The health site Stat News mistakenly reported this week that the American Psychoanalytic Association had informed its 3,500 members that they’re no longer bound by the Goldwater Rule, a longstanding—and controversial—policy against commenting on the mental health of public figures.
The rule dates back to 1973, and stipulates that mental health professionals should not make diagnoses about prominent individuals whom they haven’t evaluated. According to the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, “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 American Psychoanalytic Association quickly distanced itself from the latest report, by tweeting that the article was misleading and releasing a statement that it still stands by the Goldwater Rule. Director of Public Affairs Wylie Tene told NPR that its members “have always been free to comment on public figures, but have been cautioned against diagnosing.” As NPR notes, the much larger American Psychiatric Association, which has 37,000 members, also observes the rule—even though many mental health professionals disagree with it.
Why do we even have such a rule?
The rule originated with Barry Goldwater, a former U.S. Senator from Arizona and the 1964 Republican Presidential candidate who famously voted against the Civil Rights Act. In 1964, Fact magazine polled thousands of psychiatrists on the question of whether or not Goldwater was mentally fit to be president. That September, it announced the results in an article headlined,“1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President!”
Fact also printed some of the extra responses that some of the psychiatrists had written in the questionnaire. “B.G. [Barry Goldwater] is in my opinion emotionally unstable,” wrote one. “B.G.’s proneness to aggressive behavior and destructiveness indicates an attempt to prove his manliness,” replied another. Most damningly, one wrote: “He consciously wants to destroy the world with atomic bombs … A dangerous lunatic!” (Of the 12,356 psychiatrists who received a questionnaire, 2,417 responded. Out of those, 657 said he was psychologically fit; 571 said they didn’t know enough about him to answer the question.)
Goldwater—who, in case you missed it, lost the election to Lyndon B. Johnson in one of the biggest landslides in history—was none too pleased. He filed a libel lawsuit against Fact, and won. It was appealed all the way to the Supreme Court, but the court declined to hear it.
That incident is why, in 1973, the American Psychiatric Association implemented what’s known as the Goldwater Rule.
The Ethical Debate
Psychiatrists have long debated about whether withholding a psychiatric opinion from the public about certain individuals is irresponsible. In 1990, for example, Dr. Jerrold M. Post “presented a public profile of Saddam Hussein, in the belief that misunderstandings of Hussein’s psychology were guiding policy and could lead to loss of life if not corrected,” reports the American Journal of Psychiatry. “Thus, ‘it would have been unethical to have withheld this assessment.’”
Psychiatrists have made similar arguments regarding President Donald Trump. In February, 35 psychiatrists, psychologists, and social workers penned a letter to TheNew York Times saying that although they share concerns about Trump’s mental health, the Goldwater Rule has prevented them from speaking out. Last week, Dr. Leonard Glass wrote in Psychiatric Times that he feels the mandate amounts to a “gag rule.” In April, he resigned from the American Psychiatric Association over the issue.
Given this dissent, it’s possible that mental health professionals could one day decide to the change or abolish the Goldwater Rule. But for now, it continues to carry historical and ethical weight.