Even before he ascended to the presidency, there was a national conversation going on about the state of Donald Trump's mental fitness (or lack thereof). Was he merely unstable? Was he a textbook narcissist? Or was he just a classic schmuck? As the nation has watched him lie every day of the first month of his presidency, that conversation has only grown louder, with some mental health professionals stepping forward to argue that his "grave emotional instability" should disqualify him from the job. Even White House staffers have been reportedly leaking information in the hopes of saving the world from a deranged man.

But underneath the surface of all this chatter is a larger question about whether we should be having this conversation in public in the first place. After all, the country’s mental health organizations have long abided by a self-imposed dictum to not evaluate public figures on these grounds, and if experts don't feel it's appropriate, what place does the media have in overstepping them with armchair diagnoses based on cursory readings of the DSM-V? It may be fine to gossip and share conjecture with your friends in private Slack channels, but is it appropriate to be doing so in the press?

That group of 35 psychiatrists, psychologists and social workers who wrote a letter to the Times warning of Trump's "grave emotional instability" certainly think so now. As they put it, "this silence has resulted in a failure to lend our expertise to worried journalists and members of Congress at this critical time."

At the very least, the therapeutic community is wrestling with an issue it never thought it would need to, and both sides have compelling arguments to make. Allen Frances, a renowned psychiatrist who literally wrote the book on narcissistic personality disorder, said in a follow-up letter to the NY Times in response to the 35 psychiatrists' one, "He may be a world-class narcissist, but this doesn’t make him mentally ill because he does not suffer from the stress and impairment required to diagnose mental disorder."

Frances expanded on his concern to the LA Times about conflating professionally-diagnosed mental illness with someone whom he feels should be denounced "for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers." Frances, who is currently working on a book on the subject tentatively titled Trump’s Not Crazy. We Are., explained, "Most mentally ill people are nice, they’re well mannered, they are decent, they are unselfish, they are good people. Trump is none of these. When you lump someone who is bad with people who have mental illness, it stigmatizes the mentally ill population. Less an insult to him and more an insult to them."

There is a major flaw in Frances' reasoning, as pointed out by Science Of Us: he only differentiates Trump from mentally ill people because of his seeming lack of outward distress. Most mentally ill people are nice, surely, but some are not—do Trump's actions still fit the basic understanding of mental illness? “We don’t know if he suffers from distress,” Wendy Behary, a therapist who works with clients with Narcissistic Personality Disorder, told them responding to Frances’s letter. “We don’t know what happens behind the curtain. We don’t know if there is a vulnerability and fear that comes out in his darkest moments.”

But all of this still bypasses that larger debate about the dangers of stigmatizing the mentally ill. The most compelling argument I've yet seen for why it is so important to raise these questions—and to do so transparently—comes from Columbia Journalism Review today. While they argue that the manner in which the conversation takes place is still in flux, and needs to be carefully considered by outlets who decide to tackle it head-on, they have no doubt it is a worthy one: "The more contentious question has been whether to raise it, and to keep raising it. At this point, not to do so, especially for journalists, is a betrayal of the public trust, a denial of human nature, and an insult to posterity."

Here is the section that I keep coming back to:

As cavalier as this may sound, mental illness does not need to be professionally diagnosed. We don’t need to be told by a doctor that the guy who is coughing and sneezing at the other end of the train car is probably sick, though we don’t know if it is a cold, the flu, bronchitis, pneumonia, or an allergy. All we know is that the safe thing to do is to stay away from him. When someone is compulsively lying, continuously contradicting himself, imploring the approval of people even as he is attacking them, exalting people one day and abusing and vilifying them the next, then the question of his mental state is moot. The safe thing to do is not just to stay away from him, but to keep him away from situations where he can do harm.

In a different set of circumstances, it would be better for the press to ignore the question of a president’s mental fitness altogether. But this is not a normal set of circumstances. There is not necessarily, to use what has become an obnoxious buzz phrase, a “new normal.” There is either a shift from what we are used to that occurs within the boundaries of what is rationally and morally acceptable, or there is a shift from what we are used to that occurs outside those boundaries. We are now in the latter situation. It is new, but it is anything but normal.

If you watched Trump’s news conference last Thursday and thought, “This is Trump talking” then you would not have been sensitive to the profound transformation in the country that has occurred beneath all the distracting upheavals. But if you watched from a distance, as it were, thinking, “This is the American president talking,” then you would have been alarmed in a new kind of way.

Psychiatrists can and should argue about whether they should speculate publicly about Trump’s mental state. But it would be a mistake to marginalize that issue by specializing it and leaving it to the psychiatrists. The mental condition of the president of the United States is as legitimate a subject of journalistic concern as it is of everyday conversation.

We've seen this taking place with the likes of Andrew Sullivan and Al Franken, and just last night, psychologist Dr. John Gartner sounded that exact warning on MSNBC: "If we could construct a psychiatric Frankenstein monster, we could not create a leader more dangerously mentally ill than Donald Trump," Gartner began. "He is a paranoid, psychopathic, narcissist who is divorced from reality and lashes out impulsively at his imagined enemies. And this is someone, as you said, who is handling the nuclear codes."

He argued for the moral imperative of experts to weigh in on an increasingly unhinged situation: "I would argue to my colleagues that those who don’t speak out are being unethical," he said. "If we have some knowledge and understanding about the unique danger that Donald Trump presents through our psychiatric training and don’t say something about it, history is not going to judge us kindly."

Adding to the seriousness of these calls, Russia and Putin are currently compiling a dossier on Trump's psychology to better deal with (and manipulate) him. "Very serious preparatory work is going on in the Kremlin, including a paper — seven pages — describing a psychological portrait of Trump, especially based on this last two to three months, and the last weeks," former Deputy Foreign Minister Andrei Fedorov told NBC News. Their conclusion so far, he says, is that Trump is a risk-taker who can be naïve, which is a nice way of saying that he's not in control of his administration, and bad at listening to his top advisers.

Perhaps the problem is that many see the debate over Trump's mental health as a black and white issue—one need not be clinically mentally ill to be observed to be mentally unfit for such an important and arduous responsibility as that of being the president. We can find ways of seriously discussing these issues—not just volleying accusations or jokes on social media—without further stigmatizing the most vulnerable among us.

Trump is not and should not be a stand-in for any group: he is a man in an exceptional position, with access to the nuclear codes and the NSA spy network at his fingertips. He is also a short-tempered, short-fingered vulgarian who can't take a joke at his expense, who obsessively brings up his inauguration and polling numbers, who habitually lies or spreads mistruths that fit his worldview, who tries to devalue the free press and bully the courts. A person with the attention span of a child and the personality of a predator is in charge of our country—it would be crazy not to ask these questions.