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The election of President Trump has led to interest in his mental health and has resulted in heightened scrutiny regarding the American Psychiatric Association's Goldwater Rule, with its prohibition on opining psychiatrically on the mental health of public figures whom one has not examined in person. This article highlights the historic, methodological, forensic, and ethics challenges regarding psychiatric approaches to leadership analysis, and how these can offer policy makers options regarding national security decision-making., (© 2018 American Academy of Psychiatry and the Law.)