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What psychiatric ethics says about narcissism and presidential candidates

March 22, 2016
by H. Steven Moffic
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It would be surprising if there is not hallway talk at mental healthcare settings about our presidential candidates. That talk could range from the assumed personality traits of those who are running to wondering what each one’s election could mean to healthcare reform.

However, it would also be surprising if psychiatrists go public with our opinions. Psychiatrists did that once before some 50 years ago, when a now-defunct magazine Fact published a survey of psychiatrists, in which about half said that Republican conservative candidate Barry Goldwater was "unfit" to be president, given such personality traits as "immature," "impulsive," "paranoid," and "narcissistic." In return, Goldwater won a libel suit against Fact.

He lost the race, but psychiatry lost some public respect as well.

As a consequence, in 1973, the American Psychiatric Assn. drafted Section 7.3 of its Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, which then became known as the Goldwater Rule:

"On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted authorization for such a statement."

Although there has been some mixed opinion about this clause since, for now, it means I probably shouldn't give you a diagnostic opinion about any of the candidates, as tempting as that might be. I can assure you that I have not examined any of the candidates, let alone been granted authorization to talk about such an examination.

Stigma would likely inhibit any candidate from sharing any history of psychological problems. Although all candidates get a general medical check-up, there seems to be no requirement or expectation for a formal psychiatric assessment to be part of that. I can at least talk, though, about some general psychological issues that seem relevant.

Consider narcissism

The most obvious psychological characteristic to consider is narcissism. It seems evident that most any candidate running for high office in the United States needs to have an above average degree of narcissism. After all, they have to think highly of their capabilities and be able to withstand withering public criticism. Often, a certain amount of charisma goes hand in hand with this degree of narcissism, which helps make the candidate attractive.

Their personal high regard can be maintained by supporters who idealize them, agree with their point of view, and feel they will benefit from the candidate being elected. This sort of lock and key relationship can make outsiders seem like an enemy.

On its spectrum of severity, narcissism begins to take on pathological aspects when threats to narcissism bring on inappropriate rage in the candidate and/or followers. Examples may include inciting supporters to become violent to opposing-view protestors, or scapegoating and bullying vulnerable populations.

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...