You may have heard of the Goldwater rule, given the state of the world and our current American politics.
What is it, how did it come to be, and why was it considered necessary? Is it relevant today, or does it need to be modified or abolished? I will attempt to explain the Goldwater rule, answer these questions, and then put the rule in the context of our current political climate, leaving you to make your own decisions about its relevance.
Barry Goldwater was an American politician and businessman who was the Republican candidate in the 1964 presidential election. He was a staunch conservative from Arizona who had labored in his family business, was a transport pilot in World War II, and was later a member of the Air Force Reserve. He had been elected senator from Arizona twice before the 1964 contest, and went on to be elected to that post three more times after losing the presidential race by a landslide.
In 1964, a publication called Fact published an article entitled “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater”. In this piece, Fact had asked 12,356 psychiatrists during the political campaign with Lyndon Baines Johnson about Goldwater’s fitness to serve as president. The publication’s cover piece screamed “1189 Psychiatrists Say Goldwater Is Psychologically Unfit to Be President!”
The comments made by many of the psychiatrists who responded were harsh, negative, and sometimes just downright odd. They referred to Goldwater’s state of “chronic psychosis, grandiosity and paranoid schizophrenia”. They compared him to Mao, Hitler, Castro, Stalin, and “other known schizophrenic leaders”. It was thought that some of the responders might well have been couching their political biases in psychiatric terms. Although some of them seemed to be frightened of Goldwater and what he stood for, they could not state in specific terms that he was indeed unfit to be president of the United States.
The piece in Fact may have cost Goldwater a large number of potential votes on the way to his loss. He later sued Fact for libel and won $75,000.
The American Psychiatric Association (APA) is the oldest medical association in the United States, founded in 1844. It was the largest psychiatric organization in the world, with 37,000 physician members who specialize in the diagnosis, treatment, prevention and research of mental illness. The APA quickly responded to this piece and stated that the Fact article was not medically valid, was a hodgepodge of personal political opinions and would be disavowed by the organization. In 1973, a more formal response was formulated in the text and substance of the Goldwater rule. This rule became section 7.3 in the APA’s Principles of Medical Ethics.
It said that it was unethical for a psychiatrist to give a professional opinion about public figures that they had not personally examined, and from whom they had not obtained consent to discuss their mental health in public statements. It was also noted that a psychiatrist could offer expertise about psychiatric issues in general.
Other professional organizations had their own views on this issue. The American Psychological Association had a similar rule in its Ethics Code. The AMA, in the fall of 2017, revisited this concern through its Council on Ethics and Judicial Affairs, revising its own AMA Code of Medical Ethics. In 2016-17, several psychiatrists and clinical psychologists faced criticism by their peers and others for supposedly violating the Goldwater rule.
Related to this, in the APA Newsroom section of their website, Joseph Schachter, MD, PhD, retired and living in New York City, said that “mental health providers and psychiatrists may make political comments as any other citizen, but without selecting a psychiatric diagnosis.”
Fast forward to the presidential campaign of 2016 and the subsequent election of Donald J. Trump as president of the United States. A veritable firestorm of accusations, suppositions, outright guesses and armchair diagnoses have flooded the media in recent months, all concerning themselves with the fitness of the forty fifth president of he United States to occupy his office and carry out his many duties in a rational and professional way.
In March of 2017, the APA modified the Goldwater rule and prohibited any comments on the mental health of a public figure.
In October of 2017, the APA released a statement that reiterated the intent of the Goldwater rule, and also explained the importance of public education about mental illness. As there was already a cohort of professionals who were beginning to feel a sense of urgency about enlightening the public about the dangers of the current presidential administration, the APA also stated that a “duty to warn” was a legal concept that only applied if there was a bonafide physician-patient relationship in place.
On January 6, 2018, a vox.com article by Elizabeth Barclay examined “the case for evaluating the president’s mental capacity-by force if necessary”. At issue for some psychiatrists including Bandy Lee, associate professor in forensic psychiatry at the Yale School of Medicine, was whether the president was really unwell, or sometimes just behaving badly.
Lee and some of her colleagues have been leading the call for an evaluation. She and Judith Herman of Harvard and Robert Jay Lifton of Columbia have previously stated that President Trump was “further unraveling”. Some of her opposition psychiatrists have stated that she is violating the Goldwater rule by speaking and writing on the issue. She counters by stating that her opinions and position are her own. “We are not diagnosing him-we keep with the Goldwater rule.” She maintains that they are concerned with behaviors, tweeting patterns, paranoia, being very susceptible to fawning, denying his own voice on tape, and other behaviors that bode poorly for professional performance and good judgment.
Some prominent psychiatrists, such as Jeffrey Lieberman, former APA president, disagree with Lee and colleagues, although she maintains that she is making an educated assessment of dangerousness based on years of study and experience. She does not purport to make a diagnosis of the president, but says that she and her collaborators are simply “fulfilling a routine, public expectation of duty that comes with our profession”.
A January 10, 2018, Politico article by Bandy Lee and Leonard Glass was titled “We’re Psychiatrists. It’s Our Duty to Question the President’s Mental State”. These authors made the claim that by altering and modifying the Goldwater rule over the last twelve months, the the APA has basally turned it into a gag rule. They posit that “an individual’s dangerousness, however, can be reliably assessed by interviewing coworkers and intimates, reviewing the individuals past statements and behaviors, reviewing police reports, and, crucially, assessing context. While an in-person interview can be quite useful, it is not strictly required to assess danger.”
So, now you know what the Goldwater rule is, how It came about and why, who it impacts, and how it is being modified and challenged in our current political circumstances.
Are some rules made to be broken?
Does the current political climate call for, or even mandate, the injection of psychiatric principles into politics?
As a psychiatrist, I have my own opinion. I hope that by sharing this information with you, I have stimulated you to form your own.