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Wednesday, August 10, 2016

Analyze zis, to your hearts' content! No "Goldwater rules"! We use the "Hot water rules"! - The American Psychiatric Association issues a warning: No psychoanalyzing Donald Trump - WP

Analyze zis, to your hearts' content! 

 The APA, scientifically and intellectually (and possibly financially) bankrupt, has no right to issue moral or ethical rules, regulations, prescriptions, and proscriptions on political matters (see also politicization of psychiatry). It is clear that psychiatrists, psychologists or other professionals in the mental health field, just like any other experts and non-experts, with or without strings of letters attached to their names, just render their opinions from the non-clinical point of view, without any intentions of diagnosing the candidates for clinical purposes or offering their clinical interventions. The issue of psychiatrically diagnosing or non-diagnosing them is irrelevant, since the current system of the so-called psychiatric diagnosis is a myth and fiction, without any sufficient scientific basis in it, and it is more an attempt at the common language in professional communications, billing and research (and almost irrelevant in research either, as it was recently confirmed). Therefore the ethical standards of clinical practice are not applicable in this situation. The attempt to insist on them might be viewed as asserting "authority, or ownership, or authorship rights" to some exclusive descriptive diagnostic language, as if it were from their "proprietary" diagnostic labeling manual, which simply is a much evolved, decorated and "elaborated" version of the Kraepelinian "Table of Contents". The attempt to assert the exclusive rights to the use of the "professional language" and the use of the "professional labeling" system might raise the First Amendment concerns regarding this claimed monopoly on language. APA would be better off looking into their own problems and issues, rather than lecturing the public and journalists from its assumed high position of "medical (or any other) non-authority". This subject belongs more to psychohistory and social and political psychology than to the clinical disciplines and they have their own rules or "no-rules", whatever helps them to understand and to explain to themselves and others the subjects of their studies. They speak many different languages, mostly non-clinical, and from the various disciplines. 
There are no reasons to sprinkle these subjects in motion with the dead flowers' scents of the "Goldwater rules" and such; these rules are senseless, akin to censorship, and unenforceable. 
These rules might have, at least hypothetically, a restrictive and stifling effect on  political speech and discussions, in addition to being possibly unconstitutional. 
The political operators of our times (and the times past), unburdened by the lack of lettered strings, are more fond of the "Hot water rules": put them all into the hot water, with or without the appropriate (or inappropriate) analysis, and see what the outcome of this crucible will be. 
One more point from the "long distance diagnosis" issues: If the use of video interviews, vignettes, etc., as educational and testing tool, including for the "diagnostic skills", is broadly used and accepted, why the similar biographical materials cannot be used for essentially the same task, clinical or not, of understanding and assessment of the person, in this case, a politician, and with all the possible implications? 
Evaluations and assessments are task-specific, and some of them might have important significance, for example in the National Security matters; and some of them might be used in strategic intelligence assessments. 
Michael Morell's op-ed, for example, may be considered as one of the most notable pieces of writing (and action!) in the area of strategic intelligence. He had no need for the psychiatric assessment system at all in this instance. He had and cited his and his services' own assessment system, which is concise, clear, common sense, and convincing. 

 Michael Novakhov

 Links: 

 The Ethics of APA’s Goldwater Rule

Jerome Kroll, MD, and Claire Pouncey, MD, PhD
"Section 7.3 of the code of ethics of the American Psychiatric Association (APA) cautions psychiatrists against making public statements about public figures whom they have not formally evaluated. The APA’s concern is to safeguard the public perception of psychiatry as a scientific and credible profession. The ethic is that diagnostic terminology and theory should not be used for speculative or ad hominem attacks that promote the interests of the individual physician or for political and ideological causes. However, the Goldwater Rule presents conflicting problems. These include the right to speak one’s conscience regarding concerns about the psychological stability of high office holders and competing considerations regarding one’s role as a private citizen versus that as a professional figure. Furthermore, the APA’s proscription on diagnosis without formal interview can be questioned, since third-party payers, expert witnesses in law cases, and historical psychobiographers make diagnoses without conducting formal interviews. Some third-party assessments are reckless, but do not negate legitimate reasons for providing thoughtful education to the public and voicing psychiatric concerns as acts of conscience. We conclude that the Goldwater Rule was an excessive organizational response to what was clearly an inflammatory and embarrassing moment for American psychiatry." J Am Acad Psychiatry Law 44:226 –35, 2016 

______________________________

» Goldwater rule - Google Search
09/08/16 11:35 from Mike Nova's Shared Newslinks
mikenova shared this story . The Goldwater rule is the informal name for a precept of medical ethics promulgated by the American Psychiatric Association (APA). It forbids psychiatrists from commenting on individuals' mental state without...
» Goldwater rules - Google Search
09/08/16 11:34 from Mike Nova's Shared Newslinks
mikenova shared this story . The Goldwater rule is the informal name for a precept of medical ethics promulgated by the American Psychiatric Association (APA). It forbids psychiatrists from commenting on individuals' mental state without...
» Goldwater Rule: Don't Discuss Trump's Mental State
09/08/16 11:33 from Mike Nova's Shared Newslinks
mikenova shared this story from LawNewz.  With all of the controversial statements that  Donald Trump has made during his Presidential campaign, people have begun to speculate about his mental health. Not just jests, like, R...
» Trump, the Goldwater Rule, and Trading on Authority
09/08/16 11:33 from Mike Nova's Shared Newslinks
mikenova shared this story from PrawfsBlawg. « Law, Psychology, and Impartiality | Main | Veep, S5E8 » Friday, June 10, 2016 Trump, the Goldwater Rule, and Trading on Authority It has become a truism that a significant change i...
» Psychiatric Insights, and Ethics, Blurred From Afar
09/08/16 11:32 from Mike Nova's Shared Newslinks
mikenova shared this story . No sooner had Dominique Strauss-Kahn been arrested on sexual assault charges in New York than a parade of psychiatrists stepped forward to offer their expert opinion in the news media. Mr. Strauss-Kahn, who s...
» The Goldwater Rule | Psychology Today
09/08/16 11:29 from Mike Nova's Shared Newslinks
mikenova shared this story . 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 comm...
» Psychiatrists Can’t Tell Us What They Think About Trump
09/08/16 11:27 from Mike Nova's Shared Newslinks
mikenova shared this story from Maggie Koerth-Baker – FiveThirtyEight. In a speech last week, Hillary Clinton took her befuddlement with Donald Trump and dropped it squarely at the feet of America’s mental health professionals. ...
» Why breaking it is Unethical and Irresponsible
09/08/16 10:06 from Mike Nova's Shared Newslinks
mikenova shared this story . Every four years, the United States goes through a protracted elections process for the highest office in the land. This year, the election seems like anything but a normal contest, that has at times devolved...
» Trump, in series of scathing personal attacks, questions Clinton’s mental health - The Washington Post
09/08/16 09:53 from Mike Nova's Shared Newslinks
mikenova shared this story .
» Hundreds of mental health deaths may not have been investigated
09/08/16 09:23 from Mike Nova's Shared Newslinks
mikenova shared this story from News. None





Goldwater rule - Google Search
Tuesday August 9th, 2016 at 11:35 AM

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The Goldwater rule is the informal name for a precept of medical ethics promulgated by the American Psychiatric Association (APA). It forbids psychiatrists from commenting on individuals' mental state without examining them personally and being authorized by the person to make such comments.

Goldwater rule - Wikipedia, the free encyclopedia

Goldwater rules - Google Search
Tuesday August 9th, 2016 at 11:34 AM

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The Goldwater rule is the informal name for a precept of medical ethics promulgated by the American Psychiatric Association (APA). It forbids psychiatrists from commenting on individuals' mental state without examining them personally and being authorized by the person to make such comments.

Goldwater rule - Wikipedia, the free encyclopedia

<a href="https://en.wikipedia.org/wiki/" rel="nofollow">https://en.wikipedia.org/wiki/</a>Goldwater_rule
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Goldwater Rule: Don't Discuss Trump's Mental State
Tuesday August 9th, 2016 at 11:33 AM

LawNewz
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Trump via screengrab With all of the controversial statements that Donald Trump has made during his Presidential campaign, people have begun to speculate about his mental health. Not just jests, like, “He must be crazy.” People are actually trying to diagnose the guy.
Democratic Representative Karen Bass went to far as to start a petition claiming that Trump might have Narcissistic Personality Disorder, and that Republicans should make Trump get a psychological evaluation “to determine his mental fitness for the job.”
But the American Psychiatric Association is warning professionals not to join in. This has been an issue during elections since 1964, when Fact magazine published the results of a survey they took of psychiatrists, asking whether Republican Presidential candidate Senator Barry Goldwater was psychologically fit for the position. 2,417 people responded, with 1,189 saying no. Goldwater lost to President Lyndon Johnson in a landslide.
The ethical issue was raised that professionals should not weigh in with any kind of evaluation without ever examining the subject. In 1973, the “Goldwater Rule” was published in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. 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.”
Dr. Maria A. Oquendo, president of the APA, published an article telling her fellow doctors that “[t]he unique atmosphere of this year’s election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible.” Oquendo added that breaking the rule is potentially stigmatizing, and warned that if they did so, their patients may lose faith in them as well.
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Trump, the Goldwater Rule, and Trading on Authority
Tuesday August 9th, 2016 at 11:33 AM

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Friday, June 10, 2016

Trump, the Goldwater Rule, and Trading on Authority

It has become a truism that a significant change in the ecology of public intellectuals in the past decades has been that where once many public intellectuals were free-standing writers with no "official" position, a lot of them have since moved into the academy. (To be clear, many public intellectuals are academics, but most academics are not public intellectuals.) It has been a related but separate concern--of mine, at least, and I'm sure I'm not alone in this--that many academics and other professionals are eager to trade on their authority and/or credentials when making public statements about matters of public concern, whether their expertise has anything to do with the particular statement or not. In this they are often abetted by the press, for its own reasons. In the legal academy this comes up in discussion of whether and when law professors should join amicus briefs or sign letters and statements, but it certainly has wider application. The two points are nicely connected in a couple of recent stories.
Section 7.3 of the American Psychiatric Association's Principles of Medical Ethics, the so-called "Goldwater Rule," 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.

It's an entirely reasonable professional rule, calling to mind, for instance, Senator Frist's silly long-distance diagnosis of Terri Schiavo. Similar strictures cover dues-paying 
psychologists
. It has always drawn criticism and the Trump candidacy is re-raising the issue, as in 
this article
 in FiveThirtyEight. (And 
here
 is an earlier, non-Trump-related defense of the rule.) As the article notes, a recent 
paper
in the Journal of the American Academy of Psychiatry and the Law Online criticizes the rule, arguing that it "is not only unnecessary but distracts from the deeper dictates of ethics and professionalism." In part, the authors argue that the rule protects the interests of the profession over the psychiatrist's own moral commitments, and that "psychiatrists have a positive obligation to speak publicly in many circumstances, and the right to speak out in others." The writer of the FiveThirtyEight piece interviewed the author and summarizes it in part like this:
Kroll and his co-author, independent clinical psychiatrist Claire Pouncey, object to the way the rule stifles a psychiatrist’s ability to speak his or her mind. Certainly, Pouncey told me, psychiatrists shouldn’t run around shooting their mouths off about things they haven’t deeply studied. But it’s impossible, she said, to distinguish between the psychiatrist as a professional and the psychiatrist as a person — and that person might feel a very real ethical obligation to talk about their perspective on the mental health of a public figure angling for a position of power over the whole country. “We don’t dispute the spirit of the law,” she said. “But it’s not a real distinction and it shouldn’t be upheld by a professional body.” 
Both articles make some interesting points, especially about the non-enforcement of the rule, which with the rise of Trump's candidacy is going to be violated with increasing alacrity. But--without wanting to exceed my own expertise--it seems like a pretty sound rule to me. I suspect that one should always be suspicious whenever a professional talks about "the deeper dictates of ethics and professionalism." I also think Dr. Richard Friedman, in the Times piece I link to above defending the rule, is right to say that engaging in this kind of long-distance, drive-by diagnosis risks intellectual dishonesty.
The commentaries note that a psychiatrist or psychologist is still free to say certain things publicly, short of offering an individual diagnosis. Perhaps that's a mistake and the rule should be stricter. But at the least it means the rule's bite is not that great. And it does not appear to prevent a mental health professional from "speak[ing] his or her mind." They can do so as citizens; they simply can't do so as professionals, in a way that specifically invokes their supposed expertise to buttress their opinions and phrases it as a genuine diagnosis of an individual. The argument ad Hitlerum, which often is so unhelpful, seems useful here in judging how necessary it is to get rid of the rule. Psychiatrists, psychologists, and everyone else should have spoken out or taken action against Hitler and National Socialism, and taken other actions that have nothing to do with being mental health professionals, such as running for office, protesting, taking up arms, or assassinating him. But a statement like, "If only I had been able to offer a public mental health diagnosis of Hitler, despite never having examined him, all this could have been avoided," is clearly nonsense, and one that betrays a sort of excessive professional amour-propre at that.
It seems to me, then, that what those professionals who have spoken out, either in violation of the rule or arguing for repeal of the rule, want is not to be able to speak their conscience, but to be able to speak their conscience more successfully, by trading on their supposed expertise and authority, even when that expertise is of dubious relevance. They might be able to persuade (or manipulate, or browbeat) people more effectively if they were speaking down to them as "experts," rather than speaking to them on an equal level as fellow citizens. Our society increasingly distrusts professionals, experts, and other authoritative individuals and institutions, but it is still a credentialist society in which expertise and authority carry some additional weight. At the same time, it is one in which many professionals and professional bodies increasingly argue that they should take institutional positions that are essentially political and have little to do with their expertise as such. That's a mistake, in my view, and if professional individuals or bodies are going to make it, they should at least say that they are advocating a specifically political position that has nothing to do with their profession as such or its "deeper dictates."
In any event, the urge to trade improperly and without serious foundation on authority seems endemic, in a way that speaks to the problems with a credentialist society and its abuses. It says a lot about the rather phony use of experts in the news media as a vehicle for reporters to advance some argument rather than making it themselves. It also speaks to the erroneous conviction of many professionals, and many academics, that subject-matter expertise is the same as general intelligence or wisdom, and that because they have a political conviction about some issue that can be phrased conveniently in terms of their expertise, that opinion ought to have some special weight. That is hubris. It also suggests that even professionals themselves think of their professional status as a tool to be used and misused, not as a set of strictures and responsibilities that go along with professionalism and rightly limit the actions of those who take their professional role seriously. This kind of trading on authority is likely to exacerbate rather than reduce the general public distrust of experts, authorities, and institutions, and it should. There are arguments for and against the proposition that Trump's relative success so far indicates a kind of populist or working-class pushback of elites, and I won't weigh them here; but this kind of trading on authority does seem to encapsulate the kind of elite behavior that is likely to produce just such a pushback. 
Problems with trading on authority are in some ways greater, and in some ways lesser or more complex, with lawyers and legal academics. On the one hand, what they have "expertise" in is often closer in substance to politics and civic involvement, and so it's harder to frame a rule of conduct that would limit them too sharply in what they say. On the other hand, and for more or less the same reasons, they engage with great frequency in the public issuance of opinions that are dressed up in authority, yet do not draw in a serious way on any actual expertise. And, again precisely because so many political issues in the United States can be translated into legal terms, and because they are favorite go-tos for the press, they are asked to weigh in as "experts" on various issues far more often than, say, psychiatrists or engineers. Nothing stops them from asking the interviewer to omit their professional status from the description of them in the story, or to insist that the story make clear that they are speaking as citizens and not as experts, and that their opinion is not especially strongly related to their actual expertise. I suppose then they just wouldn't be quoted at all, but that's hardly a bad thing. One might say that readers already understand this and can disregard their opinions, but that just invites the question why the "experts" aren't explicit about it to avoid any misunderstanding--and the answer to that, I think, is that they want to trade on their authority, or perhaps have an overinflated sense of their actual authority and expertise. Legal academics ought to be wary and punctilious about this sort of thing. And the press ought to curb its unhealthy and lazy addiction to quoting law professors, except on questions that genuinely require expert opinion and on which the person interviewed is actually an expert. 
I have in mind as a partial and imperfect example in the legal field the Adam Liptak column last week in the Times on Trump and the rule of law. Mark Tushnet wrote about it last week, twice and in his usual enjoyable way. The story got a lot of Facebook prominence in my feed, unsurprisingly given who my friends are, and more surprisingly (in some ways and not others) got page one play. Headlined "Donald Trump Could Threaten U.S. Rule of Law, Scholars Say," it featured quotes backing up that assertion by what it called "legal experts across the political spectrum." In reality, this meant several politically conservative (by academic standards, anyway) and/or libertarian legal scholars and advocates. With one very important exception, I don't disagree with the general conclusion. And I believe the phrase "rule of law" and "First Amendment" has somewhat more content than Mark thinks it does. He appears to think "rule of law" is an essentially vacuous phrase with "no there there," whereas I think it's a mostly windy phrase with little there there.
Even if there's more there than that there, however, the article didn't really ask difficult questions about the rule of law and, at least on the rule of law questions, didn't actually ask questions that called for any particular expertise about the rule of law beyond that possessed by an average somewhat-informed citizen. There are relevant questions that might call for more careful expert examination and benefit from more expert speculation--specifically, whether and to what extent the larger constitutional, political, and bureaucratic structure will constrain Trump's ability to act effectively in a rule-of-law-threatening manner, in the way summarized by President Truman. A Trump presidency is bound to raise like never before the question whether those who staff the administrative state are creatures of the president or their own institution. I suspect something like uncivil obedience will be a highly relevant concept to executive-branch workers if Trump wins. This question is raised in the column, sort of, but given short shrift and not much expert consideration. Leaving aside the motives and good faith of the people quoted, I think it's hard to read the column in any other way than as one that trades on authority for persuasive purposes in service of the author's goals. That reading is even harder to avoid given the pronouncement that the article is based on discussions with experts from "across the political spectrum," and the contrasting reality that it uses conservative and libertarian law professors and advocates, clearly in order to persuade conservative and libertarian readers of Liptak's column, if any such exist. The piece is essentially a persuasive exercise, and trading on authority is clearly a key part of its persuasive arsenal. 
Posted by Paul Horwitz on June 10, 2016 at 11:35 AM in Paul Horwitz | Permalink

Comments


I think there's a more fundamental reasoning issue lurking behind these kinds of restrictions. I'm probably going to fumble this a bit, but I see the distinction as being between making a public statement that is a pure argument from authority/doctrine and making a public statement that is based at least in part upon specific data and warrants drawn from profession/laboratory-standard data-gathering methods (however filtered through doctrine). In a sense, this is an attempt to pretermit Michelson-Morley-type fiascos by imposing a "professional standards" restriction on what can be argued in which forum under which contextual circumstances.
Whether this is "right" or "appropriate" is a separate question for a separate time; it is a rule intended to protect the profession from the consequences of "too many" Dr Oz-type charlatans by shutting up everyone in contexts prejudged as too dangerous. I suppose it could be considered just another "rules versus standards" situation in which a community-favoring rule was chosen; comparison to the military officer combined-rule-and-standard regarding conflicts of interest (roughly, if something appears to be/create a conflict of interest, treat it as an actual conflict of interest unless and until cleared by investigation by a trained and disinterested third party who issues a written clearance) is both instructive and — for those of us who started out as line officers before being corrupted by law school — rather disheartening.
Posted by: C.E. Petit | Jun 11, 2016 10:34:14 AM

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Psychiatric Insights, and Ethics, Blurred From Afar
Tuesday August 9th, 2016 at 11:32 AM

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No sooner had Dominique Strauss-Kahn been arrested on sexual assault charges in New York than a parade of psychiatrists stepped forward to offer their expert opinion in the news media.
Mr. Strauss-Kahn, who subsequently resigned as chief of the International Monetary Fund, will experience “a terrible grief because he is in prison,” said one. Another offered that he would have “terrible mourning” for “the loss of social status, image and glory.”
Of course, it’s only natural for the media to seek comment from experts. But as a psychiatrist, I cringe at statements like these, for they cross an ethical line that goes back to a presidential campaign nearly half a century ago.
Just before the 1964 election, a muckraking magazine called Fact decided to survey members of the American Psychiatric Association for their professional assessment of Senator Barry Goldwater of Arizona, the Republican nominee against President Lyndon B. Johnson.
Ralph Ginzburg, the magazine’s notoriously provocative publisher, had heavily advertised the issue in advance, saying it would call Mr. Goldwater’s character into question.
A.P.A. members were asked whether they thought Mr. Goldwater was fit to be president and what their psychiatric impressions of him were. It was not American psychiatry’s finest hour.
The survey, highly unscientific even by the standards of the time, was sent to 12,356 psychiatrists, of whom 2,417 responded. The results were published as a special issue: “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.”
The psychiatrists’ assessment was brutal. Half of the respondents judged Mr. Goldwater psychologically unfit to be president. They used terms like “megalomaniac,” “paranoid” and “grosslypsychotic,” and some even offered specific diagnoses, including schizophrenia and narcissistic personality disorder.
Only 27 percent of the respondents said Mr. Goldwater was mentally fit, and 23 percent said they didn’t know enough about him to make a judgment.
There were several attempts at a psychodynamic formulation of Mr. Goldwater’s character. One unsigned comment called the candidate “inwardly a frightened person who sees himself as weak and threatened by strong virile power around him,” and added that “his call for aggressiveness and the need for individual strength and prerogatives is an attempt to defend himself against and to deny his feelings of weakness.”
Say what you will about their motivation, these doctors had given very specific and damaging psychiatric opinions, using the language and art of their profession, about a man whom they had not examined and who surely would not have consented to such statements.
The remarks were immediately condemned by both the American Medical Association and the A.P.A., and Mr. Goldwater brought a $2 million libel suit against Fact and Mr. Ginzburg. The Supreme Court awarded the senator $1 in compensatory damages and $75,000 in punitive damages — and, more important, set a legal precedent that helped change medical ethics for good.
In 1973, the A.P.A. defined a set of requirements for communicating with the media — the Goldwater rule — stating that psychiatrists can comment on mental health issues in general, but that it is explicitly unethical for them to offer a professional opinion about an individual without directly examining that person and getting his or her permission to comment.
So it would be fine for a psychiatrist to say that someone who experiences hallucinations and delusions appears psychotic, but to offer a diagnosis of schizophrenia would cross the line.
The distinction between general description and diagnosis may seem like splitting hairs. But for two reasons, the Goldwater rule is just as important today as it ever was.
First, it is intellectually dishonest for a mental health professional — or any physician — to give a diagnosis without examining the patient. A professional opinion is supposed to reflect a thorough and rigorous evaluation of a patient and all relevant clinical data obtained under the protection of strict confidentiality. Anything short of that misleads the public about what constitutes accepted medical practice and invites distrust of the profession as a whole.
Second — and especially timely as we enter another presidential campaign — the Goldwater rule prevents the misuse of medical authority as a political weapon to denigrate an opponent.
Of course, there are exceptions to all rules. Patient confidentiality is not absolute, for example: If a patient of mine told me he was thinking of killing someone, I would have an ethical and legal duty to violate confidentiality and warn both the person at risk and the police.
And one could reasonably argue that an exception should be made for psychiatric profiles of foreign political leaders, which United States intelligence services (and those of other countries) have been doing at least since World War II. An evaluation of Col. Muammar el-Qaddafi of Libya, for example, might well be in the national interest because it could help guide how we deal with this difficult figure.
Colonel Qaddafi’s ruthlessness, near-delusional grandiosity and love of absolute power all suggest a severe personality disorder called malignant narcissism. Because people with the disorder have a defect in moral conscience, they lack empathy, so there is no room to appeal to them on human terms. Instead, they are more likely to respond to the right mix of flattery, power and a credible threat of force.
Whether the foregoing diagnosis is correct or useful, I have no idea, but it is ethically defensible.
Despite what some of us might believe, though, none of our celebrities or politicians is likely to rise to the level of a national threat that justifies violation of the Goldwater rule.
It’s not sexy and probably won’t make headlines, but experts should just stick to the facts and educate the public, and leave the pleasure of diagnostic speculation to the amateurs.
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The Goldwater Rule | Psychology Today
Tuesday August 9th, 2016 at 11:29 AM

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Question: How frankly can psychiatrists speak about the mentalhealth 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 medicalethics 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 (link is external)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.
Notes
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
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Psychiatrists Can’t Tell Us What They Think About Trump
Tuesday August 9th, 2016 at 11:27 AM

Maggie Koerth-Baker – FiveThirtyEight
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In a speech last week, Hillary Clinton took her befuddlement with Donald Trump and dropped it squarely at the feet of America’s mental health professionals. “I’ll leave it to the psychiatrists to explain his affection for tyrants,” she said, in response to comments Trump had made marveling atthe political effectiveness of North Korean dictator Kim Jong Un.
She’s not the first person to suggest the Republican presidential candidate could use a session on the couch. Back in November, Vanity Fair got five psychiatrists and psychologists to weigh in on Trump’s mental health. But while Clinton is free to imply anything she wants about her opponent’s sanity, the experts in sanity (or lack thereof) are supposed to keep mum. Both psychiatrists and psychologists operate under ethical rules that prevent them from offering professional diagnostic opinions about the mental health of public figures they have not personally examined. The American Psychiatric Association’s version of this is known as the Goldwater Rule — named for another polarizing Republican presidential candidate.
The rule has its roots in the September/October 1964 issue of a magazine called Fact, which was entirely devoted to parsing the results of a survey the editors had sent to more than 12,000 psychiatrists. The survey only had one question: “Do you believe Barry Goldwater is psychologically fit to serve as president of the United States?”
Most of the psychiatrists — 9,939 of them, to be exact — didn’t respond. Of those who did, 571 said they didn’t know enough about Goldwater to answer, and another 657 declared him fit as a fiddle. But 1,189 psychiatrists said “no,” and many of them added colorful commentary that the magazine reprinted under a headline (“FACT: 1,189 Psychiatrists Say Goldwater is Psychologically Unfit to Be President!”) that conveniently left out the fact that they didn’t represent a majority opinion. The Republican presidential candidate was called “paranoid” and “a dangerous lunatic.” One respondent suggested that Goldwater had “a stronger identification to his mother than to his father” — fighting words in 1964 America, apparently.
In the aftermath, Goldwater sued Fact (and won), Fact went defunct, and the American Psychiatric Association tried to make sure that none of this would ever happen again. The result was Section 7.3 of the APA’s Principles of Medical Ethics:
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.
Or, as Ezra Griffith, professor emeritus of psychiatry at Yale and a member of the APA’s Ethics Committee, put it: “If you’re going to talk to the press and spread stuff on your opinions, it’s important to at least say very clearly, ‘I have not examined this individual and therefore much of what I’m saying is sort of mystical black magic.’ ”
The Goldwater Rule is the reason psychiatrists who comment in celebrity gossip magazines always first clarify that they have not treated Joaquin Phoenix, Lisa Marie Presley, Britney Spears, etc. It’s also why The Atlantic’s June cover story — a long personality analysis of Donald Trump written by Northwestern University psychologist Dan McAdams — was very careful to stay far away from the realm of medical diagnosis.
The idea of psychoanalyzing public figures — especially public figures you don’t like — can be appealing, McAdams told me. We feel like we have lots of information about them and who they are. In fact, he has received angry letters from readers upset that he didn’t diagnose Trump with a personality disorder. But mental health is still health, he said, and labeling Trump from afar would be no different than diagnosing President Obama with leukemia, sight unseen.
What’s more, McAdams said, the basis of diagnosing a mental health disorder is that the person feels disordered. Human behavior and personality exist on a spectrum and the thing that makes the difference between, say, somebody who is a bit scatterbrained and somebody with ADHD is that the latter is debilitated by the symptoms they experience and has trouble functioning in society. And it’s hard to make a case for that being true of somebody successfully running for president of the United States. “Whether you like him or not, he seems to function,” McAdam said.
As evidenced by the Vanity Fair, story, however, not all mental health professionals believe it’s that clear cut. What’s more, disagreement over the Goldwater Rule isn’t as simple as “here’s what psychiatrists believe and here are a few bad apples who break the rules.” Last week, the Journal of the American Academy of Psychiatry and the Law (JAAPL) published a paper questioning the foundations of the Goldwater Rule and arguing that the rule stifles psychiatrists’ ability to speak their conscience. And that perspective is nothing new. The Goldwater Rule has been controversial within the field of psychiatry since it was enacted in 1973, said Brian Cooke, a forensic and clinical psychiatrist at the University of Florida who wrote a 2014 paper, also published in JAAPL, arguing in favor of the rule.
The controversy centers around two things. First, said Jerome Kroll, professor emeritus of psychiatry at the University of Minnesota and an author of the 2016 paper, it’s disingenuous to ask psychiatrists to tiptoe around the diagnosing of public figures while still commenting on diagnoses — talking about narcissism, but not about whether Donald Trump is a narcissist, for instance. Especially when psychiatrists are allowed to diagnose dead people — a specialty called psychohistory — using data that’s not much different from what someone might use to diagnose the living Trump.
Second, Kroll and his co-author, independent clinical psychiatrist Claire Pouncey, object to the way the rule stifles a psychiatrist’s ability to speak his or her mind. Certainly, Pouncey told me, psychiatrists shouldn’t run around shooting their mouths off about things they haven’t deeply studied. But it’s impossible, she said, to distinguish between the psychiatrist as a professional and the psychiatrist as a person — and that person might feel a very real ethical obligation to talk about their perspective on the mental health of a public figure angling for a position of power over the whole country. “We don’t dispute the spirit of the law,” she said. “But it’s not a real distinction and it shouldn’t be upheld by a professional body.”
All the more so because, as far as anyone I interviewed can tell, it’s never been enforced. What’s the point of having a law on the books that has no teeth?
So, does that mean Pouncey would take a stab at diagnosing Donald Trump? She declined the opportunity, saying instead that Trump behaves so extremely that he makes her uncomfortable as a person.
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Why breaking it is Unethical and Irresponsible
Tuesday August 9th, 2016 at 10:06 AM

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Every four years, the United States goes through a protracted elections process for the highest office in the land. This year, the election seems like anything but a normal contest, that has at times devolved into outright vitriol. The unique atmosphere of this year’s election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible.
Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.
Maria A. Oquendo, M.D.
Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as “the Goldwater Rule,” which prohibits psychiatrists from offering opinions on someone they have not personally evaluated. The rule is so named because of its association with an incident that took place during the 1964 presidential election. During that election, Fact magazine published a survey in which they queried some 12,356 psychiatrists on whether candidate Sen. Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency.
While there was no formal policy in place at the time that survey was published, the ethical implications of the Goldwater survey, in which some responding doctors even issued specific diagnoses without ever having examined him personally, became immediately clear. This large, very public ethical misstep by a significant number of psychiatrists violated the spirit of the ethical code that we live by as physicians, and could very well have eroded public confidence in psychiatry.
We live in an age where information on a given individual is easier to access and more abundant than ever before, particularly if that person happens to be a public figure. With that in mind, I can understand the desire to get inside the mind of a Presidential candidate. I can also understand how a patient might feel if they saw their doctor offering an uninformed medical opinion on someone they have never examined. A patient who sees that might lose confidence in their doctor, and would likely feel stigmatized by language painting a candidate with a mental disorder (real or perceived) as “unfit” or “unworthy” to assume the Presidency.
Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.
The Goldwater Rule is published as an annotation in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. I encourage you all to read the full text of the rule below, and keep it in mind during this election cycle, and other events of similarly intense public interest.
The “Goldwater Rule:”

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.”
Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry
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Trump, in series of scathing personal attacks, questions Clinton’s mental health - The Washington Post
Tuesday August 9th, 2016 at 9:53 AM

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Hundreds of mental health deaths may not have been investigated by Laura Donnelly
Tuesday Augu

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Commented in WP:
Michael Novakhov
1:24 PM EDT
Analyze zis, to your hearts' content! 
The APA, scientifically and intellectually (and possibly financially) bankrupt, has no right to issue moral or ethical rules, regulations, prescriptions, and proscriptions on political matters (see also politicization of psychiatry). It is clear that psychiatrists, psychologists or other professionals in the mental health field, just like any other experts and non-experts, with or without strings of letters attached to their names, just render their opinions from the non-clinical point of view, without any intentions of diagnosing the candidates for clinical purposes or offering their clinical intervention. The issue of psychiatrically diagnosing or not-diagnosing them is irrelevant, since the current system of the so-called psychiatric diagnosis is a myth and fiction, without any sufficient scientific basis in it, and it is more the attempt at the common language in professional communications, billing and research (and almost irrelevant in research either, as it was recently confirmed). Therefore the ethical standards of clinical practice are not applicable in this situation. APA would be better off looking into their own problems and issues, rather than lecturing the public and journalists from its assumed high position of "medical (or any other) non-authority".


The American Psychiatric Association issues a warning: No psychoanalyzing Donald Trump 




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