More than 50 million watched the recent debate between Biden and Trump, and countless more have been talking about it since. Speculation about the political blowback from Biden’s weak performance runs rampant. The president’s defenders excuse his verbal fumbling as a single bad evening. But we have extensive recent and historical video evidence to provide context, and to document how both men’s brains are functioning in 2024.

In terms of psychiatric diagnoses, the debates supplement a large body of evidence that:

both men show decrements in verbal abilities in excess of healthy aging
both men continue to display extensive symptoms of ADHD
Trump takes stimulant medications to enhance his performances
Biden displays multiple symptoms of Parkinsonism
Trump’s excessive falsehoods are consistent with narcissism

But why is it ethically appropriate to comment on these psychiatric conclusions?
The American Psychiatric Association (APA) and other professional groups claim that publicly discussing the mental health of public figures is unethical without an in-person evaluation and the individual’s consent. But no confidentiality is being betrayed by discussing information widely accessible in the public domain.

The APA asserts, despite evidence to the contrary, that an in-person evaluation is the gold standard for a psychiatric evaluation. Research shows that viewing videos of an individual’s behavior can result in accurate and valid psychiatric diagnoses. Compared to what one can obtain in an in-person evaluation, we have far more hours of behavioral evidence on video for both men, in a variety of settings, interacting with numerous individuals, at different times of day, over a more extensive period of time. We have far more corroboration of this information, from far more sources, than one can accumulate with an in-person evaluation.

Furthermore, diagnostic criteria for ADHD, unlike other mental health conditions are based entirely on observable behaviors, without requiring knowledge of a subject’s feelings, motivations, or other internal mental states. Thus we can attain greater certainty in making an ADHD diagnosis than for a personality disorder. Similarly, many of the symptoms of Parkinson’s disease are observable behaviors.

Although medical professionals’ primary obligation is to their patients, it has been long recognized that doctors have social responsibilities as well. It is a disservice to a democracy to allow ignorant and partisan voices to dominate the conversation about the health of its potential leaders. Psychiatry has an ethical obligation to say what it knows, how it knows this, and its degree of certainty regarding conclusions about the mental health of presidential candidates.

References:
The Goldwater Rule: Perspectives From, and Implications for, Psychological Science (2020)
[ Ссылка ]


A Systematic Review on the Reliability and Validity of Semistructured Diagnostic Interviews for Borderline Personality Disorder
[ Ссылка ]

Parkinson's Organization Fact Sheet
[ Ссылка ].

My June 24,2024 interview with David Pakman
[ Ссылка ]

General:

Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.

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