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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.”

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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.

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  • Using the title of “MD” implies authority… without a history and physical examination… unethical. Use your name, but leave off the title or information that you are associated with the title.. ie. So and so medial shool…

  • The title of the article is very misleading!
    It’s the article that is “controversial”, not the Goldwater rule.
    Few psychiatrists signed the petition so they could spit their hatred against the President covering up with the medical degree.
    Luckily, most psychiatrists are decent people and don’t support this partisan initiative but rather respect the choice American people made and keep busy treating real mental illness.

    • It is a shame we have millions of people like Bill Thomas above, who reiterate these disingenuous and dishonest appraisals about the election. The Electoral College is what defines the winner of the presidency, so people need to grow up and accept the law.

      Just like psychiatrists and other mental health care professionals need to grow up and accept the rules that are set by the APA, at least for now.

      This is why partisan politics has and always will be detrimental at the end of the day, just serving the select needs of the few and not the needs of the many and the public welfare at large.

      Again, where were these people screaming for Trump’s head 6 years ago when Obama was doing even worse…

    • Bill Thomas, personal attacks against people you don’t even know don’t add validity to your arguments.
      Quoting Time or NYT on subjects of politics is pathetic. They are so biased, no article misses the opportunity to demonize the President or Republicans in general.
      Psychiatry has been used for political reputations in the past and thisis exactly what leftist psychiatrists try to do now attacking Trump.
      Violence on the leftis a huge problem and “liberal” psychiatrists add oil of hatred to the fire.

    • Joel Hassman, what precisely is dishonest or disingenuous about quoting figures that have been published everywhere and tabulated by multiple sources? Time didn’t invent those figures, they took the figures from an independent, nonpartisan source.
      Further, Founding Father Alexander Hamilton wrote in The Federalist Papers : No. 68, “It was desirable that the sense of the people should operate in the choice of the person to whom so important a trust was to be confided.” In more modern and understandable terms, “A member of the electoral college must have sufficient integrity to reflect the wishes of the public instead of using his unique position to advance his own personal wishes.” If the electoral college does not reflect “the sense of the people,” it does not serve its intended purpose and must be dissolved.

    • Mr Thomas, let it go. We have already had one set of comments removed, so, why push it. At the risk of this comment being stricken as well, it is dishonest and disingenuous to push that Hillary Clinton should be President simply because she won the popular vote. That is not the law, sir. I guess you will hope the Democrats will retake both house of Congress, impeach Donald Trump, then get rid of Pence and his Vice President, and then what, just announce that Hillary Clinton is taking over?!

      The Democrats and their partisan hacks aren’t thinking things through. They ran a corrupt and criminal candidate that the States, as a collective per the Electoral College rejected, she has lower approval ratings today than Trump, and enough people of sizeable influence in the Democrat party are saying basically they wish she would just go away.

      That is what the Democrats wanted in place of Trump now? Sorry, responsible and attentive people, if they had to chose, and they did, between lesser of evils chose Narcissism over Antisocial Personality Disorder.

      And I would bet that if I scoured the Net for facts that favored Trump winning the election, that would likely come from Right/Conservative sources, you would likely reject my offerings, because they don’t fit your narrative and aren’t from Leftist media sources. I think Times’ recent cover with the little girl and Trump that was shown to be a fraud, that they haven’t genuinely apologized for publishing, shows they can’t be trusted as a reliable and consistent resource for news.

      Thus the story of the boy who cried wolf, perhaps what you quote is true, but, people like me just don’t trust another wolf shriek…

      So, the circle is complete, your initial comment was not received as honest and forthright, and your last above follows suit.

      And to tie it in to this post about changing a policy, but is really just about ignoring the standards set by the APA in already making public comments regarding clinical opinion about public figures, that is dishonest and disingenuous as well. NO ONE has even attempted to rebut my request why they were silent while Barack Obama was President. Double standards, inconsistencies, and hypocrisy are not traits of respect and admiration, at least with me!

      Full disclosure, I am a registered independent voter since 1994, I have despised the Republican Party since I was able to vote about a decade earlier, but, I despise the Democrat Party even more these days, as they are the party of criminality.

      Ironic, I find them to be as dishonest, disingenuous, and disdainful a collective can possibly be in this country today. And equally ironic that those who shriek the loudest to try to take down Donald Trump without legitimate, due cause only echo the all consuming hate that is the narrative of the Left and Democrats.

      And that is a shame, but, hate really never wins, it just perseveres until it exhausts and negates honest and fair efforts to debate and respectfully dissuade the audience who had yet to pick a side.

      Good luck with your cause and efforts. Election 2020 is only 28 months away now, plenty of time to undue the damage, hmm?

  • It is rather late now to be discussing this especially after years of misleading the public, and failure to reign in those Television Psychologists and Psychiatrists. Suddenly this professional organization, is concerned about a rule. They were not concerned when their profession started marketing themselves on Television. They were not very concerned when they came out with the DSMV which ensured Pharma profits. We are in Post Truth America where anything goes.
    Psychologists and Psychiatrists were fine with an Epidemic of Despair they helped to obfuscate in this country. In order to ensure the profitability of their industry, they sided with creatures like realty show stars. They even market themselves “helping reality stars.” They gave a veneer of normalcy to all of this.
    Not one has come up with a real critique of the use of Psychology and Social Media to sell products, or a politician. Millions of Americans are in despair, which they re-framed as a Mental Illness. To put it in Psychological terms, they are Gas Lighting all of us.

  • I don’t really care if people think this is an overgeneralization, I think there is a level of antisocial personality disorder endemic in the Democrat Party, and the Left over all, and their lust for power is what drives this.

    Yes, narcissism has no real benefit to the human condition, but, antisocial personality disorder is incredibly detrimental to societies that are fairly civilized.

    Again, it’s probably over simplistic, but, evil is simply: pervasive lying, causing harm and disruption even if not outwardly felonious, showing no remorse for causing such disruption and chaos, and mocking and disdaining healthy and accepted boundaries by Society.

    Republicans aren’t a wonderful example of leading by accountability, but Democrats certainly are the worst of the two, they embrace my definition of evil fairly consistently and pervasively by their rhetoric and agendas.

    Again, where were all these outraged mental health care providers 6 to 9 years ago when it was obvious Barack Obama most likely revealed the traits of antisocial personality disorder, that we watched years into his presidency…

    and my last comment at this thread is simply this, Obamacare was an agenda to harm the middle class and cause more chaos and disruption for health care in general, and not only Obama knew it, but so did most of the Democrat leaders in Congress at that time. But, I’m sure people who are genuinely unbiased and objective will argue otherwise so effectively and succinctly…

    Good luck with this cause. Oh, Trump is one helluva litigious guy, eh???

  • BTW all of you high and mighty virtual signalers who are on board with this warped 25th Amendment Oedipal fantasy project…I don’t want to hear a peep out of you about the horrors of stigma and mental illness. Because that’s exactly what you are engaging in…using the stigma of a fantasized mental disability to bring down and destroy someone you don’t like. Based on what you see on CNN and MSNBC, which are highly filtered sources.

    And if you’re so damned concerned about dangerousness and the state of the nation, stop being a drama-loving poseur for just a second about how dangerous and bloody the second civil war that you think you can cause (I’m not worried, it will never happen) would be.

  • I agree with David A that the irony of the Goldwater rule is that it completely excludes public commentary by professionals. This raises the question of whether or not there should ever be public commentary by experts regarding any official. The question is not whether DJT is an immature narcissist or Obama is a sociopath. Rather it is whether or not the public truly benefits from being educated regarding the perceived psychiatric status of a figure or would the differences in opinion within our own profession simply sow more confusion. Also does such a discussion by psychiatrists tear down the profession in some fashion and if so then is the overall benefit to society worth this risk to comment on the political figure.

    • “I agree with David A that the irony of the Goldwater rule is that it completely excludes public commentary by professionals.”

      No, it doesn’t. It just means that using diagnosis as a weapon or diagnosing without an exam is unethical.

      Watch me now say a few disapproving things about Trump without a worry in the world about ethics.

      I don’t like Trump’s budget, I think he is not doing enough to control the deficit.

      I didn’t like his bombing Syria.

      I didn’t like his hiring and firing of Mooch.

      He should choose his words more carefully.

      He should not have hired Sessions for AG.

      See. There I just gave five negative opinions about Trump and I didn’t even have to use the stigma of psychiatric diagnosis as a weapon. No free speech problems at all. So we don’t need to exaggerate what Goldwater Rule does and play oppressed victim. And I’m not the least bit worried about Sessions coming after me.

  • Most good clinicians would agree that observed behaviors are more accurate and useful than a diagnostic interview for diagnosing mental disorders. The APA policy as it is formulated sucks. Would it be ethical for we psychiatrists to say nothing in the event there were clear signs to of a leaders psychosis.

  • Quit APA if you feel it gags you.
    We have witnessed what Mr. Trump says and does almost everyday for years. I believe we have more info about him than some of our patients. If you can not form an opinion and diagnosis, you should disqualify yourself as a psychiatrist. Does one have to have a face-to-face interview to make a psychiatric diagnosis? A sociopath can be very charming during the interview. A manic and/or psychotic patient can hold himself or herself very calm and rational for a few hours during the interview. The premise APA holds is that one can make a psychiatric diagnosis only if one has a face-to-face interview. Is that true?

    • Oh Jimbo,

      You still don’t get it. This isn’t just about whether or not a psychiatrist (or psychologist) could potentially diagnose a person without an in-person interview. I’m sure they could given enough collateral information.

      But they shouldn’t. Especially not for politicians.

      Ya see, Jimbo. I’m going to diagnose you with paranoid personality disorder. Why? Because I can. I know we’ve never met, but that doesn’t matter. I simply don’t like you or your politics. I hope this new diagnosis doesn’t have any impact on your current or future jobs. Because that would be a shame.

    • We do not have more information about our patients… If so, we are incompetent. Information about Trump is hearsay and subtle propaganda. Yes, Trump was elected president according to our constitution. don’t like it change it. simple.

  • The GW rule is very appropriate so psycho-political tendencies are not expressed as fact. Without the GW rule psychiatry could influence social thinking and action rather than the US public doing so via the election process. Remember only a democracy can elect NOT to have a democracy( this is the ultimate freedom… the freedom NOT to be free)

    • Yes, that is exactly what Germans did when they voted in Hitler. 50 million lost lives later you might ask yourself : Where were my psychiatrist colleagues who knew a madman was elected but did not speak out? Will they say:” My professional organization forbade it???”

  • My freedom of speech is more precious to me than my APA membership. Don’t make me choose. We all know the smell of an I flushed toilet in the White House when we smell it.

    • I hereby diagnose you adjustment disorder for your inability to cope with Hillary losing the election.

      I’m doing that, because as you said, our opinions are more important than APA membership. Have a great day.

    • Why is an APA membership precious at all? They lobby against the best interests of private practitioners (only one APA president in the past couple of decades pushed back against managed care), they publish a ridiculously political and nonscientific diagnostic manual, and take your money at both a local and national level for very little tangible return. They lied about promoting the discredited chemical imbalance theory and they embraced Soviet psychiatry at one time. Many of their Presidents have been KOLs who were involved in some pretty serious research scandals and conflicts of interest. Most of their CME is PGY2 level stuff and it’s a lot easier and cheaper to get better CME on-line from other sources. I haven’t been an APA member in over thirty years and there has been no negative impact.

      But the one thing they did right is the Goldwater Rule. People forget the lawsuits that came out after the 1964 campaign and how bad this makes psychiatry look. Many people won’t see psychiatrists in rural areas because they consider us bicoastal ivory tower eggheads and I can’t really blame them as we are not as a group relatable.

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