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Do doctors have a “duty to warn” if they believe a leader is dangerously mentally ill?

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1087 (Published 09 March 2017) Cite this as: BMJ 2017;356:j1087

Rapid Response:

The mental health and competence of political leaders matters - a lot.

All 70 year olds have cognitive deficits - that is the bald reality. Personality or behaviour traits that are at the margins of normality are widely seen in politicians in all places and times. Trump is not alone amongst current and past political leaders in exhibiting behaviours and cognitive traits that cause concern or alarm. Thatcher and Reagan both became demented and the premonitory symptoms were evident in both during their periods in office. How many other current leaders from across the globe cause us concern?

Hitler, Stalin, Mao, Pol Pot, numerous Latin American leaders, Ceausescu, Mussolini, Gadaffi, Franco ...it's a very long list of those who were definitely not normal. What about those who are/were, to put it no higher, very peculiar ... this is an even longer list. The list of past and present British parliamentarians to consider is not a short one either.

Alcohol and substance misuse is rife amongst the political class. The widespread aversion to objective evidence, unreflectingly rigid adherence to systems of belief or thought and indifference to the suffering of those affected by policy are not desirable traits.

Those with professional skills to detect symptoms and signs of psychological or psychiatric disorders have an absolute obligation to speak out and exert influence wherever possible. The warnings must be couched in measured but clear terms.

Timely intervention and effective regulatory instruments in countries all across the world could have saved so much suffering, death and waste in the past and, self-evidently, could do so in the future.

Britain should lead the world in obliging those who seek elected office to undergo regular and searching physical and psychological evaluation - not to determine whether they might stand or remain in office but to ensure that the electorate know what they are voting for. Tangentially, I would be fascinated to see the results of wide ranging tests of general knowledge and awareness of current affairs too.

Once we have our own house in order, our country's governance will improve and we can then consider offering advice to others.

Aux armes citoyens!

Steve Ford

Competing interests: No competing interests

10 March 2017
Steven Ford
Retired GP
Dr
Haydon Bridge