Diagnosing Trump: How Psychoanalysis Lost Its Voice

Mental health professionals have been doing a lot of handwringing since the election of Donald Trump . A cottage industry of mental health professionals has developed to opine on the behavior – described variously as unstable, grandiose, narcissistic, authoritarian -- of the person now at the helm of the most powerful country on earth.

Still, a vibrant debate has emerged between mental health professionals on one side who consider it unethical at worst or irrelevant at best to diagnose or even characterize President Trump’s behavior and those on the other side who feel his behavior poses a clear and present danger of such magnitude that old rules no longer apply.

The latter camp includes 25,000 mental health professionals who were signatories to a petition by former Johns Hopkins psychologist John Gartner calling for the president’s removal from office based on his fitness to competently discharge his duties, a concern they believe is addressed in the 25th Amendment to the U.S. Constitution. The other group, coalescing around psychiatrist Richard Friedman from Cornell University’s Weil Medical Center, invoke restrictions dating from the 1970s, when Barry Goldwater won a libel suit that compelled the American Psychiatric Association to develop rules limiting the ability of psychiatrists to make diagnoses to the media of people they have not examined. Fear of running afoul of the rule has nevertheless provoked enough self-doubt among mental health professionals even outside the purview of the APA that much of the perspective that the field could potentially offer has been confined to our own internal vehicles for deliberation rather than shared broadly with the public.

In reality, though, the large-scale disenfranchisement of psychoanalysts from public debate is a product less of court rulings visited on the field from outside than of educational restrictions imposed from within. Psychoanalysis has lost much of its voice in political and social science not because of the pall cast over the entire mental health field by the Goldwater Rule, but because of an historical misjudgment that well pre-dates the Goldwater rule and has been baked into the operation of education programs in psychoanalysis virtually from their inception in the U.S. This educational and professional tradition pushed many academic researchers fascinated by the cross-pollination of psychoanalysis and social science outside mainstream educational institutions of organized psychoanalysis and left them to acquire their clinical knowledge improvisationally. And it left psychoanalysts, trained in independent institutes outside the university, vying for scientific authority as expertise increasingly centered in the research universities.

Unlike in the U.S., the cross-pollination of psychoanalysis, social reform, and social research was a mainstay of psychoanalysis in Europe, where the field was born. Politics and social reform infused the work of psychoanalysts from Berlin to Budapest and Vienna in the 1920s and 1930s, producing not just a system of free psychoanalytic polyclinics but embracing theoreticians and practitioners with strong political commitments. Psychoanalytic theory was used to understand issues ranging from juvenile delinquency to political propaganda. This period produced such formative psychoanalytically-informed works as The Criminal, the Judge, and the Public and Wayward Youth .

This vibrant role for psychoanalysis in the public square shrank considerably, however, when the center of gravity in psychoanalysis shifted to the United States. Today's debates about the ethics of public commentary by mental health professionals make me look back wistfully at the 1920s and 1930s and especially at a novel, but ultimately doomed effort to ensure that the burden of psychoanalytically-informed public commentary would not be left entirely in the hands of those who, through practice and policy would find themselves most constrained in shouldering it.

That effort brought together clinical psychoanalysis with political science and sociology, and was led by University of Chicago political scientist Harold Lasswell, the communications theorist and one-time head of the American Political Science Association, whose psychoanalytically-informed work helped lay the foundation for modern political persuasion theory. Today’s shortage of clinically-informed political science is in part a product of the demise of this effort.

Today, as I listen to the debates about Trump and how he was elected, I often wonder what Lasswell, the author of such classic works as Psychopathology and Politics and World Politics and Personal Insecurity would have said. One thing seems certain: He would have been better positioned to comment on the substance of the issues than on the ethics of the commentary itself.

Lasswell had been a patient of Viennese psychologist and psychoanalyst Theodor Reik, notable as the provocateur of the contentious debate about whether non-medical “lay” practitioners could practice the new technique. For Lasswell the options at the University of Chicago were far fewer than in Europe. His research into the non-rational sources of political behavior relied on clinical data acquired not through participation in the embryonic system of American psychoanalytic education, which to Freud’s chagrin left little room for non-medical scholars, but by traveling to Europe and by conducting analyses himself in a lab at the University of Chicago.

Lasswell’s was a fruitful start, but he never claimed this work was scientific and he spent years bemoaning the difficulty of obtaining access to the kind of clinical material today's psychoanalysts have, and which they believe offers them a useful, if not necessary voice, to comment on political behavior. Lasswell, in fact, spent years trying to develop a clinical infrastructure for political science. During the late 1920s, he asked the psychiatric directors of the most important psychiatric institutions in the country to describe cases of politicians they had treated and examined clinical records at pioneering psychoanalytically-informed institutions such as St. Elizabeth's in Washington, D.C. and Sheppard and Enoch Pratt Hospital near Baltimore. In a 1929 paper published in the American Journal of Psychiatry , he addressed the psychiatric community directly, underscoring the need for adequate personality records and the importance of making them available to serious investigators.

Nothing in the way that the early psychoanalytic training institutes was taking shape would offer much help bringing together clinical psychoanalysis and the kind of political science research that Lasswell envisioned. In its founding years, with roots in Lasswell’s effort, the Chicago Institute for Psychoanalyis had helped to advance the fortunes of psychoanalytic research broadly, modeling itself in its early years not on the East Coast institutes which were training psychoanalysts focused on clinical practice, but on the Rockefeller Institute for Medical Research, whose sole mission was the advancement of science. But pressure from the Institute’s early foundation funders, who were interested in medical psychiatry and suspicion of universities – especially the limits they would impose on clinical practice and the scientific demands they might place on an emerging body of theory – left psychoanalysis and political science to develop largely in separate domains.

Psychoanalysis is still paying the price for its longstanding isolation from the university. Nowhere is it more apparent today than in the absence of clinically informed political scientists whose perspectives not just on President Trump but on the electoral as a whole, is sorely needed. To be sure, this problem has not gone unnoticed. More than one leading psychoanalyst, perhaps most prominently Robert Wallerstein, has lamented the impact of ”the isolation of our educational structure from cognate disciplines concerned with human mental life.” This stunning historical blindness has permitted discussions of these challenges to overlook the ambitious effort Harold Lasswell and others undertook to help amplify the impact of psychoanalysis as a tool in social problem solving.

The situation has gotten a bit better since Lasswell’s day. Many psychoanalytic training centers now have a research track open to academics seeking psychoanalytic training to enhance their primary fields of research, and the institutes have given considerable thought to how best to integrate scholars into training programs designed primarily for clinicians. But these programs are sparsely populated perhaps in part because of the resistance such programs can unleash. Even as psychoanalysts bewail their declining professional stature and the inadequate attention paid to their science, some clinicians at institutes protest the inclusion of non-clinical academics who they say dilute the discussions in their case conferences or compromise confidentiality.

For most of the 20th century, organized psychoanalysis has sought to elevate its stature through a strategy of exclusion from its educational apparatus. Conversations like those that took place at a recent Yale University conference on what psychotherapists have the obligation to say about Donald Trump, make me think back about the University of Chicago effort and specifically about the value of engaging political scientists like Harold Lasswell. In our eagerness to assess how best to add a psychoanalytic voice to discussions about the capacity of the president to govern, we should take a step back and ask ourselves whether it is really the Goldwater Rule or our own historical reluctance to share our clinical perspective more freely with experts outside our clinical realm who are less encumbered than we are to offer this commentary. Robert Wallerstein, the one-time head of the America Psychoanalytic Association, noted just about a century after Freud’s only visit to the United States, that our field’s isolation from the university has exacted a high scientific price in terms of theory development and science. Its lack of inclusiveness has also exacted a high political price, perhaps higher than anyone might have anticipated.