In a "clarification" issued this March, the APA doubled down on the 44-year-old rule by broadening its prohibition against members' public musings on a leader's mental health, Pouncey said. Two months into the Trump administration, the APA said the rule should be understood to apply to "any opinion on the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry."
That did not stop such psychiatric luminaries as Harvard University's Dr. Judith Lewis Herman and Dr. Leonard Glass, and other mental health professionals mostly steeped in the psychoanalytic tradition, from offering their perspectives on Trump's psychological makeup in the book.
Pouncey, a psychiatrist in private practice and a fellow at the Philadelphia College of Physicians, calls these essayists "thoughtful, experienced, well-meaning mental health professionals."
In the spirit of their professions' highest ethical principles, she writes, "the authors take themselves to be contributing to the improvement of the community and the betterment of public health."
"I believe that the APA, in the interest of promoting public health and safety, should encourage rather than silence the debate the book generates," Pouncey said.
She also cautioned the psychiatric establishment against enforcing "an annotation that undermines the overriding public health and safety mandate that applies to all physicians." The American Medical Association's ethical standards, by which all physicians are bound, says: "A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health."
To justify mental health professionals' right to express their opinions, then, Trump's mental state need not be so dangerous as to be disabling, or to require his removal from office. If psychiatrists believe their insights will improve the public's health, she suggested, their public commentary should be welcomed.
"Standards of professional ethics and professionalism change with time and circumstance, and psychiatry's reaction to one misstep in 1964 should not entail another in 2017."
Lieberman remains unconvinced.
In a letter to the editors of the New England Journal of Medicine, Lieberman said he believes Lee, Pouncey and the rest are "acting in good faith and are convinced they are fulfilling a moral obligation." But the history of psychiatry is littered with examples of mental health professionals being "exploited" for political purposes, he wrote, citing doctors who gave cover to Nazi eugenics policies and those who helped confine dissidents to mental hospitals in China.
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