Psychiatry’s Recusal from the Mad World: Deconstructing the Goldwater Rule

More and more, both arm chair diagnosticians and mental health professionals alike are questioning the mental stability of President Trump.  They’re asking what’s the matter what this guy?  What’s his malfunction?  What the hell is going on?   Is he psychotic? Senile?  Brain damage?  Or is he a monster?  Given his very public paranoia, forgetfulness, lashing out impulsivity, self-aggrandizing, sexual impropriety, contempt for laws, ethics and social norms, it poses an interesting question.  Pointedly, is the Tweeter in Chief stable?  Does the Donald need a welfare check?  Is he really two steps away from playing with his own poop?  Is Trump a bonafide madman with the nuclear codes?  And if so, is there anything medical or psychiatric to stop him?  As Richard Nixon famously said, “The people have a right to know if their president is a crook.  Well, I’m not a crook.”  Likewise, the people would like to know if their president is sane.  Is he sane?

 

This is a fair question in the interest of the public good, so says a group of thirty three mental health professionals, who wrote to the The New York Times in a letter to the editor reading:

 

Mr. Trump’s speech and actions demonstrate an inability to tolerate views different from his own, leading to rage reactions.  His words and behavior suggest a profound inability to empathize. Individuals with these traits distort reality to suit their psychological state, attacking facts and those who convey them (journalists, scientists). In a powerful leader, these attacks are likely to increase, as his personal myth of greatness appears to be confirmed. We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.

 

There has been suggestion to section Mr. Trump on an involuntary commitment hold and needs to be sent to a psychiatric hospital for evaluation, a move doctors take when a patient is a danger to self or others due to a mental illness.  Change.org has charted a petition of over 2,000 further mental health professions with a similar warning.    Some calling him a narcissist, others raising questions of senility.   These red flags are not only coming from disheartened liberals.  Republicans of all stripes were questioning the mental health of Trump, among them unlikely-accented Louisiana Governor Bobby Jindal, who called Trump a “narcissist” and “egomaniac,” and former Republican Presidential candidate Mitt Romney, who called Trump a con artist and pathological liar who “lacks the temperament to be president,” and is “playing America for suckers.”

 

All of this talk has the alt-right alarmed. Shock jock Alex Jones, a major league paranoiac himself, and agent provocateur Roger Stone believe that there is a psychiatric coup d’etat in the making based on the 25th Amendment provision to replace a president deemed incapacitated or unfit to execute the duties of office.  They have reason to believe so.  Maryland Congressman Jamie Raskin has introduced H.R. 1987 “Oversight Commission on Presidential Capacity Act,” which would give Congress the ability to form a committee and tools to possibly declare a president, present or future, unfit for office.

 

With all of this coming to a head, the psychiatric establishment is caught between a moral rock and an ethical hard place, which is established by the Goldwater Rule to recuse themselves, to refrain from public, especially political and psychiatric speculation.  But this problem poses a challenge at the heart of psychiatry itself, which in effect delineates the school’s ethics, method, and societal role.

 

I should inform the reader that I am an actual psychotherapist familiar with mental health law and ethics.

 

This short essay is the first of two parts.  The first part deconstructing psychiatry’s ostensible recusal from politics.  The second and forthcoming develops a reconstructed political psychology.

 

 

What is the Goldwater Rule?

The trouble started in troubled times.  Elections are usually very emotional affairs, but it’s particularly important to remember the harried, paranoid climate of the 1964 Johnson versus Goldwater election.  It was two years after the Cuban Missile Crisis, and not even a year after the assassination of JFK.  At the movies in 1963-1964 played The Manchurian Candidate, Fail Safe, Seven Days in May and Dr. Strangelove.  There were speculation of a Pentagon-lead coup amid this Cold War bluster.  Richard Hofstader wrote his famous Harper’s article, then book The Paranoid Style of American Politics about the paranoiacs of the right – the McCarthyists and Birchers.  It was in this climate that Fact magazine sent out 9,000 surveys to psychiatrists, returning with 1,189 respondents claiming Goldwater was psychologically unfit to be president.  The article, titled “The Unconscious of a Conservative” (a riff on Goldwater’s influential book The Conscience of a Conservative) was forty pages of admittedly rather slanderous babble:

 

“Do you believe Barry Goldwater is psychologically fit to serve as President of the United States?” Ruth Adams of New York replied that she saw in the GOP candidate “a strong identification with the authoritarianism of Hitler, if not identification with Hitler himself,” and other responding psychiatrists echoed that theme. “I believe Goldwater has the same pathological make-up as Hitler, Castro, Stalin and other known schizophrenic leaders,” wrote Chester M. Johnson, Jr., of Long Beach, while Philadelphia’s Paul Fink observed that, like the Führer, the Republican nominee “appeals to the unconscious sadism and hostility in the average human being.” G. Templeton, of Glen Cove, New York, warned that “if Goldwater wins the Presidency, both you and I will be among the first into the concentration camps.” – quoted in “The Goldwater Takedown” CJ Magazine Harry Stein Autumn 2016

 

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The article caused a minor sensation, but didn’t have a determinative effect as Johnson walloped Goldwater in the election in one of election history’s biggest landslides.  Goldwater later sued Fact editor Ralph Ginzberg, successfully for libel and was awarded $75,000.

 

There was much the psychiatric establishment was embarrassed about in the 1960s. The Diagnostic and Statistical Manual and the Goldwater Rule were two attempts to clean up their professional reputation and make sure a debacle like the Fact article would never happen again.  The 1973 rule reads:

 

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.

 

Portrait of politician Barry Goldwater
Barry Goldwater.  Madman?

 

Arguments for keeping the Goldwater Rule

Since the controversy over the last year, the APA has doubled down on the Goldwater Rule. In words of APA President Doctor Maria Oquendo, “Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.”

 

Joining in on the discussion too is Jonathan D Moreno, son of famed psychoanalyst and psychodrama innovator J.L Moreno.  Moreno argues in his Psychology Today piece that psychiatry’s embarrassment in the 1960s was basically due to Freudian psychodynamic school of thought and has become as passé as oedipal repressions and the guilt complex, refrigerator mothers and the pathologizing of homosexuality.   It was a time when psychoanalysis regularly speculated about the psychological biographies of all kinds of famous figures – either historical or mythical, living or dead.  The problem especially is in regards to the living, which is a fair minded point.

 

Writing in the Journal of the American Academy of Psychiatry and the Law, professor psychiatrists at Western Michigan University Redinger, Gibb and Longstreet argue that:

 

The APA’s Goldwater Rule exemplifies a necessary and justifiable professional norm that is intended to temper the potentially imprudent and self-indulgent motivations of psychiatrists to use the cloak of their profession to further a particular political ideology and neutralizes a fallacious appeal to their own authority. Justifications based on freedom of speech, conscientious objection, or the public interest fail to offset the likely harms to the psychiatrist, profession, and public figure. We argue that the dictum remain firmly entrenched in the APA’s Code of Ethics and the professional norms of prudent psychiatrists.

 

It is a prudent statement in the interest of the profession, but is it convincing enough versus other ethical claims?

 

 

Arguments for breaking the rule

A compelling case is made in the event there is a Duty to Protect type of mandate, which I believe all states have.  Originating from California, it is called a Tarasoff mandate, which compels the clinician to warn the police and intended victim.  It also protects the clinician from breaking client confidentiality in the event that the client revealed that he or she had intent to harm someone else.  Broadly understood, it is the idea that public safety and the public good can supersede the client’s individual rights in this emergency situation.  (Was it Immanuel Kant, or Mr. Spock, who said, “The needs of the many outweigh the needs of the few.?”)  Of course, the trouble is that the Tarasoff mandate only applies when the potential offender is your client and poses a specific threat to a reasonably indefinable person or persons.  Clients who are generally offensive to society – say for instance, clients in a corrections facility, one cannot predict with certainty their potential threat to specific people.

 

So, no, sorry, I as a psychotherapist, I cannot issue America a warning that it’s going to be snuffed out by Donald Trump.  First of all, Donald J. Trump is thankfully not my client.  Second, it’s only a vague and generalized threat.  Who would I tell?  Everyone?  And third, and perhaps most importantly – everyone already seems to know they’re under threat, I wouldn’t be giving you information you didn’t already know.  In fact, America, you’re telling me that you’re on red alert!

 

Some psychiatrists argue, however, that in the case where there is a clear and present danger to others – something that was overblown in the Goldwater case with speculations about his “anal character” – that some sort of warning might be publicly useful.  In the Journal of the American Academy of Psychiatry and the Law, Doctors Kroll and Pouncy write, “Some third-party assessments are reckless, but do not negate legitimate reasons for providing thoughtful education to the public and voicing psychiatric concerns as acts of conscience. We conclude that the Goldwater Rule was an excessive organizational response to what was clearly an inflammatory and embarrassing moment for American psychiatry.”

 

There are other conditions in mental health that also skirt around issues of privacy that the Goldwater Rule mentions. For example, forensic psychological evaluations are sometimes court ordered.  So too with psychological evaluations in child custody cases.  Psychological evaluations are required for astronauts as well.  Further, American intelligence uses psychological profiles of their rivals, sometimes their friends.  Psychiatrist Orlando Garcia writes further:

 

In our culture we need a psychological clearance for people working in intelligence, in the FBI, in the police. Should not we demand a clean bill of mental health for the person who is going to literally control our lives? For as long a such needed regulation does not exist, should responsible professionals remain silent, obediently abiding by a rule that in this case protects what many consider a manifestly dangerous character at the helm of the world? One should also consider the ethical obligations to protect public health imposed by the psychiatric profession.

 

It is an interesting proposition to have psychological clearance for what is really one of the most sensitive positions in all of government.

 

What exactly are these rogue psychiatrists and psychologists warning us about? Perhaps the tip of the spear in this effort is Dr. John Gartner, who organized the Times letter.  Gartner’s diagnosis in his article for the New York Daily News: Trump he says is the “worst case of narcissism” he’s ever seen.  More specifically, he calls Trump a malignant narcissist.

 

Most of us hear this and are like, “thank you, uh, doctor … we, er, wouldn’t have ever known.”

 

A Critical Frame Work

Dr. Sally Satel writes in her article, “It’s OK to Speculate About Trump’s Mental Health” in Slate, “A diagnosis of a PD is not disqualifying from the presidency.”  Exactly.  The question of import is not whether Trump is or is not a narcissist, because even if he is, this there is no legal, ethical, or functional reason why this condition would disable him from performing his duties.  In fact, narcissism is really a very common trait in politics at all.  Politics is so nuts that it really selects for narcissists, which brings me to my next point, and forthcoming essay.

 

Part two, called “Post-Truth President / Post Truth World” will precisely speculate about Trump’s malignant narcissism, not to simply diagnose Trump, but as a critical political psychological framework with which to understand the existential rabbit hole of madness our entire society has fallen into.

 

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Alice in Wonderland (Disney)

 

 

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