, by contrast do not know much about mental health. When doctors issue a warning or take steps to protect public health, we’re actually responding to our professional responsibility to society—and here that can mean calling on Congress or the Cabinet, who have the power to act. So I do believe that doctors have a role—and it is not a role that we can abandon—to address our concerns when they get to the point of affecting public well-being and public health and to meet a constitutionally designated responsibility. A public figure is not our patient, and we don’t approach the situation as we would a patient but rather as our responsibility to society.
Sally Satel: It’s one thing to be consulted, but it’s another to be proactive making a diagnosis or an assessment of fitness, which is what you’ve done [with your book]. That’s how you interpret the mandate of the profession. “Duty to warn” is when a doctor has a relationship with a patient and he or she has good reason to think that patient will harm a third party—the duty is to inform that third party and/or officials. To say that it extends to people or figures who are not your patient? I have a much more narrow reading of what professionals should be doing, which is: wait to be asked.
The president is already getting consultations. In the typical role of consultant, we ask three questions about a patient: What is the diagnosis? What is the treatment? And what is the prognosis? To me, it’s that third part, the prognosis, that is most important in the public realm. Whatever it is, is it impairing this person’s capacity to do their job and discharge those duties? That is one of the most relevant things a medical adviser can tell the people in politics, who are the ultimate decision makers here. If you’re a patient, you should want to know what the diagnosis is. But from the standpoint of observing the public figure, diagnosis is irrelevant. What’s the prognosis? We want to know the diagnosis from the standpoint of the individual patient because we have to treat that person. But from the standpoint of whether that patient can discharge their responsibilities, that is based on the symptoms, manifestations, or behaviors we see in front of us—which in the case of character pathology and the media these days is on display for the world to see. No one needs a psychiatrist to come along and say the same things that frankly the public has observed.