Mood Swings

A psychiatrist surveys the mind and the wider world

Psychiatrists Can Speak Too

Understanding the Goldwater Rule

In some of my writing about politics and psychology, I have noted that, if some recent and current political leaders say they are mentally healthy, then this supposed mental health may impair their ability to lead.  (See my recent blog post on Mitt Romney, the Republican presidential candidate).

Those who share the ideologies of those politicians have tended to be upset, sometimes citing the "Goldwater Rule", the ethical guideline of the American Psychiatric Association (APA) which was written after a notorious poll of psychiatrists in the 1964 election, in which a majority agreed with the diagnosis of schizophrenia for Senator Goldwater.  Such donning of psychiatric labels for one's political ideology was rejected by the APA,  as part of its Ethics Guidelines.  I have not had to rely on Wikipedia for this information, as some commenators have, since  I was a member of the APA Task Force to Revise the Ethics Guidelines, that met over a number of years, and whose recommendations were incorporated into the current Ethics Guidelines which were published in revised form in 2009.

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The Goldwater Rule clearly had to do with attributing mental illness to current political figures, without adequate basis. Some have argued that psychiatrists should not make any psychological analyses or intepretations of anyone without personally examining such persons.  This extremely broad interpretation is not part of the language of the APA guidelines and certainly not the spirit of the original rule.  (Actually, due to confidentiality, the reverse is usually the case: most psychiatrists can’t comment on persons they treat).

This broad interpretation would mean that Erik Erikson’s books about Gandhi and Martin Luther were unethical; instead they received Pulitzer Prizes. His entire life's work on psychohistory would be deemed immoral.  The biography of Lawrence of Arabia by the psychiatrist John Mack should also have been deemed unethical instead of receiving the Pulitzer.  Sigmund Freud would be judged unethical for his book on Woodrow Wilson.  Robert Jay Lifton's impressive  life work, like his research on Nazi doctors and on the psychology of atomic warfare, would be grounds for ethical imprisonment. Erich Fromm should go to jail for psychologizing about American society and its leaders, and Harry Stack Sullivan, the greatest perhaps of American psychiatrists, should have lost his license for arguing that psychiatrists should actively be involved in commenting on political and social life

To cite the Goldwater Rule in relation to political commentary employing psychological concepts is pure nonsense - an ignorant, but sadly common, misinterpretation of the Goldwater Rule.

On the Ethics Committee, we specifically discussed the Goldwater Rule at length in relation to psychiatrists employed by the government, either in the military or in the CIA, or specialists in political psychology. We concluded that the Goldwater Rule is not violated if someone is making psychological judgments about diagnoses or psychological traits based on a documented psychological rationale, and without a primary political rationale. 

(It is notable that the American Psychological Association, in contrast to the psychiatric group, has no such restrictions. This is why psychologists are often on television commenting on possible psychiatric diagnoses for political figures, whereas psychiatrists rarely do so, and I in particular have refused to do so when requested.)

You can read the APA ethics guidelines here.

The specific section is as follows, on page 7 (and it does not use the phrase "Godlwater Rule" per se on purpose; these new ethics guidelines wanted to go beyond the constraints of the 1964 debate):

“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.”

Nowhere - either in the APA Ethics Guidelines, the review by our task force, or anywhere in the psychiatric literature –  is the claim made that the spirit of the Goldwater Rule applies to claims that someone is mentally healthy, not mentally ill or abnormal in some way. The Goldwater Rule would only apply if the claim here is that Gov. Romney would object to being deemed mentally healthy, and would like to state that he has a mental illness instead. In fact, he and almost all politicians claim to be quite mentally healthy, and thus I am making no psychiatric judgments different from what the candidate himself says. I am only drawing psychological inferences based on the meaning of mental health for leadership, based on research on that topic. The ethics guidelines specifically allow for such judgments. Again on page 7 above:

“Section 7 A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. 1. Psychiatrists should foster the cooperation of those legitimately concerned with the medical, psychological, social, and legal aspects of mental health and illness. Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government. A psychiatrist should clarify whether he/ she speaks as an individual or as a representative of an organization. Furthermore, psychiatrists should avoid cloaking their public statements with the authority of the profession (e.g., ―Psychiatrists know that...).”

For these reasons, misinterpretations of the Goldwater Rule are irrelevant to the judgment that some politicians who claim to be mentally healthy may not be great crisis leaders.   I will add that in my work I never have diagnosed any living political figure with a mental illness, specifically following the spirit of the Goldwater Rule in that respect.

Let's not hide our politics behind illogic: Confidentiality precludes talking about your patients, and this distorted Goldwater Rule means you can never talk about anyone else.  How does that make sense?

Psychiatrists have a right to speak. The first amendment applies to us as well as everyone else, within legal constraints of confidentiality and professional constraints of good judgment.  The APA Ethics statement clearly allows the kind of political and social commentary I've provided. With Erikson and Freud and Fromm and Sullivan and Lifton - I'll take my stand. 

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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