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WASHINGTON (AP) — Amateur psychoanalysts have put Donald Trump on the couch, calling him a sociopath, unhinged, a narcissist. Amid all this psych-talk, there is one group of people who aren’t talking as much: the professionals. Or at least they’re not supposed to.

Professional ethics dictate that psychiatrists and psychologists avoid publicly analyzing or diagnosing someone they’ve never examined, but there is new and unusually vocal dissension against this long-held gag rule because of what some of them think they hear and see in Trump. Because these professionals tend to be more liberal the result is a juggling act of propriety, politics and ethics.

Armchair psychology has exploded into social media and op-ed columns over the past week, most recently with Trump’s comment Tuesday calling on gun-rights supporters to stop Democratic rival Hillary Clinton. His political opponents have grabbed hold, with President Barack Obama calling the Republican presidential nominee “unfit” and a Democratic congresswoman starting a petition to force Trump to undergo a mental health evaluation.

Members of the American Psychiatric Association are bound by a 43-year-old ethics rule, called the Goldwater rule because it stems from mistaken public concerns about the mental health of the 1964 Republican presidential nominee, Sen. Barry Goldwater. Psychiatrists have been reprimanded and can be booted out of the organization if they violate that rule.

But some are now chafing at the restriction, saying they feel obligated to speak out with their worries about Trump. Others see those analyses of the candidate as dangerous and jumping to false conclusions. The Associated Press spoke to 11 psychiatrists and psychologists for this story and they were split about whether they should talk publicly about candidates’ mental health.

Analysis and diagnosis without meeting a patient, and without medical records, “are so likely to be wrong, so likely to be harmful to that person and so likely to discourage people from seeking psychiatric treatment that psychiatrists should not engage in that behavior,” said Columbia University’s Dr. Paul Appelbaum, a past president of the American Psychiatric Association.

This month the psychiatric association even posted a warning on its website, reminding professionals to stay mum: “The unique atmosphere of this year’s election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible.”

But a few experts do discuss Trump publicly, dancing the fine line between diagnosis and merely describing what they see in his public appearances and pronouncements. The University of Minnesota’s Dr. Jerome Kroll is one of them. He co-wrote an academic journal commentary calling for the end of the Goldwater rule.

“I am a citizen,” he said. “If I have something to say, what I say might be stupid. What I say may embarrass psychiatry, but it’s certainly not medically unethical.”

“I think he (Trump) comes as close to the narcissistic description as one would find,” Kroll said. “I think that would disqualify him. I am breaking the Goldwater rule as we speak.”

The Trump campaign did not respond to repeated requests for comment.

Trump and his supporters have leveled their own accusations at Clinton. “She is unhinged,” Trump said last week, “she’s truly unhinged, and she is unbalanced, totally unbalanced.” Polls show that voters lack trust in Clinton and her marriage has for years been the subject of amateur analysis centered around why she stays with a philandering husband. None of the psychologists or psychiatrists interviewed raised mental health issues about Clinton.

Katherine Nordal, the American Psychological Association executive director for professional practice and interim ethics chief, considers it “inappropriate behavior” for psychologists to diagnose people they haven’t examined.

“To be throwing around diagnoses willy-nilly,” Nordal said, “is just kind of a dangerous thing to do.”

A group of mental health professionals warned about the dangers of Trump’s ideology in a petition signed by more than 2,000 therapists. They don’t suggest a diagnosis, instead concentrating on what he says and does. They say his rhetoric normalizes what isn’t normal: “the tendency to blame others in our lives for our personal fears and insecurities.”

Experts say narcissistic personality disorder, which involves an inflated sense of self-worth, a deep need for admiration and a lack of empathy for others, is actually a behavior rather than a mental illness that can be diagnosed, like schizophrenia.

“He talks about himself all the time,” said Northwestern University psychology professor Dan McAdams, who wrote an Atlantic magazine article on Trump’s personality. “Even at his father’s funeral he talked about himself. He can’t quit talking about himself.”

For some professionals, speaking out is a matter of warning the public of impending danger.

“We recognize certain patterns of behavior to be potentially dangerous and if a mental health professional feels compelled to warn they should be able to do it,” said Philadelphia psychiatrist Dr. Claire Pouncey, president of the Association for the Advancement of Philosophy and Psychiatry and co-author of the anti-Goldwater rule commentary with Kroll.

“I think he is dangerous and erratic, but it doesn’t take a psychiatrist to point that out,” she said, noting that she isn’t diagnosing his mental condition, just commenting on what Trump says and does.

Goldwater was an ultra-conservative candidate, and a now-defunct magazine sent out a survey to thousands of members of the psychiatry association and asked them what they thought of Goldwater. More than 1,000 psychiatrists responded and some gave intricate diagnoses such as “paranoid” and “dangerous lunatic” and “counterfeit figure of a masculine man.” Goldwater sued the magazine and won.

In 1973, the psychiatry association adopted the Goldwater rule. Dr. Alan Stone, a professor of psychiatry and the law at Harvard, was the lone board member to vote against it.

“I believe in free speech,” Stone said. “If psychiatrists want to make fools of themselves, they have that right.”

Stone later met Goldwater. “He was an extremely well-balanced person,” he said. “We (psychiatrists) were thinking politics. We were against Goldwater.”



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