Just a short time ago, the idea of an Ivy League psychiatrist privately meeting with members of Congress to convince them that the president is mentally unstable would have been the stuff of crazed conspiracy theories. But that’s exactly what Bandy Lee has been doing since early December.
As Politico first reported, Lee, an assistant clinical professor of psychiatry at the Yale School of Medicine, briefed roughly a dozen Democratic lawmakers last month on the president’s mental state, which she describes as “dangerous.” Now, more meetings are in the works, and congressional staffers tell me that additional members of Congress are interested in attending.
The fact that so many lawmakers want to hear from Lee may suggest growing interest in removing Trump from office; Lee argues in the briefings that he should undergo a capacity evaluation to assess his fitness for duty. (The Atlantic’s James Hamblin has made a similar argument.) But lawmakers’ interest is notable, even radical, for another reason as well: In defiance of the American Psychiatric Association’s ethical guidelines, Lee is relaying her analysis of the president’s mental health without having ever examined him.
In the wake of Politico’s report, the APA issued a statement reiterating its objection to such public statements by physicians. “We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable-news appearances, books, or in social media,” it read in part. “Armchair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.”
Trump’s temperament and leadership style have been the subject of public debate since he launched his presidential campaign in 2015. His detractors have repeatedly argued that he is temperamentally unfit to serve as president. But Lee takes this criticism a significant step further: She argues that Trump may actually be a dangerous person—one who’s shown a “pattern of violent behavior and violent tendencies”—and she’s considered whether the president should be involuntarily committed to a hospital mental-health program. “We can forcibly commit somebody and could be held legally liable if we don’t when the signs are obvious,” Lee told me.
Lee explained that she believes she has a duty to warn the public about what she sees in Trump. She’s been calling for a mental-health evaluation of the president for almost a year. Last April, she organized the Duty to Warn coalition, made up of psychiatrists concerned about the president’s capacity, and in October, she published The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. Her campaign coincided with public outcry over Trump’s recent tweets about American nuclear capabilities, and the release of Michael Wolff’s new White House exposé, all of which reinvigorated debate over Trump’s disposition and health.
The “pattern of violent behavior” Lee sees in Trump includes his incendiary tweets, his comments about groping women on the infamous Access Hollywood tape, his encouragement of violence against protesters at his campaign rallies, and his defense of white nationalists in Charlottesville last summer. She’s told me that Trump currently poses a public-health risk—most of all because of his ability to wage nuclear war unilaterally. His tweet last week about the size of his nuclear button, Lee told me, was a warning “of even the ultimate violence that could annihilate humanity as we know it.”
Some of her colleagues in the medical field believe that Lee and her fellow Duty to Warn coalition members are making irresponsible speculation. “These are armchair amateurs who are using their professional standing to profess things that make no real sense,” said Allen Frances, a psychiatrist and the author of Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump. “They’ve been taken seriously because they have degrees from fancy universities, and they know something about psychiatric diagnosis.”
Lee argues that she is merely pressing for the president to participate in a capacity evaluation—the same sort of mental-health assessment taken by members of the military—as soon as possible. (Trump will undergo his first official physical on Friday, but a White House spokesman said he will not receive a psychiatric evaluation.) Sitting U.S. presidents aren’t required to take such a test, nor are fitness-for-office exams required to become president. It’s not clear how a test would be put in place, whether Trump would actually take it, and what exactly would happen if Trump were to fail. But Lee told me her role is to educate the public so that people can demand that their lawmakers create a mechanism for evaluation. She suggested they do so “through the 25th Amendment,” but acknowledged “it’s not my area.” The amendment allows for the removal of a president if members of the Cabinet and the vice president decide he isunable to perform his duties.
Frances views Lee as well-meaning but misguided. “The medicalization of politics is always a mistake, and there’s actually no chance that Trump will be removed from office as mentally unfit under [Amendment] 25 of the Constitution,” he told me. “Trump should not be underestimated; he’s crazy like a fox,” Frances said, but “there is clearly nothing substantial to [Lee’s] claims and no reason to believe an evaluation would change anything.”
In our interview, Lee also told me that there are Washington-based doctors and legal groups who’ve said they would be willing to help commit the president involuntarily if they receive concerned reports from the White House that the president is an immediate danger to himself or others. (She declined to name the doctors or legal groups). “Surprisingly, many lawyer groups have actually volunteered, on their own, to file for a court paper to ensure that the [White House security staff would] cooperate with us,” Lee recently told Vox. “But we have declined, since this will really look like a coup, and while we are trying to prevent violence, we don’t wish to incite it through, say, an insurrection.” Lee also claims that “if [a psychiatrist] were to see [the president] on film and he were decompensating”—exhibiting a sharp deterioration—“and no other psychiatrist were stepping forth, then we actually have to step forth, we don’t have a choice, that’s an emergency. A physician has emergency clearance so they should be able to get to the site of emergency.”
According to the Treatment Advocacy Center, in Washington D.C., an emergency psychiatric evaluationcan be ordered by a police officer; an agent of the Department of Mental Health; or a person’s qualified psychologist “who has reason to believe that a person is mentally ill and, because of the illness, is likely to injure himself or others if he is not immediately detained may, without a warrant, take the person into custody.” But it’s not likely that an emergency evaluation—let alone involuntary commitment—would be ordered on hearsay or television evidence alone.
“You’ve got to be kidding. That’s preposterous,” said Jeffrey Lieberman, the chairman of the Columbia University Department of Psychiatry. “What kind of chaos would you have? … That would be anarchy.” The president could hypothetically be compelled to undergo tests under the 25th Amendment, but that would be up to the vice president and the Cabinet—and is not something an independent psychiatrist could instigate, he said.
Even so, the number of congressional Democrats interested in hearing from Lee appears to be growing, though they still constitute a small share of the party’s total representation in Congress. Earlier this week, I contacted the offices of every House and Senate Democrat to find out which lawmakers have already attended the private briefings and which are interested in attending in the future. While the majority of offices didn’t respond, 16 indicated that they are seriously considering the question of Trump’s mental fitness for office, including two who are planning to attend upcoming briefings.
A spokesperson for California Representative Jackie Speier said she is weighing attending a future briefing, and Texas Representative Lloyd Doggett’s office said he plans to meet Lee at the home of Connecticut Representative Rosa DeLauro later this month. A spokesman told me DeLauro organized a briefing for her colleagues after meeting with Lee last month, in the hopes that “everyone can make up their mind.” And a spokesman for Representative John Garamendi of California confirmed that he met with Lee on Wednesday.
According to Lee, lawmakers have been receptive to her assessment of Trump. “When we actually met with them,” she said, “[the lawmakers] would say, ‘You don’t have to convince me of that. You don’t have to convince any of us of that.’” She added that interest on the Hill has only amplified since last spring, when she held a Duty to Warn town hall. “After the April conference, only a handful of lawmakers got in touch to find out more,” she said. But by December, “I was astonished by the level of eagerness to speak with us.”
In total, only three House Democrats I contacted ruled out attending a briefing. Staffers for House Minority Leader Nancy Pelosi told me she wasn’t involved in arranging the sessions and declined to comment further.
While Lee is pushing for a medical evaluation of Trump, other proposals for constraining presidential powers have similarly surfaced in recent months. Democrat Jamie Raskin of Maryland, who confirmed that he was one of the dozen to have met with Lee in December, said he has recently seen increased interest in his proposal to create an independent commission to determine presidential capacity. “The framers foresaw a time when this could become an issue,” Raskin told me, referring to the 25th Amendment. “And we simply have to have the courage and sense of responsibility to implement the procedure they set up.”
So far, congressional Republicans haven’t shown the same interest in Lee’s assessment, though she confirmed she’s spoken with some GOP Senate staff. She had one encounter with a Republican senator, but called it “incidental”: She happened to be speaking with the senator’s staffers about Trump when the lawmaker returned from a meeting. Several Republicans told me they simply aren’t interested in the issue. “I’m not particularly fond of the president, but I think this mental-instability talk is bush league,” said one Republican Senate staffer, on condition of anonymity in order to speak candidly. “It’s no different than the birther issue. It’s trying to beat a political foe on a technicality rather than at the ballot box.”
Lee told me her concerns have nothing to do with partisanship: “It’s the first time that I’ve jumped into this domain because of medical concern, because of human survival,” she told me, adding that psychiatrists “could be held legally liable if we don’t [speak out] when the signs are obvious.” But in doing so, she’s dived head-first into a decades-long debate within the psychiatric community about their standards and obligations—not to mention a political and constitutional minefield.
Since 1973, the APA’s Principles of Medical Ethics has included the so-called “Goldwater Rule,” which states that it’s unethical for psychiatrists to diagnose a public figure without first examining them personally. The organization recently affirmed its commitment to the policy, and emphasized that offering any professional opinion about an unexamined individual “compromises both the integrity of the psychiatrist and the profession.”
“There’s a consistent pattern to mislabel bad behavior as mental illness and that stigmatizes the mentally ill,” Frances said. “Trump has made amateur diagnosticians of us all.” And Lieberman put it this way: “You don’t have to be a psychiatrist to talk about dangerousness. Everybody can draw their own conclusions when someone says, ‘I’ve got a big nuclear button my desk.’”
Steven Hoge, the director of the Columbia-Cornell Forensic Psychiatry Fellowship Program, was similarly skeptical of Lee’s claims. “Our ability [to predict future violence] is relatively modest,” Hoge explained to me. “It requires extensive evaluation, access to the individual, records of past behavior and past violence.” If someone who hasn’t conducted a one-on-one evaluation of a patient—and doesn’t have access to their medical information or psychiatric history—offers an opinion on their capacity for violence, “that clearly runs afoul of the Goldwater Rule.”
Hoge also questioned whether Lee’s assessment is truly based in science. “The vagueness of ‘violence against the public’ or ‘dangerousness’ masks an underlying political judgment,” he wrote in a follow-up email. If Trump’s actions are legitimate choices for a president to make, Hoge argued, “doesn’t this make clear that the psychiatric prediction is fundamentally a political judgment?” Dinah Miller, a psychiatrist at Johns Hopkins School of Medicine and the author of Committed: The Battle Over Involuntary Psychiatric Care, was similarly concerned. “My guess is that if you find Republican psychiatrists, that some of them are going to say he’s doing a good job,” she said.