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Day: 01/09/2018
Are Presidents Required to Pass a Mental Health Test?
Why Candidates for the Highest Office Should Undergo a Psychological Evaluation.
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Presidents are not required to pass mental health exams or psychological and psychiatric evaluations before taking office in the United States. But some Americans and members of Congress have called for such mental health exams for candidates following the 2016 election of Republican presidential nominee Donald Trump.
The idea of requiring presidential candidates to undergo mental health exams is not new, though.
In the mid-1990s, former President Jimmy Carter pushed for the creation of a panel of physicians who would routinely evaluate the most powerful politician in the free world and decide whether their judgment was clouded by a mental disability.
“Many people have called to my attention the continuing danger to our nation from the possibility of a U.S. president becoming disabled, particularly by a neurologic illness,” Carter wrote in a December 1994 issue of the Journal of the American Medical Association.
Why the President’s Mental Health Should Be Monitored
Carter’s suggestion led to the creation in 1994 of the Working Group on Presidential Disability, whose members later proposed a nonpartisan, standing medical commission “to monitor the president’s health and issue periodic reports to the country.” Carter envisioned a panel of expert physicians who were not directly involved in the care of the president determining whether he had a disability.
“If the president of the United States must decide within minutes how to respond to a dire emergency, its citizens expect him or her to be mentally competent and to act wisely,” wrote Dr. James Toole, a professor of neurology at Wake Forest University Baptist Medical Center in North Carolina who worked with the working group.
“Because the presidency of the United States is now the world’s most powerful office, should its incumbent become even temporarily unable to exercise good judgment, the consequences for the world could be unimaginably far-reaching.”
There is currently no such standing medical commission in place, however, to observe a sitting president’s decision-making. The sole test of a candidate’s physical and mental fitness to serve in the White House is the rigor of the campaign trail and elector process.
Why Mental Fitness Became an Issue in the Trump Era
The idea of requiring presidential candidates to undergo mental health evaluations arose in the general election campaign of 2016, primarily because of Republican nominee Donald Trump‘s erratic behavior and numerous incendiary comments. Trump’s mental fitness became a central issue of the campaign and became more pronounced after he took office.
A member of Congress, Democrat Karen Bass of California, called for a mental-health evaluation of Trump before the election, saying the billionaire real-estate development and reality-television star exhibits signs of Narcissistic Personality Disorder. In a petition seeking the evaluation, Bass called Trump “dangerous for our country.
His impulsiveness and lack of control over his own emotions are of concern. It is our patriotic duty to raise the question of his mental stability to be the commander in chief and leader of the free world.” The petition carried no legal weight.
A lawmaker from the opposing political party, Democratic Rep. Zoe Lofgren of California, introduced a resolution in the House of Representatives during Trump’s first year in office encouraging the vice president and the Cabinet to hire medical and psychiatric professionals to evaluate the president. The resolution stated: “President Donald J. Trump has exhibited an alarming pattern of behavior and speech causing concern that a mental disorder may have rendered him unfit and unable to fulfill his Constitutional duties.”
Lofgren said she drafted the resolution in light of what she described as Trump’s “increasingly disturbing pattern of actions and public statements that suggest he may be mentally unfit to execute the duties required of him.” The resolution did not come up for a vote in the House.
It would have sought the removal of Trump from office by employing the 25th Amendment to the Constitution, which allows for the replacement of presidents who become physically or mentally unable to serve.
Trump Declines to Make Health Records Public
Some candidates have chosen to make their health records public, particularly when serious questions have been raised about their well being. The 2008 Republican presidential nominee, John McCain, did so in the face of questions about his age – he was 72 at the time – and previous ailments including skin cancer.
And in the 2016 election, Trump released a letter from his physician that described the candidate as being in “extraordinary” health both mentally and physically. “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency,” wrote Trump’s doctor. Trump himself said: “I am fortunate to have been blessed with great genes — both of my parents had very long and productive lives.” But Trump did not release detailed records about his health.
Psychiatrists Can’t Diagnose Candidates
The American Psychiatric Association banned its members from offering opinions about elected officials or candidates for office after 1964, when a group of them called Republican Barry Goldwater unfit for office. Wrote the association:
“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”
Who Decides When a President Is Unfit to Serve
So if there’s no mechanism in place by which an independent panel of health experts is able to evaluate a sitting president, who decides when there might be a problem with his decision-making process? The president himself, which is the problem.
Presidents have gone out of their way to hide their ailments from the public and, more importantly, their political enemies. Among the most notable in modern history was John F. Kennedy, who didn’t let the public know about his colitis, prostatitis, Addison’s disease and osteoporosis of the lower back. While those ailments certainly would not have precluded him from taking office, Kennedy’s failure reluctance to disclose the pain he suffered illustrate the lengths to which presidents go to conceal health problems.
Section 3 of the 25th Amendment to the U.S. Constitution, which was ratified in 1967, allows a sitting president, members of his cabinet – or, in extraordinary circumstances, Congress – to transfer his responsibilities to his vice president until he has recovered from a mental or physical ailment.
The amendment reads, in part:
“Whenever the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that he is unable to discharge the powers and duties of his office, and until he transmits to them a written declaration to the contrary, such powers and duties shall be discharged by the Vice President as Acting President.”
The problem with the constitutional amendment, however, is that it relies on a president or his cabinet to determine when he is unable to perform the duties of the office.
The 25th Amendment Has Been Used Before
President Ronald Reagan used that power in July 1985 when he underwent treatment for colon cancer. Though he did not specifically invoke the 25th Amendment, Reagan clearly understood his transfer of power to Vice President George Bush fell under its provisions.
Reagan wrote to the House speaker and Senate president:
“After consultation with my Counsel and the Attorney General, I am mindful of the provisions of Section 3 of the 25th Amendment to the Constitution and of the uncertainties of its application to such brief and temporary periods of incapacity. I do not believe that the drafters of this Amendment intended its application to situations such as the instant one. Nevertheless, consistent with my longstanding arrangement with Vice President George Bush, and not intending to set a precedent binding anyone privileged to hold this Office in the future, I have determined and it is my intention and direction that Vice President George Bush shall discharge those powers and duties in my stead commencing with the administration of anesthesia to me in this instance.”
Reagan did not, however, transfer the power of the presidency despite evidence that later showed he might have been suffering from the initial stages of Alzheimer’s.
President George W. Bush used the 25th Amendment twice to transfer powers to his vice president, Dick Cheney. Cheney served as acting president for about four hours and 45 minutes while Bush underwent sedation for colonoscopies.
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How Not to Talk About Suicide
There’s a right and a wrong way to do it.
When Logan Paul, a YouTube vlogger with more than 15 million subscribers, posted a video to his channel showing the body of a man who had died by suicidein Japan’s Aokigahara forest, the backlash was swift. Many outraged viewers accused the YouTube star of exploiting a dead body for shock, awe, and more video views.
Paul later apologized with a message on Twitter, where he wrote, “I intended to raise awareness for suicide and suicide prevention…I thought ‘if this video saves just one life, it will be worth it.’” He also took down the offending video and posted another apology on his channel.
Although posting a video of a dead body in the name of suicide prevention and awareness seems like an obvious ethical blunder—not to mention traumatic for the deceased person’s family members and friends—Paul had an army of defenders. Reminiscent of how the creators of the Netflix series 13 Reasons Whydefended showing graphic images of the show’s main character Hannah dying by suicide, Paul’s supporters claimed that posting the consequences of a suicide would be a deterrent for those struggling with suicidal thoughts.
As it turns out, the opposite is true.
Posting graphic images or descriptions of how someone has killed themselves can lead to what experts call suicide contagion.
Contagion is the idea that how the media portrays the issue of suicide could lead to suicidal behavior in people, Richard McKeon, PhD, clinical psychologist and chief of the suicide prevention branch at Substance Abuse and Mental Health Services Administration (SAMHSA) tells SELF. “There is scientific research literature on this that shows that how newspapers, movies, and other things cover suicide can have a measurable impact.”“If the aim is to bring awareness to suicide prevention, that’s very different than bringing awareness to suicide,” John Draper, PhD, executive director of the National Suicide Prevention Lifeline, tells SELF. Although he hasn’t seen Logan Paul’s video and declined commenting on it directly, Draper says that how the media covers suicide does have a major impact. “Media really influences behavior,” he explains. “If you’re actually talking about and showing specific suicides in some ways that are dramatizing, glorifying, or specifically showing people how, then that has been associated with increasing suicide.”
A significant issue, however, is that the media these days isn’t limited to mainstream media outlets; social media influencers like Paul draw a large and loyal following, and the way they talk about suicide matters.
There are actually specific guidelines about how to talk about suicide (and how not to) to prevent the contagion effect. These guidelines, called the Recommendations for Reporting on Suicide are specifically for the media, but they’re a good resource for anyone with a large audience. The Recommendations for Reporting on Suicide are based on more than 50 international studies on suicide contagion, and they include not using sensational headlines, not showcasing photos or videos of the location or method of death, and not interviewing first responders about the cause of death.
It’s also important not to frame suicide as an “epidemic.” “[Epidemic] implies that something is so frequent that one could consider it normal, and that that might, for a vulnerable person, decrease their inhibitions,” McKeon explains. While over 44,000 Americans died by suicide in 2015, according to the Centers for Disease Control and Prevention’s most recent data, millions more seriously considered dying by suicide but didn’t, according to SAMHSA.
“Obviously, there needs to be attention to suicide because it’s the 10th leading cause of death in America,” McKeon says. “But we don’t want the dimensions of the tragic losses that we experience from suicide to so overwhelm the message that it blocks out the fact that help is available, that people do get through dark times, that there is hope, that people can get treatment for mental health issues and mental disorders, and that people can recover and can lead a fulfilling life after a suicidal crisis or a suicide attempt.”
It’s also smart to avoid using the term “commit.” McKeon says, adding that this is out of sensitivity to the family members who have survived the loss of a loved one to suicide. “They have pointed out that we use the language of commit around things like committing a crime, committing a sin; and suicide, while a tragedy, should not be considered as a sin or a crime,” he says. “Died by suicide” or “killed himself or herself” are better options.
Emphasizing resources such as the National Suicide Prevention Lifeline, which is available 24 hours a day, seven days a week at 1-800-273-8255, is also critical for people discussing suicide on a large platform.
There are also established best practices for handling the topic of suicide with the people you’re close to.
Talking to a friend or family member who you think may be having suicidal thoughts can be scary, but it can also help you keep them safe. If you’re not sure where to start, these five steps from BeThe1To.com, a suicide prevention website from the National Action Alliance for Suicide Prevention and the National Suicide Prevention Lifeline, can help:
1. Ask.
Asking the question “Are you thinking about suicide?” lets them know that you’re open to speaking about suicide with compassion and without judgment. You can also ask how you can help them. The flip side, the website notes, is that you also need to listen to their answers, even if they’re upsetting or hard for you to understand. Also, don’t promise to keep their suicidal thoughts a secret, because your telling other people may be what they need to get help.
2. Keep them safe.
If after the “Ask” step you’ve determined that they are thinking about suicide, it’s important to find out a few things to establish immediate safety. You should determine whether they’ve already done anything to harm themselves before talking with you; if they know how they would try to kill themselves with a specific, detailed plan; what the timing of their plan is; and whether they have access to the tools they would need to see it through. Depending on their answers, you may need to call the police or take the person in question to the emergency room. You can always call the Lifeline if you’re not sure what to do (again, that number is 1-800-273-8255).
3. Be there.
Maybe this means going over to their place when they’re feeling upset, or staying on the phone with them while they prepare to call a hotline. You shouldn’t verbally commit to being there in any way that you don’t think you’ll actually be able to accomplish, the guidelines note—dependability is really key.
4. Help them connect.
Calling the lifeline at 1-800-273-8255 is one way to help a person with suicidal ideation connect to someone who can help them. Another is to create a more robust safety plan with a list of contact information for mental health resources in their community, along with exploring the possibility of them seeing a therapist if they’re not already. .
5. Follow up.
Doing all of the above means you’ve taken meaningful steps to help someone experiencing suicidal thoughts. After that, make sure to follow up with them, express that you care, and ask if there’s anything else you can do to help. This shows that they’re important to you, and that you’re there to support them with an extremely common issue that, unfortunately, is still subject to far too much stigma and misunderstanding.
If you or someone you know is struggling with suicidal thoughts, please contact the National Suicide Prevention Lifeline at 800-273-8255.
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