A comment on the Goldwater Rule

I can explain this interaction and its implications, but I'm not supposed to do that. Individuals who don't know what they're talking about are, however, free to express their First Amendment-protected opinions.

Also,

The Ethics of APA's Goldwater Rule, Journal of the Academy of Psychiatry Law, June 2016 (pp 226-235) Abstract

Section 7.3 of the code of ethics of the American Psychiatric Association (APA) cautions psychiatrists against making public statements about public figures whom they have not formally evaluated. The APA's concern is to safeguard the public perception of psychiatry as a scientific and credible profession. The ethic is that diagnostic terminology and theory should not be used for speculative or ad hominem attacks that promote the interests of the individual physician or for political and ideological causes. However, the Goldwater Rule presents conflicting problems. These include the right to speak one's conscience regarding concerns about the psychological stability of high office holders and competing considerations regarding one's role as a private citizen versus that as a professional figure. Furthermore, the APA's proscription on diagnosis without formal interview can be questioned, since third-party payers, expert witnesses in law cases, and historical psychobiographers make diagnoses without conducting formal interviews (ital. mine*). 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.

*To the list, I would add psychiatrists and psychologists who are employed by the CIA and some law enforcement agencies to offer diagnostic opinions of world leaders and criminals, respectively, without formal interview.

 

Comments

[abear]

X: As you know there have been some psychiatrists that have been apparently breaking the Goldwater rule:
http://www.zerohedge.com/news/2017-04-22/yale-psychiatrists-just-warned-there-something-seriously-wrong-trump
I agree with their assessment. Not only should his picture be included in the encyclopedia entry of narcissist, he appears to be losing touch with reality and is possibly becoming senile.
On the other hand, pointing this out very likely isn't likely going to influence his supporters or set in motion any mechanism to remove him and could just in fact lead to the politicization of the mental health profession.

[abear]

Also, further to the idea of politicizing the profession, you get the inevitable formation of Democrat vs. Republican/ Conservative vs. Liberal psychiatrists where party affiliation drives the diagnosis.
Dr. Keith Ablow says the fact that he has won means he can't be insane:
http://www.foxnews.com/opinion/2017/02/15/relax-trump-is-stone-cold-sane.html

[Gabriel Conroy]

This is a long comment, but here's the short version: I think I see where you're coming from, and I can probably meet you halfway. But for reasons I have difficulty explaining, I can't or won't meet you all the way.

As you know, I've been very uneasy about these kinds of professionally informed observations (I won't use the loaded term "diagnosis"). You've spoken enough--and spoken thoughtfully enough--about this to at least make me more sympathetic to those who would make those observations.

At the same time, I think I'll always be critical of the practice of mental health professionals publicly opining on the mental health or personality constellations (or what have you) of public officials,* even when they're done by thoughtful and well-informed people such as yourself. In part, I'm wishing for a bit more hedging and more explicit acknowledgment that the undertaking is always going to be tentative in the best of circumstances and especially when the observer hasn't meant the official in question.** However, and if I'm being honest, I'd still get antsy and pouty even if the observer uses the full array of caveats and acknowledgments every single time he or she offers an opinion.

So maybe that's not my true rejection? Maybe I'm just defensive in a pro-Trump direction in a way that I'm not defensive in other directions? For example, I have little problem with people who, with less information than we have about Mr. Trump, call President Nixon a megalomaniac.

*I actually hadn't given any thought to the CIA and law enforcement profilers you mention. The big difference I see is that to my knowledge, those profiles are designed for practical dealing: how to catch [the criminal] or neutralize or contend with (or topple) [the world leader]. The profiles that are variously offered about Mr. Trump seem to have less practical purpose other than to say, "oh my god, this guy is nuts! I wish he weren't president." But it's not clear to me that that is a relevant distinction on which I can base a criticism of those who offer their observations about Mr. Trump.

**The video clip, taken by itself, could be read as a politician making a calculated move to put a talking point out there for his base and then cutting off a member of the "liberal media." Not my idea of a good president, but not necessarily pathological. Of course, we can't take this clip "by itself." There's a context, and part of that context is all the other things Mr. Trump has said and done.

[Dr X]

*I actually hadn't given any thought to the CIA and law enforcement profilers you mention. The big difference I see is that to my knowledge, those profiles are designed for practical dealing: how to catch [the criminal] or neutralize or contend with (or topple) [the world leader]. The profiles that are variously offered about Mr. Trump seem to have less practical purpose other than to say, "oh my god, this guy is nuts! I wish he weren't president."

Diagnostic evaluations include practical implications and recommendations. The implications and recommendations are the reason diagnoses are conducted.

During the campaign:

Press Diagnostician: "Candidate A will pivot, He's just acting like this to win the nomination."
Psychologist Diagnostician: "No, he will not pivot. He cannot pivot. Here is why that's so..., and here's what it tells you about his critically important reactions to future crises, his judgment and his decision-making processes.... This is what you would be voting for."

I literally had these conversations privately.

About 25% of my work is employee selection and risk evaluations. The work isn't about saying someone is nuts. It's about saying how they will function and what they will they do given this or that set of circumstances. That is what a diagnostican can add that the lay public generally doesn't know how to consider. Even better when the diagnostician explains these matters in ways that the lay public can understand. I do that that kind of explaining at least a couple of times a week in my evaluations and thrid-party consultations.

This is the same thing the CIA asks psychologists to do with respect to foreign leaders. The purpose is to analyze their personalities and predict their behavior across a variety of scenarios.

The press is always doing this sort of diagnosing, but they do it very badly, leading to statements like: "Don't worry. He's really capable and sensible. He will pivot when he gets the nomination."

I think we went over much of this ground at WT's site, but, nonetheless, I want to clarify (and defend) the applicability of what my profession can do and does do when we're doing our jobs the right way.

[Dr X]

There's another completely different angle I'm going to discuss in a post. Not sure when I'll get to it, but probably before the weekend is over. I've got a full day of continuing ed tomorrow and we have our film group in the evening.. Ordinarily a post might give me something to do during a c.e. presentation, but I think the lectures tomorrow will be interesting and worthwhile, so I'll either post later today or over the weekend.

[Gabriel Conroy]

For risk evaluations, do you actually meet with the employee in person? Or is there a pre-set test they take and you interpret the results? Either way, both sound different from looking at someone from a distance as we must do with Mr. Trump.

At the same time, I realize that I made my own non-professionally informed "psychological analysis" when my belief that Mr. Trump didn't have the temperament to be president was one of the reasons I voted against him. I realize it's a challenge to say I as an untrained person can make that determination, but that a trained mental health professional oughtn't. And to riff off a point our made at Will Truman's blog, I might resent it if someone said I, as a trained historian, cannot be critical about the likely effect of a Trump presidency on US political economy. (I'm not sure what such "being critical about" would look like, but I'd resent, or at least I'd be perplexed about, people saying my training as a historian disqualifies me from offering a historian's perspective.)

Thanks, by the way, for addressing my points. I'm more and more seeing where you're coming from. I'll admit upfront I'll probably never be completely comfortable with mental health professionals commenting on public officials' mental health (I realize "mental health" might be the wrong term). I'm still trying to suss out the reasons--both good and bad--why.

At any rate, I look forward to that future post when you get a chance to write it.

[Enrico62]

I've been teaching in a prison for 16 years. Talk of Trump's sanity is subjective and irrelevant to our concerns. It addresses the "why" of his behavior, not the "what." The President's grandiosity and disdain for the truth is the behavior of a criminal. That's our problem.