Huge Announcement from Major Psychiatrist’s Group Is Very Bad News for Trump
President Donald Trump’s mental health is now an issue in our nation’s life. The American Psychoanalytic Association told its members in an email this month that they do not need to refrain from making statements about the mental health of public figures whom they have not personally examined, including the president. The association changed its informal rule against speaking about public figures in part because of the president’s unique public behavior.
The current president’s behavior is “so different from anything we’ve seen before” in a president, Dr. Prudence Gourguechon, a past president of the psychoanalytic association told STAT News this week, that the Association thinks that its “psychoanalytic knowledge in explaining human behavior” can be of value in this case.
Ethics Rules in psychoanalytics
Psychological professionals comprise the only health care group with a ethics rule against discussing the condition of individuals whom they have not examined. For example, when a public figure makes a cancer diagnosis public, oncologists are free to discuss with the media typical courses of action after they make it clear that they have not examined the patient and are not a part of their treatment team. Since the 1960s, mental health professionals have held themselves to a stricter standard than this, however: they do not discuss the mental health of public figures whom they have not examined unless that public figure gives consent.
Section 7 in the American Psychiatric Association’s (APA) Principles of Medical Ethics, the so-called “Goldwater Rule,” reads in part: “… [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 rule is an informal one as there is no professional consequence if a member violates it. The APA can not suspend a member for speaking about a public figure’s condition because that would violate the member’s personal free speech rights.
The American Psychoanalytic Association, which made the change in its policy this month, is not affiliated withe American Psychiatric Association, but it has a similar policy to the American Psychiatric Association’s “Goldwater Rule” in place, which is what the group addressed this month.
The ‘Goldwater Rule’
The “Goldwater Rule” is named after former senator Barry Goldwater, who was the Republican Party’s 1964 nominee for president. That year, one of the senator’s applause lines was, “Extremism in the defense of liberty is no vice,” which is a libertarian sentiment that was not often heard in that era. Fact magazine, a short-lived quarterly, published an article titled, “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater,” in which 1200 psychiatrists responded to poll questions about Sen. Goldwater. The results were not in Goldwater’s favor. The editor, Ralph Ginzburg, received a letter in advance from the American Psychiatrist Association that explained that the article ought not be published as a psychiatrist’s evaluation can only be given after a thorough clinical examination. The senator sued for defamation and was awarded punitive damages. The U.S. Supreme Court voted to not review the decision, so the defamation decision stood.
Partly in response to the incident, the American Psychiatric Association instituted the “Goldwater Rule” as policy in 1973. In March of this year, the association reaffirmed the rule and emphasized, “Offering a professional opinion on an individual that a psychiatrist has not examined is a departure from established methods of examination, which require careful study of medical history and first-hand examination of the patient. Such behavior compromises both the integrity of the psychiatrist and the profession.”
The decision was controversial. On July 20, Dr. Leonard Glass, a psychiatrist at Harvard Medical School, wrote in a letter to the association’s publication, Psychiatric Times, that he will drop his membership in the organization after 41 years specifically because of its insistence on the “Goldwater Rule.” He wrote that the Association has:
“confused the personal and necessarily private doctor-patient relationship with the right, some would say duty, of psychiatrists to publicly add their understanding of widely available but bewildering behavior of political leaders that is regularly and haphazardly analyzed by non-professionals.”
Dr. Glass was one of 33 psychiatrists who wrote about President Trump to the New York Times in February: “the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.” Dr. Glass and the others emphasized that this is not a diagnosis but is an informed opinion.
The same issue of the Psychiatric Times offered a rebuttal to Dr. Glass, entitled “The Goldwater Rule Is Still Relevant” by Dr. Rebecca Brendel. In it, she argues that the “Goldwater Rule” protects the “the integrity of psychiatric practice” because “psychiatric opinions based on insufficient data and/ or method, whether they include diagnoses, compromise both the integrity of the individual psychiatrist and the profession. This behavior also has the potential to lead patients to question the rigor and confidentiality of their own care, or discourage those suffering from mental illness from seeking help for the same reasons.”
More psychiatrists are taking Dr. Glass’ side on the issue. With the American Psychoanalytic Association’s decision this month, mental health professionals will feel free to offer their professional opinion about the president’s behavior, especially if that behavior continues to offer evidence of instability.
Featured image by Scott Olsen/Getty Images
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