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 — even the president.

The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, 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. It will likely make many of its members feel more comfortable speaking openly about President Trump’s mental health.

The impetus for the email was “belief in the value of psychoanalytic knowledge in explaining human behavior,” said psychoanalytic association past president Dr. Prudence Gourguechon, a psychiatrist in Chicago. “We don’t want to prohibit our members from using their knowledge responsibly.”


That responsibility is especially great today, she told STAT, “since Trump’s behavior is so different from anything we’ve seen before” in a commander in chief.


Sign up for our Morning Rounds newsletter

Please enter a valid email address.

An increasing number of psychologists and psychiatrists have denounced the restriction as a “gag rule” and flouted it, with some arguing they have a “duty to warn” the public about what they see as Trump’s narcissism, impulsivity, poor attention span, paranoia, and other traits that, they believe, impair his ability to lead.

Reporters, pundits, and government officials “have been stumbling around trying to explain Trump’s unusual behavior,” from his seemingly compulsive tweeting to his grandiosity, said Dr. Leonard Glass, a psychiatrist at Harvard Medical School. The rule against psychiatrists offering their analysis of the emotions, thought patterns, and beliefs underlying such behaviors, Glass said, robs the public “of our professional judgment and prevents us from communicating our understanding” of the president’s mental state.

Last week, in an essay in Psychiatric Times, Glass called the prohibition on such communication “an unacceptable infringement on my right and duty” to discuss issues “where the perspective of psychiatrists could be very relevant and enlightening.” He ended the essay by announcing his resignation from the American Psychiatric Association, which adopted the rule in 1973. He had been a member for 41 years.

Called the “Goldwater rule,” the prohibition on offering opinions about the mental state of public figures was adopted after some psychiatrists answered a 1964 survey on whether Sen. Barry Goldwater, the Republican presidential candidate that year, was mentally fit for the Oval Office. The rule states that it is unethical to offer a professional opinion about a public figure’s mental health, including the presence or absence of a disorder, without that person’s consent and without doing a standard examination. In March, the psychiatric association reaffirmed the rule.

The group acted despite growing criticism that the Goldwater rule is outdated and even unethical for preventing psychiatrists from pointing out behaviors that raise questions about a government official’s mental state. No other medical specialty has such a rule; cardiologists are not prohibited from offering their views of an official’s fainting spell, for instance, as long as they make clear that they have not examined the person.

Although opposition to the Goldwater rule has existed for years, it intensified with Trump’s candidacy and then election. In October, a book titled “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President” will be published.

“When the book comes out, there will be renewed furor about the Goldwater rule, since it is precisely about what is wrong with him,” said psychiatrist Dr. Lance Dodes, a retired professor at Harvard Medical School who is now in private practice in Los Angeles.

A number of psychologists have spoken to reporters about what Trump’s statements and actions might reveal about his emotional and cognitive state. 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, an official told STAT.

The psychoanalytic association went further. In its July 6 email, it explicitly stated for the first time that the organization does not subscribe to the rule. That position had been implicit for years, but the association’s “leadership has been extremely reluctant to make a statement and publicly challenge the American Psychiatric Association,” said one psychoanalytic association member who asked not to be publicly identified criticizing the other group.

One stated rationale for the Goldwater rule is that psychiatrists need to examine patients in order to properly evaluate them. In fact, for decades the State Department and other federal agencies have asked psychiatrists to offer their views on the psychological state of foreign leaders, Glass pointed out, evidence that government officials believe it is possible to make informed inferences about mental states based on public behavior and speech.

“In the case of Donald Trump, there is an extraordinary abundance of speech and behavior on which one could form a judgment,” Glass said. “It’s not definitive, it’s an informed hypothesis, and one we should be able to offer rather than the stunning silence demanded by the Goldwater rule.”

The Goldwater rule has long been odd in that violating it carries no penalties. In principle the psychiatric association could file a complaint with a member’s state medical board. That has apparently never happened. Nor has the association ejected a member for violating the Goldwater rule. That is something it, as a private association, would be legally permitted to do.

A state agency, however, is subject to the U.S. Constitution, civil liberties experts say, and penalizing psychiatrists for speaking out would likely be a violation of their First Amendment rights.

Correction: The headline of this story has been changed to make clear that the American Psychoanalytic Association has told its members that they are free to ignore the “Goldwater rule” and comment about public figures’ mental state.

Leave a Comment

Please enter your name.
Please enter a comment.

  • Also, has psychoanalytic association past president Dr. Prudence Gourguechon undergone a recent neuropsych exam? She argues that “We don’t want to prohibit our members from using their knowledge responsibly” because “Trump’s behavior is so different from anything we’ve seen before in a commander in chief.” She’s apparently forgotten that Trump is not a politician and therefore behaves differently than what we’ve mostly seen before. As such, one diagnosing from afar her without an examination might conclude that she is suffering from dementia or Early Stage Alzheimer’s. A neuropsychological examination might be reassuring for her clients.

  • Psychology Today writes:

    “In circumstances where reason is at odds with subjective taste, it is the latter that carries the day. In most cases we tend to pay attention selectively to the evidence that confirms our political orientation while pretending that the conflict between reason and taste does not exist.”

    Before the “psychoanalytic” industry allows its members to render opinions on our political leaders without assessment, it should develop a test to ensure that professional proclamations are not biased by personal opinions. Said another way, in the current situation, the industry must develop a test to evaluate it’s members for Trump Derangement Syndrome.

    Some of the evidence presented in the referenced book is the fact that Trump talks about the “conspiracy” against him. Not to pull the tired Hillary card again, but the Clinton camp has been talking about the “right wing conspiracy,” among many others, for years. To the best of my knowledge, no one has questioned her mental fitness.

    We are currently also hearing questions about the POTUS mental stability because of his “Big Button” comment. Those who express concern for this comment are delusional. The US has had a standing policy of “mutually assured destruction” when it comes to nuclear power since the Eisenhower administration. Trump’s comment is openly and plainly stating what our diplomats have been saying behind closed doors for more than half a century. Also shows they have no concept of “Big Stick” diplomacy, which, when employed by Theodore Roosevelt earned him the Nobel Peace Prize.

  • All Psychiatrists, Psychoanalysts, Psychologists should keep their opinions to themselves since they can only speak to public behavior ,which is no different than his behavior for years. They are unqualified to make diagnosis when they have not even personally seen, spoken with, or evaluated that person. It is unethical too bad their local licensing bureau does not take action to correct them.

  • Although terms such as narcissistic are part of common language now (though used often commonly to convey merely perceptions of selfishness or pride), when proffered as professional diagnoses AGAINST those not medically examined by those in our profession, it is an abuse of our profession. It HARMS all of us. I support malpractice standards against those who lend false professional credence to bolster their banal political dislikes by publicly diagnosing as professionals without exam, let alone consent. Shameful.

    But, the insanity of the most obvious having even to be stated does lend credence to the possibility of development of new DSM criteria for a Trump Derangement Syndrome in the population, mental health professionals being clearly explicated here to be not themselves immune.

  • I am a psychologist and psychoanalyst. For what it’s worth, I don’t like the idea of diagnosing someone from a distance, and it plays into the notion that we can make behavior illness rather than what it is. Nevertheless, we are all left with the language of psychiatry, psychology and psychoanalyst. Terms like narcissistic and sociopathic are both in common use and also represent diagnostic terms.

    HIPAA and privacy have nothing to do with this discussion. These only apply to patients and patient health information. Whether mental health professionals can or should talk in clinical terms about Trump is an ethical debate, but not a HIPAA problem.

    • Of course we are not “left with the language of psychiatry, psychology and psychoanalyst.” We rejected that language, and diagnostics, when it was used to characterize masturbation, homosexuality, and female sexual enthusiasm. Member of those profiting professions responded to public outrage and repudiation. Psychiatrists once characterized the desire of a slave to escape as “drapetomania.” The mental health professions are in the business of social control, and the diagnostic terms reflect that, not the naming of actual disease. If Trump has CTE or Alzheimer’s, which is to say brain damage, then he doesn’t have a “mental illness.”

  • Let me first say that I am a retired registered nurse with some background in psychiatric nursing. I realize you are simiply discussing things but do remember the HIPPA Law is in place and President Trump’s mental health is not supposed to be speculated about where anyone can read it .You and your colleges should know better.

    • If psychiatry were about health, there would be biological tests to validate so-called mental health diagnoses. There are none.

      Psychiatry is about unconventional and disapproved behaviors, which is why anyone with a keyboard can offer a diagnosis. Behavior is not disease.

    • Nicolas-
      So because there is no medical test to diagnose fybromyalgia does that mean rheumatology also has nothing to do with health?

      And whatever your thoughts are on the matter, Sheryll is still correct about HIPPA and the privacy rule applying to all aspects of mental health.

      And more importantly, this is obviously political. There are hardly a fraction of psychiatrists and psychologists that believe it’s ethical to speculate about his health, its laughable for anyone to pretend anything resembling consensus exists regarding that very matter in the mental health community.

    • 1. Psychiatry is entirely about behavior, not putative physical problems, as in the case of fibromyalgia. 2. Psychiatric diagnoses and “treatments” are often imposed on persons against their will. If you are diagnosed with fibromyalgia you can refuse treatment; if you are diagnosed with “schizophrenia,” you cannot refuse treatment. 3. It has not been proven that fibromyalgia is a rheumatological disease. 4. Sheryll, with a background in psychiatric nursing, has probably participated in imposing coercive treatments on unwilling persons, so her concern with HIPPA is ironic. 4. Given that no psychiatric diagnosis can be validated by physical tests (urine, blood, scans, etc.), all psychiatric diagnoses are quackery, not medicine. They would be laughable if they were not also imposed by force.

  • 27 flip cases are going to target the pres. After a year of dems crying about losing the election.
    There is no definition of normal. The odd behavior Trump posesses is merely that of a billionaire. Ask Ross Perot. But someone that cries over an election A YEAR AGO, might wanna be checked out.

  • Narcissist: psychoanalytic term for the person who loves himself more than his analyst considered to be the manifestation of a dire mental disease whose successful treatment depends on the patient learning to love the analyst more and himself less. — Thomas Szasz

    • Nicholas, oh my what a special boy you can copy paste.

      You realize again that is a broad spectrum, what can sometimes appear as one thing can often be something completely different. This is why a psychiatrist /psychologist cannot diagnose anyone they have not treated. Bipolar/borderline personality disorder/narcissistic peronsality disorder have many overlapping symptoms. Which fyi is clearly stated in the dsm. Also the man who wrote the definition even says trump does not meet the criteria so that should tell you armchair diagnosis pushing individuals a lot about the subject. Don’t believe me look it up.

  • Hmmm sounds like a lot of liberals I know, as well as news media sites that post fake news stories. Also it actually does as what someone may perceive as narcisim may actually be something completely different. As many different diagnosis may present with a variety of similar symptoms. Take for instance the belief that you obviously have that it is a me mentality, have you ever stopped for a moment to consider that perhaps it is in jive with other members of society even though it is contrary to your perceived notions. Also if you’re solely going off body ticks well one could then point out that both Clintons exhibit classic body language that would indicate that of liars. Which generally there are several techniques to detect both of which obviously showed. However if say people were to jus able as this says go around diagnosing solely off of no actually interaction one could infer that you are perhaps a person who suffers from delusional disorder despite the facts that mounting evidence proves contrary to your held beliefs. I suppose it’s a good thing couch diagnosing is ethically or morally wrong because it’s a slippery slope isn’t it Louise?

  • Dont have to be a ‘professional’ to diagnose a narcisstic. Only requirement is to have lived & experienced one for a certain amount of time to see thru the body language, the facial expressions, the ‘its all about ME bullshit & lack of care about how his actions affect others. And of course his inability to admit mistakes & apologise. Erin!

    • You don’t have to be a professional to diagnose any “mental illness.” It merely requires a willingness to superimpose your value judgements on others.

    • Since you have experience with narcissistic personality, have you noticed the symptoms in Bernie Sanders’ supporters? I hear there is an assessment” of millennials that a trait is ‘entitlement.’ – I don’t put all millennials into one basket. I am exposed to Sanders supporters constantly even over a year later, and noticed they won’t admit their “mistakes or apologise.” They are insistent their way is right and refuse to compromise.

Sign up for our Daily Recap newsletter

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy