The danger of diagnosing mental iIllness through the media

Almost half of the first 37 U.S. presidents had mental health issues, according to a study from the Duke University Medical Center Department of Psychiatry. The study includes Abraham Lincoln, Thomas Jefferson, and Ronald Reagan among former commanders-in-chief who have battled a variety of mental illnesses including depression, anxiety, bipolar disorder, and substance use disorders (particularly alcohol). Despite this, many presidents included in this study were some of the country’s most high achieving.

Speculation about President Donald Trump’s mental health has been swirling in the media. Between a string of off-the-cuff tweets and claims about being a “very stable genius,” people are questioning whether Trump is mentally fit to be president.

{mosads}Many are labeling him mentally ill and suggesting it should preclude him from holding the highest office. While Trump says many things that are curious — or even alarming — there are two dangers in making unfounded declarations about anyone’s mental health.

First, claiming that someone with a mental illness cannot be president carries a heavy stigma and is a misrepresentation of the capabilities of people living with mental illness. Second, making a public claim that someone is “mentally ill” without formal medical training or a formal assessment is irresponsible.

Such claims stigmatize those with mental illness and reduce their capacity to be a highly functioning member of society. The latest estimate is that 1 in 6 people have a diagnosable mental illness. If we exclude all those people from leadership positions, we decrease the candidate pool significantly. And for no good reason.

A variety of celebrities have opened up about having a mental illness including Catherine Zeta-Jones, Howie Mandel, and Chrissy Teigen. One of the most notable and outspoken celebrities with mental illness was Carrie Fisher. Instead of hiding behind their diagnoses, they used their celebrity status as a platform to bring light to mental illness.

Beyond celebrities, some of the greatest minds in history have also been diagnosed with mental illness. Artists such as Vincent van Gogh and Pablo Picasso suffered from depression. Famous composers Beethoven and Tchaikovsky were also known to battle depression. And while this is not intended to compare Trump to some of the most brilliant minds in history, it is meant to show that those with mental illness can achieve greatness.

A proper diagnosis of mental illness requires a lengthy evaluation by a psychiatric expert. During the initial evaluation, the expert asks specific questions related to symptoms, evaluates their mental status and takes a detailed history. Without analyzing all of this information together, it is impossible to come up with a definitive diagnosis.

As a psychiatric nurse practitioner, I have diagnosed hundreds of patients in a variety of settings. I can’t simply look at my patient’s Twitter posts and read news stories about my patient to formulate my diagnosis; it would be considered careless. If I were to diagnose someone after only looking at the patient but not having an actual conversation with them, it would not be a reliable diagnosis. As true psychiatric experts, we must look at the whole picture to determine the most accurate diagnosis.

Not everyone making claims on Trump’s mental fitness is unqualified to do so, but still may be unequipped to do so. Some psychiatric experts have weighed in on this debate. In a recently released book, 27 experts  declare that Trump has symptoms of narcissism, paranoia, and is delusional. And with the information they have been given, they may feel justified in making these determinations. Ultimately, though, nothing replaces an actual in-person interview.

What is more dangerous than these critics saying Trump is mentally ill are the politicians and news commentators who take a stab at diagnosing mental illness with no formal training. One Senator was caught calling Trump “crazy” on a mic that he thought was turned off. This type of language carries a stigma and applies not just to Trump but to anyone who has ever been diagnosed with a mental illness.

As a nation we are entitled to our opinions and freedom of speech. But at risk of sounding similar to the very person we are criticizing, we have begun to use insults and stigmatizing language that only perpetuates hatred. We have to use our words with caution and understand the implications of our characterizations. And let’s leave the diagnosing to the experts.

Michelle Heyland is an Assistant Professor of Community, Systems, and Mental Health Nursing at the Rush University College of Nursing, a Psychiatric Nurse Practitioner, and a Rush Public Voices Fellow.