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Authors of The Dangerous Case Urge Revision of the Goldwater Rule

Posted Jun 28, 2018

The Goldwater Rule, Section 7.3 of the American Psychiatric Association’s ethical code became highly contentious when, on March 16, 2017, the APA ethics committee issued an expansion of the rule beyond anything it had been before.  Many psychiatrists have called the new interpretation a “gag order.”  The authors of The Dangerous Case of Donald Trump, along with members of the National Coalition of Concerned Mental Health Experts worked on a Goldwater rule revision statement, which is being submitted to the APA this morning.

The proposal asks that the APA recognize the importance of psychiatrists’ social responsibility to warn the public when they discern danger to its well-being that arises from the mental state of an official who is in a position to cause great harm. As such, it is important that they identify themselves as psychiatrists with training and experience and make clear that they are not doing so casually or from personal bias.

It is an important contribution to our profession in that it offers a thoughtful consideration of the role of the Goldwater rule in its current form. Intensive back-and-forth discussion among the contributors to The Dangerous Case of Donald Trump was devoted to the issue of the Goldwater rule prohibiting diagnosis without a personal interview, and a consensus position was reached.  This reflected full consideration of the important concerns of the Working Group and the Leadership among the authors.  The Goldwater rule revision statement can be found below.

Bandy Lee and Thomas Singer

Revising the Goldwater Rule

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, 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” (emphasis added). American Psychiatric Association’s (APA) Principles of Medical Ethics, Section 7.3

This is the American Psychiatric Association’s ‘Goldwater Rule’ which constrains the public statements of psychiatrists and most other mental health professionals because many other national mental health organizations have embraced it.

We, the authors of various chapters in the book, The Dangerous Case of Donald Trump, believe it is necessary that the Goldwater Rule be substantially revised and updated to reflect current research and evolving social awareness.

We call on the American Psychiatric Association (APA) and all other mental health associations that have adopted or follow the APA’s Goldwater Rule, to significantly revise and amend it in accordance with the following points:

1) Formally recognize an affirmative responsibility for mental health professionals to publicly address mental health issues discerned in public figures when there is a clear and present danger to the public’s health and well-being.

2) Acknowledge our right to identify ourselves as mental health professionals when speaking out, as opposed to being constrained from identifying ourselves as such.

3) Recognize that our duty to use our professional knowledge to educate the public on matters that fall within our areas of expertise like all other specialties, does not violate the confidentiality or privacy rights of patients because such constraints on speech do not apply in the absence of a bona fide doctor-patient relationship.

4) Affirm a duty to address the public in a manner that respects the limits of our knowledge and clearly acknowledges those limits in our public comments.

5) Refrain from speaking out as identified mental health professionals when motivated by personal or partisan preferences; and only speak out identified as mental health professionals when indicated by our recognition of clear and present threat to the public’s well-being that arises from public figures in a dangerous position. (Clearly, this precludes commenting as professionals on others who are outside this narrow delineation.)

6) The Goldwater Rule’s insistence that it is unethical for a mental health professional to comment on a public figure’s psychological functioning without an interview is misguided and without scientific foundation. Forbidding any such commentary conflates a professional’s public speech with his/her taking care of a patient. In the former role, we, as citizen professionals, are addressing the welfare of the community; in the latter we provide care for an individual and affirm our profession’s adherence to strict confidentiality. Further, since the Goldwater Rule was adopted (1973) there has been substantial multidisciplinary research questioning the necessity of an in-person interview as the sole basis for assessment in all circumstances.

7) In calling for the adoption of the above points, we explicitly acknowledge the need to avoid stigmatizing individuals dealing with mental health problems through ill-considered use of psychiatric terminology.

These changes are necessary because the Goldwater Rule, in its present form, is antiquated, illogical, without scientific foundation, and intrinsically undermining of mental health professionals’ efforts to protect the public’s well-being.

Revising Goldwater Working Group: Leonard Glass, Chair (other names are available upon request)

The Dangerous Case Leadership Group: Bandy Lee, Thomas Singer, Judith Herman, and Robert Jay Lifton

Our fuller Psychology Today editorial can be found here:

https://www.psychologytoday.com/us/blog/psychiatry-in-society/201806/mental-health-experts-urge-revision-the-goldwater-rule

 Download the pdf of the letter to the APA here:

Suggestions to the American Psychiatric Association for Revisions of the Goldwater Rule