasco in 1972? he was the democratic nominee for vp. but, once it was found out that he had ect and suffered from depression he was gone. ironically, later he was elected to several more terms as a senator from his home state. and, served his state well.

i have other mixed feelings as well about your article. of course, we all want a healthy president, in all ways. but, is that realistic? there is no perfection in the human experience. here is another irony for you to consider; abraham lincoln was a severe depressive. put on 'suicide watch' at least 2 times in his life. some call him the greatest president of all time. he would never have been elected today with his background being made public. (i highly recommend the book; 'lincoln's melancholy' by the way.)

i have also read that many other presidents have suffered from mental conditions; depression, anxiety, etc. so, what of it? nixon and kennedy are two that quickly come to mind. kennedy supposedly suffered from depression and had a special doc who gave him 'vitamin' shots on a daily basis for his back pain. i think you would be surprised as to what drug cocktail was in that 'vitamin' shot. nixon, well, easy to see why he suffered. and while i am at it; what about fdr?

since i got depressed almost 2 years ago i am amazed to have found out the amount of public figures who suffered with this awful condition, but continued to fight and serve. if anything, it made them more 'human' and compassionate.

i'm thinking i respectfully disagree with your statement; 'physical health, tax returns,marriage infidelities...especially mental health' should all be disclosed. why this need to know everyone's personal biz? let democracy takes it's course. we have been thru many ups and downs and are now entering our 3rd century of existence. your response may be; 'too much is at stake not to know this info.' maybe, but i personally doubt it. poke around a bit on presidential history. just for fun, go back to dawn of the atom bomb and work your way up. i'm pretty confident that every single president, had there personal history been known (by today's public) would not have been elected. how about this one; eisenhower had a 19 year-old mistress! that's just disgusting! :) still, he served 2 full terms. no one gave a rat's ass because the economy was kicking butt.

you are an advocate for de-stigmatizing mental health issues. i applaud you for that. but, in this article i feel you are doing the exact opposite.

finally, keep-up the good work. i do enjoy coming by from time-to-time. your articles are always well-written and interesting.

be well.


John McManamy said...

Hey, Anonymous. I appreciate where you're coming from. Just to make sure there are no misunderstandings:

On mcmanweb you will find an article I wrote on Lincoln and his depressions. Bottom line: Depression made him a great President.

Also on mcmanweb, in my article on ECT I mention Tom Eagleton. Bottom line: Eagleton's past depression did not disable him serving in the Senate. Revelation of his ECT, however, made him radioactive as a VP candidate - the country wasn't ready for this, and probably still isn't.

On this blog are two pieces about LBJ. Bottom line: the stress of the job got to him. He became delusional and and dangerous.

Also pieces on Ghamei's book, A First Rate Madness. Bottom line: A little bit crazy can be good.

Then there's Newt and company. Sorry, the guy was a disaster as Speaker of the House. Proof: None of his colleagues from the era have anything good to say about him. But they all have bad things to say. Bottom line: He is no leader. He lacks the capacity to lead.

We the People are auditioning candidates for the most important job in the world. We have the right to ask any questions we please and draw any conclusions we want. In certain situations, mental illness may be an asset. So, too, may marital infidelity. But we can only come to that conclusion by being aware of the facts.