COMMENTARY

The Goldwater Rule and Presidential Mental Health: Pros and Cons

Nassir Ghaemi, MD, MPH

Disclosures

June 07, 2017

Avoiding an 'Anarchy of Opinion'

The final speaker was the discussant Dr Paul Summergrad, recent past president of the APA and chairman of the department of psychiatry at Tufts Medical Center. He agreed with Dr Appelbaum more than with the other speakers, and pointed out that political concerns could be addressed in ways other than changes in APA policies.

For instance, he noted that the Constitution allows for the creation of a body of experts to examine the physical and mental fitness of the president, if needed. This would be an advisory group appointed by Congress. Furthermore, any changes to the law calling for psychiatric evaluation of presidents or candidates could be pursued politically, and could provide a mechanism for the involvement of psychiatrists in evaluation of public figures.

He noted that the Goldwater Rule is not a general mechanism for censure of psychiatrists, but instead is a policy of the APA that is applicable only to APA members. Any psychiatrist is free to comment on public figures as they like, irrespective of the Goldwater Rule, as long as they are not members of the APA or if they wish to drop that membership. There are no larger legal or licensing implications that would come into play.

In an extensive discussion that followed, some members of the audience expressed concern about an anarchy of opinion that might follow if there were no Goldwater rule, and some felt that discussion should be limited to political experts, such as Dr Post. Dr Allen Dyer, who was part of the APA ethics committee that passed the original 1973 language, emphasized that the concept was never meant to be a "rule" but rather a "caveat" given in the setting of allowing for a role of psychiatrists as citizens in social and political life.

This perspective contrasted with Dr Appelbaum's view that a rule is not rule if it can be broken. Dr Appelbaum also commented that psychiatric diagnosis was "irrelevant" to leadership, and repeated that the comments of psychiatrists on political leaders are personal and political in origin, and have no legitimate scientific/professional basis.

Such psychiatrists seek a "cloak of legitimacy" of their profession to propound their personal political preferences. I responded that there is scientific research that supports the relevance of psychiatric diagnosis to leadership, as in the work on manic-depressive illness that I had discussed. At the end of the discussion, there seemed to be a general sense that further revision of the language in the APA ethics guidelines related to psychiatrists and public figures may be needed.

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