It’s hard to talk about mental health at the best of times, which these are not

Illustration by Thomas Pullin

Illustration: Thomas Pullin for the Guardian

Should we talk more openly about mental illness, or should we shut up? It depends which side of the Atlantic you’re on. In Britain, the future head of state has thrown his weight behind an admirable campaign for more conversation, but in America, where the current head of state seems profoundly psychologically disordered, the official position is to zip it. The American Psychiatric Association (APA) is standing firm on the “Goldwater Rule”, which prohibits members from offering opinions, let alone formal diagnoses, on those they haven’t evaluated in person. (It was devised after a poll of psychiatrists deemed Barry Goldwater, the 1964 Republican presidential candidate, unfit for office.) Needless to say, the rule hasn’t stifled media speculation about celebrity mental health; instead, it precludes precisely those who might bring some credibility and sobriety to the discussion.

The best argument for the royal family’s Heads Together initiative is that it could reduce the stigma surrounding mental illness, yet the APA’s best argument for not talking about Trump’s problems is also to avoid stigmatising other mentally ill people through association with the Orange Horror. There’s something amiss here: we claim we want to acknowledge that mental illness affects pretty much everyone, but at the same time, we don’t want to acknowledge that it affects some highly unsavoury people. And we certainly don’t want to acknowledge that their illness and bad actions might be intertwined.

Yet clearly Trump’s narcissism and sociopathy, if that’s what he has, aren’t irrelevant to the threat he poses. Not because being a narcissist, or even a sociopath, automatically makes you bad; but because the conditions interact with his broader personality and the post he occupies, so as to magnify the threat. Nobody, even Trump, should be blamed for being mentally ill. But nor should we pretend mental illness affects only the nice.

The Goldwater Rule isn’t the only way the noble goal of destigmatisation can backfire. As others have noted, saying “We all suffer” risks implying we all suffer equally and minimising the pain of those with severe conditions. More subtly, it reinforces the notion of mental illness as a biological inevitability. “It happens to all of us” suggests it always will. But that lets governments and communities off the hook: if life in the modern economy is uniquely anxiety-inducing, to pick one example, maybe it’s society that needs to change. We need to talk. But we don’t only need to talk.

A few brave Goldwater dissenters held an open meeting at Yale University last month. “We have a duty to warn,” said one psychiatrist, Bandy Lee, “about a leader who is dangerous to the health and security of our patients.” She’s right: there’s a risk that talking about the state of Trump’s mind, if done badly, might stigmatise others. But there’s also a risk that Trump, inflated by grandiosity and furiously intolerant of criticism, might launch a nuclear war. He’s already done plenty of lesser damage. The mental health of the planet demands that we don’t stand on ceremony here.