MILAN — House of Representatives speaker Nancy Pelosi supported a bill last month proposing the establishment of a committee of physicians, psychiatrists and high-profile personalities, including former presidents and vice-presidents, to judge the physical and mental capability of those who sit in the Oval Office.

Beyond its political significance, this proposal is part of a broader debate on Donald Trump's sanity, with the past four years consumed by articles, books and interviews seeking sociopathological insight into the president's behavior.

In recent weeks, the New York Times noted Trump's "inability to express empathy" towards African Americans, as demonstrated during an interview with Watergate investigative reporter Bob Woodward for his latest book, Rage. In early September, an association of psychologists and psychiatrists that calls itself "Duty to warn" published a documentary titled #Unfit: The Psychology of Donald Trump. It argues that the president is a "malignant narcissist" — that is, suffering from a narcissistic personality disorder mixed with other alarming features not part of the official diagnostic manual on mental disorders.

The documentary's website clearly states that the film is not actually intended to offer a diagnosis, but as a warning to Americans and the rest of the world. For these specialists, it is a duty to warn citizens of the dangers of a disturbed president. Among the founders is Dr. John Gartner, author of a 2008 psychological biography on Bill Clinton, who he determined has a hypomanic temperament.

Still, we must ask what is the proper place of psychiatrists' views on a nation's leadership. In the United States, the Goldwater rule is a principle of medical ethics created by the American Psychiatric Association which urges doctors not to voice their opinions on public figures they have not personally examined. Yet for those who support a "duty to warn," the Goldwater rule must be bypassed in some circumstances so citizens can be made aware of the psychological condition of the person holding the briefcase with the nuclear codes.

The tension in the relationship between mental health and political power extends well beyond America's borders. In recent years, several major international newspapers have published articles on the mental state of politicians, such as President Recep Tayyip Erdogan of Turkey and Rodrigo Duterte of the Philippines. In 2016, a psychological study on Duterte, carried out years earlier on the subject of his annulled marriage, was published, stipulating that he suffers from both antisocial and narcissistic personality disorder. Italy has posed similar questions in the past, such as the alleged cyclothymia attributed to Francesco Cossiga and the alleged sex addiction of Silvio Berlusconi.

We must ask what is the proper place of psychiatrists' views on a nation's leadership.

Does it make sense, then, to question the mental disorders of prime ministers or presidents? Shouldn't we judge them only their political actions?

"We must be careful when making a diagnosis based on political actions, [which are] indirect diagnostic instruments — and then feeding it into public opinion," warns Patrizia Catellani, professor of social psychology at the Catholic University of Milan.

Labeling a politician as mentally ill also risks "stigmatizing the disorder," stresses Alessandro Amadori, a public opinion expert and partner of the Piepoli Institute. "We must not forget that the vast majority of people suffering from mental illness are harmless, and at most only harm themselves, not others."

Amadori says the question is not so much whether to discuss in the media the state of mental health of this or that leader, but rather to try "to prevent, as we do with airplane pilots, that people with certain mental disorders wind up holding such great power in their hands."

Trump and Duterte meeting in Manila in 2017 — Photo: Karl Norman Alonzo and Robinson Niñal Jr.

While we are waiting to develop a safeguard against mentally unfit people from coming to power, the discussion in the media continues. Therefore, we also need to assess what effect this has on individuals when they constantly hear about the (in)sanity of politicians on TV and Twitter.

"We tend to have a very rationalistic view of politics. In reality, politics always goes with a profound emotional investment, and the relationship between the voter and the leader is often a messianic one," Amadori adds. A media debate on the topic can only wind up radicalizing the positions of supporters and opponents, he says, "because it is read as an attack to disqualify one's object of love" by the former, while "galvanizing" opponents.

But since the pathological narcissist leader still needs a base of citizens willing to follow him, how is this bond formed? One hypothesis is that some people experience deep dissatisfaction and look for culprits. "The answer to this dissatisfaction could take two paths," social psychology professor Catellani explains: "one is collective protest, the other is collective narcissism, which is to say 'I believe I am the best and I respond to my disadvantage by showing hostility towards others.'"

The relationship between the voter and the leader is often a messianic one.

At this point it is legitimate — though problematic — to ask whether it is worse to be ruled by an alleged psychopath or to entrust psychiatrists with the judgment about what constitutes good governance.

There is a term that shows all the ambiguity of entering the gray areas of the relationship between power and madness: pathocracy. The word, which describes a form of government in which psychopaths dominate, was coined by Polish psychiatrist Andrzej Łobaczewski, a member of the resistance during World War II. However, if you search "pathocracy" on Google, you'll find a conspiracy website with a list of "psychopaths who rule the world." It goes from Bill Gates to Benjamin Netanyahu, by way of George Soros, Paul Kagame and Margaret Thatcher.

Be warned, the list is only partial — by tomorrow, any name could be added.


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