Political players and cranky voters have long thrown around personality-themed terms to offer non-professional assessments of public officials, and their words are not generally flattering. Insane. Unhinged. Wacko. Paranoid. Narcissistic. Manic. The broad-brush use of such terms, especially those with actual, clinical definitions, tends to make mental health professionals a little –well, crazy. Not only do the terms unfairly stigmatize people with actually mental ailments, but they're often not even used correctly to describe someone's behavior or personality. And even when a professional has a more educated opinion on a public person, there's a resistance to saying it out loud, for ethical and other reasons.

But what are mental health professionals to do when faced with an elected leader who appears to them to meet all the criteria for a personality disorder or mental illness – and who has a finger on the nuclear button, to boot?

The issue is dividing psychiatrists and psychotherapists, who are grappling with their consciences as they ponder the case of a man many of them believe to be, if not mentally ill, mentally ill-prepared to be president. Does President Donald Trump truly have a "serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States," as John Gartner, a Baltimore-area psychotherapist, wrote in his petition to remove Trump from office that has been signed by tens of thousands? Should they refrain entirely from speculating about it? Or does he not need a formal diagnosis for psychiatrists to speak up about their worries?

For Dr. Bandy Lee, an assistant clinical professor at the Yale School of Medicine, "silence was not an answer." So she hosted a town hall meeting at Yale medical school Thursday to debate the question.

"I describe it as the elephant in the room," Lee says. "I would say among my colleagues, there is a majority who have expressed some element of alarm or concern" over Trump's behavior and its psychological roots, she says.

Critics think "this is about politics. This has nothing to do with politics," says Dr. Lance Dodes, a retired assistant clinical professor of psychiatry at Harvard Medical School and a signator to an open letter calling Trump "incapable of serving safely as president." Instead, it's about Trump's behavior and what Dodes sees as a threat to the American people and the world.

Mental health is a delicate issue for both the public and candidates. Until a few decades ago, even the physical fitness of presidents was not much of an issue to voters, and presidents tended to be private about it. President Grover Cleveland had a cancerous tumor in his mouth, which he had removed – secretly – in 1893. President Woodrow Wilson had an incapacitating stroke, and the public knew nothing about it until months later. President John F. Kennedy hid his Addison's Disease. Modern candidates, meanwhile, go for public jogs and routinely release medical reports attesting to their vigor.

Addiction, too, has become less of a negative. Former First Lady Betty Ford openly acknowledged her alcoholism, and members of Congress have discussed their own past struggles with alcohol and pills. Former President Bill Clinton famously admitted he had tried marijuana – but didn't inhale – when he was a student in England. President Barack Obama, in one of his books, admitted trying cocaine and marijuana as a youth.

But when it comes to mental health, there's still a stigma, Lee notes. Former President Ronald Reagan was diagnosed with Alzheimer's six years after leaving office, but his son, Ron Reagan, later said he thought his father showed signs of the illness while he was in office.

In 1972, Sen. Thomas Eagleton was forced to leave as Democrat George McGovern's running mate after it was revealed he had had electroshock therapy for depression. And former Rep. David Wu, D-Ore., was badgered by his staff to get mental health treatment because of his erratic behavior, including emailing a photo of himself in a tiger outfit. Wu resigned in 2011, after acknowledging he had a sexual relationship with the 18-year-old daughter of a friend, but the mental health questions lingered as much as the sex scandal.

So questioning a presidential candidate's mental fitness – let alone that of a sitting president – carries a powerful negative connotation. People still find mental ailments mysterious and threatening, and are unfairly viewed as a sign of weakness, much as physical disabilities once were, Lee says.

"We now know medically that psychiatric illnesses are very similar to other medical illnesses, and absolutely is not a reason to put a moral judgment on therapy, or feel shame about it," Lee adds. That reasoning is behind a piece of legislation wending around the Hill – with some bipartisan support – that would require the presence of a psychiatrist and not just a physician, at the White House to tend to the president's health, says Gartner, who has been having meetings with lawmakers and staff.

The problem with Trump, Gartner argues, is that he displays signs of "malignant narcissim" – a personality disorder that includes anti-social behavior, paranoia and a tendency to live in one's own, self-aggrandizing reality. And it's not curable, Gartner says.

"The abnormal is being normalized. That's how dictatorships work. They take over the definition of reality," says Gartner, who began the "Duty to Warn" movement to oust Trump.

Central to the mental health professionals' conundrum is the so-called Goldwater Rule, an ethics code the American Psychiatric Association adopted in 1973 after a magazine was successfully sued for libel for a story featuring psychiatrists discussing 1964 GOP presidential nominee Barry Goldwater's mental fitness. The rule, which the APA vehemently reaffirmed last month, says psychiatrists should not be diagnosing patients they have not examined, and further should not release such diagnoses without the consent of the patient.

"The complexity of today's media environment demands that we take special care when speaking publicly about mental health issues, particularly when what we say has the potential to damage not only our professional integrity, but the trust we share with our patients, and their confidence in our abilities as physicians," APA president Dr. Maria A. Oquendo wrote on the matter.

But there's another important tenet of medical ethics, experts in the field say, and that is the "duty to warn" – the obligation, despite the sacred doctor-patient relationship, that medical professionals let people know if they are in danger of being hurt by a mentally ill person. Lee and others say they believe firmly in the Goldwater rule, but don't think it applies in cases where people could be put in danger.

"It's not whether [Trump] is mentally ill or not. It's whether he's dangerous or not," Dr. James Gilligan, a clinical professor in the NYU School of Medicine psychiatry department, told the Yale assembly.

Yale psychiatry professor Charles Dike, former chair of the ethics committee for the American Academy of Psychiatry and the Law, told the group they must adhere to the Goldwater rule.

"The primary duty of a psychiatrist is to his patient," Dike told his colleagues. "Our duty is to help the patients get better. When they get better, society is safer. We do not owe society a primary duty."

Dodes argues that the Goldwater rule is outdated, since when it was written, personality disorders were diagnosed by talking with patients and their families and examining their histories. Now, Dodes says, such assessments are rooted primarily in outward behavior, something he says is easy to observe in someone like the president. "For anyone to diagnose Donald Trump is easy," Dodes says. "Any competent therapist knows what's wrong with Donald Trump."

Gartner is continuing to collect signatures on his petition, and advocates have already met with about a dozen members of Congress or their staff to discuss possible legislation. Aside from having a staff psychiatrist at the White House, Gartner and his colleagues are mulling having an independent panel to assess the president's mental fitness.