"The Presidency should not be used as a platform for proving one's manhood . . ."

"Inwardly he is a frightened person who sees himself as weak and threatened by strong virile power around him . . ."

"Since his nomination I find myself increasingly thinking of the early 1930s . . ."

"Unconsciously he seems to want to destroy himself.  He has a good start, for he has already destroyed the Republican party . . ."

What sound like remarks that could have been made about Donald Trump were actually written by psychiatrists in response to a survey during the 1964 presidential campaign.  This embarrassing incident led to the now-famous Goldwater Rule, which bars psychiatrists from diagnosing public figures long-distance.  Yet in this election cycle physicians are commenting on what they regard as one of the candidate's medical problems without being sanctioned by the American Medical Association.

What explains this difference?  For the answer one has to turn to the historical context of the Goldwater Rule.

The off-beat Fact magazine's September-October 1964 issue was called "The Unconscious of a Conservative."  The editor-publisher, Ralph Ginzburg, opened the issue with a 19-page psychological essay that cited various facts, memoirs, and observations about Senator Barry Goldwater, followed by a number of excerpts from the survey results.  In response to the question whether Goldwater was fit to be president, 2,417 out of 12,356 responded.  Of those, 657 said he was fit, 1,189 said he was not, and 571 said they didn't know enough to answer the question.

Goldwater sued and won. Normally a public figure is not protected against libel. However, in this case the judge found that Ginzburg had malicious intent.  For example, Ginzburg edited some of the supposed quotations from articles and from the psychiatrists.

So the Goldwater Rule was not a response to the legal case.  Even before publication, the medical director of the American Psychiatric Association had warned Ginzburg that the responses were not valid absent a "thorough clinical examination" of Goldwater. Six years later the American Psychiatric Association made that policy official, warning its members not to repeat that mistake.

But why did the American Psychiatric Association go beyond warning its members not to be malicious (something that shouldn't be necessary) and barring any comment on individuals' mental states without examining them?  Why did the American Psychological Association not follow suit?  And why has the American Medical Association not ruled that long-distance medical diagnosis by its members is also subject to sanction?

One reason for the difference is that there's still a stigma attached to mental illness that does not apply to "medical" conditions.  But the backstory of the Goldwater Rule goes deeper than that.

To understand why the psychiatric association stands alone in its tough position, and why the Goldwater Rule is so unique, one has to appreciate the context of the 1960s and 1970s.  At that time psychoanalytically oriented psychodynamic theorizing was the dominant style in psychiatry.  In this period that gave rise to the young Woody Allen's neurotic character, sophisticates were far more obsessed with Freud and Freudianism than they are now.   In the mid-1960s no one gave a thought to eliminating homosexuality from the diagnostic manual, as happened in 1973. Experimental neuroscience was vastly less developed and promising 50 years ago, especially in human beings.  Other than some behaviorist therapy in massive mental hospitals psychoanalysis was the major game in town.

So psychoanalytic psychiatrists had serious clout in 1964, therefore they had much to lose by being embarrassed by association with amateurish psychological assessments and poor political prognostication - not to mention a scurrilous publication like Fact.

But there was yet another reason for professional psychiatry's reaction to the Goldwater debacle.  For decades some psychoanalysts had dabbled in analysis of major figures, including those who were dead.  Freud himself attempted to analyze Dostoevsky and da Vinci.  In Moses and Monotheism he contended that Moses was really an Egyptian prince whose Jewish status was concocted by Jews, guilt-ridden about murdering their father figure.

Psychiatrists had long had mixed feelings about these practices.  At the 1931 annual meeting of the American Psychiatric Association my father, the psychiatrist and psychodrama therapy founder J.L. Moreno, debated Freud's American representative, A.A. Brill, who diagnosed Abraham Lincoln as a manic schizoid personality whose depressive moods stopped short of mental illness.  Turning the tables on Brill, my father questioned Brill's need to engage in the symbolic patricide of the Great Emancipator.  A 2003 historical note in Psychiatric News said that "Moreno tore apart Brill's paper as being based on unproven and unsubstantiated conclusions."

The Lincoln episode made national news as other psychiatrists protested Brill's paper as unfair and even unpatriotic. What my father called "necroanalysis" was long a controversial practice in psychiatry.  Three years after the Goldwater incident a former American diplomat and patient of Freud's, William C. Bullitt, published a psychoanalysis of Woodrow Wilson based on notes he made of conversations about Wilson with Freud.  The book was roundly criticized by psychologist Erik Erikson in the New York Review of Books and by my father on national television.

Analysis of the dead is not a legal violation, but it nonetheless raises the question of fairness as the dead cannot defend themselves.  To analyze a living person without data is not only bad practice, it also runs the risk of making the analyst look foolish if the individual later behaves in a way that the analysis didn't predict.  If Goldwater had become president and didn't start World War III, more than a few psychiatrists would have had egg on their face.

Analyzing a political figure, living or dead, runs the risk of politicizing a whole field.  In the Goldwater case, it was no surprise that many if not most psychiatrists turned out to be liberals who were ill-disposed toward Goldwater's tough rhetoric, but mixing politics with professional expertise was and remains toxic.  On pain of inconsistency, the same standard should be applied to all physicians, regardless of their specialization.

Originally published on the Hastings Bioethics Forum.
 

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