Thread by @DutytoInform

🧵Shortly after Trump’s election in 2016, many mental health professionals spoke out about what they saw as the new president’s unfitness for office. Many associated Trump’s behaviors with particular psychological vulnerabilities that, in turn, predicted dangerousness. (1/x)

By doing so, these professionals were flirting with violation of an ethical provision of the American Psychiatric Association (APA) called the Goldwater Rule, which prohibits professionals from diagnosing anyone they have not personally examined. #GoldwaterRule (2/x)

In March of 2017, no doubt in response to those speaking out about the new president, the APA not only reaffirmed the #GoldwaterRule, but asserted that members should not offer any kind of opinion on public figures, even if was based on evidence and observable behavior. (3/x)

However, this did not prevent many in the mental health community from trying to educate the public about Trump.

@BandyXLee1, then a Yale University professor, provided leadership by organizing concerned mental health professionals into The World Mental Health Coalition. (4/x)

Lee also edited a book, The Dangerous Case of Donald Trump that contained articles spelling out “the clear and present danger” that Trump’s mental health posed to the nation. The book became a New York Times #bestseller (all royalties were donated to the public good). (5/x)

In a similar vein, John Gartner, a psychologist and former instructor at Johns Hopkins, posted a Facebook petition in January 2017 calling for Trump’s removal from office because of his dangerously unstable mental condition. 60,000+ mental health professionals signed on. (6/x)

Gartner went on to found @duty2warn, an organization dedicated to educating the public about Trump’s unfitness for office. He also edited Rocket Man: Nuclear Madness and the Mind of Donald Trump, which contained thoughtful discussions on Trump’s fitness for office. (7/x)

A handful of writers and public intellectuals made unique contributions to delineating Trump’s psyche. @tonyschwartz, @MichaelWolffNYC & @gtconway3d had a history of access to Trump & shared a wealth of insights aligning with the critiques from the mental health community. (8/x)

Did this effort have an impact? In the run-up to 2020, there was clearly a strong interest in Trump’s psyche. Thanks to the likes of @BandyXLee1 & @duty2warn, expert commentary about Trump’s psychiatric vulnerabilities & fitness for office entered the national conversation. (9/x)

And then Trump lost.

The election was primarily a referendum on Trump and the record-breaking turnout was seen as largely due to negative appraisals of Trump. Substantive portrayals of his pathologies no doubt contributed to the large voter turnout that helped defeat him. (10/x)

Clearly, many voters considered the 2020 election an existential moment for the country, and the psychological commentary validated that concern. It certainly seemed that the effort from the mental health community was one of the factors contributing to Trump’s defeat. (11/x)

And yet… for many of us, it seemed like our findings should have had even more impact. Many of us had spelled out pathologies that demonstrated Trump was clinically dangerous. He really was an existential threat. Given that, how could the election have even been close? (12/x)

How did Trump get more votes (other than Biden) than any candidate in history?

A quick answer is tribalism. It is folly to suggest reasoned arguments about Trump’s fallibilities could sway MAGA-land. Research suggests such arguments only embolden the support of his base. (13/x)

But tribalism is an insufficient answer as to why our findings didn’t have more sway. We showed that #Trump was a public health menace, someone who was incapable of passing a fitness of duty test for any number of professions, much less the presidency. (14/x)

There was sufficient evidence that Trump suffered from a condition associated with recklessness and dereliction.

And #Covid19 proved it.

Given that, how could any moderate Republican vote for him (virtually all did) or any independent voter, for Chrissake? (15/x)

Why wasn’t discussion of Trump’s psychiatric condition more front & center in the media & our collective consciousness?

Why isn’t it now?

There remains a gap between the deadly implications of Trump’s psychiatric disabilities & the country’s appreciation of that reality. (16/x)

The gap remains consequential.

The existential threat himself has been voted out of office but still lurks. The former and, potentially future, emperor—exposed by mental health professionals to have no clothes—is still elegantly robed in the eyes of too many. (17/x)

Trump’s poll numbers don’t look great at the moment, but we’ve seen this movie before. His approval/disapproval ratings were noticeably worse than Hillary’s right up to election day in 2016. He remains the leading candidate for the Republican nomination. (18/x)

What now?

How do we make clear to all those not blinded by the blazing politics of tribal warfare that Trump remains a “dangerous case”?

I believe it is time to unite behind a single diagnosis… (19/x)

In this new essay, I spell out why Trump meets diagnostic criteria for a psychological disorder of destructive personality traits that leaves him demonstrably unfit for higher office: drvincentgreenwood-89455.medium.com/the-open-and-s… (20/x)

Psychopathic Personality Disorder (PPD) is the diagnosis that trumps all others. I suggest it’s one the mental health community—and the media community—embrace now, before it’s too late. (21/21) @JoeNBC @Acosta @alexwagner @JoyAnnReid @mehdirhasan @andersoncooper @AliVelshi