Question: How frankly can psychiatrists speak about the mental health of public figures?
Answer (in part): Psychiatrists who belong to the American Psychiatric Association are constrained in their public comments by the Goldwater rule, which guides them to speak mostly of diagnostic categories and people in general.
As I wrote last week, the American Psychiatric Association was somewhat blindsided in 1964, when their members responded to a survey in Fact magazine concerning the character of Senator Barry Goldwater. The Senator was then running for president against the incumbent, Lyndon Johnson. Senator Goldwater was an unpopular candidate among psychiatrists (and lost the popular election by a landslide). The psychiatrists who responded to the survey described him in various ways. Although some saw him as normal, others perceived him as "paranoid," "schizophrenic," "obsessive," "psychotic," and "narcissistic." Their responses were published in the election issue of Fact.
Roughly six years later, the American Psychiatric Association formulated a section of their medical ethics especially relevant to psychiatrists who wanted to speak out on the mental health of public figures. Because Section 7.3 of the Ethics was widely regarded as motivated by the Fact magazine survey on Senator Goldwater's personality, it became known as "the Goldwater rule." It states:
"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." (cited In Friedman, 2008, p. 1348).
The Goldwater rule has many attractive aspects. For example, it potentially constrains rogue psychiatrists who might be tempted to denounce the mental health of political figures on political bases alone. It also protects politicians from unflattering and potentially erroneous assessments of their character.
On the other hand, I wonder who is to protect the public from unstable and problematic politicians?
The legal scholar Stanley Fish distinguished between psychiatrists and psychologists by emphasizing that psychiatry, as a branch of medicine, is primarily a healing profession. The obligation of psychiatrists is to the well being of their patients.
Psychology, by contrast, includes not only healers, but also scientific researchers. The product of psychology, in Fish's thinking, is knowledge about a person's mental processes and behavioral expressions, as well as how to predict and control such phenomena. The application of such knowledge potentially leads to the well-being of the public over the longer-term.
The eminent psychologist and psychohistorian A. C. Elms views the Goldwater rule as excessively restrictive. Elms is a member of the American Psychological Association and so is not restricted by the Goldwater rule, but given that it is the rule of an allied profession, he is concerned about it. Elms has argued that:
"Throughout their vote-seeking careers, politicians regularly hold themselves up for public inspection, and I think professional psychobiographers have as much right and responsibility to inspect their qualifications for office as journalists and competing politicians do." (p. 252).
Although Elms does not like the Goldwater rule, he does believe that psychiatrists and psychologists should take responsibility for their remarks. Elms deplores "unnecessary and abusive" invasion of privacy, and he advises that those intending to take up such work choose as subjects those that they neither abhor or idealize, but rather, those toward whom they feel some ambivalence.
For psychologists, respecting the person who is being analyzed may provide a better approach than not analyzing at all.
Analyses can go awry and reflect poorly both on those who make erroneous judgments and on those who they judge. Everything in life carries risk, however. Psychiatry survived the Goldwater incident, as did Senator Goldwater himself.
It is worth learning from the incident, but the lessons I draw do not necessarily end up in the same place as the American Psychiatric Association's ethics. I believe there are good reasons to analzye public figures, and that it can be done from afar with some responsibility, if good practices are followed (for example, as with motivational analyses of presdients).
More on the ethics of such analysis-at-a-distance in my next post.
American Psychiatric Association (2008). The principles of medical ethics: Principles with annotations especially applicable to psychiatry. Arlington, VA: American Psychiatric Press Inc, 2008.
Professor Alan Elms dispenses his own ethical guidelines for psychobiographers, described in part above, on page 179 of Elms, A. C. (1976). Personality in politics. New York: Harcourt Brace Jovanovich. He comments on the Goldwater rule on p. 252 of Elms, A. C. (1994). Uncovering lives: The uneasy alliance of biography and psychology. New York: Oxford University Press.
Anonymous (1964, October 2nd). Doctors deplore Goldwater poll. New York Times, p. 20.
Fish, S. (2008, November 9). Psychology and torture. In, "The Opinionator." The New York Times.
Friedman, R. A. (2008). Role of physicians and mental health professionals in discussions of public figures. JAMA, 300, 1348-1350.
Copyright © 2010 John D. Mayer