Yale Fires Prof for Trump Mental Health ‘Diagnoses’

What at first blush appears a case of hypocrisy and cancel culture is a violation of professional ethics.

This tweet from Georgetown professor Don Moynihan is amusing:

Yes, it’s ironic.

Clicking through to the story, though, Derschowitz rather had a point.

Yale News (“Former professor says Yale fired her over tweet on Trump, Dershowitz“):

Bandy Lee MED ’94 DIV ’95, a formerly Yale-affiliated faculty member in the Department of Psychiatry in School of Medicine, filed a complaint against the University on Monday alleging “unlawful termination… due to her exercise of free speech about the dangers of Donald Trump’s presidency.”

So, far, I’m with Lee. Academic freedom is a core tenet of faculty life, even if it’s practically dicey for contingent faculty such as her. Further, I agree that Trump’s presidency was dangerous.

Lee’s complaint alleges that Yale fired her in response to a January 2020 tweet that characterized “just about all” of former president Donald Trump’s supporters as suffering from “shared psychosis” and said that Alan Dershowitz, a lawyer on Trump’s legal team, had “wholly taken on Trump’s symptoms by contagion.” Dershowitz responded to the tweet with a letter to Yale administrators, in which he complained that Lee’s tweet constituted “a serious violation of the ethics rules of the American Psychiatric Association” and requested that she be disciplined. 

So, on the one hand: dick move by Derschowitz. He’s been a very prominent public intellectual for decades and probably shouldn’t even respond to critic. On the other, Lee, of whom I had not heard until this morning, is actually rather prominent: she’s president of the World Mental Health Coalition and has 96,000 Twitter followers. So, when she questions his mental health, it’s not just some yahoo spouting off on social media but a clinical diagnosis.

Beyond that, Yale did not fire her for a single tweet but for a pattern of unprofessional conduct:

According to court documents, after Dershowitz sent his letter on Jan. 11, chair of the Psychiatry Department John Krystal MED ’84 warned Lee via an email that the department “would be compelled to ‘terminate [her] teaching role'” if she continued to make similar public statements. She continued to tweet about the mental fitness of Trump even after Krystal’s warning. Lee then met with Krystal and additional unnamed faculty members and was told that she “breached psychiatric ethics,” according to an email excerpt in the filing. According to court documents, Yale refused to hold additional discussions or investigate the accusations further. On May 17, 2020, Lee was notified that she was terminated. She appealed the decision multiple times in August and September, to no avail.

Krystal wrote to Lee in a Sept. 4 letter included in the court filing that the department’s main consideration in the termination was her “clinical judgement and professionalism” after she publicly stated her “diagnostic impressions” of Trump and other public figures. Krystal emphasized in the letter that the termination “was not because of the political content” of her statements.

“Although the committee does not doubt that you are acting on the basis of your personal moral code,” the letter read, “your repeated violations of the APA’s Goldwater Rule and your inappropriate transfer of the duty to warn from the treatment setting to national politics raised significant doubts about your understanding of crucial ethical and legal principles in psychiatry.”

The American Psychiatric Association’s Goldwater Rule states that it is unethical for psychiatrists to comment on a public figure’s mental faculties in an official capacity unless granted permission or after a medical examination.

So, two things are important here. First, she wasn’t a full-time professor at Yale but rather a “voluntary faculty member.” She is therefore entitled to far less due process in the matter than a tenured or even tenure-track professor. Second, she continued to violate the norms of her profession after being warned to stop.

She was certainly not fired because she held or expressed negative views about Trump or his policies. One imagines the overwhelming number of Yale faculty would have been at risk under that standard.

Lee also considers the Goldwater Rule — which the APA clarified in 2017 prohibits member psychiatrists from giving professional opinions about the mental state of someone they have not personally evaluated — a “gag order,” according to court documents. Her complaint states that she believes the rule goes against her role as a psychiatrist “in light of her belief that Donald Trump posed a dangerous threat to this country and the world.” Lee has not been a member of the American Psychiatric Association since 2007.

Lee also claims in her complaint that she was not diagnosing Dershowitz, “but rather commenting on a widespread phenomenon of “shared psychosis.'”

Lee graduated medical school in 1984. The Goldwater Rule has existed since 1973. Whether she considers it a “gag rule” is immaterial; it’s a longstanding ethical tradition and one the Yale School of Medicine takes seriously and warned her she must comply with.

Nor, incidentally, was this just a couple of tweets carelessly sent late in the evening after a glass or three of her beverage of choice. It has become Lee’s primary focus. She has published two books on the subject, one of which is in its second edition! The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President was published in 2016 and Updated and Expanded with New Essays in 2019. And she has “just released” Trump’s Mind, America’s Soul.

Even as someone who has gone on record repeatedly offering my view that Trump is mentally ill and dangerously unfit for the presidency, it’s simply outrageous for mental health professionals to do so. As the above-linked APA discussion on the Goldwater Rule notes, it was based on a magazine survey asking 12,356 psychiatrists “Do you believe Barry Goldwater is psychologically fit to serve as President of the United States?” during the 1964 presidential campaign between Goldwater and Lyndon Johnson. The vocipherousness and unprofessionalism of several of the responses gave the profession a black eye.

[M]any other respondents understood immediately the greater implications of the question for psychiatry’s purported role in the electoral process.

“Your inquiry for a professional opinion regarding Sen. Barry Goldwater’s general mental stability is an insult to me,” wrote Thomas Stach, M.D., in 1964. “An inquiry of this type regarding any individual can only be based on ignorance of the field of psychiatry.”

Stach demanded an apology from the editors to all the psychiatrists who had received the survey.

“It was astounding to me when the survey first came out,” Stach, now retired in Willowbrook, Ill., told Psychiatric News. “It was impossible for a psychiatrist to come to a conclusion like that without a personal examination. The psychiatrists who were baited into giving responses were imprudent.”

And, indeed, the APA recognized it instantly, too:

“[S]hould you decide to publish the results of a purported ‘survey’ of psychiatric opinion on the question you have posed, the Association will take all possible measures to disavow its validity,” wrote APA Medical Director Walter Barton, M.D., in a letter to the magazine’s editors on October 1, 1964.

APA President Daniel Blain, M.D., denounced the compilation as “a hodge-podge of the personal political opinions of selected psychiatrists speaking as individuals. … [T]he replies to the question have no scientific or medical validity whatsoever.”

Tying political partisanship to the psychiatric profession, continued Blain, “has, in effect, administered a low blow to all who would work to advance the treatment and care of the mentally ill of America.”

Lee has every right to express her personal opinions about American politics and politicians. But, if she’s offering diagnoses of their mental health, she’s in violation of the standards of her profession and Yale had not only the right but the duty to remove her from its faculty. Indeed, given the prominence with which she was doing so, I’m surprised it took Dershowitz’ letter to spark action.

Beyond that, even a casual reading of the literature on shared psychotic disorder makes its application to “just about all” of Trump’s 77 million supporters absurd. It’s one thing for blog commenters to make that kind of assertion. It’s quite another for a faculty member of a great medical school.

FILED UNDER: Academia, Education, Health, Health Care
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Scott says:

    What happened to Lee is analogous to what happened to Dr Keith Ablow, formerly of Fox News. He freely mixed punditry, politics, and medical practice. He resigned from the APA, has his medical license suspended by Massachusetts and New York. He seems genuinely to be a nasty piece of work.

    Seems both were treated equally.

    Now about Dershowitz. If only the legal profession had any ethical guidelines.

    12
  2. Kylopod says:

    Something tells me this incident will not be cited by the right as an example of “cancel culture.”

    8
  3. Kylopod says:

    Dershowitz has a history of rank hypocrisy on the free-speech issue.

    5
  4. CSK says:

    Prof. Joyner, I’m surprised you hadn’t heard of Lee before this. The first book she edited, The Dangerous Case of Donald Trump, really made quite a splash.

  5. Just nutha ignint cracker says:

    @CSK: Is this public spat at all about juicing the sales for her new book, I wonder? “My treatment is outrageous, and I just happen to have recently written about just such treatment”

    1
  6. CSK says:

    @Just nutha ignint cracker:
    It could be. The more press she gets, the more her sales will rise is how the thinking goes.

    2
  7. James Joyner says:

    @CSK:

    Prof. Joyner, I’m surprised you hadn’t heard of Lee before this. The first book she edited, The Dangerous Case of Donald Trump, really made quite a splash.

    There have been so many books with similar titles that I must have missed it.

    3
  8. Hal_10000 says:

    Yeah, I’m sort of with you on this one. Dersh is a flaming hypocrite. But she’s been making money violating an ethical principle here.

    3
  9. CSK says:

    @James Joyner:
    There are indeed.

  10. grumpy realist says:

    If your professional guild tells you you’re crossing the line of what they consider unprofessional behaviour and to stop stop stop….

    …and then you continue to do so….yeah, no sympathy for Lee and the buzzsaw she ran into.

    We’ve got silly idiots on the left as well, it seems.

    8
  11. Gustopher says:

    I’m not convinced that the Goldwater Rule is a good rule — it cuts out an important science from contributing to political science — but she is definitely violating it, and most in sensationalist ways.

    As the kids say these days: fuck around and find out.

    Alternately: play stupid games, win stupid prizes.

    It also does not surprise me that Dershowitz is a bedbug.

    2
  12. Just Another Ex-Republican says:

    “Even as someone who has gone on record repeatedly offering my view that Trump is mentally ill and dangerously unfit for the presidency, it’s simply outrageous for mental health professionals to do so. ”

    While I happen to agree, there is something very ironic about the idea professionals should leave commentary on a public figures mental health to the amateurs 🙂

    3
  13. James Joyner says:

    @Just Another Ex-Republican:

    there is something very ironic about the idea professionals should leave commentary on a public figures mental health to the amateurs

    Indeed!

    But here’s the thing: As brilliant and accomplished as she is in her field, Lee is only slightly more competent to comment on the mental health of Donald Trump, who she has not professionally examined, than you or me. And she’s no less likely to render those armchair judgments based on her political preferences and cultural sensibilities than we amateurs.

    2
  14. charon says:

    @James Joyner:

    But here’s the thing: As brilliant and accomplished as she is in her field, Lee is only slightly more competent to comment on the mental health of Donald Trump, who she has not professionally examined, than you or me.

    Because he is such a public figure, she actually knows more about him than psychiatrists typically know about the patients they diagnose. Psychiatrists often rely on the patients’ families to describe symptoms and history to them.

    Maybe the Goldwater Rule is a bit overdone.

    @Gustopher:

    I’m not convinced that the Goldwater Rule is a good rule

    I think it is an overreaction.

  15. charon says:

    @charon:

    Of course, she does not know what medications might be affecting his behavior, or what any MRI’s might say about his neurological health.

  16. Daryl and his brother Darryl says:

    Obviously Lee is correct, Trump is mentally ill and he was, and continues to be, a danger. Same with his sycophants.
    But…Lee was warned by Yale and seemingly ignored the warning. So this is on her, IMHO.

    1
  17. James Joyner says:

    @Gustopher: @charon: Alan Stone, the Touroff-Glueck Professor of Law and Psychiatry in the Faculty of Law and the Faculty of Medicine, Harvard University, Emeritus with a long list of distinguished credentials (Guggenheim Fellow, a Fellow at the Center for Advanced Study in Behavioral Sciences, and past President of the American Psychiatric Association) explains at Lawfare that, while he voted against the rule when it was implemented on free speech grounds, he’s fully on board with the notion that psychiatrists have no ability to diagnose from afar. His essay is well worth a read.

    1
  18. CSK says:

    Lee has claimed the her “duty to warn” superseded the Goldwater Rule.

  19. James Joyner says:

    @CSK: Alan Stone dismantles that argument in the above-linked Lawfare piece (which doubles as a review of her book). It’s wrong on two fronts. First, the duty only inheres when the psychiatrist has privileged knowledge from the doctor-patient relationship. Second, the duty is to warn authorities of imminent danger, not to tweet out insults.

    3
  20. CSK says:

    @James Joyner:
    Oh, I know. But “duty to warn” seems to be the defense she’s adopted for the occasion.

  21. de stijl says:

    Telediagnosis is bad.

    I understand her impulse, but her actions were unprofessional and she was warned many times she was line stepping.

    She has a right to do so, but her professional guild and employer can discipline her or fire her for her speech.

    Consequences. Accountability.

    2
  22. Stormy Dragon says:

    Presumably the state of Connecticut has a process for investigating and adjudicating accusations of ethical violations by licensed Psychiatrists.

    I’m guess that “random Yale admin decides the whole thing themselves” is not that process.

    So who died and made John Krystal the king of the APA?

  23. EddieInCA says:

    My wife is a licensed therapist, and she diagnosed Trump during the 2016 primaries. She never published her findings, nor shared them with anyone but me, but given what we know of Trump, it’s not a hard diagnosis if anyone knows anything at all about the DSM-5.

    3
  24. James Joyner says:

    @Stormy Dragon:

    So who died and made John Krystal the king of the APA?

    He’s the Chief of Psychiatry at Yale Medical School and presumably has the authority to fire voluntary scholars associated with his department. He’s not taking her medical license away.

    2
  25. James Joyner says:

    @EddieInCA:

    My wife is a licensed therapist, and she diagnosed Trump during the 2016 primaries.

    Is she a psychologist or a psychiatrist? Only the latter have this prohibition.

  26. Kylopod says:

    “Donald has so many pathologies and they’re so complex, there’s so much co-morbidity that it’s really difficult to tease out what’s exactly going on without testing.” — Mary Trump

    1
  27. CSK says:

    @Kylopod:
    I was thinking about this. She’s a psychologist, and therefore not bound by the same rules as is Lee.

  28. EddieInCA says:

    @James Joyner:

    She’s a psychologist. She didn’t go to Med School. She can’t prescribe medication.

  29. Sleeping Dog says:

    @Kylopod:

    “Donald has so many pathologies and they’re so complex…

    Lay person’s translation, choose one or more from the following list.

  30. Just nutha ignint cracker says:

    @CSK: Considering that some hold a “duty to protect” within foreign policy/affairs and civil law (think “reckless indifference”), “duty to warn” isn’t much of a reach.

  31. CSK says:

    @Just nutha ignint cracker:
    No, but “duty to warn” for psychiatrists is considerably more limited than a warning to the general public.

    Those of us who know Trump is governed by his pathologies have known so for years. In my case, for decades. The hardcore Trumpkins will never–at least, not publicly–admit that the man is anything less than a brilliant businessman, the greatest president we’ve ever had, a devout Christian, a faithful husband, and a loving father.

    2
  32. charon says:

    @James Joyner:

    First, the duty only inheres when the psychiatrist has privileged knowledge from the doctor-patient relationship. Second, the duty is to warn authorities of imminent danger, not to tweet out insults.

    I want to comment on this, just do not have time just now. Later, even though thread likely be dead by then.

  33. de stijl says:

    @CSK:

    Head Doctors of any stripe should not try to diagnose someone unless under direct care.

    Yeah, I know Trump is an extreme example of a narcissist, but I’m a layman so that’s fine to share. But a pro should not diagnose from afar and share. It’s unseemly and unprofessional.

    Telediagnosis is bad and often projective.

    The raw public are free to conjecture, but pros need to keep their traps shut.

    If you really need to spill tea call up a reporter and do it anonymously. Even that is pretty sketchy as you have no direct evidence.

    Kvetching about if Lee is not bound because reasons misses the point.

    If I am me, I am free to postulate and determine the relative guilt of a defendant. If I am a juror, I must abide by the rules set forth.

    Terri Schiavo and Sen. Bill Frist come to mind.

  34. Mimai says:

    Without giving away too much (for personal and professional reasons), I am a mental health professional and a tenured faculty member. A couple points of clarification:

    1) A lot of discussion has used language noting that she is “bound” by “rules.” The Goldwater rule isn’t really a rule per se. Rather it is a guideline included in a larger document outlining ethical principals for one professional association – American Psychiatric Association. They can “punish” members who commit ethical transgressions, but don’t have a lot of direct power (ie, the APA doesn’t license providers). Moreover, the APA guidelines only technically apply to APA members, though the guidelines are considered “industry standards.”

    2) Bandy Lee is a psychiatrist (MD). AFAIK, she is not a member of the American Psychiatric Association (see point above).

    3) Clinical Psychologists have a PhD and did not go to med school. Most do not prescribe medication, but a growing number of states and the VA have allowed for a limited scope of prescription privileges upon securing the requisite training (by the way, this training far exceeds the training in mental health medication management that psychiatrists and other prescribing providers receive). This is an ancillary point and not relevant to the issue.

    4) Psychiatrist and Clinical Psychologist are regulated terms. Therapist, counselor, psychotherapist, etc. are not. Caveat emptor.

    5) Most importantly and relevant to the topic at hand, by widely accepted standards across the mental health field, Dr. Lee’s behavior has been consistently and purposefully in violation of “best practices.” Moreover, her behavior has been at odds with the standards of the academy, and she doesn’t have the protection of tenure (or otherwise) to shield her.

    In my opinion, and regardless of my thoughts about Trump/Dershowitz, she is long overdue for professional sanction.

    This entire saga is but another illustration of the “fact” that Trump(ism) brings out the worst in everyone.

    5
  35. de stijl says:

    @Mimai:

    I believe I recently replied to you with “You should be a therapist.”

    You ask interesting questions in a probing, but not confrontational manner.

    I had good radar.

    1
  36. Mimai says:

    @de stijl:
    You did. Thanks. You do.

    Speaking of mental health, condolences on the demise of Liquor Lyle’s.

    1
  37. charon says:

    Second, the duty is to warn authorities of imminent danger, not to tweet out insults.

    So who are the relevant authorities?

    So consider Joe Blow, whose behavior is worrying people. For example, the recent Boulder, CO shooter whose family tried to get psychiatric involvement. Other than law enforcement and the courts, who else has any potential to do anything about the guy? There is no one else, who could do with some psychiatric input.

    Sitting presidents have some significant differences from that situation.

    Consider Ronald Reagan. His close associates could see there was something wrong, but the public never got any inkling, it was kept on the down low. Information suppression is typical with national chief executives.

    Now TFG, who was surrounded by sycophants, minions, family – all with motivation to not disturb their situations. Would the Cabinet do anything? Not a Cabinet made up of grifter incompetents (e.g., Betsy DeVos, Dr. Ben Carson etc.) and ideological fanatics (e.g., William Barr, Mike Pompeo).

    What about the Senate? Two impeachments, no joy.

    There is no relevant authority both able and willing to address the situation other than the public, the voters. No one else. Shouldn’t they be apprised of any relevant information?

    1
  38. Mimai says:

    @charon: Before responding, I want to make sure I understand your point. Are you saying the mental health professionals have a duty to warn (in the case of a politician)? And that the voting public are the relevant authorities?

  39. charon says:

    @Mimai:

    They don’t have an obligation or “duty” to warn, but I do not think they normally should be censured or disciplined if they do speak out.

  40. charon says:

    @Mimai:

    (in the case of a politician)

    Not any politician, just the President as a unique case.

  41. Mimai says:

    @charon: Thanks, that clarifies a point I was going to contest but now don’t have to. I an issue is how one defines “speak out” in this context. It seems to me that Dr. Lee was commenting specifically on psychiatric diagnoses that she perceives Trump to meet criteria for. That is professionally problematic. I don’t think she would be in this situation if she had merely expressed disgust, contempt, etc. about Trump and/or his actions….indeed, many healthcare professionals have spoken out in this way and have done so without professional censure/discipline.

    4
  42. Mimai says:

    @Mimai: (no edit button) That second sentence should have read: “I think an issue…”

  43. de stijl says:

    @Mimai:

    I used to live about 100 yards from Liquor Lyle’s. It was my joint for years.

    It was an interesting crowd & good staff. I am of the mind that staff basically make or break a dive bar.

  44. James Joyner says:

    @charon:

    There is no relevant authority both able and willing to address the situation other than the public, the voters. No one else. Shouldn’t they be apprised of any relevant information?

    Leaving aside the provisions of the 25th Amendment and the impeachment power, the fact of the matter is that she had no relevant information. She had no more information about Trump’s erratic public behavior that the average television viewer. That’s the whole point of the Goldwater Rule.

    1