No  Trump doesnât need a mental fitness evaluation
President Trump waves while departing for Camp David on the South Lawn of the White House in December. (Chris Kleponis/Bloomberg News)
 President Trump  is scheduled to have  his  annual medical exam at Walter Reed National Military Medical Center on Friday. Many people  including some of my prominent psychiatric colleagues  think it should include a mandatory mental fitness evaluation.
Even without experts weighing in  the public has more than a reasonable basis to question  Trump âs mental capacity to serve as the countryâs leader. After all   he  is famously impulsive  dishonest  thin-skinned and unpredictable. Such characteristics would impair any chief executive; in a president  they are a threat to the country.
As some critics question  President Trump 's mental fitness  many psychiatrists are being reminded of the Goldwater Rule. Here's what you need to know about it. (Elyse Samuels/The Washington Post)
The publication of Michael Wolffâs âFire and Fury: Inside the Trump White Houseâ last week reignited concern about  Trump âs cognitive function. In response   the president  took to Twitter to defend  his  mental fitness  describing  himself  as a âvery stable genius.â But  his  boastful cognitive self-assessment stands in stark contrast to  his  often rambling and incoherent statements  ultra-short attention span  repetitive speech pattern and rather impoverished vocabulary â all of which understandably invite worry by any layperson about  his  cognitive state.
So what would an expert mental fitness evaluation add to our understanding of  Trump ? Typically  a psychiatric evaluation involves an in-depth interview  history taking and collection of laboratory data that might reveal hidden biological contributors to various abnormal mental states. This approach is particularly useful in diagnosing more subtle forms of psychiatric illness  such as mild anxiety  depressive states  or covert drug or alcohol abuse  which can color oneâs perception of the world and bias behavior.
But such an interview for  Trump  would likely be uninformative and largely irrelevant. The reason is that mental illness per se is not a bar to being president. In fact  one study based on biographical data suggests that mental illness is hardly a stranger to the White House: 18 of Americaâs first 37 presidents met criteria for a psychiatric disorder during their lifetimes â 10 of whom showed signs of mental illness while in the White House.
What about conducting neurocognitive testing on  Trump ? Such tests could quantitatively assess cognitive functions such as attention  memory  verbal comprehension and analytical reasoning. But even mild deficits in attention or short-term memory would hardly disqualify a president from service. A president with attention-deficit/hyperactivity disorder or dyslexia  for example  would manifest predictable deficits on neuropsychological testing  but no one would argue that this would be a dealbreaking impairment.
Sure  some speculate that  Trump  is showing signs that can be indications of dementia affecting the prefrontal cortex  given  his  poor impulse control and difficulty constructing a logical argument. Perhaps  but these traits apparently have been characteristic of Trumpâs behavior for quite some time. And when you see such enduring behavior in the average person  it makes dementia questionable.
There is another reason my colleagues should be hesitant to provide a diagnosis from afar or encourage Congress and the Cabinet to remove  Trump  under the 25th Amendment. All our diagnoses are clinical in nature  requiring some degree of subjective judgment. Unlike  say  an EKG or cholesterol level  which speak for themselves  our opinions are unlikely to be free of personal or political bias any more than those of the Supreme Court justices.
Much of the public would inevitably view expert intervention as a politically motivated attempt to disqualify a sitting president  whether true or not. That is something our profession must avoid  unless we have knowledge and insight that were inaccessible and vital to the publicâs well-being  which is clearly not the case with  Trump .
In the end  neither the public nor Congress needs the advice of us psychiatric experts. The most accurate measure of a personâs fitness  whether mental or physical  is observable function in the real world â not the results of a fancy test or expert opinion. The fact is that Americans already have all the data they need to judge Trumpâs fitness.
President Trump waves while departing for Camp David on the South Lawn of the White House in December. (Chris Kleponis/Bloomberg News)
  [TGT] is scheduled to have   [TGT]   annual medical exam at Walter Reed National Military Medical Center on Friday. Many people  including some of my prominent psychiatric colleagues  think it should include a mandatory mental fitness evaluation.
Even without experts weighing in  the public has more than a reasonable basis to question   [TGT]  âs mental capacity to serve as the countryâs leader. After all    [TGT]   is famously impulsive  dishonest  thin-skinned and unpredictable. Such characteristics would impair any chief executive; in a president  they are a threat to the country.
As some critics question   [TGT]  's mental fitness  many psychiatrists are being reminded of the Goldwater Rule. Here's what you need to know about it. (Elyse Samuels/The Washington Post)
The publication of Michael Wolffâs âFire and Fury: Inside the  [TGT]  White Houseâ last week reignited concern about   [TGT]  âs cognitive function. In response   the president  took to Twitter to defend  his  mental fitness  describing  himself  as a âvery stable genius.â But  his  boastful cognitive self-assessment stands in stark contrast to  his  often rambling and incoherent statements  ultra-short attention span  repetitive speech pattern and rather impoverished vocabulary â all of which understandably invite worry by any layperson about  his  cognitive state.
So what would an expert mental fitness evaluation add to our understanding of  [TGT]  ? Typically  a psychiatric evaluation involves an in-depth interview  history taking and collection of laboratory data that might reveal hidden biological contributors to various abnormal mental states. This approach is particularly useful in diagnosing more subtle forms of psychiatric illness  such as mild anxiety  depressive states  or covert drug or alcohol abuse  which can color oneâs perception of the world and bias behavior.
But such an interview for   [TGT] would likely be uninformative and largely irrelevant. The reason is that mental illness per se is not a bar to being president. In fact  one study based on biographical data suggests that mental illness is hardly a stranger to the White House: 18 of Americaâs first 37 presidents met criteria for a psychiatric disorder during their lifetimes â 10 of whom showed signs of mental illness while in the White House.
What about conducting neurocognitive testing on  [TGT]  ? Such tests could quantitatively assess cognitive functions such as attention  memory  verbal comprehension and analytical reasoning. But even mild deficits in attention or short-term memory would hardly disqualify a president from service. A president with attention-deficit/hyperactivity disorder or dyslexia  for example  would manifest predictable deficits on neuropsychological testing  but no one would argue that this would be a dealbreaking impairment.
Sure  some speculate that  Trump  is showing signs that can be indications of dementia affecting the prefrontal cortex  given  his  poor impulse control and difficulty constructing a logical argument. Perhaps  but these traits apparently have been characteristic of Trumpâs behavior for quite some time. And when you see such enduring behavior in the average person  it makes dementia questionable.
There is another reason my colleagues should be hesitant to provide a diagnosis from afar or encourage Congress and the Cabinet to remove  Trump  under the 25th Amendment. All our diagnoses are clinical in nature  requiring some degree of subjective judgment. Unlike  say  an EKG or cholesterol level  which speak for themselves  our opinions are unlikely to be free of personal or political bias any more than those of the Supreme Court justices.
Much of the public would inevitably view expert intervention as a politically motivated attempt to disqualify a sitting president  whether true or not. That is something our profession must avoid  unless we have knowledge and insight that were inaccessible and vital to the publicâs well-being  which is clearly not the case with  Trump .
In the end  neither the public nor Congress needs the advice of us psychiatric experts. The most accurate measure of a personâs fitness  whether mental or physical  is observable function in the real world â not the results of a fancy test or expert opinion. The fact is that Americans already have all the data they need to judge Trumpâs fitness.