It is unethical for a psychiatrist to diagnosis a person, either private citizen or public figure, without personally examining him. If the psychiatrist has indeed personally examined a person, it is then unethical to make that diagnosis public, or even the fact that the examination occurred, except in some rare exceptional circumstances which would almost certainly include having the examinee’s consent.
The exception would be in legal cases, where the person examined is informed in advance that the examination is not confidential and will be discussed in court. Still, the psychiatrist’s information sharing would be confined to the court, not in the general public.
In other words, a psychiatrist cannot ethically comment on the psychiatric status of any other person if they have not examined them, or if they have examined them.
I don’t know what the rules are for psychologists, but suspect they are about the same. Not my problem.
However, there is no reason that I cannot share my own diagnosis, it’s adult ADHD.
My ADHD causes me a lot of problems in life, with the following symptoms:
Often makes careless mistakes and lacks attention to details
(Examples: overlooking or missing details or handing in work that is inaccurate)
Often has difficulty paying attention to tasks
(Example: difficulty remaining focused during lectures, conversations, or lengthy readings)
Often seems to not listen when spoken to directly
(Example: mind seems elsewhere, even in the absence of obvious distraction)
Often fails to follow through on instructions, chores, or duties in the workplace
(Example: starts tasks but quickly loses focus and is easily sidetracked)
Often has difficulty organizing tasks and activities
(Examples: messy, disorganized work; poor time management; fails to meet deadlines)
Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort, like preparing reports, completing forms, or reviewing lengthy papers
Often easily distracted by other things, including unrelated thoughts
Often acts as if “on the go” or “driven by a motor”
(Example: is unable to be or uncomfortable being still for an extended time, as in meetings or restaurants)
Often talks excessively, blurts out an answer before a question has been fully asked, blurts out inappropriate comments. (Examples: completes people’s sentences; cannot wait for next turn in conversation)
Often interrupts or intrudes on others (Examples: butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; may intrude into or take over)
Often has difficulty keeping commitments.
Often has trouble getting pictures to show properly on facebook or script to line up right on wordpress.
And this just a sample, I have other symptoms as well.
Adult ADHD affects approximately 4% of the US adult population.
But with strategies, and sometimes medication, we can manage to function. With difficulty.
Oh, well.
doug
@ADHD @dougmkpdp #adhd
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Did ADHD make you a target? Or a bully?
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Yes, it is utterly unethical to make a causal psychiatric diagnosis without proper assessment of the patient. In my estimation it probably takes about 4-6 hours work at a bare minimum to confirm even an obvious diagnosis (of ADHD for example) and have it confirmed by relative reports. When you are dealing with a public figure from afar there are many issues other than incomplete history that you have to deal with.
First and foremost in the example of Donald Trump ( who I have informally “diagnosed” as an unpleasant prat btw) all we see is that which the mainstream media choose to present to us. It seems that the MSM have a bias.
So how can you possibly make any adequate diagnosis the basis of an incomplete and deliberately skewed representation of the real person?
I strongly suggest that this idea of diagnosing a person in public life from afar is the very most form of hubris, and should be dealt with not as merely unethical, but as unprofessional conduct, with de-registration as the only possible remedy.
Honestly I do not know what has gone wrong with doctors lately. We are acting as though we are the fount of all wisdom. I call bull$h!t on that.
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Counterpoint, Doug–
We ask teachers to screen for patterns that might indicate ADHD or learning disorders, but not to diagnose. Couldn’t we ask ourselves to do the same?
One doesn’t have to formerly diagnose a public figure to observe that they have a limp or a goiter, and it’s not unethical to point it out. Neither is it unethical to point out narcissistic traits, illogical thought progression, bullying, mental cruelty, simplistic or inarticulate language forms, grandiose thoughts, contradictory statements, short attention span, vilification, gaslighting or sexual predation.
If a mental health expert observes these traits in public figures, is it ethical to call for formal diagnosis? Is it ethical not to? Finally, is it ethical to foresee a danger and not warn the people who might be affected?
All the best,
Oren
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oren an astute and interesting comment. I think the rule only applies to psychiatrists and diagnosis So you say that I could comment “I am really having trouble following his train of thought” or “he surely seems to think a lot of himself, and I can’t see any basis for it.” or “It kind of looks as though he just blurts things out with our any forethought.” or ” I can’t see any evidence empathy or tact or kindness or courtesy” those would probably be OK. They are not diagnoses.
thank you for commenting . hope for more input from you
doug
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Hi Oren,
all of the observations you make may be correct, but there is no need to rely on a diagnostic tag to flag them as problematic. Nor have you addressed the potentially unreliable sources of the information we are depending on to come at a diagnosis.
We have not got enough to come to any diagnosis and we never will have unless the individual we are discussing submits voluntarily to our medical care.
The other consideration is the area that we work in. We are interested in ADHD, and keen to help people who have it (and in Doug’s case and my case that includes ourselves!)
The number one objection that is raised about ADHD is that doctors are too quick to diagnose it, that we do not have adequate history or other assessment.
Now if we go proffering diagnoses left, right and center without ever having seen and evaluated the person who is freely seeking our advice, then we are demonstrating that we are diagnostic cowboys, and in doing that we put at risk the futures of all patients who would benefit from a diagnosis.
That is a bad look.
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Good blog!
Love, M
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thank you
love
doug
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