Goldwater rule

The Goldwater rule is Section 7 in the American Psychiatric Association's (APA) Principles of Medical Ethics,[1] which states that it is unethical for psychiatrists to give a professional opinion about public figures whom they have not examined in person, and from whom they have not obtained consent to discuss their mental health in public statements.[2] It is named after former US Senator and 1964 presidential candidate Barry Goldwater.[3][4]

The original piece in Fact magazine which prompted the introduction of the Goldwater rule. Likely costing Barry Goldwater a large number of potential votes, this practice was later deemed unethical by the APA.

The issue arose in 1964 when Fact published "The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater".[3][5][6] The magazine polled psychiatrists about US Senator Barry Goldwater and whether he was fit to be president.[7][8] Goldwater sued magazine editor Ralph Ginzburg and managing editor Warren Boroson, and in Goldwater v. Ginzburg (July 1969) received damages totaling $75,000 ($523,000 today).[3]

Description

Section 7, which appeared in the first edition of the American Psychiatric Association's (APA) Principles of Medical Ethics in 1973 and is still in effect as of 2018,[9] says:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.[1]

Similar ethical codes in different organizations

American Psychological Association

The APA Ethics Code of the American Psychological Association (a different organization than the American Psychiatric Association) does not have a similar rule explicitly defined in its code of ethics. Instead, the APA suggests that various statements made in different parts of its Ethics Code would apply to cases of the diagnosis of a public figure. In 2016, in response to the New York Times article "Should Therapists Analyze Presidential Candidates?", American Psychological Association President Susan H. McDaniel published a letter in The New York Times in which she offered her opinion and interpretation of the current Ethics Code:

Similar to the psychiatrists' Goldwater Rule, our code of ethics exhorts psychologists to "take precautions" that any statements they make to the media "are based on their professional knowledge, training or experience in accord with appropriate psychological literature and practice" and "do not indicate that a professional relationship has been established" with people in the public eye, including political candidates. When providing opinions of psychological characteristics, psychologists must conduct an examination "adequate to support statements or conclusions." In other words, our ethical code states that psychologists should not offer a diagnosis in the media of a living public figure they have not examined.[10]

American Medical Association

In the fall of 2017, the American Medical Association's Council on Ethical and Judicial Affairs wrote new guidelines into the AMA Code of Medical Ethics, stating that physicians should refrain "from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine."[11][12]

Violations

Regarding Donald Trump

In 2016 and 2017, a number of psychiatrists and clinical psychologists faced criticism for violating the Goldwater rule, as they claimed that Donald Trump displayed "an assortment of personality problems, including grandiosity, a lack of empathy, and 'malignant narcissism'", and that he has a "dangerous mental illness", despite having never examined him.[3][13][14] In defense of this practice, Bandy X Lee, a forensic psychiatrist at the Yale School of Medicine, wrote in USA Today "[that] diagnostic practices have changed from accepting interviews to observations, so any assertion that a personal interview is mandatory for a valid professional opinion does not hold."[14]

John Gartner, a practicing psychologist, and the leader of the group Duty to Warn, stated in April 2017 that: "We have an ethical responsibility to warn the public about Donald Trump's dangerous mental illness."[15]

The American Psychoanalytic Association (APsaA), a different organization from the APA, sent a letter on June 6, 2017, that highlighted differences between the APA and APsaA ethical guidelines, stating that "The American Psychiatric Association's ethical stance on the Goldwater Rule applies to its members only. APsaA does not consider political commentary by its individual members an ethical matter."[16][17] In July 2017, the website Stat published an article by Sharon Begley, labeled "exclusive" and titled "Psychiatry Group Tells Members They Can Defy 'Goldwater Rule' and Comment on Trump's Mental Health". The article, with a photograph of Barry Goldwater as the headline image, stated that "A leading psychiatry group has told its members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures", first sourcing the statement to the July 6 American Psychoanalytic Association (APsaA) letter, but also claiming that it "represents the first significant crack in the profession's decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians' behavior"; the article then repeatedly referred to the "Goldwater rule", quoted an unnamed source as saying "leadership has been extremely reluctant to make a statement and publicly challenge the American Psychiatric Association", and claimed that an unnamed "official" had said that "Although the American Psychological Association 'prefers' that its members not offer opinions on the psychology of someone they have not examined, it does not have a Goldwater rule and is not considering implementing one".[18][19] Yahoo News reporter Michael Walsh criticized the Stat article, saying it was "misleading" by stating that the letter "represents the first significant crack": The American Psychiatric Association retains the Goldwater rule, and the APsaA never had the rule and was not changing.[17] Also, even though the APsaA has no Goldwater rule for its members and allows its members to give individual opinions about specific political figures, its Executive Councilors unanimously endorsed a policy that "the APsaA as an organization will speak to issues only, not about specific political figures".[17]

In February 2017, Allen Frances wrote a letter to the editor of the New York Times, regarding Trump and narcissistic personality disorder: "I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them."[20][21] According to the American Psychiatric Association, "saying that a person does not have an illness is also a professional opinion."[22]

In September 2017, Jeffrey A. Lieberman published an article extensively speculating on diagnoses for Donald Trump despite claiming to adhere to the Goldwater Rule in the beginning paragraph. He arrived at a diagnosis of "incipient dementia"[23] but faced no sanctions.[24]

On December 5, 2019, a group of mental health professionals led by Yale Medical School psychiatry professor Bandy X. Lee, George Washington University professor John Zinner, and former CIA profiler Jerrold Post, publicly urged the House Judiciary Committee to consider Donald Trump's “dangerous” mental state that was ostensibly arising from his “brittle sense of self-worth” as part of the Congressional impeachment ongoing process.[25]

Since April 2017, Lee has been stating[26] that while she has been an adherent to the Goldwater Rule "for over 20 years,"[27] the APA was "violating its own rule"[28] by modifiying it so that it would not be possible to meet its "affirmative obligation."[29] She formed an organization with thousands of other mental health professionals "in opposition to the American Psychiatric Association, which, with the Trump presidency, not only failed to meet the psychiatric profession’s societal responsibility but inhibited individual professionals from doing so."[30] Some accuse the APA of conflict of interest, since it receives federal funding,[31] which has been increased since its actions under the Trump administration.[32]

See also

References
  1. American Psychiatric Association (2013). "The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry" (PDF) (2013 ed.). Arlington, Virginia: American Psychiatric Association. Retrieved April 23, 2017.
  2. "Ethics Reminder Offered About 'Goldwater Rule' on Talking to Media". Psychiatric News. May 18, 2007. doi:10.1176/pn.42.10.0002. Retrieved April 23, 2017.
  3. Carey, Benedict (August 15, 2016). "The Psychiatric Question: Is It Fair to Analyze Donald Trump from Afar?". The New York Times. Retrieved August 16, 2016.
  4. Friedman, Richard A. (February 17, 2017). "Is It Time to Call Trump Mentally Ill?". The New York Times. ... psychiatrists can discuss mental health issues with the news media, but that it is unethical for them to diagnose mental illnesses in people they have not examined and whose consent they have not received.
  5. "Revisiting the Goldwater Rule: Psychiatry, Ethics, & Politics". ScattergoodEthics. Retrieved August 29, 2016.
  6. Boroson, Warren (September–October 1964). "What psychiatrists say about Goldwater". Fact. Vol. 1 no. 5. pp. 24–64.
  7. Friedman, Richard A. (May 23, 2011). "How a Telescopic Lens Muddles Psychiatric Insights". The New York Times. Retrieved May 24, 2011.
  8. "LBJ Fit to Serve". Associated Press. May 23, 1968. Retrieved May 24, 2011. Publisher Ralph Ginzburg, defendant in a libel suit for an article on a poll of psychiatrists on Barry Goldwater that he conducted in 1964 says ...
  9. Kroll, Jerome; Pouncey, Claire (2016). "The Ethics of APA's Goldwater Rule". Journal of the American Academy of Psychiatry and the Law. 44 (2): 226–235. ISSN 1093-6793. PMID 27236179.
  10. McDaniel, Susan H. (March 14, 2016). "Response to Article on Whether Therapists Should Analyze Presidential Candidates". American Psychological Association. Archived from the original on April 20, 2016. Retrieved June 30, 2017.
  11. "Reference Committee on Amendments to Constitution and Bylaws" (PDF). American Medical Association. 2017. Retrieved January 4, 2018.
  12. Moran, Mark (December 7, 2017). "AMA Goes Beyond 'Goldwater Rule' In Ethics Guidelines on Media Interaction". Retrieved June 24, 2019.
  13. Steakin, William (April 21, 2017). "Dozens of Psychiatry Experts Claim Trump Has 'Dangerous Mental Illness' at Controversial Conference". AOL.com. Retrieved April 24, 2017.
  14. Lee, Bandy (October 11, 2019). "Mental health experts see Trump is dangerous, but our professional gatekeepers protect him". usatoday.com. Retrieved December 15, 2020.
  15. Bulman, May (April 21, 2017). "Donald Trump Has 'Dangerous Mental Illness', Say Psychiatry Experts at Yale Conference". The Independent. London. Retrieved April 25, 2017.
  16. "Letter" (PDF). Letter to members. American Psychoanalytic Association. July 6, 2017. Retrieved July 26, 2017.CS1 maint: others (link)
  17. Walsh, Michael (July 25, 2017). "Clarifying the 'Goldwater Rule' for Psychotherapists in the Age of Trump". Yahoo News. Retrieved July 26, 2017.
  18. Begley, Sharon (July 25, 2017). "Psychiatry Group Tells Members They Can Defy 'Goldwater Rule' and Comment on Trump's Mental Health". Stat. Boston Globe Media. Archived from the original on July 25, 2017. Retrieved July 26, 2017.
  19. Begley, Sharon (July 25, 2017). "Psychiatry Group Tells Members They Can Defy 'Goldwater Rule' and Comment on Trump's Mental Health". Yahoo News. Stat. Retrieved July 26, 2017.
  20. "Opinion | An Eminent Psychiatrist Demurs on Trump's Mental State". The New York Times. February 14, 2017. ISSN 0362-4331. Retrieved January 21, 2020.
  21. "Misdiagnosing Trump: Doc-to-Doc with Allen Frances, MD". www.medpagetoday.com. September 6, 2017. Retrieved January 21, 2020.
  22. "APA Remains Committed to Supporting Goldwater Rule". www.psychiatry.org. Retrieved January 21, 2020.
  23. MD, Jeffrey A. Lieberman (September 8, 2017). "These Experts Think Trump May Actually Have Dementia". Vice. Retrieved January 21, 2020.
  24. "Goldwater rule should be rolled back, leading psychiatrists say". STAT. June 28, 2018. Retrieved January 21, 2020.
  25. Feinberg, Andrew (December 6, 2019). "Trump's mental state is deteriorating dangerously due to impeachment with potentially 'catastrophic outcomes', psychiatrists urgently warn Congress". The Independent. London. Retrieved December 6, 2019.
  26. "Psychiatrist issues urgent warning over Trump's mental health". The Independent. April 25, 2017. Retrieved January 22, 2020.
  27. Ganeva, Tana. "Yale psychiatrist dismantles the Goldwater rule for preventing mental health experts from speaking out about Trump". www.rawstory.com. Retrieved January 22, 2020.
  28. Lee, Bandy X. (January 7, 2020). "American Psychiatry's Complicity with the State". Medium. Retrieved January 22, 2020.
  29. Lee, Bandy X. "Mental health experts see Trump is dangerous, but our professional gatekeepers protect him". USA TODAY. Retrieved January 22, 2020.
  30. "Our Mission". World Mental Health Coalition. Retrieved January 22, 2020.
  31. Gersen, Jeannie Suk. "How Anti-Trump Psychiatrists Are Mobilizing Behind the Twenty-Fifth Amendment". The New Yorker. Retrieved February 6, 2020.
  32. Kendall, Joshua (April 25, 2020). "Muzzled by Psychiatry in a Time of Crisis". Mad In America. Retrieved April 25, 2020.
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