On the morning of July 25, I scrolled through my Twitter account to see tweets flying: Psychiatrists can now defy the Goldwater Rule! Oops, wrong organization; no ,they can’t. Over the course of the day, articles appeared in Scientific American, the Los Angeles Times, Newsweek, International Business Times; and statements were issued by both the American Psychiatric Association and the American Psychoanalytic Association.
So what happened?
At the annual meeting of the American Psychoanalytic Association – an organization of 3,500 interdisciplinary mental health professionals – its executive councilors were polled about whether they endorsed APsaA’s existing policy that allows for the organization’s comments on sociopolitical issues and not on specific political figures. The vote was unanimous to continue with its existing policy of commenting on issues, not individuals.
On July 6, 2017, the ApsaA had sent an email to all its members informing them of this decision. The email also stated: “However, it is important to note that members of APsaA are free to comment about political figures as individuals. The American Psychiatric Association’s ethical stance on the Goldwater Rule applies to its members only. The APsaA does not consider political commentary by its individual members an ethical matter.” (Bolding per the email). This was not considered to be a change in its policy.
Citing that email, on July 25, STAT reporter Sharon Begley wrote an article titled, “Psychiatry group tells members they can ignore ‘Goldwater rule’ and comment on Trump’s mental health.” The article was linked to on Twitter, and the retweets and comments started to fly. As a single example, Josh Marshall, editor and publisher of Talking Points Memo, tweeted out to his 215,000 followers: “Truly amazing am psych assoc says Trump so f’ing nuts they’re lifting Goldwater Rule.” The APA issued several statements over the course of the day, notably: “We are the largest psychiatric organization in the world with more than 37,000 members. The Goldwater Rules applies to our members.” Commenters expressed frustration with the Goldwater Rule, and suggested that the APA had a duty to warn.
Shortly after noon that day, the APsaA put a statement on its website to clarify information in the STAT article: “In an email to association members, our leadership did not encourage members to defy the “Goldwater Rule” which is a part of the ethics code of a different mental health organization, the American Psychiatric Association (APA). Rather, it articulated a distinct ethics position that represents the viewpoint of psychoanalysts. The field of psychoanalysis addresses the full spectrum of human behavior, and we feel that our concepts and understanding are applicable and valuable to understanding a wide range of human behaviors and cultural phenomenon.”
Later in the afternoon, I spoke with Wylie Tene , director of pubic affairs for the APsaA. He noted: “The article in StatNews had a misleading and sensational headline. It didn’t represent what our email was about.”
I found it interesting that a sensational headline on STAT’s website could lead to so much comment and so many articles in major news outlets. July 25, 2017, was not a slow news day: John McCain (R-Ariz) returned to the Senate that day and voted to proceed with the debate to repeal Obamacare. A single vote cast by Vice President Mike Pence broke the tie, allowing the debate to go forward.
Like many, I feel conflicted about the Goldwater Rule but for a single reason: I am a strong believer in free speech, and the rule squelches psychiatrists. But as I noted in a column in August 2016, I don’t believe that our opinions should, would, or could change our political environment. Psychiatric treatment is about compassion and healing, and diagnoses are based on symptoms that patients often tell us about in a setting of intimacy and trust. Diagnosing celebrities, on the other hand, is often about name calling; it risks insulting our patients and perpetuating stigma.
Regarding Mr. Trump, I’m going to finish with the same words I wrote back in August, prior to his election as president. You’ll note that my insights in Clinical Psychiatry News and circulated on the Internet – devoid of a diagnosis – did not influence the outcome of the general election. Psychiatric diagnoses are made by observing a constellation of symptoms that occur together.
Mr. Trump has given the whole world years of data – he’s lived his life in a very public way. As a real estate developer, he has had countless employees who all know how they’ve been treated. We’ve seen him through three marriages and watched how he interacts with his children. We’ve seen him take out full-page ads calling for the death penalty for a group of young men who were wrongly convicted in the rape and assault of the Central Park jogger in 1989. If that’s not enough, he has hosted his own reality television show, and we’ve now seen him countless times in debates and rallies. We know how he treats his running mates, journalist Megyn Kelly , a news reporter with a disability, and the parents of a fallen soldier. We’ve watched him allude to the size of his genitals during a primary debate. Every individual is free to decide if Mr. Trump’s widely viewed patterns of behavior represent much-needed spunk and change with political beliefs that align with their own, or if his words and behaviors represent cruelty, impulsivity, poor judgment, and a pattern of actions that some might not feel is dignified enough for our country’s leader. No degree is required to observe and draw conclusions.
Dr. Miller, who practices in Baltimore, is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press, 2016).