President Trump’s behavior has made questions about his mental fitness unavoidable. Between his Twitter outbursts, his conspiracy-mongering, and his obsession with disparaging his critics, it’s becoming impossible to report on the Trump administration without mentioning concerns about the president’s stability. And according to recent reports, similar concerns are being raised inside the White House, where even aides question Trump’s ability to understand the world around him and make good decisions.

The question of Trump’s mental fitness has also caused a rift in psychiatry, where experts are now reconsidering the role of mental health professionals in public debates.

That’s due in part to the “Goldwater Rule,” a decades-old ethical guideline created by the American Psychiatric Association (APA), which prohibits psychiatrists from offering their professional opinion about a public figure they haven’t personally examined.

In March 2017 the APA expanded that rule, clarifying that offering a professional opinion about the president’s “affect, behavior, speech, or other presentation” is unethical. That has sparked a heated debate in the psychiatric community, including those who don’t think that Trump’s fitness for office is a medical issue.

But other experts say the expanded Goldwater Rule violates their “duty to warn” the public about potential danger. One of those experts is Yale University psychiatrist Dr. Bandy Lee, who argues that silencing mental health professionals when it comes to public officials denies journalists an important tool for understanding the dangers posed by Trump.

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