Is Psychoanalyzing Our Politicians Fair Game?

Nassir Ghaemi, MD, MPH

Disclosures

August 15, 2016

In This Article

Do We Need Presidential Psych Evaluations?

To summarize, I propose that the Goldwater rule should be revised in this way:

In the case of living public figures, psychiatrists should not provide diagnoses unless they have adequate documentation, as defined by current scientific standards of psychiatric diagnosis, and only if they deem the political and social circumstances to be serious enough that their duties as citizens in a democracy outweigh their responsibilities as regulated professionals. In such settings, they should provide sufficient documentation to defend their views if subject to the scrutiny of an ethics committee of the APA.

The revised rule could read: Regarding living public figures, a psychiatrist may provide a professional opinion if he or she has adequate documentation, as defined by current scientific standards for making clinical diagnoses, of a scientifically valid psychiatric diagnosis. Without such documentation, and outside of scientifically valid diagnoses, it is unethical for a psychiatrist to offer a professional opinion.

I would take it one step further. In agreement with nonpsychiatrist physicians, such as former British foreign minister Lord David Owen[5], I would agree with colleagues who have said that we need a systematic and independent medical and psychiatric examination of all political candidates for president. This evaluation would go beyond the current standard of voluntary release of medical information, which is quite limited and doesn't address psychiatric history at all. This psychiatric evaluation should be presented to the public by experts with sufficient context and interpretation to diminish the risk for pejorative and discriminatory uses based on our current cultural ignorance and bias against psychiatric disease.

No politician would ever give "consent" to being psychiatrically diagnosed, as the Goldwater rule puts it, and thus the rule dooms us to complete censorship. Rather, we as a profession—psychiatrists and all physicians—should insist that the public has a right to know about the medical health of those who wish to lead it, and medicine includes psychiatry. In a democracy, "consent" sits with the governed, not those who govern. If leaders want to be in a position to send our sons and daughters to die in war, we should demand their consent to tell us about their medical and psychiatric history. This is not unethical, as the Goldwater rule has it. Rather, the Goldwater rule could be seen as unethical in depriving the public of knowledge regarding its leaders that it has a right to know.

Goldwater ran for office 50 years ago. Psychiatrists were mostly psychoanalysts and mostly unscientific. Psychiatric illness was completely stigmatized and discriminated against, as was race, gender, and sexual orientation. In the intervening five decades, we've made progress on discrimination on all fronts, but less so with psychiatric disease than on the other features of being human. It's time to revise Goldwater, for the same reasons that we have changed our attitudes toward race, gender, and sexual orientation.

A half-century has passed. Yet the psychiatric profession is still stuck in Cold War-era stigmatizing attitudes. Let's get to work on ending this last bastion of discrimination, not only in the larger culture, but also inside our own profession.

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