Clarifying the ‘Goldwater Rule’ for psychotherapists in the age of Trump

Barry Goldwater, Donald Trump. (Yahoo News photo illustration. Photos: Art Rickerby/The LIFE Picture Collection/Getty Images, Evan Vucci/AP, Alex Brandon/AP)

Two major psychology organizations were forced to clarify their ethical guidelines regarding the “Goldwater Rule” against commenting on the mental health of someone they have not evaluated — including presidents.

STAT News published an article Tuesday morning saying that the American Psychoanalytic Association’s (APsaA) executive committee sent an email to its 3,500 members earlier this month saying they could defy the long-lasting rule. It was presented as the “first significant crack in the profession’s decades-old united front” against discussing “the psychiatric aspects of politicians’ behavior.”

But that’s a misleading assertion. The APsaA never had a Goldwater Rule and was just restating its longstanding position. The much larger American Psychiatric Association (APA), with roughly 10 times the membership, retains the Goldwater Rule in its code of ethics.

Prudence Gourguechon, a Chicago-based psychiatrist and psychoanalyst who served as the APsaA president from 2008-2010, told Yahoo News the organization didn’t want to prohibit its “members from using their knowledge responsibly.” She added, “It’s fair to say this controversy was provoked by the many commentaries on Trump’s mental state from people outside the mental health field.”

The APsaA’s clarification followed a reaffirmation of the Goldwater Rule by the APA’s ethics committee in March, after receiving inquiries on the topic from psychiatrists, the media and the public. Political commentators have openly questioned whether Trump is psychologically equipped to serve as president.

Gourguechon told Yahoo News that the ensuing commotion reveals confusion over the difference between psychiatry, psychoanalysis, psychology and similar fields.

“There has not been a united front in the mental health field. In fact, each mental health organization has its own ethical code and ethical standards,” Gourguechon said. “What our president’s email was saying was that the American Psychoanalytic Association encourages members to speak out in public and share our expertise and has a different ethical standard and code from the American Psychiatric Association. Our ethics code hasn’t changed.”

President Trump on Feb. 9. (Digitally enhanced photo: Saul Loeb/AFP/Getty Images)

A psychiatrist is a physician specializing in the diagnosis and treatment of mental illness, including by medication. A psychoanalyst is a person trained in psychoanalysis, which, broadly speaking, treats emotional disorders with talk therapy derived from the theories of Sigmund Freud. The two categories may overlap.

Following considerable uproar on Tuesday, the APsaA was forced to clarify the contents of the email from July 6. Rather than encouraging members to defy the APA’s Goldwater Rule, the organization was articulating its own ethics position for psychoanalysts.

In other words, there is not a monolith that covers all mental health professionals. There are many mental health professions with their own codes of ethics.

“Some of our members are psychiatrists and some of those psychiatrists — I’m one of them — are also members of the American Psychiatric Association. And the STAT article headline is not correct. We didn’t tell our members they could defy the Goldwater Rule. We said that our standards are different,” Gourguechon said.

She said the Goldwater Rule does not apply to members of their organization who are not also members of the APA.

“We would never challenge or go to war with an organization that we think highly of and work closely with even though we have a different standard on this issue,” Gourguechon said.

The July 6 email updated members on a poll of APsaA’s executive councilors from June 19-23. They had been asked whether they endorse the policy that APsaA as an organization should only comment on sociopolitical issues — not specific political figures — and whether they would support a poll of membership about whether the organization should take public stances on specific people.

Of the councilors who replied, 100 percent endorsed the policy that the organization should only speak to issues and 79 percent opposed a poll of membership. Based on this information, APsaA decided not to poll membership and reaffirmed that it will speak to relevant issues. APsaA did provide the following caveat:

“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. APsaA does not consider political commentary by its individual members an ethical matter. APsaA’s ethical code concerns clinical practice, not public commentary.”

The APsaA’s official position encourages psychoanalysts to provide relevant psychoanalytic insights to the public on a wide range of human affairs, such as politics. But the organization expects psychoanalysts to “exercise extreme caution when making statements to the media about public figures” and “respect the limits of psychoanalytic inference” about people one does not actually know.

“We think it’s very valuable to share our expertise with the public in responsible ways,” Gourguechon said.

Republican presidential candidate Barry Goldwater in October 1964. (Digitally enhanced photo: Henry Burroughs/AP)

The APA established the Goldwater Rule in 1973 based on an incident that occurred during the 1964 presidential election. The now-defunct Fact magazine had published a survey in which 12,356 psychiatrists were asked whether Republican candidate Sen. Barry Goldwater was psychologically fit for the presidency. Out of the total 2,417 responses, 1,189 said Goldwater was unfit for the office. Goldwater later sued the magazine for defamation and was rewarded $75,000 in punitive damages.

The APsaA did not establish a similar prohibition in its code of ethics for members.

After the STAT News article appeared, the APA was bombarded with questions about its suspected change in position on the Goldwater Rule. In a series of tweets, the APA announced that it still stands by its previous statements in support of the Goldwater Rule.

Later Tuesday morning, APA released the following statement:

“The American Psychiatric Association stands firmly behind the Goldwater Rule. Our position has not changed. The Goldwater Rule applies to the 37,000 physician members of the American Psychiatric Association, not other groups, non-members, or non-physicians. The rule represents sound psychiatric ethics, preserves the integrity of the profession, and respects the patients that our members serve.”

“It was unethical and irresponsible back in 1964 to offer professional opinions on people who were not properly evaluated, and it is unethical and irresponsible today,” APA president Maria A. Oquendo said.

According to the APA’s ethics committee, offering a professional diagnosis or opinion of someone who has not undergone proper examination compromises the integrity of the profession and further stigmatizes mental illness. Providing a psychological diagnosis of a public figure based on news reports also violates the principle that evaluation must happen with that person’s consent.

In its official opinion, the APA ethics committee also addressed several common arguments against the Goldwater Rule — among them that it encroaches on an individual psychiatrist’s freedom of speech and civic duty. The committee pointed out that psychiatrists are free to speak out about the behavior of a public figure as citizens — but not in their professional capacity as therapists and physicians.

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