Trump and The Goldwater Rule

The standard ethical position in psychiatry and clinical psychology has long been that a diagnosis of an individual should not be made without a personal diagnostic work-up. It’s called the Goldwater Rule and was put in place after unprofessional and distinctly unflattering opinions were put forward by psychiatrists about Barry Goldwater’s mental health during the ‘64 presidential campaign. It was painfully clear that these “remote” diagnostic conclusions about his mental state were being driven, not by legitimate psychiatric considerations, but by politics. It’s worth noting that Goldwater sued the magazine that published the so-called diagnosis and won a substantial award.

 

Since then, mental health care professionals have adhered to the principle which is enshrined in the code of ethics of the American Psychiatric Association. Section 7.3 of the code states that ”… it is unethical for psychiatrists to give a professional opinion about public figures they have not examined in person, and obtained consent from, (or) to discuss their mental health in public statements.” The American Psychological Association has a similar clause in its ethical guidelines.

 

However, there is a movement afoot that is challenging this principle and, of course, it is being driven by concerns about the mental health of one Donald John Trump. An article outlining the issue and arguing in favor of a reconsideration of the Goldwater Rule was published recently by Rosemary Sword and Philip Zimbardo and can be found here.

 

Zimbardo, it’s worth noting, is one of the country’s most respected psychologists. He is a Past President of the American Psychological Association, winner of that organization’s Gold Medal for a lifetime of significant contributions to psychological science and, I’ll note in passing, a graduate of Brooklyn College where I was on the faculty for 35 years.

 

There are two key elements in this reconsideration of the ethical standards of mental health practitioners and they need to be taken very seriously.

 

(a) Ultimately it is what a person does and says that forms the foundation for a psychiatric diagnosis. While a full, in-person assessment under informed consent is needed for an “official” diagnosis, a consistent pattern of irrational public behaviors and statements is sufficient for a “remote” consideration that the individual does, in fact, fulfill the standard criteria for a mental disorder.

 

(b) While the Goldwater Rule was designed to protect an individual from unethical attacks, in the case of Trump the rule goes out the window. It is not the individual (Trump) who needs protection from an unethical psychiatrist, it is the rest of the country (indeed, the world) that needs protection from the damage that an unstable, irrational person with immense power can wreck.

 

In short, the ethical argument is being flipped and the flip is gaining momentum. As of this writing over 30,000 mental health therapists have agreed that Trump is mentally unfit to hold the position of president of the United States — this is a remarkable number given the long-standing, inflexible adherence to the Goldwater Rule.

It’s important to understand that in the health care professions there are circumstances where the ethical guidelines may be set aside. For example, the doctor-patient confidentiality clause can (in fact must) be abrogated in the physician is convinced the patient is about to commit a felony. A doctor who is certain a patient is going to murder someone has a moral obligation to step outside the confidentiality clause and notify authorities. 

In a sense, what Sword and Zimbardo (and many others) are arguing is that Trump poses a similar threat, one sufficiently severe that mental health practitioners are obligated to suspend the Goldwater Rule and make public their professional opinion that Trump suffers from a number of identifiable psychiatric disorders that threaten the country — a country that, ironically, recently elected him president.

Like almost everything else surrounding Trump since he announced his candidacy, we’ve not seen anything like this before.

Let me end with a warning. If this this shift in the position of the mental health professions reaches a genuine consensus among practitioners and the carrying out of this kind of “remote” diagnosis is accepted as legitimate by the electorate, care needs to be taken. It must not be seen as some sort of psychiatric precedent but as a procedure only to be used in extreme cases such as the one presented by Trump. It should not become a cudgel to wield against a political adversary simply because his/her positions and actions are ones a clinician does not agree with.

Not Your Bubba's Mac & Cheese

The current political scene is like watching a slow-motion, hundred and fifty car-pickup-semi-SUV-motorcycle mash-up on the I-5. Just when you think it might be ending another 18-wheeler careens on its side into the pile. It’s horrible, bloody and should have been preventable. Its only remotely beneficial element is the dollop or two of Schadenfreude that comes from watching assholes like Flynn get the boot and racist creeps like Sessions melting away.

The way out of these doldrums is cooking. Tonight we shall have my favorite Mac & Cheese, the one dubbed around here as “sure as hell ain’t my bubba’s” recipe. It’s more work than nuking one from the take-out counter at the deli but it is sooo worth it. It’s a forgiving recipe and lots of ingredients can be in- or decreased and other things like garlic, bacon or mushrooms can be added. It should serve four with a salad on the side.

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3/4 lb macaroni — I use “Scooby doos” (a double curved macaroni) but regular will do if you can’t find ‘em 

1/2 lb chorizo, removed from casings and broken up

1/2 large onion — rough chop

1 medium tomato — rough chop

1 jalapeño pepper — chopped (I keep the seeds and inner ribs — hotter that way)

1 1/2 T powdered mustard

1 chipotle with 1 t of adobo sauce — chopped (toss in another t of the sauce if you like it strongly favored)

3 T olive oil

1 T butter

3 T of flour

1 c milk (or cream or half and half)

1 c cheddar cheese — grated

1 c bread crumbs (Panko preferred)

3 T (or more) cilantro

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heat oven to 350°

cook macaroni el dente — set aside

brown chorizo in 10” pan in a drop of olive oil — set aside

sauté onion in same pan for 5, 6 minutes, add jalapeño and tomato, sauté another minute or two — set aside

add 3 T olive oil and butter to same pan, heat, add flour and stir to make a white roux

add milk (or cream) and powdered mustard — stir to thicken

add 3/4 c of cheese — stir to melt

combine everything in large baking dish

sprinkle remaining cheese and bread crumbs over top

bake 35 minutes

garnish with cilantro

good with fresh sourdough bread and a glass or two of a decent red (maybe three if you’re planning on watching the news)

A Community Confused: A Microcosmic View of How We Got Trump

We had a most interesting town-hall meeting last night here in our lovely outpost of Point Roberts. I’ve written here several times about this oddity of a town where we live. There’s an intoduction to our “exclave” here. The meeting was called for a very specific purpose, to get input from the residents about how to finalize the revision of our community’s Character Plan (CP).

It degenerated into a semi-civilized brawl — sans any actual fisticuffs. But it did something more important — it let me understand with greater clarity how Trump got elected. It was a display of insane, unthinking, angry voices lashing out at illusory demons and searching to find a way to bring down the edifice — without having a clue what they were doing. This is a long post but it is illustrative.

First, some background: Back in 1992 a group of business owners and concerned residents here in Point Roberts met to discuss how to improve economic conditions, how to bring in jobs, encourage the establishment of new businesses and, importantly, find ways to keep young adults from having to move away to find well-paying work.

They looked at other more-or-less isolated communities like those on the San Juan Islands and other small towns along the Washington and Oregon coasts and determined that one potentially positive move would be to establish a kind of “image” for Point Roberts, something that reflected our history as a fishing outpost with its marine themes and promoted the period lighting, carved wooden signs and the local architecture which was largely Craftsman buildings with clapboard and board and batten design. They also wanted to try to keep any new development from being too large, garish, plastic or over-lighted.

Over a two-year period they crafted a Character Plan that provided a set of guidelines on new construction and renovations and made strong recommendations about things like the size, height, materials and lighting of signs. The regulations only applied in areas zoned “commercial” and “resort commercial.” There are only three streets so zoned and the plan exempted private homes.

The Character Plan was approved by the community. It became part of the official Whatcom County Code in 1994 and the county’s Planning and Development Services (PDS) agreed to adopt its guidelines when issuing permits for new projects. A Character Plan Committee (CPC) was established and began reviewing all new projects that fell under its umbrella before any permits were issued.

That was all well and good. Not surprisingly, the CP didn’t produce the kinds of economic gains or job growth that was hoped for but it did function in its own gentle way — for a while. The inevitable combination of demographic shift and ennui hit. Folks moved away, lost interest, got bored and dropped off the committee. Within a few years the CPC faded away and decisions fell to the personnel in PDS. Again, not surprisingly, the CP lost any remaining influence. New hires at PDS were often not given instructions about the guidelines; other agents simply forgot about it and projects began to be permitted that clearly violated the codes outlined in the CP.

In 2010 Whatcom County Council, working with several Point Roberts residents, established a Point Roberts Community Advisory Committee (PRAC), the community’s first “official” advisory panel. It was established to function as a liaison between Point Roberts and the County Executive’s Office. PRAC assumed the role of the defunct CPC and began reviewing all new projects within the assigned zones before PDS would consider permitting.

In 2014 PRAC formed a Special Committee for the purpose of revising the twenty year-old CP. The committee spent two years gathering data, reviewing existing guidelines, exploring changes in the community since the original CP was drafted and holding several open meetings to get input from the larger Point Roberts community. The committee drafted a Revised Point Roberts Character Plan which was given to PRAC. They distributed the draft to the community and, following the procedures established back in ‘92, scheduled a town-hall meeting to get input from the larger community.

The announced purpose was to work to reach a consensus about the draft, in particular to resolve a number of fine points where the committee was unsure of the best, workable option. For example, whether buildings in the “West Coast Modern” architectural style are appropriate, whether private homes within the identified zones should be included, whether “sandwich board” signs which announce that a business is open are appropriate.

It never happened. The meeting turned into a donnybrook only barely held in check by the efforts of the Chair of PRAC who did a remarkably effective job of preventing fist fights and the hurling of chairs. And, of course, we never got around to even getting the Revised CP on the table for discussion.

The session began with one resident raising the question of solar panels. An effort to provide an answer (“yes, they are permitted so long as they are designed to resemble shingles or other approved roofing materials”) was shouted down by a man who jumped to his feet brandishing a sheaf of papers which he said were the two hundred plus signatures on a petition to repeal the entire Character Plan.

A resident who served on the revision committee pointed out that the CP played a critical role in our winning a long (and expensive) battle to keep an array of five 105’ radio transmission towers from being built and that repealing it would let the owners of the radio station build some other monstrosity on the land they still own. There was no sympathy (or understanding) of this critical point by the gentleman who continued angrily waving the petition.

The next two hours went straight down the rabbit hole. Person after person stood up and complained bitterly about the economy, the lack of jobs, their concerns about their children and grandchildren, where they were going to find work, how Point Roberts hasn’t had any serious business development in years, how depressed people are, how they’re forced to use our food bank, etc. etc. and etc.

The various people who were on the revision committee (including me) tried to respond by pointing out that the current economic difficulties were certainly not the result of the CP and that repealing wouldn’t help. One woman, who was on the original CP committee back in ‘92, tried to point out that the purpose of the CP was precisely to encourage business, not to limit it and certainly not to discourage it.

Many of those objecting refused to believe that the CP didn’t apply to private residents. Others raised fears of “regulation creep” without realizing that no such thing is possible. The Chair of PRAC tried his best to explain the actual process of guiding a project through the various committees and to reassure everyone that no new regulations can be introduced under existing county code. His effort, as an old colleague of mine put it, “entered one ear, finding no impediments to its travels, immediately exited the other.”

Another, long-time resident gave a rousing speech about how these goddamn committees were wasting everyone’s time worrying about how damn tall a building should be or what goddamn color paints are allowed when they should be finding ways to make jobs come to Point Roberts. Efforts to point out that creating jobs isn’t the mission of those who drafted the CP were hooted down.

Finally, after over two hours, the meeting was adjourned. The Revised CP is still in draft form. We never got the feedback on the issues we thought the community might have reasoned views on. And, of course, when we got to actually look at that “petition” it clearly has no legal force. It’s a bunch of names without addresses, phone numbers, email addresses or any other form of identification to show that the signers even exist, let alone live in Point Roberts or rent or own property here. It has no reasoned argument against the CP. It fails to note any downside to the CP or outline any rationale for thinking that repeal would improve the quality of life or the economic wellbeing of residents.

I guess we’re going to have another meeting…. We can do this. But, as one resident noted when we were walking out, “this is how we got Trump.”

Trump on Science

Donald Trump, as we have all become painfully aware, is one of the least curious people to ever hold the Presidency.  We thought Bush II was bad. Trump makes him look like a rational philosopher in Karl Popper’s school of thought. One the biggest and most disturbing of the many lacunae we see emerging is in the domain of science. Here he appears to be a total dunce as evidenced by his questioning of anthropogenic climate change and his belief that vaccinations can cause autism.

A broad-based set of fears has settled down on the scientific community as evidenced by the several dozen articles in Scientific American worrying about what may come after Trump’s people begin offering specific pieces of legislation. They range from concerns about undermining STEM (Science, Technology, Engineering and Math) education, supporting creationist teaching, cutting funds for stem cell research, reducing efforts to counter climate change and generally putting the budgets of agencies like NASA, NIH, NIMH , NSF and others on the chopping block.

Disturbingly, neither Trump nor anyone in his team of advisers has even raised the issue of the Science Adviser or entertained candidates for the position. The international science journal Nature is particularly concerned by this lack of focus.

As a Fellow of the American Association for the Advancement of Science I’m deeply worried about the lack of interest in science and science policy. The AAAS’s journal Science, generally regarded (along with Nature) as the most prestigious in the world, has had a series of editorials expressing the deep concerns of scientists from all areas.

These essays have an eerie quality to them. The authors are trying their very best to be diplomatic, to not draw the anger that Trump famously unleashes on anyone who criticizes him and, importantly, to not turn off the persons whom Trump will appoint to run the agencies that fund their research. This kind of deep anxiety is something I’ve never experienced before. I’m glad I’m retired and no longer need Federal grants to fund my research. 

Now if you’re not a scientist you might ask, why is this a problem? Why are we all so openly worried — especially when most of the lay public isn’t. It’s not uncommon these days to hear people ask, “What’s so important about doing science anyway?” And “Don’t scientists get things wrong all the time?” To a scientist, these are odd questions to ask — but when I hear them I understand. I realize that they are rarely being asked out of annoyance or anger. It’s almost always the result of ignorance. Here’s the truth about science and its role in our lives.

Every single advance in our quality of life that has contributed to our health, longevity, convenience and social functioning has come from advances in science. All of it. All our homes and public buildings are large and safe because of advances in materials science and their applications in architecture and construction. All our medicines and surgical procedures and health care delivery systems are the direct products of the findings and discoveries of the bio-chemical and medical sciences. Our rapid advances in communications, computer technology, satellite-supported systems, smart phones, tablets are all products that came from scientific theory and empirical findings.

Our understanding of society, how it operates, why and how complex cultural factors play out in real time are derived from pure research in psychology, sociology and political science. Our ability to guide economic systems, to make fine-tuned decisions about debt, deficits, interest rates, monetary supply all emerged from micro- and macroeconomic models and data collection.

I could go on and on and …. I could look at roads, bridges, how courts and the justice systems operate, at the stunning discoveries in genetics, epidemiology, agriculture, animal husbandry, botany, birth control, modern medical techniques like MRI, PET and non-invasive surgery, in forestry, geology, education, child-rearing, GPS systems, land-use principles, weather prediction, mining, mineral extraction, pharmaceutical advances, energy production not to mention policing, fire prevention and firefighting, the military, jet planes, nuclear weaponry, transportation over water, land and air, techniques for controlling pollution, reducing smog and giving us clean air and water.

In short, everything. Every blessed advance in society, every improvement in the quality of our lives, every increase in our health and well-being has come from scientific theory, scientific research and the translation of scientific knowledge into applications that improve the lives of everyone.

Do scientists get things wrong from time to time? Of course. It’s the nature of the process. As you home in on the truth, on reality you take many different paths, some lead nowhere, others reveal errors made in the past. But the system, the “doing” of science is a self-correcting process. So long as you have to make contact with the data, the findings and the numbers you constantly move closer and closer to the right answers. This is how science operates and this is why it has been so brilliantly successful.

To sit back and watch a President pay not even lip service to science is disturbing but to have one who has derided science and scientific research is downright terrifying. And don’t get me started on some of the morons in Congress.

"Libratus" Takes on the Top Poker Players

In 2015 an Artificial Intelligence (AI) dubbed “Claudico” played 80,000 hands of No Limit Hold ‘Em poker against four of the top online poker pros. The ‘bot (short for “robot”) was a program written by the AI experts at Carnegie Mellon University’s computer science department. While this might seem like a lot of hands to most folks, it turned out not to be enough data to settle the issue. The human players won but not enough to be statistically meaningful.

Starting today a newer more powerful poker playing computer (named Libratus) will take on the same four pros. This time they’ll be playing 120,000 hands each and hopefully settle the issue. If they win the four pros will get more than bragging rights, they will split a $200,000 prize. Most handicappers think Libratus still isn’t up the job and the international betting markets have the AI as a 4 - 1 and even 5 - 1 underdog.

There are some fascinating elements of this project that go way beyond poker. They involve the development of a remarkably effective procedure that is used to “teach” the computer how to play an effective game of poker. It uses an algorithm called the counterfactual regret-minimization routine that operates as follows. 

The AI starts out knowing nothing about poker other than the basics like hand rankings and the rules of the game. It’s dealt a hand and makes a decision about how to play it. It then sees whether it won or lost money on it and how much. The next step is the key (and requires a very fast, powerful computer): it runs through every other possible decision it could have made against all the things its opponent might have done. That is, it looks at all the counterfactuals and selects the one that would have minimized regret (won the most or lost the least) and moves it up in the hierarchy of possible ways to play that hand. The ones that would have won less or lost more are moved down.

Then they ran several trillion (that’s not a misprint) iterations — all played against a second instantiation of the program which was carrying out the same routines. Each time a better decision (i.e., one that “minimized” regret ) was found the hierarch of decisions was revised. The “regret” notion is used here in the sense of “Oh damn, I should have done that instead.” 

Over time the AI slowly homed in on the most effective strategies. Whether it has found the ones that can beat these top pros will be determined soon.

Note that this “brains v. bot” contest is being played “heads-up.” That is there are only two players in each hand, one of the humans and Libratus. Even though Libratus is playing at a world-class level of skill heads-up, poker is such a complex game that it cannot handle the computational load that having a third player at the table produces. The reason is that poker, unlike other complex games like chess and go where there are AI’s that can beat any human, is a game of partial, and sometimes unreliable information. Each player only knows some things but is missing the most important data, what one’s opponent’s cards are and what its bets mean. This simple fact makes the problem one of overarching complexity and arriving at an optimal set of decisions extremely difficult.

What’s even more fascinating is that the counterfactual regret-minimization algorithm is a general one. As the researchers at CMU are showing, it can be applied to any situation where the number of counterfactuals is large but within the computational capacity of the computer, where only some of the relevant information is available and where some of it may be misdirection and misleading. The applications they are exploring are in areas like medical diagnosis, cybersecurity, financial markets, economic decision-making, business and political negotiations, military situations — all circumstances where there is only incomplete and potentially misleading information but concrete decisions need to be made.