Donald Trump: Presidential Disability, Competence and The 25th Amendment

Many observers have noted publicly that President Trump shows signs of a potentially serious mental disability. Questioning Trump’s ability to think rationally and to function accordingly has, in fact, become a national preoccupation. Warnings from every sector of the public and from both sides of the political divide now appear daily in the media This week alone, George Will added his own concerns to the public demand for credible confirmation that the President is, in fact competent

Unfortunately the mental health professions have been less than clear about what we can ethically offer in this national crisis. As professionals, we have often avoided any comment, despite the gravity of this situation. At other times, some have offered speculations about the President’s character and diagnosis, which are not really germane.

At this point it is crucial for the public to know what professional observations we can legitimately offer in this disturbing situation. Based on what public information we all have, any mental health professional should by now have serious doubts about President Trump’s capacity to fulfill the duties of his office.

The media focus on finding the ‘ right’ diagnosis has been misguided. These are many possibilities, not one, but none can be confirmed without an actual examination. Further, it is quite possible to carry a psychiatric diagnosis and still be fully competent to hold even the highest office. For this reason, the President’s specific psychiatric diagnosis, if any, is largely irrelevant. More pressing is the question of what lies behind, what actually motivates Trump’s erratic behavior. Some argue that the President’s lies, his easily disproved accusatory tweets, are evidence of a well–thought-out strategy to play to his base, and sow confusion, Are these simply tactics to derail attention from public concerns about conflicts of interest and Russian influence? This may well be true. However, we want the public to know that a person can be quite strategic, highly intelligent and even function well in some areas while still being significantly impaired, unfit and ultimately incompetent in the role of president and commander in chief.

Psychiatrists recognize specific patterns of behavior that are suggestive of mental or cognitive disorders. Some have ominous implications. Recognizing this is analogous to a physician seeing a person suddenly clutching his chest in pain. Any doctor would realize that the safest way to proceed at such a time is to consider the most dangerous possibility first- a heart attack- and act without delay. Similarly, as psychiatrists, we know that the prudent approach to behavior that suggests serious, even potentially dangerous, defects in judgment, self -control and the appraisal of reality, is to evaluate and intervene as soon as possible. As professionals, we recognize many public indications that justify questioning President Trump’s mental and emotional capacity to conduct himself in office without doing serious damage to our nation.

Competence is a matter of great concern in all high-risk, potentially dangerous jobs, When doubts arise in such fields it is common practice to require what is called a mental capacity assessment to evaluate an individual’s ability to perform in a specific job. This is routine, especially when matters of public and personal safety arise. These assessments, carried out by specifically trained mental health professionals, involve careful determinations regarding a person’s decision -making process. To this end, the evaluator assesses the subject’s ability to understand and process information relevant to the job, his ability to recognize the limits and obligations of his position and authority, and his ability to anticipate the likely consequences of any decision. The essential purpose of this kind of evaluation is to determine the person’s capacity to rationally understand and logically synthesize information in the process of decision-making on the job. It is not primarily focused on a diagnosis, nor are capacity assessments simply medical/psychiatric examinations. They include observations made by other personnel, and the evaluator must have a very clear understanding of the specific requirements of the job for which the individual is being evaluated. A comprehensive professional opinion of mental capacity is then produced. This report constitutes an important factor in a multidisciplinary team’s determination of occupational competence.

The Constitution addresses potential presidential disability in the 25th Amendment. But it does not specify a general procedure to follow if the President is “unable to discharge the powers and duties of his office” i.e. if there are serious questions about his competence. The President should be required to have a neutral professional assessment of his mental capacity and ultimate competence. We urge the Congress and the public to demand this. Does he have a disqualifying disability, as so many fear? That would be the basis for invoking the 25th Amendment. The American public must be able to trust in the President’s sound judgment. Addressing these questions about Mr. Trump’s stability is truly a matter of national safety and security.

Stephanie Brandt M.D.

Marie Rudden M.D.

Dr. Brandt and Dr. Rudden are Assistant Clinical Professors of Psychiatry at Weill-Cornell School of Medicine. Dr. Brandt is also Chair of Ethics at the New York Psychoanalytic Institute and is an experienced psychiatric expert witness. Dr. Rudden is a Training and Supervising Analyst at Berkshire Psychoanalytic Institute and has conducted research on the subject of leadership and group regressive processes.