Trump / Biden Presidential Debate and Mental Health

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Over 50 million watched the June 2024 debate between Biden and Trump. The debate sank Biden's re-election prospects, but there are still important insights to be gained about how both men’s brains are functioning.

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.

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My book on Recognizing Adult ADHD:

Recognizing Adult ADHD: What Donald Trump Can Teach Us About Attention Deficit Hyperactivity Disorder

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