APA Citation
Lee, B. (2017). The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. Thomas Dunne Books/St. Martin's Press.
Summary
Forensic psychiatrist Bandy Lee assembled essays from 27 mental health professionals addressing whether professionals have a "duty to warn" about a public figure they view as dangerous. The contributors argue that observable behavior—not clinical examination—provides sufficient evidence to assess dangerousness when public safety is at stake. The book sparked debate about the "Goldwater Rule" (prohibiting diagnosis of public figures without examination), professional ethics, and the intersection of mental health expertise with political concerns.
Why This Matters for Survivors
This book represents an important debate about professional responsibility, observable behavior, and when mental health concerns become matters of public safety. While controversial, it raises questions relevant to narcissistic abuse: How do we assess danger from observable behavior? When does "diagnosing from a distance" provide useful warning versus overstepping bounds? The tension between professional caution and public protection mirrors survivors' experience of whether to speak about what they've witnessed.
What This Work Establishes
Observable behavior can indicate danger. Contributors argue that formal examination isn’t necessary to assess dangerousness when behavior is public and patterns are clear. Direct observation provides evidence.
Professional ethics conflict. The Goldwater Rule (prohibiting assessment without examination) conflicts with duty to warn (obligation to prevent harm). Different professionals weigh these obligations differently.
Context shapes appropriateness. Whether professional comment is appropriate depends on context: public safety concerns, quality of available information, professional role, and potential harm of silence versus speech.
The debate reflects broader tensions. Questions about who can speak about what they observe, when warning is appropriate, and how to balance caution with protection extend beyond this specific case.
Why This Matters for Survivors
Validation of observational knowledge. If you’ve been told you can’t “diagnose” the narcissist, this debate provides context. Professionals disagree about when observation provides sufficient evidence. Your direct experience is evidence.
The warning dilemma. Survivors often face whether to warn others about the narcissist. The book’s debate mirrors this: professional caution versus duty to protect, potential consequences of speaking versus silence.
Naming versus labeling. The difference between describing behavior you witnessed and applying diagnostic labels is important. The book’s more careful contributors model this distinction—describing observable patterns without necessarily applying DSM categories.
Institutional response. Professional organizations’ reaffirmation of the Goldwater Rule mirrors how institutions often protect the powerful over those sounding warnings. Understanding this dynamic helps contextualize experiences of not being believed.
Clinical Implications
Navigate the ethics carefully. The debate highlights genuine professional tensions. Clinicians should understand the arguments on both sides while maintaining appropriate boundaries in their own practice.
Distinguish assessment from diagnosis. Dangerousness assessment doesn’t require formal diagnosis. Clinicians can assess risk from observable behavior while remaining appropriately cautious about diagnostic labels.
Support patients’ warning decisions. Patients who’ve experienced abuse may struggle with whether to warn others. Help them navigate this decision—considering safety, potential consequences, and their own wellbeing.
Understand political context. The intense reaction to this book reflects broader political polarization. Be aware how political context affects reception of mental health perspectives.
How This Work Is Used in the Book
The debate Lee’s book sparked appears in chapters on political narcissism and professional responsibility:
“Bandy Lee’s controversial collection raised questions central to narcissistic abuse: When can we assess danger from observable behavior? When does ‘duty to warn’ override caution about labeling? Survivors face similar tensions—torn between professional advice not to ‘diagnose’ and their own direct observation of dangerous patterns. The debate remains unresolved: professional organizations reaffirmed caution, while many practitioners argued silence enables harm.”
Historical Context
The book appeared in 2017 amid unprecedented concern about presidential behavior. It reignited a debate that had been largely settled since 1964, when psychiatrists speculated publicly about Barry Goldwater. The APA’s response—reaffirming and strengthening the Goldwater Rule—represented the mainstream professional position, while Lee and supporters argued the rule shouldn’t apply when public safety is at stake.
The debate continues, reflecting unresolved tensions in mental health ethics between professional caution and public responsibility. These same tensions appear in individual contexts—when survivors weigh whether to warn others about a narcissist they’ve experienced.
Further Reading
- Lee, B.X. (Ed.). (2019). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President (expanded edition). Thomas Dunne Books.
- Friedman, R.A. (2017). Is it ethical to diagnose Trump from afar? New York Times.
- American Psychiatric Association. (2017). APA reaffirms commitment to Goldwater Rule. Press release.
- Post, J.M. (2004). Leaders and Their Followers in a Dangerous World: The Psychology of Political Behavior. Cornell University Press.
About the Author
Bandy X. Lee, MD, MDiv is a forensic psychiatrist who was on the faculty at Yale School of Medicine. She has expertise in violence prevention and has consulted with the World Health Organization on global violence reduction.
Lee organized the book arguing that mental health professionals have a "duty to warn" that supersedes the Goldwater Rule when public safety is at stake. Her position is controversial within psychiatry, with major professional organizations reaffirming the Goldwater Rule in response.
Historical Context
The book appeared in 2017 amid unprecedented concern about presidential behavior. It reignited debate about the "Goldwater Rule"—the APA's ethical guideline prohibiting psychiatrists from diagnosing public figures without direct examination, established after psychiatrists speculated about Barry Goldwater in 1964. The APA reaffirmed the rule; Lee and contributors argued it shouldn't prevent professionals from warning about danger.
Frequently Asked Questions
The American Psychiatric Association's ethical guideline stating that psychiatrists should not offer professional opinions about public figures they haven't personally examined. It was established in 1964 after psychiatrists speculated about Barry Goldwater's fitness for office.
The legal and ethical obligation for mental health professionals to break confidentiality when a patient poses serious danger to others. Lee and contributors argue this duty extends to warning about danger observed in public behavior, even without clinical relationship.
Critics argue it violates professional ethics by diagnosing without examination, mixes politics with clinical judgment, and undermines professional credibility. Supporters argue observable behavior provides sufficient evidence for danger assessment, and silence enables harm.
Survivors often face similar tensions: Is what they observed real, or are they 'diagnosing' without qualification? Should they warn others, or maintain silence? The book's debate mirrors personal decisions about speaking up about observed dangerous behavior.
The 27 contributors offered various perspectives but generally agreed that observable behavior provided sufficient evidence for concern about fitness, dangerousness, and potential escalation. They argued professional silence amounted to complicity.
The American Psychiatric Association reaffirmed the Goldwater Rule. The American Psychological Association was less definitive. The debate continues about when professional judgment based on public behavior is appropriate.
Contributors vary in their approach. Some specifically avoid diagnosis; others argue specific disorders are evident. The book's framing emphasizes danger rather than diagnosis—focusing on behavior and its implications rather than labeling.
The debate highlights tensions between responsible caution (not labeling without full information) and public protection (warning about observable danger). These same tensions exist in personal contexts—when is it appropriate to name what you've experienced?