Sergei Chirikov/Associated Press
Thomas G. Plante (@ThomasPlante) is the Augustin Cardinal Bea, SJ University Professor, professor of psychology and, by courtesy, religious studies at Santa Clara University and an adjunct clinical professor of psychiatry at Stanford University School of Medicine. He has been a scholar of the Markkula Center for Applied Ethics for over 25 years and a licensed psychologist in practice for 35 years.
The current horrific war and humanitarian crisis in Ukraine during recent weeks has led many to question the mental health of the Russian President, Vladimir Putin. It is hard, if not impossible, to imagine what might be going through the mind of a leader as they inflict unspeakable carnage on a neighboring country of 43 million people strategically targeting shopping malls, maternity hospitals, apartment complexes and other locations where innocent civilians are located. Some have wondered if Mr. Putin is a “madman” with nuclear, biological, and chemical weapons that might unleash World War III and perhaps the end of civilization as we know it. These are scary and apocalyptic times, not only for the innocent people of Ukraine, but also for the entire world. If we can better understand how Mr. Putin thinks and feels, or what makes him tick, might we be able to find a way to influence him to stop the war or at least not to escalate it?
Psychologists, and other mental health professionals such as psychiatrists, know a thing or two about human behavior and especially about psychopathology. While everyone following this awful story of war might speculate about Mr. Putin’s psychological functioning, these professionals have tools to do so with some degree of expertise. However, there are important ethical issues that emerge when doing so that have challenged the mental health community for the last half century. These ethical issues are best understood through the tension that occurs balancing the Goldwater Rule with the Duty to Warn Rule.
The Goldwater Rule refers to the former Arizona senator, Barry Goldwater, when he was running for president in the 1960s. Mental health professionals at that time were commenting on his extreme views and offering psychiatric diagnoses from afar to the public about Mr. Goldwater’s mental health and stability. The American Psychiatric Association issued an ethics rule stating that psychiatrists should not comment on the mental health functioning or potential psychiatric diagnoses of public figures who they have not evaluated or treated in person. They also, by the way, could not comment on public figures that they actually did evaluate or treat due to both legal and ethical constraints regarding confidentiality. Other mental health professionals, such as psychologists, followed suit and were encouraged by their ethics policies to also refrain from offering public commentary on the psychological functioning of public figures. Thus, when the mental health and behavioral functioning of public figures were in the news (e.g., Michael Jackson, Kanye West, O.J. Simpson, Bernie Madoff, Brittney Spears, Robin Williams) mental health professionals generally remain silent.
The Goldwater Rule was vigorously challenged during the 2016 presidential election, as many mental health professionals were concerned about the psychological health and well-being of then presidential candidate, Donald Trump. A Yale University-based psychiatrist, Brandy Lee, was the lead author of a book entitled, The Dangerous Case of Donald Trump, where these leading experts referred to the Duty to Warn Rule that, excuse the pun, “trumped” the Goldwater Rule. They claimed that the severe risk to the nation and world warranted mental health professionals to publicly comment about their concerns regarding Donald Trump’s mental health. Brandy Lee has continued to be an outspoken critic of President Trump and other dangerous leaders, such as Mr. Putin, and has received significant backlash, including being removed from her faculty position at Yale.
Dr. Lee, among others, argues that leaders such as Mr. Trump and Mr. Putin are “malignant narcissists” and are therefore extremely dangerous. These men, they argue, have narcissistic, antisocial, and paranoid personal dimensions that make them exceedingly difficult and catastrophically dangerous. Narcissism implies that their own personal interests are paramount and they are not interested in the common good or the interests of others unless it serves their needs and desires. Antisocial implies that they experience no empathy for others or any guilt regarding their actions. Additionally, rules and laws simply do not apply to them in their view. The ends justify the means with antisocial personalities. Paranoid implies that they trust no one and that others are seeking to do them harm. The combination of these three personality elements along with access to military power, including nuclear, biological, and chemical warfare, is so dangerous and a threat to the planet that the duty to warn the public overrides the Goldwater Rule to stay silent on the psychiatric functioning or dysfunction of public figures. Trying to convince malignant narcissists of the errors of their ways is futile and only containment alters their dangerous behaviors.
Applied ethics is always a balancing act between different problem-solving approaches to solve ethical dilemmas. Different approaches may lead to different conclusions and reasonable people may come to disagree about what the best path might be to follow. However, watching the horrors of the war in Ukraine unfold in real time, doing anything to help ease suffering and to support the common good and the well-being of innocents might be the best action to follow. The fate of the world, and of civilization, may ultimately depend on good, but difficult and conflicted, ethical decision-making.