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.