Among other things, Dr. Bandy X. Lee is the president of the World Mental Health Coalition, the only professional organization to address the issue of dangerous leadership. Remarkably, this is something quite new, which feels both long overdue and just in time.
Dr. Lee is connected to the Berkshires through her mentor, Dr. James Gilligan, who regularly lectured at the Austen Riggs Center. Over the last four years, Dr. Lee repeatedly warned members of Congress about the dangers of Donald Trump. As a result of this outspokenness [see below the tweet that caused an uproar], she suddenly finds herself in the odd position of suing her alma mater, Yale University; you can read the lawsuit here. No matter how it turns out, I have enormous respect for Dr. Lee’s sense of professional duty, her ethical lens, and her moral compass. Imagine how much worse we’d be if she hadn’t articulated alarms early and often.
Sarah Wright: I have followed your work for a number of years now and truly appreciate how seriously you take public mental health. Your grandfather instilled in you the belief that practicing medicine involves social responsibility. How has your credo changed, given what you now know?
Bandy Lee: My grandfather turned down a comfortable position as dean of Seoul National University College of Medicine, the top medical school at the time, to spend all his waking hours — truly 20 hours a day — treating those who needed care after the Korean Civil War. His motto was never to turn a patient away because one could not pay, but always to take some form of payment, whatever the person could offer, to retain the person’s dignity. My love of ethics came from him.
The Hippocratic Oath speaks of beneficence and social justice as a physician’s virtues, in addition to non-maleficence, of course. The modern version, the Declaration of Geneva, which the World Medical Association instituted in 1948 after the experience of Nazism, emphasizes principles above technical rules, and humanitarianism over obedience to destructive governments. Indeed, either collusion or silence with dangerous regimes would be considered unethical, as with the Nazi doctors.
My credo has not changed, but rather my moral compass was activated when the American Psychiatric Association (APA) imposed a gag order with the start of the Trump presidency. At the time, I saw that it was taking a reasonable guideline that I had kept for 20 years, “the Goldwater rule” — even though I was exempt as a forensic psychiatrist — and turning it into something I no longer recognized. Originally, it was intended to prevent irresponsible diagnosis without having all the necessary information: a personal interview is not always needed since 1980, but medical records are, and you diagnose someone who is your patient.
Public figures are not patients, and physicians are not beholden to them; rather, we are beholden to our patients and to society, according to our ethics. So when the APA changed “the Goldwater rule” to prohibit any comment whatsoever on public figures and not just diagnosis — and eliminated any exceptions including danger to patients or to society — this was a major red flag for me. It was essentially telling us to violate not only our core ethics but our universal pledge as physicians not to collude with destructive regimes.
Alan Dershowitz’s employing the odd use of “perfect”— not even a synonym — might be dismissed as ordinary influence in most contexts. However, given the severity and spread of “shared psychosis” among just about all of Donald Trump’s followers, a different scenario is more likely. https://t.co/m3XK3ztQgA
— Bandy X Lee, MD, MDiv (@BandyXLee1) January 3, 2020
I was alarmed enough to hold an ethics conference at Yale School of Medicine the very next month and to publish the public-service book, “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President,” which became a runaway New York Times bestseller, later in the year. In my mind, speaking up about the APA’s action was just as important as warning against a dangerous president, for a professional association ceding its authority to power was for me the first sign of authoritarianism.
I correctly surmised that, if we could not hold the president accountable for mental unfitness, the defining emergency of the presidency, then we would not hold him accountable for anything — and that is what has happened so far, even after half a million American deaths that did not need to happen and the near-loss of our democracy that almost kept him in power. Not only that, he has spread his symptoms, through the kind of communication that Charles Lasègue and Jules Falret described since the 19th century, and Carl Jung depicted as a “psychic epidemic.” We would never count a viral illness as “healthy” just because it afflicts a whole segment of the population; why should we do that with mental disease?
SW: After reading Mary Trump’s page turner “Too Much and Never Enough,” I thought a lot about the Adverse Childhood Experiences Scale (ACES). Is there an argument to be made that surviving a pandemic in childhood is akin to experiencing other traumatic events in early life?
BL: Yes — I am glad you mentioned this pioneering work by Dr. Vincent Felitti. Adverse Childhood Experiences (ACES) are perhaps the most underappreciated determinants of a person’s entire future course, including violence victimization and perpetration, lifelong health, and life opportunities. I have largely been involved with public health, especially through the World Health Organization. I helped launch its 2002 World Report on Violence and Health, which shifted violence from being a criminal justice and security issue to a public health problem that we can study and prevent, and so I value the ACES greatly.
Preventing early childhood trauma is about strengthening families, neighborhoods, and communities, and a world where every child can thrive; violence prevention is ultimately about societal improvement and social justice. One of the reasons why the Trump presidency was so dangerous was because his personality would not allow for justice — he could not even tolerate democracy, which would mean he would be equal to other citizens — and the exact opposite of what was needed for a stable, nurturing society was going to happen. And it did.
In March 2020, I said in an article: “The greatest risk factor of disease and death is not being considered, and that is Donald Trump. If he continues in this presidency, he is on course for having three main effects: First, he will make a deadly pandemic much worse. Second, he will stoke divisions between ‘believers’ and ‘unbelievers’ in his alternative reality. And third, he will vastly augment suffering, which he will be tempted to direct into widespread violence.” Would this be traumatic for children? Absolutely — it is even traumatic for adults, regardless of one’s support for him.
Whether this would be equivalent to other traumatic events for children depends on several factors. First, human beings are highly resilient and can withstand considerable calamity; hardship alone is not traumatic. However, this is not the same pandemic that much of the world experienced: the United States was an outlier, amplifying the suffering and casualties multifold because of a president who needed to deny what was happening and had to block effective intervention. As a result, the lockdowns, instead of lasting a couple of months, lasted over a year with little result, and we know how this has increased domestic violence, with a heavy toll, especially on children. The economic devastation is also of a level unseen in other advanced nations, and this will vastly increase suicides and homicides. Hence, trauma is greater not because of the pandemic but because of the human factor — moral injury is felt where social injury occurs — and trauma transmits intergenerationally.
SW: As someone currently embroiled in a free speech lawsuit, I assume you oppose physician gag laws when it comes to asking patients about guns in their home. On the other hand, you study dangerousness. Where do you stand on legislation that would encourage vs. require doctors to have such conversations with patients? In other words, should these discussions be voluntary or mandatory, from a psychiatrist’s point of view?
BL: Although I cannot talk about my lawsuit, I believe it is obvious how much I object to the silencing of physicians and scientists. The National Rifle Association blocked the Centers for Disease Control and Prevention (CDC) from funding gun research for more than two decades, which was a gag on scientists — and look at the damage we are subsuming from a lack of knowledge. With escalating gun violence that kills almost 40,000 Americans a year, we are at a loss as to how to handle these gun deaths that are five- to 20-fold of other economically developed nations. Guns are, of course, the chief means by far of both homicide and suicide, and so asking about them is of primary relevance to providing care for the eighth leading cause of death in the U.S. (or ninth, now that COVID-19 has arrived) that is violence.
When the APA gagged mental health experts from educating the public about the dangerous psychology of a leader, who had the arsenal to destroy the planet many times over, it helped lay the groundwork for a culture that would condone epidemics of violence, and even tolerate vast pandemic deaths. Similarly, when climate scientists were silenced under the Trump administration for not toeing the president’s ideological line, it was work that is not just a matter of life and death but of the preservation or extinction of our species. Hence, I am of the opinion that physicians’ speech should focus on saving lives and protecting the public’s health, not on industry or government interests, and professional associations should not collude with a dangerous government to protect federal funding, as the APA turned out to have done. Medical associations must meet medical standards, even if difficult — not behave as political fronts and then portray conscientious professionals as “unethical.”
SW: You interned at Bellevue Medical Center in New York. And during your residency at Mass General, you were designated as the chief resident. Do you root for the Red Sox or the Yankees?
BL: I am still a New Yorker by upbringing. I am sorry, it is the Yankees for me.
SW: Finally, if you could add anyone to Mount Rushmore, who would it be and why?
BL: It would not be a politician, as I believe we glorify them too much. I am tempted to say William Osler, but I think I would settle for Willem de Kooning, since civilization is more important, and indeed helps lay the foundation for a society to thrive.
