“The major improvement that Robert Spitzer wanted to make was that mental disorders should be diagnosable by clearly observable behaviors,” said Gartner. “So, things that aren’t based on inferences about inter-psychic processes, but things that basically anyone can observe.”

This is how Gartner and many of his co-signers now understand the manual. He read to me from the DSM’s list of “criteria for personality disorders.” In the case of anti-social personality disorder, they include: “exploitation as a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others … embellishment or fabrication when relating events,” and “anger or irritability in response to minor slights and insults.” Gartner points to multiple specific instances of these behaviors being recorded in the public record and corroborated by multiple witnesses.

“These are facts, insofar as facts exist,” he said. “And I think it’s important that we do stick to that idea that facts exist.”

If it were so straightforward, of course, the question before the Supreme Court would be almost moot. A neutral, independent psychiatrist would be able to give an objective evaluation based on clearly observable or quantifiable evidence.

But this is where the American Psychiatric Association has pushed back hard.

* * *

In the wake of so many psychiatrists attempting to apply diagnostic labels to Trump, this March the APA reaffirmed its support for the Goldwater rule. In a new statement from its ethics committee, the organization insisted that psychiatrists “should not give professional opinions about the mental state of someone they have not personally evaluated.”

“Such behavior compromises both the integrity of the psychiatrist and the profession,” the statement read. “When psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness.”

Why, though, if there is an objective set of criteria, and a person has publicly displayed behavior that very clearly meets those criteria, should remote diagnosis never be possible?

Rebecca Brendel, a psychiatrist at Harvard’s Center for Bioethics, worked with the APA on the statement. As she explained it to me further, “The DSM has lists of criteria, but if you look in the front of the book, it says specifically, this is not a checklist, and it’s not a cookbook. A patient could have every single thing on that list and not have that illness. Or they could have none of the things on that list and have the illness.”

The APA’s position is that it would simply never be possible for mental-health professionals to use diagnostic language for anyone who is not their patient. Even if an elected official began––for example––insisting that the election he won had been rigged against him. Even if he did this while wearing a tin-foil hat. And this insistence—that there is simply no objective set of observable behaviors that can be said to constitute mental illness—poses challenges judicial situations. It becomes easy to dismiss an expert as “partisan.” Even a jury made up entirely of psychiatrists could not rightly judge a person to be mentally ill.