I'm from Chicago. I live a
few blocks from where I was born and a few blocks in the other direction from
where Barack Obama and his family live until they move to the White House. But
no sooner did I begin to bask in the proximity of this history-making leader
of the free world than I found myself cringing instead because of Rod
Blagojevich. Unfortunately, the behaviors of which our Illinois governor has
been accused (as of this writing, he has not been convicted) break no new
ground in Illinois. Should Blagojevich go to prison, he could room with his
immediate predecessor.
I can't explain my state's tradition. Which is fortunate, because that is
not what this column is about. It's about another question I can't answer. If
Blagojevich is guilty of the crimes of which he has been accused, including
the attempt to extort money to sell a seat in the Senate of the United States,
why did he do it? Within days after his arrest, I was getting media calls
asking to explain. The Associated Press reporter had heard the term"
delusions of grandeur" bandied about, and people could not
understand how, apparently, a man of gubernatorial stature could boast that he
was perfectly aware his communications were being monitored and then
repeatedly incriminate himself during those communications. They were saying
that behavior that irrational must be the result of some psychiatric
condition. The AP reporter wanted my opinion.
When Barry Goldwater, a "hawk," ran for president of the United
States, some psychiatrists took it upon themselves to proclaim that he had a
mental illness. As a result, our ethics code came to include the"
Goldwater Rule": it is unethical for a psychiatrist to diagnose a
public figure or other individual he or she has never seen. I could have told
the reporter that and ended the conversation. However, one of the major
missions of APA is to familiarize the public with and educate the public about
psychiatry. Some people still think psychiatrists are weird; why miss an
opportunity, if only to be quoted saying something sensible—or even
something thought provoking? So what is this sensible and provocative remark
I'm going to make?
First of all, so that things would be perfectly clear, I reminded the
reporter of the Goldwater Rule. I told her that psychiatric disorders could
cloud people's judgment or make them feel invulnerable to the usual
consequences of their actions. However, I said, it is also true that people
often do things they know perfectly well are dangerous, and say or do things
that contradict one another: "I love my wife.... I am having an
affair."
This explanation gave me the opportunity to demonstrate that psychiatrists
do not automatically pathologize all human foibles. I told her that if there
were real reason to worry about Gov. Blagojevich's mental health, he should
have a complete evaluation, not an impressionistic diagnosis. That gave me the
opportunity to remind her, and her readers, should she choose to quote me,
that psychiatrists are physicians and that it requires expertise and care to
make a psychiatric assessment.
I summed it all up by making those points explicit. I pointed out a
paradox. Some people accuse psychiatrists of devising a DSM category
for any undesirable behavior, unusual idea, bad habit, or unpleasant mood.
Many people are under the completely mistaken impression that vicious
criminals often get off scot free with the help of psychiatrists who attribute
their heinous acts to psychiatric pathology. At the same time, every time
somebody commits a terrible crime or engages in ultimately forbidden and
ultimately self-defeating behavior—sex with an intern in the Oval
Office, for example—people ask us to make a psychiatric diagnosis.
I don't know whether the reporter quoted from our discussion. Experience
teaches me that it is unlikely that my preferred comment will be quoted (the
only way to accomplish that is to say the same thing over and over), but also
unlikely that my comments will be misused. I hope I left the reporter with the
impression that psychiatrists have sensible and interesting things to say,
that we do not make snap judgments about public figures, that we take the art
and science of diagnosis seriously, and that we don't claim to understand all
human behavior. Yes, I am a psychiatrist from Illinois. But no—I don't
have a diagnosis for Rod Blagojevich. ▪