Is Psychoanalyzing Our Politicians Fair Game?

Nassir Ghaemi, MD, MPH

Disclosures

August 15, 2016

In This Article

Introduction

Psychiatry imposes on itself a unique kind of self-censorship. It's called the "Goldwater rule," because it came about after a 1964 magazine poll of psychiatrists about the Republican presidential candidate Barry Goldwater. The basic idea is that psychiatrists shouldn't give clinical opinions about politicians. The rule makes sense in some ways, but not in others. In this article, I'm going to suggest where it's helpful and where it only adds to the problem of inappropriate and discriminatory psychologizing.

At the outset, let's be clear about one thing: Much of this debate is rooted in discrimination against psychiatric disease, a bias that is not only immoral but also false. What if having a psychiatric condition made you more fit to lead, rather than unfit? Think of Abraham Lincoln's melancholy and Winston Churchill's manic-depression.[1]

By emphasizing how dangerous it is for psychiatrists to diagnose public figures, and rendering it "unethical," we psychiatrists are accepting and feeding into the public's discrimination against psychiatric illness. In fact, research[1] shows that manic symptoms enhance creativity and resilience, and depressive conditions increase realism and empathy. Manic-depressive leaders, I've argued, can be our best leaders. But risks also exist.

Thus, the debate about the Goldwater rule needs to happen, I would suggest, in the context of being clear that having a psychiatric diagnosis is not necessarily a bad thing. In fact, it can have positive aspects.

On this topic, a current political leader whose example we should follow instead of Goldwater's is that of ex-Congressman Patrick Kennedy, whose courageous memoir details his bipolar illness and substance abuse. Instead of accepting and adding to our cultural discrimination against psychiatric illness, our profession should combat it. We shouldn't stop psychiatrists from talking about politicians; we should encourage it, in a responsible way, which is what I will propose to explain here.

Let's begin with Goldwater. A 1964 survey conducted by Fact magazine was sent to over 12,000 psychiatrists, of whom about 2400 responded; of this group, about one half offered the opinion that Goldwater was unfit to be president. Common diagnoses were schizophrenia and "narcissistic personality disorder."

The magazine ran these results sensationalistically, under the title "1189 Psychiatrists Say Goldwater Is Psychologically Unfit to Be President!" (In reality, the article could have said the reverse, because the same number of psychiatrists thought he was fit to be president, or at least weren't willing to say he was unfit). Goldwater sued the magazine and won a libel case.

The American Psychiatric Association (APA) responded with an ethical guideline stating that no member of the APA is supposed to give any opinion about a psychiatric diagnosis for any public figure. The exact phrasing is thus:

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 core summary is: You cannot give a diagnosis of a public figure if you do not personally examine the individual and have that person's consent.

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