Several people have asked me about the many statements being made regarding President Clinton's mental health. He has been labeled by some as a "sex addict", by some as a "sociopath", by some as suffering from being an "adult child of an alcoholic". Some people claim that we should not hold him responsible for his misconduct because he is "ill". Some propose that he invoke Article 25 of the Constitution to declare himself temporarily unable to discharge the duties of President, that he enter into some sort of therapy, and resume office when he is "cured".
From a strict medical and psychiatric standpoint, there is no such disorder as "sexual addiction", although it is possible to diagnose a "sexual disorder" in someone who is distressed about using a succession of people for sexual gratification. Personally, I believe that "sex addiction" is not a medical or psychiatric disorder, but rather an attempt to avoid responsibility by medicalizing misbehavior. In other words, "It's not my fault, I'm addicted to sex", just doesn't convince me at all.
On a related note, there are psychiatric disorders in which a person may behave in sexually inappropriate ways, and in some cases persons so affected truly do not understand that their behavior is wrong or may be unable to control that behavior. But even in those cases, the person remains responsible for any damage or emotional distress caused by such behavior.
Finally there are people who are mentally incompetent. Both competency and insanity are _legal_, not _medical_ terms, and such a determination can be made only by a judge or jury. Clearly if Mr. Clinton is too incompetent to manage his own affairs, or if he is insane, he is unfit to serve as President.
That one is an "adult child of an alcoholic (ACOA)" is also not a psychiatric diagnosis. It is true that certain thought and behavior patterns occur more often in people who were raised by an alcoholic parent. But ACOA is a way of conceptualizing certain behavior patterns, not an illness. It is not diagnostic, but rather descriptive. It is a tool used to help children of alcoholics, their families, and their therapists better understand their particular psychological vulnerabilities. And of course, ACOA is not deterministic; some people raised by alcoholic parents do not develop psychological or behavioral problems.
Finally we come to sociopathy, although the current terminology is "Antisocial Personality Disorder". Antisocial Personality Disorder is a specific psychiatric diagnosis. I'd like to simply be able to say that Mr. Clinton either does or does not have Antisocial Personality Disorder. But it's not that simple.
First of all, I (like most other psychiatrists) consider it to be highly unethical to diagnose a person whom I have not interviewed in person. I have never met, much less interviewed Mr. Clinton, so I will not diagnose him. So any conclusions I may draw are my opinion. It may be an educated opinion, but I want to be very clear that I am _not_ diagnosing anyone _in absentia_.
Secondly, psychiatric diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV), is bit like ordering from a Chinese menu. To be diagnosed with a specific disorder, a person must meet so many criteria from section A, so many from section B, none from section C, for example. Personally, I'm not convinced that this is the best approach to diagnosis, but as the name implies, the system is used for statistical evaluations also, and concrete criteria are absolutely necessary for accurate statistics.
So for the curious and the armchair psychiatrists among us, I'm posting the full description of Antisocial Personality Disorder along with the diagnostic criteria on my Web page. You can find it at http://www.therighter.com/dsm.html. (You'll have to scroll down a bit, since this column is included.) If you do not have Web access, but have the ability to receive e-mail in HTML format, let me know and I'll send you the entire document. But it is quite long, which is why I'm not attaching it to this column.
Antisocial personality disorder is, by definition, a mental illness. However, what is or is not a psychiatric disorder is not absolute. It is determined by a committee of psychiatrists, and is subject to change. For example, homosexuality was considered a mental disorder until the 1970's, but it is no longer included in the list of psychiatric disorders. Therefore you should read the description and criteria for yourself, and draw your own conclusion as to whether or not antisocial behavior is a mental disorder. I believe a strong case may be made for either position.
Further, I do not mean to imply that should Mr. Clinton be so diagnosed, we should excuse his behavior because he is "sick". First of all, I do not believe that being "sick" relieves one of the responsibility to deal with the consequences of one's behavior. Second, while I have great compassion for those people who are mentally ill, that does not mean that I necessarily support the idea of a mentally ill person occupying the White House. If Mr. Clinton is mentally ill, he should act in accordance with Article 25 and resign.
Antisocial personality is among the more difficult psychiatric disorders to treat. It generally requires long-term therapy in a hospital setting, followed by ongoing psychotherapy and supervision. Thus any suggestion that Mr. Clinton can take a few weeks off, get help, and return to office "cured", is nothing more than the type of con job for which those with antisocial personality disorder are noted.
My opinion? Mr. Clinton clearly meets the criteria as described in Sections A and B. I have no adequate information about his youth, so I am unable to determine whether or not he meets the criteria in Section C. Please note that without this information, no formal diagnosis may be made. Mr. Clinton also meets the criterion in Section D.
It is my opinion that President Clinton _probably_ suffers from Antisocial Personality Disorder, but I do not have sufficient information to make a formal diagnosis. But don't take my word for it - read the description and criteria and decide for yourself!
My best wishes for a year of life, health, peace and liberty to all of you.
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Permission is granted for individual distribution of this column as long as no changes are made, full attribution is given and this message is left intact. Re-publication, whether print or electronic, requires the permission of the author. If you choose to disseminate the DSM-IV information, please be sure to do so only under fair use guidelines, and to include the citation and copyright information for the American Psychiatric Association.
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Sarah Thompson, M.D.