wenty-two psychiatrists and psychologists, including some of the field’s most prominent thinkers, are calling on the American Psychiatric Association on Thursday to substantially revise its controversial Goldwater rule, which bars APA members from offering their views of a public figure’s apparent psychological traits or mental status.
In a letter to be delivered to the APA, Dr. Robert Jay Lifton, one of the world’s leading experts on the psychological effects of war and political violence; Philip Zimbardo of the “Stanford prison experiment”; violence expert Dr. James Gilligan; and their colleagues argued that the Goldwater rule, which the APA adopted in 1973, deprives the public of expert opinion on crucial questions, such as the mental health and stability of elected officials.
While the policy holds that it would be unethical for mental heath professionals to offer their opinions on anyone they have not examined, the letter’s signers argue it would be unethical to withhold their views. Psychiatrists and psychologists, they contend, have “an affirmative responsibility” to publicly discuss “mental health issues discerned in public figures” when they pose “a clear and present danger to the public’s health and well-being.”
Although there have long been rumblings about the rule, which the American Psychological Association and a few other mental health groups have also adopted, opposition intensified in 2016 when some mental health experts wanted to offer their views on then-candidate Donald Trump but felt gagged by the rule. Some of Trump’s incendiary rhetoric and behavior was dismissed by both supporters and critics as mere posturing and as something that would disappear if he took office, but the public might have benefitted from experts’ views, said Dr. Leonard Glass of Harvard Medical School.
“If you understand character and the typical psychological needs of someone reacting to threats to his self-esteem, you know that that behavior and speech doesn’t change readily,” said Glass, who helped organize the letter to the APA and is a contributor to the 2017 book “The Dangerous Case of Donald Trump: Psychiatrists and Mental Health Experts Assess a President.”
He and the other signers support a prohibition against mental health professionals speaking publicly about anyone they have treated, since doing so would violate patient confidentiality, or about non-public figures, where there is no compelling national interest in making their views known.
The Goldwater rule should also apply to public figures who do not pose a danger to the public’s health and well-being, the letter says. That would keep psychiatrists and psychologists from frivolous armchair psychoanalyzing.
Glass said the signers believe they have not only ethics but also science on their side. The scientific rationale for the Goldwater rule is the idea that only an in-person mental health evaluation (always done via interview; there are no blood tests or brain scans for psychiatric disorders) can yield insights into someone’s motivations, insecurities, emotions, and other psychological traits. A study last year, however, found both that the interview-based exam can be misleading — because patients lie or obfuscate or have poor self-insight, and because psychiatrists err — and that public behavior, writing, and speech can provide more accurate insights.
The Goldwater rule’s “insistence that it is unethical for a mental health professional to comment on a public figure’s psychological functioning without an interview is misguided and without scientific foundation,” the letter to the APA argues. The rule is therefore “antiquated, illogical, without scientific foundation, and intrinsically undermining of mental health professionals’ efforts to protect the public’s well-being.”
The practical effects of the Goldwater rule are unclear. Some psychiatrists have told STAT they do not dare offer their views on public figures for fear of violating it. Some of the contributors to “Dangerous Case” received letters threatening to report them to their state medical board, Glass said, though that apparently didn’t happen.
But Dr. Judith Vida, a psychiatrist in Southern California, received a letter last year from the Southern California Psychiatric Society saying it was pursuing “a review of allegations of unethical conduct” because she was one of 35 experts who signed a letter to the New York Times saying that Trump had shown “an inability to tolerate views different from his own” and that people with similar traits “distort reality to suit their psychological state.”
Although an attorney said any complaint to the state licensing board would be dead on arrival because the First Amendment protected her right to speak, Vida instead resigned from the APA, saying she had lost all respect for the APA and its local branch. “My sense of betrayal by my colleagues, by my district branch, by my national association, and by my profession is overwhelming,” Vida said.
The rule is selectively enforced, however. When one of the APA’s past presidents, Dr. Jeffrey Lieberman, gave a full-throated defense of it last year — but then added that Trump shows signs of incipient dementia and possibly a personality disorder — he apparently faced no sanctions.
The psychiatrists who want the Goldwater rule relaxed are fighting an uphill battle. As criticism of the rule mounted last year the APA, far from relaxing it, expanded it. The previous interpretation barred members from diagnosing a public figure (“she shows signs of narcissistic personality disorder,” say) from afar. Now, members are prohibited from rendering any opinion “on the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry,” whether or not they mention a diagnosis.
As a result, psychiatrist Dr. Claire Pouncey of the University of Pennsylvania wrote in the New England Journal of Medicine, “psychiatrists are the only members of the citizenry who may not express concern about the mental health of the president using psychiatric diagnostic terminology.”
Members can propose changes to their APA Assembly delegates, most of whom are chosen at the regional level. Changes require a two-thirds vote by both the APA Board of Trustees and the Assembly.