World Mental Health Coalition Statement on Mass Violence and the American Psychiatric Association

The most recent mass shootings in El Paso, Texas, and Dayton, Ohio, have once again ignited a national discourse on gun control and mental illness.  The American Psychological Association and the American Psychiatric Association have rightly made public statements condemning these shootings. Both their statements focus on the need not to blame mental illness as the cause, as evidence shows little link between dangerousness and mental illness (ref. 1). Those suffering from mental illness are no more likely than the general public to commit violent acts against others, and are in fact more likely to be victims (ref. 2).

Yet, we must not fail to discuss the powerful psychological effect on our culture when Donald Trump consistently and repeatedly makes dehumanizing statements and delineates groups as “other.” Since January 2019, Trump’s reelection campaign has run over 2,000 Facebook ads characterizing immigration as an “invasion,” with up to 5,559,801 views for these ads (ref 3). The language used by the alleged El Paso killer replicates the language used by these same ads. Mr. Trump’s telling four U.S. Congresswomen “to go back where they came from,” and encouraging chants of “send her back” is in direct violation of his own country’s laws, as enforced by the U.S. Equal Employment Opportunity Commission (EEOC) (ref 4). Research shows that hateful rhetoric, especially by national leaders, that dehumanizes groups of people, increases associated violence (ref. 5). Very predictably, there has been a marked rise in hate-based violence and mass shootings since Mr. Trump took office (ref. 6), with many of the alleged assailants claiming direct inspiration from him (ref. 7).

We continue to be highly concerned that Mr. Trump’s statements and action make him dangerous to our nation and the world, given his access to thermonuclear weapons and other vast powers of the presidency. Thousands of mental health professionals have been warning of the dangers of the president’s behavior and the need for a response to those dangers. Yet there has been no word from our professional organizations.

We find it very disturbing that the American Psychiatric Association took measures to silence psychiatrists on these issues. It took the otherwise outdated “Goldwater rule,” which included a guideline not to diagnose public figures without an in-office examination and without their consent, and turned it into a gag order by expanding it and allowing no exceptions. It even made it impossible to comply with the part of the Goldwater rule that is a mandate to act—to “contribut[e] to the improvement of the community and the betterment of public health” by educating the public when asked about a public figure. The result of this action is that we have a most extraordinary situation where the new rule effectively works to sideline the people most qualified to comment about the president’s mental health, ceding the issue to non-expert commentators.

There is near medical consensus on the character of Mr. Trump’s dangerousness. But in the very context where mental health professionals are crucial in pointing out dangerous patterns of speech and behavior, the gag order of the APA has contributed to the normalization of malignant forms of psychological pathology in national affairs. By silencing the most relevant discourse at a critical time, this new gag order has enabled a destructive regime to proceed with dangerous acts without being checked.

In 1948, in response to the horrific history of Nazism, the General Assembly of the World Medical Association adopted the Declaration of Geneva, the universal health professional’s pledge of dedication to the humanitarian goals of medicine. It recognizes that not only participation, but also silence by health professionals, can assist in atrocities.  Particularly when so many political actors abdicate their duty to preserve and protect the public, it is especially crucial that those in neutral fields such as medicine and mental health speak for public health and safety. We know from our nation’s founders that all tyranny needs to gain a foothold is for those of conscience to remain silent.

Bandy X. Lee, M.Div, M.D., President

Prudence Gourguechon, M.D., Vice President

Scott M. Banford, LCSW, Secretary