The American Psychiatric Association (APA) takes a hard line position when it comes to psychiatrists asserting a public opinion about an individual’s mental health or mental illness.
Since 1973, the APA has prohibited psychiatrists from offering professional public opinions or diagnoses of individuals they have not assessed. This position, known as the Goldwater Rule, came about due to an incident that occurred in 1964 where thousands of psychiatrists were asked by a magazine to weigh in on Senator Barry Goldwater’s mental fitness as a presidential candidate. Many psychiatrists responded that Goldwater was unfit to assume the presidency, and some even offered clinical diagnoses of him. The harm that came to Goldwater resulted in a libel suit against the magazine, which he prevailed on, and the inception of the Goldwater Rule.
The Goldwater Rule is published in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, and reads as follows:
“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.”
The Goldwater Rule is consistent with the ethical and aspirational objectives embodied in the physicians’ Hippocratic Oath. But what about psychologists, professional counselors, marriage and family therapists, social workers and others, who, as mental health professionals, are trained to diagnose and treat patients? Shouldn’t they too be held to these standards? In my opinion, the answer is unequivocally yes. I and my peers should be accountable for what we say publicly about any individual, and should honor the Goldwater Rule to avoid the risk of doing harm – whether to a presidential candidate, athlete, actor or any other public figure.
This presidential election cycle is an excellent example of what could actually happen when mental health professionals use their training and credentials to inappropriately speak out about a public figure.
Simply do an online search of Donald Trump and follow it with “therapist diagnosis,” “narcissistic personality disorder,” “mentally ill,” “bipolar disorder” or a number of other mental disorders, and you will find the opinions of many.
Throughout the presidential campaign, media pundits conjectured without restraint on the meaning of Trump’s behaviors and statements. While it’s not uncommon for journalists to turn to mental health professionals on this topic, and while Trump certainly invited the scrutiny, these sort of arm chair diagnoses by mental health professionals are not appropriate and ought to stop.
As a clinical psychologist, I was deeply offended by the biased, anti-Trump commentaries published in the media by many of my fellow mental health professionals. It wasn’t a matter of politics for me, but rather about professionalism.
The bias is indisputable in that article after article described Trump’s possible diagnoses and the anxiety his statements and actions were causing their patients. While there were a smattering of articles on Hillary Clinton’s actions and behaviors, this was nothing compared with the number and the negative tone of those about Trump.
This year I’ve had many patients who brought up politics while in therapy. About half of them were upset by and complained about Trump, and the other half were upset by and complained about Clinton. Am I the only psychologist in America who listened to patients with negative thoughts and feelings about Hillary Clinton? I doubt it, and my patient experience is consistent with the presidential election results.
Two conclusions can to be drawn for why articles about patients who were upset about Clinton weren’t written or published much: (1) many of the mental health professionals who wrote those articles had an agenda, specifically an anti-Trump agenda; and (2) the media as a whole did not choose to solicit or publish articles by mental health professionals who had something bad to say about Clinton.
Take narcissistic personality disorder (NPD) as an example. There is no denying that Trump’s brash and grandiose style, alongside his xenophobic, sexist and antagonistic statements, made him a target for analysis by mental health professionals. However, individuals with NPD, or any of the other nine personality disorders, have deeply ingrained ways of thinking and behaving that typically impair their well-being and functioning across the most important areas of functioning.
Perhaps NPD is Trump’s reality, but perhaps it’s not. A great deal of attention was placed on the ways in which Trump appeared to be narcissistic, but there was also plenty of information to demonstrate that he may not be. After all, he appears to be happily married, his children and family appear to love him and he has been quite successful.
Trump is liked and disliked among the public in large numbers, but privately he seems to be doing just fine. This is usually not the case for someone who suffers from a personality disorder or another form of severe mental illness. Personality disorders are life-long, and if you have one, important areas of your life will suffer in significant ways – your career/work life, home life and social life.
Nonetheless, and to my dismay, this past year a number of well-respected mental health professionals asserted the opinion that Trump suffers from NPD. Authority Dr. Sam Vaknin asserted strongly that Trump is a narcissist, based on his distant, arm chair views. “To my mind, Trump is the most perfect example I have come across of a malignant, and probably, psychopathic narcissist,” he said. Vaknin concluded, “Is this the kind of person you want in the White House?” That’s an overreach by any medical or mental health professional looking in from the outside.
Beyond the personal and professional harm a public diagnosis could cause someone, patients can also suffer when mental health professionals opine speculatively or offer diagnoses as reckless attacks to promote a political positon. How might a patient who supports Trump feel, for example, when they learn that their therapist is promoting a negative opinion about Trump in the news? The potential for emotional conflict and the possibility of harming the therapeutic relationship and treatment arguably increases at that sort of moment. That’s why treating mental health professionals, regardless of their credentials, should not attempt to influence patients toward their own political ideologies or beliefs – privately or publically.
In the end, just like the Goldwater Rule for psychiatrists, other mental health professionals shouldn’t have publically opined on Trump’s mental health this year. Regardless of how one feels about Donald Trump, Hillary Clinton or any public figure, mental health professionals should not use their training and knowledge to assume more than they actually know to be true. As the old saying goes, “don’t judge a book by its cover”.
With this election behind us, I am putting a call out to all mental health organizations to adopt the American Psychiatric Association’s Goldwater Rule. It’s the right thing to do.
Dr. Michael Oberschneider, Psy.D, is a clinical psychologist and founder and director of Ashburn Psychological and Psychiatric Services, a private mental health practice based in Loudoun County, Virginia. He is a regular contributor to The Loudoun Tribune.