A Statement on Yale’s Response

When Yale Responded to My Appeal, I Could Not Believe What I was Reading

My attorney asked for a short statement in response; I ended up writing a treatise to him, which follows below.

Yale’s response has the feel of a “theater of illusions,” focusing excessively on personal disparagement, distractions, and repetitions of disinformation that is advantageous to Yale’s position, regardless of the truth and the harm it has done to academic freedom, to the role of free speech in a democracy, and to public health education.

The issue inherent in this appeal is an urgent matter not just of myself but of thousands of psychiatrists and mental health experts who believe that we thoroughly kept with medical ethics when we spoke up about the dangers of the Trump presidency, without diagnosing.[1]

What we realized was that there was a danger of unprecedented violence, domestic and geopolitical instability, and—with the Covid-19 pandemic—needless suffering and the death of over one million Americans, because the person in the office of the U.S. presidency had, in our collective judgment, very serious and dangerous mental impairments.  As psychiatrists and mental health experts, we decided we had a professional responsibility to try to provide the public with an educated understanding of what it observed.  We genuinely believed our knowledge could help empower the public to protect itself.

Over fifty members of the U.S. Congress invited me to meet with them, shortly following the 2017 conference I organized at Yale School of Medicine on the subject of our professional responsibility to speak about dangerous impairments in a powerful leader—without diagnosing, since a diagnosis was irrelevant.  There was even greater interest later in the year when I published the content in a book that became an instant New York Times bestseller, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.

Not only did some of the most nationally and internationally renowned psychiatrists contribute to the book, but at least a dozen chairs of psychiatry departments from around the country believed that we conducted ourselves ethically.  For example, former Chair of Psychiatry at the University of California, San Francisco (UCSF), Samuel Barondes stated publicly:     

“When I first heard about the conference that gave rise to this book at Yale, I was worried that a manifesto would come out with a diagnosis….  That is not what happened: what happened is a very thoughtful assessment based on lots of public data, which gives us a very clear way of thinking about the terrific vulnerabilities of our current president that elicits a duty to warn.” 

Among the prominent psychiatrists who agreed with and supported us was Dr. Steven Sharfstein, a respected leader of the APA who is considered a model for his ethical stance against the Bush administration’s torture program for prisoners of war.

The collective acceptance of our endeavor did not end with our colleagues.  One of the most respected senior journalists of our time, Bill Moyers, said, regarding our work:

“There will not be a book published this fall more urgent, important, or controversial than The Dangerous Case of Donald Trump.”

Everything I pursued was done with considerable encouragement and involvement from some of the most distinguished and well-known academic leaders in my field and consistent, as we all unanimously agreed, with the highest academic and medical standards.

Among these most distinguished persons are Drs. Robert Jay Lifton, Judith Herman, and Jerrold Post.  Dr. Post, fully educated at Yale, was in fact the person who originated the Center for the Analysis of Personality and Political Behavior for the CIA (Post never met any of the individuals he evaluated and went further than I did, and was complimented by President Jimmy Carter).  Dr. Post himself endorsed me, participated in my book, and published Dangerous Charisma, under inspiration from The Dangerous Case of Donald Trump.

It is extremely disappointing that Dr. John Krystal, chair of psychiatry at Yale, has merely echoed the false narrative that the government-funded American Psychiatric Association (APA) and the right-wing media have promulgated, rather than upholding the viewpoints of some of the most respected psychiatrists in the world, who are also in agreement with authentic psychiatric scholarship[2] and evolving practice.[3]  It is difficult to imagine the reason for his support of the APA’s position,[4] with which an overwhelming majority of psychiatrists disagree,[5] other than political expediency.[6]

The APA itself had inexplicably modified its guidelines, shortly after Donald Trump’s inauguration, by creating a new “gag order”[7] out of the Goldwater rule, before it publicly denounced me for breaking it.  It did so by eliminating our societal responsibility (the Preamble to our Code of Ethics states that we have a “responsibility to patients … as well as to society,”[8] in a manner that caused an inundation of protest letters, urgent demands for its ethics committee to review its decision, and mass resignations from the organization, which included high-ranking officers of the APA.

The origins of the false narrative that our actions were a violation of psychiatric ethics—rather than a fulfillment—can be traced to a former APA president, Dr. Jeffrey Lieberman.  Dr. Lieberman, who has had ethical breaches himself,[9] crusaded against us with extremely disparaging, aggressive rhetoric, which was published in the New York Times, the New England Journal of Medicine, and APA press releases, as well as various other media platforms.  He compared us to “Nazi and Soviet psychiatrists,” not noticing the irony that the lead psychiatrist of our book was none other than Dr. Robert Jay Lifton, a leading scholar of Nazi doctors who warned that we in our time cannot cower into doing the same as they under Nazi Germany.

Dr. Lieberman’s use of the APA’s clout to disparage us publicly—even though we were by then public figures and subject to the protection of the Goldwater rule!—chilled all discourse in the national media.  He falsely accused us of practicing “armchair psychiatry,” and of using psychiatry as a “political tool” for “self-aggrandizing purposes.”  Yet, Dr. Lieberman was ironically one of two well-known psychiatrists who actually publicly diagnosed the president,[10] for which official complaints were made to the APA ethics committee and accepted.  He was also apparently masking his own hidden agendas when he received large increases in government grants and subsequently applied for a very high government position,[11] before he was suspended from his chairmanship[12] for other ethical violations, such as his misogynist, racist, dehumanizing comments against other public figures.[13]

A group of U.S. Congress members, led by Rep. Jamie Raskin, asked if we needed a public statement to counter the APA’s attacks and to certify that Congress needed to hear from us.  Unfortunately at that time, we declined this offer as unnecessary,[14] not knowing that the APA would go so far afield as to violate its own ethics code, Section 7.1, which states:

“Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.”

Just last year, we learned that our book served as a critical guide for General John Kelly, the embattled White House chief of staff.[15]^,[16]  Our revealing book may have helped avert a nuclear catastrophe when, appealing to Donald Trump that he could be “the greatest salesman in the world,” General Kelly persuaded him to pursue a diplomatic compromise over nuclear war,[17] which led the president to believe that he would be nominated for the Nobel Peace Prize for his breakthrough “love affair with Kim Jong-Un.”

Toward the end of Donald Trump’s presidency, after the January 6 attack on the U.S. Capitol, General Mark Milley and Speaker Nancy Pelosi agreed with me and my colleagues: that the risk of a very impulsive president launching a nuclear war was very high.  Indeed, major media consider my warnings to be so on the mark as to be “vindicated”.[18]^,[19],[20]

Consider the consequences of what happened after the APA’s silencing of all mental health experts through its public campaigns:

The Twenty-Fifth Amendment, which was a heated topic of debate at the time, became all but impossible to implement.  Former Dean and Prof. John Feerick, who drafted the Twenty-Fifth Amendment, confirmed at the conferences and workshops he co-presented with me that he intended medical data to drive the Amendment.  He clarified that the Amendment would not be effective as a purely political procedure detached from medical guidance.

Thereafter, there ensued two impeachments, election results denial, and the president becoming the source of half the world’s disinformation on the deadly Covid-19 pandemic.  When he told people to “drink bleach,” when revelations of his multiple rapes, including of minors, came to light, and when he incited a violent insurrection against the government, he ushered in a new era of anarchy, the result of which is now very challenging to contain.

In this context, the APA’s “new” Goldwater rule has superseded and overridden all other principles of medical ethics, but silence on the part of the medical profession is not innocuous.  Establishing a new dystopian ethos where those most qualified to comment are precisely those who are prohibited from saying, “the emperor has no clothes,” in a nuclear era, is to place all of humanity in existential peril.  The APA’s motivation was not ethics, science, or professional standards but fear of the political and institutional consequences in honoring its ethical responsibilities—at the expense of the nation and the world.  Yale Psychiatry should not follow suit.

This is precisely what the 1948 Declaration of Geneva of the World Medical Association, which updates the Hippocratic oath and takes precedence over the American Psychiatric Association, was meant to confirm: that silence on the part of medical professionals in the face of a destructive, inhumane regime such as Nazi Germany is antithetical to the humanitarian goals of medicine.

The bottom line is that the essence of what needs to be expressed in my case cannot be cited as a legal reference or be found in a prior legal case, for what the APA did by modifying the Goldwater rule was to establish an artificially-created new norm in which censorship supplants truth.  This dynamic of camouflaged censorship does not portend well for American democracy—the foundations of which depend on transparency and the open exchange of information.

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[1] Most trained psychiatrists understand that not all statements by medical professionals are “diagnoses”, as defined by the Diagnostic and Statistical Manual, Fifth Edition.  “Danger” is not a “diagnosis”, just as “any opinion of a professional” is not a “professional opinion” (only the latter is admissible in court).  Danger (to self, to others, or to the public) assessments are made in all settings at all times, where the physician, regardless of whether one has completed an examination, is expected to err on the side of safety.

[2] https://jaapl.org/content/44/2/226 (a definitive study by specialists of the Goldwater rule)

[3] https://journals.sagepub.com/doi/abs/10.1177/1745691617727864?journalCode=ppsa (a comprehensive examination of the defensibility of the Goldwater rule in our era)

[4] The Goldwater rule was already considered outdated when it entered the books in 1973, and in 1976 the APA itself established a task force intended “to arrive at proposals with respect to ethical guide-lines for the writing of … psychobiographies and psychiatric profiling” of public figures.  Over the years, the interpretation of the Goldwater rule grew more lenient, but this dramatically reversed direction when Donald Trump became president, not because of psychiatric scholarship but as a countermeasure to prevent psychiatric commentary on what the public was perceiving as alarming behavior.

Dr. John Martin-Joy’s definitive study of the APA archives on the Goldwater rule (2020) outlines the controversy and contrast between the interpretations of the Goldwater rule before and after the Trump presidency:

https://www.cambridge.org/core/books/abs/diagnosing-from-a-distance/diagnosing-from-a-distance/C8558E0940638011CB5705925364CD39

[5] https://www.mdedge.com/psychiatry/article/159384/personality-disorders/goldwater-rule-should-be-modified-debate-audience (an overwhelming majority of psychiatrists disagreed with the Goldwater rule, according to an informal poll, which the APA refused to take)

[6] An uncomfortable truth is that Donald Trump was promoting esketamine – a drug for which Dr. Krystal and Yale hold the patent – and therefore the president I was criticizing was also a marketing agent for Yale University’s investments (a leading medical ethicist, Dr. Arthur Kaplan, stated that, on account of Dr. Krystal’s ties to esketamine, Yale had a conflict of interest in my case and an ethical duty to disclose it):

https://www.statnews.com/2020/01/06/only-15-vets-treated-esketamine/

[7] https://www.medpagetoday.com/psychiatry/generalpsychiatry/70152

[8] When the APA stated that we have no “duty to warn,” therefore, it was speaking only of the context of a patient (the Tarasoff doctrine) and not that of society.

[9] https://www.counterpunch.org/2015/05/29/whos-the-real-menace-to-society-journalist-or-leading-psychiatrist/

[10] https://www.vice.com/en/article/wjjv3x/trumps-brain-and-the-25th-amendment

[11] https://www.madinamerica.com/2020/04/muzzled-psychiatry-time-crisis/

[12] https://www.thecity.nyc/2022/2/24/22949146/racist-tweet-columbia-psychiatry-chair-jeffrey-lieberman-new-york-medical-elite

[13] That the APA turned a blind eye to Dr. Lieberman’s inappropriate actions, but censored our conscientious efforts, reveals the APA’s bias.  The APA itself enjoyed unprecedented federal funding, according to its own accounting:

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/91502

This happened under an administration that cut funding for scientific organizations that did not meet the administration’s ideological or political objectives:

https://jamanetwork.com/journals/jama/article-abstract/2656798

Shortly afterward, the APA moved to a highly valued area of Washington, DC, from its historic location in Arlington, VA.

[14] We were doing exactly what the Goldwater rule instructs psychiatrists to do: “to participate in activities contributing to the improvement of the community and the betterment of public health” – without offering a specific “professional opinion” or diagnosis.

[15] https://www.theguardian.com/books/2022/sep/15/john-kelly-dangerous-case-donald-trump-peter-baker-susan-glasser-divider

[16] https://www.theguardian.com/books/2022/sep/16/the-divider-review-donald-trump-peter-baker-susan-glasser

[17] https://www.nbcnews.com/politics/donald-trump/trump-discussed-using-nuclear-weapon-north-korea-2017-blaming-someone-rcna65120

[18] https://www.motherjones.com/politics/2022/08/donald-trump-violence-mental-health-dangerous-jan-6-fbi-mar-a-lago-civil-war-bandy-lee-psychiatry-goldwater-rule/

[19] https://www.scientificamerican.com/article/the-shared-psychosis-of-donald-trump-and-his-loyalists/

[20] https://nymag.com/intelligencer/2021/12/the-yale-professor-fired-for-tweeting-about-alan-dershowitz.html