COMMENTARY

The Goldwater Rule and Presidential Mental Health: Pros and Cons

Nassir Ghaemi, MD, MPH

Disclosures

June 07, 2017

At this year's American Psychiatric Association (APA) meeting in San Diego, Dr Philip Candilis and I organized a symposium[1] on the Goldwater Rule, the 1973 statement in the APA's Ethics Guidelines that has come to be seen as prohibiting any commentary on any public figure by any APA member psychiatrist. This symposium included two former APA presidents, a former head of Central Intelligence Agency (CIA) psychiatry, and a psychiatrist-philosopher.

The audience in attendance exceeded the allotted space and, in conversation with the panel, the allotted time. Dr Candilis and Dr Alan Stone, a former APA president, both forensic psychiatry experts, were unable to attend in person, leading to a final panel of four speakers and a discussant.

The initial speaker was Dr Paul Appelbaum, former president of the American Psychiatric Association; professor of psychiatry, medicine, and law at Columbia University; and a well-known international expert in forensic psychiatry. Dr Appelbaum reviewed the history of the Goldwater Rule, the rationale for its introduction, its evolution, and reasons for its continued support.

In brief, the process began in the 1964 presidential election, when Republican candidate Barry Goldwater was opposed by many who feared that he was a warmonger and might trigger a nuclear war. Goldwater's famous convention acceptance speech ("extremism in the defense of liberty is no vice") alarmed some even more.

The publisher of Fact magazine sent a poll to thousands of psychiatrists, about two thirds of whom either didn't respond or stated that they felt Goldwater was normal psychiatrically. However, about one third diagnosed Goldwater with a range of ills, including schizophrenia. The magazine published a cover story stating that over 1000 psychiatrists believed that Goldwater was mentally ill and unfit to be president. After the election, Goldwater sued the magazine for libel and won his case.

In 1973, the APA prepared an ethics guideline in which it stated that psychiatrists should be active in society, but a specific caveat was inserted stating that APA member psychiatrists should not offer a diagnosis or professional opinion on a public figure where two criteria hold: (1) Consent was not obtained by that person and (2) they were not personally examined. Thus, no professional comment should be given on the basis of publicly available information where those two criteria were not met.

Dr Appelbaum emphasized the problem that in every election cycle, every 4 years for over four decades, psychiatrists regularly have opinions about candidates, often on the right wing (eg, Trump and Bush), sometimes on the left (eg, Clinton). Dr Appelbaum argued that such professional opinions always, without exception, follow the political preferences of said psychiatrists. He noted that psychiatrists will offer different opinions on diagnoses—say, attention-deficit disorder, sociopathy, narcissism, and bipolar disorder—about the same person. When many diagnoses are offered, he stated, one can conclude that they are all wrong.

In this setting of a cacophony of politically driven opinions, Dr Appelbaum argued that it is irresponsible for psychiatrists to give professional opinions about public figures, and the Goldwater Rule is thus justified.

The second speaker was Dr Jerrold Post, professor of psychiatry, political psychology, and international relations at the George Washington University, and for over two decades a top psychiatrist at the CIA. Dr Post described how in the early 1990s, he had contributed to a political profile of Saddam Hussein during the Persian Gulf War. An article in the New York Times about his work led to a letter from an APA official raising concerns that Dr Post's work was unethical, breaking the Goldwater Rule.

Dr Post described how his entire career had involved psychological and psychiatric assessments of political leaders whom he had never examined personally and whose consent he had not obtained. Yet such work was important for national security and the political interests of the United States, work for which he has been recognized professionally by the psychiatric profession and the US government.

Dr Post has felt constrained by the Goldwater Rule at times, to the point where he felt morally torn. He gave an example of how during the standoff in 1993 with the religious extremist David Koresh, Dr Post was interviewed on television and felt unable to state what he really thought—namely, that Koresh had certain messianic traits that might lead to a mass killing, which is what happened.

Instead, the Federal Bureau of Investigation (FBI) was being advised by a nonpsychiatrist mental health professional who had judged that Koresh was "sociopathic" and could be intimidated into submission (as with loud noise and music)—an error that was fatal. Over the years, Dr Post has wondered whether his silence, driven by concern about the Goldwater Rule, might have contributed to false FBI judgments, leading to more deaths than might have occurred otherwise. Dr Post felt that the Goldwater Rule was too strict and needs to be revised and more limited in its scope.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....