Alan D. Blotcky, PhD

” has been a part of the American Psychiatric Association’s (APA’s) 

Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry

 Known as “Annotation 7.3,” the Goldwater Rule prohibits psychiatrists from proffering diagnoses of current public and political figures who have not been professionally examined.

 More precisely, the annotation states, “… 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.”

It is a seemingly straightforward statement that has not been substantially modified since its inception. However, in 2017 and 2018—in response to some psychiatrists’ concerns about the mental health of then-President Donald Trump—the APA Ethics Committee reaffirmed and tightened Annotation 7.3 by clarifying what is meant by “a professional opinion.”

Making a diagnosis, for example, would be rendering a professional opinion. However, a diagnosis is not required for an opinion to be professional. Instead, when a psychiatrist renders an opinion about the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry, the opinion is a professional one. Thus, saying that a person does not have an illness is also a professional opinion.

Since 1973, the Goldwater Rule has served its original purpose of keeping psychiatrists and other mental health professionals from making flippant, speculative, and/or unverifiable inferences about the mental health of (living) public and political figures. In our view, the Goldwater Rule’s basic rationale is correct. However, ethical guidelines are not meant to remain static and fixed. Over years or decades, provisions may need to be revised or at least further delineated. Such is the case, in our opinion, with respect to the Goldwater Rule.

, “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.”

 Accordingly, there needs to be acceptable and ethical ways for psychiatrists and other mental health professionals to opine about political and public figures on behalf of the public’s well-being and society’s greater good. Serving society and the public health does not occur in a clinician’s office—it often requires reaching out to the public via the media. And because of explosive advances in technology, the media now include cable television, radio, print, internet websites, audio recordings, video recordings, tweets, podcasts, and so many more platforms. It is through these various media outlets that psychiatrists and other mental health experts can responsibly influence and improve the community and public health.

Back in 1973, when Annotation 7.3 was adopted, only a handful of media outlets were available. Today, the media are vast and ever-present, and an expert’s opinions can be seen and heard almost instantaneously throughout the world. Having a clear understanding of what is ethically acceptable will make interacting with the media more comfortable and effective.

The public is bombarded with mountains of information and opinions on a minute-by-minute basis. Unfortunately, much of the material is inaccurate and even harmful. Misinformation and disinformation regarding mental health and mental illness now abound. Who better to provide accurate and helpful knowledge than mental health experts, whose education, training, knowledge, and expertise can be brought to bear on the prevailing public and social issues of the day?

By necessity, then, the Goldwater Rule needs to be better defined, clarified, and expanded so that it provides a clear direction for psychiatrists who want to interact ethically with the media. Building on a 2016 article by Pies,

 we propose that the following 5 categories of professional discussion and opinion be deemed ethical and specifically incorporated into a revised Goldwater Rule.

A professional opinion may explain the positive and negative effects of a specific mental disorder in a hypothetical public or political figure. For example, psychiatrists could explain how antisocial or narcissistic personality disorder might manifest in a hypothetical elected public official.

A provisional diagnosis or professional opinion regarding a (deceased) historical figure may teach us something about current public or political figures. An example would be a discussion of Abraham Lincoln’s depression or Richard Nixon’s well-documented alcohol abuse and paranoia.

A professional discussion regarding a living public or political figure may focus exclusively on publicly observable behaviors or behavior patterns that, in principle, might affect the person’s ability to perform their duties. This type of discussion would not proffer a diagnosis or reach a conclusion regarding the person’s fitness for duty, dangerousness, or ability to serve in a specific capacity. To illustrate, we offer 1 inappropriate and 1 appropriate response to a typical media- generated question:

“Senator Brown” has been observed, on several occasions, walking unsteadily in public and slurring his speech. There are persistent rumors in the lay press that Senator Brown has a drinking problem. A mental health professional is asked by a television news reporter, “Doctor, can you comment on Senator Brown’s abnormal behavior? Do you think he is an alcoholic? Is he fit to do his job?”

 “Based on his unsteady gait and slurred speech, it is my professional judgment that Senator Brown likely has a serious drinking problem. This could well impair his ability to carry out his functions as a senator and lead to some dangerous behaviors.”

 “I have not evaluated Senator Brown, so I do not want to speculate on his condition or mental capabilities. Certainly, when someone shows gait instability and slurred speech, I would want to have that person evaluated medically. The problem could be some type of intoxication, involving alcohol or some other substance. But these reported behaviors could also be consistent with a metabolic or neurologic disorder of some sort. For example, hypoglycemia and various postictal (ie, following a seizure) states may be mistaken for alcohol intoxication.

 Whether the senator’s condition—whatever it may be—would impair his ability to carry out his duties or cause dangerous behaviors would require a careful neuropsychiatric examination.”

A professional discussion may focus on the differential diagnosis of publicly observed behaviors or behavior patterns in relation to a current public or political figure. As in the previous example, a discussion could be provided by a mental health professional without diagnosing the person in question or opining on the person’s job fitness or dangerousness. Again, we provide an inappropriate and an appropriate professional response:

“Congresswoman Young” is running for president of the United States. Over the past 6 months, reports in the media have raised the question of manic-depressive illness or bipolar disorder. Reports in the lay press have cited Congresswoman Young’s extreme mood swings and intervals of abnormal speech and erratic, impulsive behaviors that have lasted for 2 to 3 days. A psychiatrist is asked by a newspaper reporter, “Doctor, can you comment on Congresswoman Young’s mood swings and erratic, impulsive behaviors? Could she have bipolar disorder, and would this render her unfit for the presidency?”

 “In my professional opinion, Congresswoman Young’s obvious and extreme mood swings; emotional lability; rapid, pressured speech; and periods of irritability all point to a diagnosis of bipolar disorder. This condition, if left untreated, could well impair her ability to function in the role of US president.”

“I have not evaluated Congresswoman Young, so I do not want to speculate on her condition or mental capabilities. When psychiatrists evaluate the behaviors you are describing, we consider a number of neuropsychiatric disorders in our differential diagnosis. For example, bipolar disorder can, indeed, be characterized by significant mood swings; emotional lability; rapid, pressured speech; and periods of irritability. But similar symptoms may be seen in several substance use disorders, such as methamphetamine use disorder, or in borderline personality disorder.

 Endocrine disturbances, such as abnormal thyroid function, or the periodic use of corticosteroids can also produce signs and symptoms that may be mistaken for a mood disorder. Only a professional evaluation can determine what is actually going on with a particular person and what degree of impairment exists.”

A discussion of specific behaviors or behavior patterns attributed to a current public figure may be related to general categories of mental disorders. For example, the constellation of repeated lying; multiple legal infractions or arrests; interpersonal manipulativeness; and lack of empathy and concern for the rights of others could be discussed in relation to certain personality disorders (eg, narcissistic personality disorder, antisocial personality disorder). Absent a professional evaluation, care must be taken to avoid implying that the public figure in question fits one of these categories. Again, mental health professionals should refrain from making a diagnosis or speculating on the job fitness or dangerousness of a living public figure.

As can be seen, there are at least 5 ways in which psychiatrists and other mental health professionals can educate, inform, and provide guidance regarding public or political figures without violating the intent and spirit of the Goldwater Rule. To better understand and implement Annotation 7.3, it would be helpful for examples of the type we have provided to be presented and discussed in the revised annotation. Once revised, the Goldwater Rule could serve as a roadmap for psychiatrists and others who have a responsibility to improve the community and better the public health as they avoid the pitfalls of “armchair diagnosis.”

Finally, it must be emphasized that the Goldwater Rule does not limit psychiatrists or other mental health professionals as private citizens from expressing political views concerning a current situation, policy, or political figure. Health care professionals may always offer their opinions as concerned citizens without characterizing their views as professional judgments.

 Indeed, our representative democracy functions best when all its citizens are active, vocal, and assertive.

 is a clinical and forensic psychologist in private practice in Birmingham, Alabama. He is also clinical associate professor in the Department of Psychology at the University of Alabama at Birmingham. 

 is professor emeritus of psychiatry and lecturer on bioethics and humanities at SUNY Upstate Medical University. He is also clinical professor of psychiatry at Tufts University School of Medicine and Editor-in-Chief Emeritus of 

 is an award-winning psychiatrist who specializes in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is retired from his tenured professorship at the Medical College of Wisconsin.

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Goldwater Rule’s origins based on long-ago controversy

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. American Psychiatric Association. March 16, 2017. Accessed November 15, 2021.

American Psychiatric Association Ethics Committee Opinion

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Deconstructing and reconstructing the “Goldwater Rule.”

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Do some leaders have ‘first-rate madness’?

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Latest Nixon biography portrays an isolated leader

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Alcohol intoxication mimics: ED DDx + approach to management

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Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders

Psychiatry, “dangerousness,” and the president

. February 16, 2018. Accessed December 2, 2021. ❒

Articles

How can we better define, clarify, and expand the Goldwater Rule for ethical and effective use in today's society?

The Goldwater Rule Is Fine, if Refined. Here’s How to Do it.

Parental alienation is a mental state in which a child—usually one whose parents are engaged in a high-conflict separation or divorce—allies strongly with 1 parent (the offending, but favored parent) and rejects a relationship with the other parent (the alienated parent) without legitimate reason.

 This condition occurs in the context of a maladaptive family dynamic involving at least 3 individuals: the alienating parent, who intentionally and purposefully manipulates the child to reject the other parent; the child, who experiences parental alienation; and the rejected, alienated parent. A variety of tactics and maneuvers are used by alienating parents to achieve their goal, ranging from bad-mouthing and disruption of visitation time to false allegations of abuse and criminal charges.

Research indicates that parental alienation is present in 11% to 15% of divorce cases. It has also been found that 20% to 25% of parents engage in alienating behavior as long as 6 years after divorce. Alienating parents can be either mothers or fathers.

Parental alienation is poorly understood by many mental health professionals, not to mention attorneys, guardians ad litem, and judges. It is a confusing and vexing problem because many of its features and dynamics are hidden behind the scenes, ferociously denied, and counterintuitive from what one would expect.

Because of its counterintuitive nature, many false assumptions are made by professionals who are involved in cases of parental alienation. Much can be learned from recognizing and understanding these false assumptions, both in terms of diagnosis and treatment. This is especially important since early diagnosis and intervention are predictive of better outcomes for the child.

What follows is a description of many false assumptions that are made routinely in alienation cases. Richard Warshak, PhD,

 have written about fallacies and fundamental attribution error in these cases, and 1 of us has written about misinformation in alienation theory.

 The following concepts serve as the foundation for our fuller understanding of the role of false assumptions in parental alienation cases.

. When we think intuitively, our decisions tend to feel “right,” regardless of whether they are or not. To accurately understand parental alienation, a clinician must have an advanced understanding of the typical dynamics in these cases. Relying on intuition can lead to major mistakes right from the get-go. For example, just because a parent seems healthy or believable, does not make it so.

 It is a common fallacy that both parents are equally responsible for high conflict during a separation or divorce. It is always important to consider the possibility that 1 parent may be the aggressor, while the other parent is the victim. In most cases, both parents are not equally responsible for the ongoing conflict. It can be a major blunder to assume so.

Outward demeanors are indicative of truth. 

Alienating parents typically present as calm, verbal, and convincing. In contrast, alienated or rejected parents usually present as agitated, angry, and afraid; they are victims.

 In many cases, the alienating parent appears to be healthier and more believable—but that is a manipulation and a distraction from their intentionally alienating behavior. The rejected parent appears more psychologically disturbed, and so it is assumed that he or she is the one engaging in problematic behavior. Outward demeanors can be quite deceiving and must be considered cautiously in diagnostic decision-making.

 The intrapsychic defense of projection is often seen in cases of alienation. In essence, the alienating parent accuses the rejected parent of being the aggressor. If you fall for the offending parent’s distortion and misperception, poor diagnostic decisions will be made, and the case can quickly go haywire. Projection can lead to the wrong person being identified as the alienating parent.

Children’s denials and “truths” are gospel. 

Simply believing a child’s denial of alienation by a parent can be a recipe for disaster. Children are not usually aware of the maneuvers employed by the offending parent to turn them against the rejected parent. Plus, such children are frequently enmeshed with the offending parent and will defend that parent to the bitter end. Independent thinker phenomenon is often seen, whereby alienated children assert that their rejection of a parent is solely their idea and decision—not due to the offending parent’s influence. So just listening to a child’s denials can be a serious error that will undermine good decision-making in a case. There is a body of literature that tells us that children and teenagers do not know what is in their own best interest.

 This is especially true when they are the unwitting participants in alienation by a parent.

Alienation does not involve total rejection. 

Children naturally want to love both of their parents without interruption or impediment. A child does not totally reject a parent unless there is an alienating influence in the mix. This is true even for abusive parents. Indeed, children who have been verbally, physically, or sexually abused by a parent experience profound ambivalence because they still love the parent. They are upset and in turmoil by the fact that they cannot have a continued relationship despite the well-established abuse.

 As such, total rejection by a child is much more indicative of alienation. And to use a child’s rejection of a parent as corroboration or validation of the rejected parent’s badness can be flat-out wrong.

Estrangement and alienation are the same thing

. When children resist contact with a parent for legitimate reasons, this is called estrangement, not alienation. Estrangement is very different than alienation; it is important not to confuse them. For example, it would make sense for a child to be estranged from a parent if that parent engages in substance abuse during the child’s visits. Estrangement can be corrected if the parent is willing to make the necessary changes. Alienation, in contrast, tends to be camouflaged, insidious, and recalcitrant.

Alienating behavior is relatively harmless and will not impact the child’s long-term mental health. 

Engaging persistently in alienating behavior is child psychological abuse. It is a mistake to deny it or rationalize it away. According to DSM-5, child psychological abuse is nonaccidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child. In light of this, parental alienation is considered a psychiatric emergency, especially in moderate to severe cases. Minimizing the severity of the problem does a terrible disservice to the child. Unfortunately, it enables the abusive behavior to continue unchecked.

Since persistent alienating behavior constitutes child psychological abuse, the top priority should be to protect the child from further abuse. Until this is accomplished, no form of psychotherapy will be effective. In other words, protecting the child from further abuse must be the first step before psychotherapy of any kind is started. This mistake is common. In many court cases, it is erroneously assumed that psychotherapy can fix the problem when, in fact, little or nothing can be accomplished because the alienating behavior is ongoing.

Removing the child from the home is harmful. 

There is no credible evidence that removing an alienated child from the home of the offending parent causes a significant risk of psychological harm. The opposite is true. In almost all severe and some moderate cases of parental alienation, the risks of not protecting the child are far greater than the risks of protecting the child. Removal of the child from the offending parent’s care may be necessary, at least temporarily. Children and teenagers may fuss about it, but they will comply with, and benefit from, such an intervention.

Reunification therapy can start at any time and is easy. 

Reunification therapy cannot be successful unless the alienating behavior by the offending parent is stopped. Otherwise, progress will be impeded by the continued alienation, and everyone will be perplexed as to why significant gains are not being made. The reunification therapy itself may not be the issue at all. Its progress may be stalled by the omnipresence of alienating behavior by the 1 parent.

Reunification therapy is difficult and complex. It requires a knowledgeable and seasoned therapist. The therapist must be directive and assertive, not passive, lethargic, or naïve. An inexperienced or unknowledgeable therapist can make things worse. Such therapists can begin to feel overwhelmed, frustrated, and disappointed. A negative expectation for improvement can take over and become a complicating and limiting factor.

There are no interventions for alienation situations. 

Active interventions for parental alienation are available and they do work. The interventions must be aimed at (1) stopping the alienation by the offending parent, (2) clarifying and resolving the alienation in the child, and (3) repairing the child-rejected parent relationship. More traditional psychotherapies that do not target these specific areas are doomed to fail. The right therapy at the right time is critical.

Children’s school performance is the best guide. 

Just because a child is doing well in school or other activities does not mean they are doing well psychologically or emotionally. This is a common misconception. Focusing on school grades can miss the larger issues at hand.

The truly guilty party will confess eventually. 

No matter how much pressure is applied, the severely alienating parent will never admit to their intentionally harmful behavior. There is never a 

 moment. Do not be misguided or misled by this parent’s persistent denials, as they are disingenuous and untruthful.

Alienating behavior always results in alienation. 

Not all children who have an alienating parent become alienated. However, even if the child is not alienated does not mean the parent’s alienating behavior is harmless. The negative consequences of alienating behavior tend to be cumulative over time. In addition, the child might become alienated if the damaging behavior does not cease.

All cases of parental alienation are fraught with complexities and difficulties. None are easy or straightforward. False assumptions are pitfalls to be understood and avoided in these cases. Missteps anywhere along the way can result in misdiagnosis, miscalculations, and ill-fated interventions.

Early diagnosis and intervention are important in alienation cases. The offending parent’s behavior must be stopped as soon as possible. All professionals—from mental health experts to attorneys to judges—must understand this principle. It is unacceptable to turn a blind eye. By doing so, complicity with the offending parent will be established and the child’s mental health will be rendered unimportant.

Professionals want to help children and their parents when they are embroiled in high conflict and escalating acrimony. But falling for any of these false assumptions can take a case down a dangerous path. And, in every instance, a child’s psychological wellbeing and mental health are at stake.

is a clinical and forensic psychologist in private practice in Birmingham, Alabama. He is also a clinical associate professor in the Department of Psychology, University of Alabama at Birmingham. He is a member of the Parental Alienation Study Group.

is professor emeritus, Department of Psychiatry, Vanderbilt University School of Medicine in Nashville, Tennessee. He was the founder and first president of the Parental Alienation Study Group.

. Springfield, Illinois: Charles C Thomas Publisher Ltd. 2020.

Current controversies regarding parental alienation syndrome

3. Miller SG. Clinical reasoning and decision-making in cases of child alignment: diagnostic and therapeutic issues. In Baker AJL, Sauber, SR, eds., 

Working with Alienated Children and Families: A Clinical Guidebook

. New York, New York: Routledge. 2013:8-46.

Recurrent misinformation regarding parental alienation theory

Payoffs and pitfalls of listening to children

6. Baker AJL, Creegan A, Quinones A, et al. 

Foster children’s views of their birth parents: a review of the literature

Ten parental alienation fallacies that compromise decisions in court and in therapy

Here’s how to avoid false assumptions in cases of parental alienation to ensure better outcomes for children.

Avoiding the Pitfalls of False Assumptions in Parental Alienation Cases

As a clinical and forensic psychologist, I have been involved in hundreds of cases of divorce and child custody. The topic of false allegations of abuse is a complicated and thorny one that deserves much attention. In particular, there needs to be a focus on the alienating beliefs that often underly and compel false allegations.

False allegations of abuse are an all-too-common phenomenon during divorce and child custody proceedings. One parent fabricates a false allegation against the other parent to gain leverage in court and to undermine the parent-child relationship going forward. The frequency of false allegations in custody cases is not fully understood, with estimates ranging from 2% to 35% of all cases involving children.

 Whatever the percentage, attorneys, judges, and mental health experts all know firsthand that it is a vexing problem in court cases. And nothing can disrupt, sidetrack, or impede a case more than an allegation of abuse that eventually proves to be false.

Parents never admit to their conniving and harmful behavior during a legal action. As such, proving an allegation is false can be extremely challenging. Why? Because a false allegation is hatched in the mind of the offending parent, who then enlists the help of their child to unwittingly carry out the plot. The intent is to harm the other parent, but to do so as if the offending parent is the real victim. Parents know that an allegation of abuse has the potential to help them win their case, which is their ultimate goal. Unfortunately, being honest and fair is not always a virtue in a contentious child custody case.

Detecting a false allegation is critical because judges can be swayed by the accusation, even if it is not substantiated by the evidence. More often than not, custody decisions go in favor of the accusing parent.

 So, uncovering and exposing a false allegation is vital in making sure the offending parent is not rewarded for his or her destructive behavior.

The surest way to prove a false allegation of abuse is to uncover the alienating belief system of the offending parent. Alienating beliefs often underlie a parent’s decision to fabricate a false allegation against the other parent. With careful interviewing and psychological testing, these beliefs can be brought to the surface. A mental health professional is best suited to address this clinical problem. It takes patience and a probing attitude by the clinician to elicit alienating beliefs that are being hidden from view by the offending parent. Sentence Completion Series is one psychological instrument that will elicit thoughts, feelings, actions, intentions, and motivations. In interviewing, hypothetical questions, a focus on nonverbal cues, and exploration of apparent discrepancies can be productive.

Here are 7 common alienating beliefs that occur in false allegations:

1. “I am afraid our child will love you more than me and will want to live with you.”

3. “If you don’t want me, you don’t get our child, either.”

4. “I want to exact revenge on you, and what better way than to deprive you of your child?”

5. “I don’t want my child to be anything like you.”

6. “I’ve been the real parent in this family, not you.”

7. “I don’t want my child to love their new stepparent because I might be pushed out.”

There are important implications to consider in cases of false allegations of abuse. First, the desire to alienate the child from the other parent is at the core of most false allegations of abuse. And, when a parent makes multiple false allegations during a legal proceeding, you can bet that alienating beliefs are in play. Yet, it is important to note that not all false allegations are due to alienating motives. Sometimes, for example, a parent may over-interpret a comment or report from a child, thereby jumping to an erroneous conclusion. Rather than clarifying the benign situation, the parent makes what proves to be a false allegation. Other examples exist where alienation is not a major component in a false allegation.

Second, a child needs to love both parents without impediment or interruption. Being caught in a loyalty fight is damaging, as a child’s long-term adjustment is dependent upon having a close relationship with both parents. Anything short of that is unacceptable. A false allegation of abuse can go a long way to disrupt a child’s relationship with the accused parent. Loving that parent may become strained or even impossible going forward. Thus, a false allegation against a parent can have a tragically negative impact on the child.

Third, offending parents tend to view their children as possessions to be controlled and manipulated. They see them as extensions of themselves. That is not parental love, but rather, narcissistic self-absorption. It is the offending parent’s hostile needs and motivations that are the real problem in these cases, not the rejected, victimized parent. Offending parents lodge false allegations against the other parent to meet their own needs, not their child’s. Teaching a child to be a victim under false pretenses can set the stage for a lifetime of victimhood for the child.

Fourth, vindictiveness is a malignant emotion that causes great pain, sorrow, and unhappiness in any relationship. Being consumed with vindictiveness is profoundly unhealthy. It has nothing to do with love and care for the child. Vindictiveness is common in false allegations of abuse. What is portrayed as protectiveness of the child is actually hostility and destructiveness toward the other parent, with little genuine concern for the child’s best interest.

Fifth, false allegations of abuse must be stopped as soon as possible for the child’s wellbeing. If they are not stopped, the offending parent’s pernicious behavior will gain steam and impact over time. False allegations cannot be condoned in any way. Several courses of action are reasonable: limited parenting time, supervised visits, change of custody, court-ordered therapy, and others. Turning a blind eye to a false allegation of abuse is not an option.

Finally, judges and attorneys need to be educated about the seriousness and deleterious consequences of false allegations of abuse. Mental health experts can help inform, explain, and guide during the legal proceeding or at trial. False allegations and alienation are highly disruptive to the wellbeing and mental health of the child.

It should be reassuring to know that alienating beliefs can be uncovered and exposed. That is the key to unlocking the “proof” of a false allegation. Without exposure, a child custody case can be hijacked by a false allegation, and the child’s wellbeing may be lost in the confusion. After all, a child’s future can be at stake.

This is the first installment in Dr Blotcky’s new column, “Forensic Practice.” Feedback and suggestions for future articles can be sent to 

 is a clinical and forensic psychologist in private practice in Birmingham, Alabama. His specialty is false allegations of abuse and parental alienation. He can be reached at 

Recantation and false allegations of child abuse

The National Children’s Advocacy Center

2. Meier JS, Dickson S, O’Sullivan C, et al. 

Child custody outcomes in cases involving parental alienation and abuse allegations

False statements and the differential diagnosis of abuse allegations

Psychological impact of being wrongfully accused of criminal offences: a systematic literature review

How can mental health experts help identify false allegations and alienation during divorce proceedings?

False Allegations of Abuse During Divorce: The Role of Alienating Beliefs

Perhaps now is an appropriate time to reassess the so-called 

, after the controversy over President Trump’s mental status during his presidency. Although the Goldwater Rule only officially applies to members of the American Psychiatric Association (APA), it is considered a general standard for other mental health professionals, the public, and the media.

What are the major ethical principles involved in this controversy? In the 

Principles of Medical Ethics, With Annotations Especially Applicable to Psychiatry 

of the APA, the first relevant commentary is in the preamble, where it states: “As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.”

 The prevailing question here is, what does our obligation to society encompass?

For APA psychiatrists, much of that tries to be clarified in Section 7, which states: “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.” Under Section 7, there are various annotations especially applicable to psychiatrists. They are listed in order of incorporation, and thereby after the general ethical principle has been adopted.

In Annotation 7.1, it states that psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of government. In 7.2, psychiatrists may interpret and share with the public their expertise on various psychosocial issues that may affect mental health and illness. In 7.3, it states that a psychiatrist may share with the public their expertise about psychiatric issues in general, but cannot offer a professional opinion about a specific person unless they have conducted an examination of that person and have obtained a confidentiality release. It is this last provision, Annotation 7.3, that constitutes the Goldwater Rule. But to be clear, that term is not used anywhere in Section 7, and 

 is an unusual term to use in ethical guidelines. It appears that the name has become a short-handed code in conversation and in the mass media.

To review, the Goldwater Rule had its genesis in the 1964 United States presidential campaign. 

of psychiatrists who were asked whether Republican nominee Barry Goldwater was psychologically fit to be president. There were 12,356 psychiatrists queried, though only 2417 responded to the questionnaire (which was less than 20%). Of those, 1189 said no, 657 said yes, and 571 said they were unsure. At the time, the APA warned 

 against publishing the wild and inflammatory responses and deemed the article as “attaching stigma of extreme partisanship to the psychiatric profession as a whole.” Goldwater won his subsequent suit against 

Despite the concern of the time, it took until 1973 to produce Annotation 7.3. The reason for the delay is not clear, though the Democratic Vice-Presidential nominee in 1972, Senator Thomas Eagleton, had a history of severe depressive episodes requiring hospitalizations, but all that had been kept secret until then. When revealed, he was forced out of the race. Behind the scenes, recommendations by psychiatrists were suspected to have played a role in the decision, but that is uncertain. The timing, though, does suggest a connection of the Eagleton exposure with the clear emergence of the Goldwater Rule.

There were no concerns about violations of the Goldwater Rule until the presidency of Donald Trump. That was true even during the presidency of Richard Nixon, where concerns about paranoia started to emerge, but psychiatrists kept quiet.

On March 17, 2017, as the controversy about President Trump’s mental state escalated, the Ethics Committee of the APA issued a very detailed opinion about Section 7.3. The Rule was tightened to apply to all professional opinions offered by APA psychiatrists about someone not examined, not just diagnoses. Their opinion also offered rebuttals to many of the arguments against the Goldwater Rule, including freedom of speech, forensic case profiles, and the Tarasoff Doctrine about duty to warn people threatened by a patient. Of course, an APA psychiatrist can communicate about political figures as a citizen, but how does one prove it is a citizen’s opinion that is uninfluenced by professional knowledge and expertise?

According to the Ethics Committee, the only exception listed is the “psychological profiling of historical figures aimed at enhancing public and governmental understanding of their conditions.” But such profiling must not include a diagnosis and should be based on peer-reviewed scholarship.

Where and why, then, is there sufficient ethical justification to overrule the Goldwater Rule regarding a public figure? Although we could list many new annotations and guidelines, many of them have already been rebuked by the APA Ethics Committee.

Some members have quit the APA in order to speak out, but how much weight that carries with the public and the media is uncertain. And although President Trump lost the reelection, who knows how much influence psychiatric opposition had on the results. To go even further, a group of such psychiatrists can decide to form a new psychiatric association with their own ethical principles. Such psychiatrists can join forces with other like-minded health and mental health professionals, all of whom are not under the constraints of membership in the APA.

Ethics are not forever. They often are not black-and-white. Professional ethics change over time, and sometimes it is a small minority that forges a new ethical pathway. Until it is revised by the APA, the Goldwater Rule has to be a matter of personal conscience and morality, to be overruled by those who have the insight and courage to publicly disagree.

is a clinical psychologist in private practice in Birmingham, Alabama. 

 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the 1-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of 

The Principles of Medical Ethics, With Annotations Especially Applicable to Psychiatry

https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/principles-medical-ethics.pdf

The Goldwater Rule has been in place for decades, but recent events have caused some to ponder its utility and appropriateness. 

Overruling the Goldwater Rule?

Americans are being bombarded with all kinds of information about the

. As we can see every day, this information can be partial, fragmented, conflicting, inaccurate, or downright wrong. Information can be distorted by politics or religion or conspiracy theories. What is needed—and has been sorely missing—is critical thinking by all Americans. And until we apply critical thinking to the issue of vaccines, our nation will continue to flail and remain on its deadly course.

It does not have to be this way. All mental health professionals should be voicing their opinions about the vital role of critical thinking in individuals’ lives.

Critical thinking refers to the objective analysis and evaluation of an issue. It requires 5 central steps: identification of an issue; open-mindedness in bringing to light all sides of the issue; evaluation of the factualness of each piece of information; synthesizing the best facts into a cohesive whole; and formulating superior conclusions.

Historically, schools have done a terrible job of teaching us critical thinking. Most of us had classes where information was provided to us, we memorized it, and then we recited it back on exams. High grades reflected strong memorization. But the ability to think critically was seldom taught, even in high schools.

Colleges and universities have made critical thinking a priority in their classrooms. But, of course, only 42% of Americans have a college education. That means the vast majority of citizens have not had the opportunity to learn critical thinking.

Thus, we are inept at conquering complicated—and potentially deadly—national problems.

Let us apply critical thinking to the COVID-19 vaccines. If we do, here is what we know for certain: vaccines are effective and safe; upward of 90% of Americans must be vaccinated or have had the coronavirus for the pandemic to be soundly defeated; our national history of vaccinations has been extremely impressive; and decisions about vaccines must be based on medical and scientific evidence.

Our country is founded on the ideals of freedom and individual liberties. No one wants to take those away. But at this moment, when 

is running wild, critical thinking must be far more salient in our decision-making than individual wishes, desires, politics, or religion. Critical thinking can debunk lies, conspiracy theories, and misinformation. It can lead us to the truth.

Until critical thinking is widely accepted about vaccines, thousands of Americans will continue to die each week. This is profoundly sad and tragic since these deaths are almost totally preventable.

All Americans must be vaccinated as soon as possible. It is the vehicle by which we can defeat this deadly pandemic. This is a certainty. This is the truth. Critical thinking can save lives. We just need to use it. Mental health professionals can be a role model for its use.



is a clinical psychologist in private practice in Birmingham, Alabama.

Critical thinking is sorely missing in our decision-making about the COVID vaccines—and it is having tragic results.

Critical Thinking, COVID-19 Vaccines, and Deadly Consequences

About half of marriages end in divorce, and approximately 6 out of 10 divorces involve children. Even when amicable, a divorce is a difficult situation. However, divorces can be tumultuous, and children often pay the price. One way this is manifested is in false allegations of abuse in child custody cases. Typically, one parent accuses the other parent of physical and/or sexual abuse of their child to gain leverage in their court proceeding. This tactic can be particularly impactful because judges tend to award primary physical custody to the parent who made the allegation, even if the accused parent’s actions are not substantiated. Thus, false allegations can be a powerful weapon to limit or deny custody and/or visitation in a vindictive manner.

Although a strong visceral reaction to an abuse allegation is expected, it can be counterproductive. Similarly, a rushed response can make the situation worse. In contrast, a wait-and-see attitude leaves the door open for a thorough evaluation before a disposition is decided upon.

To be clear: False allegations of abuse are a form of parental alienation. Alienation involves the concerted effort of one parent to undermine the other parent’s relationship with their child. Nothing could be worse than a custody decision that is based on a false allegation. To make matters worse, once a custody decision has been issued, modification of it is burdensome and an uphill challenge.

The clinical evaluation is an important part of proceedings in which allegations have been made. A successful case requires coordinated efforts among the judge, attorneys, and a court-appointed evaluator, who is often a psychiatrist or clinical psychologist.

The approach outlined in this article is based on years of experience with hundreds of cases of abuse allegations, and it consists of sequential steps. The evaluation process is aimed at determining if an allegation of abuse has occurred or not—in other words, whether the allegation has been fabricated by a parent with the intent of sabotaging and harming the other parent.

For obvious reasons, the evaluation must include both parents and the child to understand the entire narrative. All 3 individuals—the accused parent, the accusing parent, and the child—must be a part of the evaluation process. After all, we want our conclusions and recommendations to be based on full and accurate information.

The accused parent is often advised by their attorney not to participate in the evaluation process. This is ill-conceived advice. By doing so, the mental health professional evaluator will be deprived of critical information that can shine a light on the falsity of the claim. Otherwise, all the information will be coming from the accusing parent, whose allegation will hold greater weight if it is not disputed.

It is always a good idea for the child in such a case to be seen for an independent forensic evaluation. This would be in addition to the child’s involvement with the court-appointed evaluator.

If this is the first allegation of abuse, and it occurs during a child custody case, its validity must be questioned. In fact, there is a significant probability that the allegation is false, as it is unlikely that a parent’s first abuse of the child occurs after the child custody case has been initiated. Thus, if a parent does not have a history of abusing the child, it is not likely that the first abuse is occurring during the legal proceeding.

A series of allegations against a parent during a child custody proceeding is also a major red flag. An accusing parent often believes that multiple allegations against the other parent are more convincing to a judge than a single allegation. However, repeated abuse of a child during a circumscribed time period—during a child custody case, for example—is quite improbable.

Detecting a false allegation is easier with the use of a timeline. Marking the major occurrences in a child custody case can show the specific sequence of events. A false allegation of abuse may occur during the custody case, and not before. It may also occur in response to legal action taken by the other parent. For example, if a mother files for full custody of her child, this sets the stage for the father to report a false allegation of abuse against the mother with the hopes that the allegation will derail the mother’s quest. The motive of the false allegation can be detected by examining its place on the timeline of events.

False allegations of abuse often include unwitting help from the children. Children aged between 3 and 7 years can be easily coached by a parent to testify against the other. Because most children want to please their primary parent, they are easily swayed, cajoled, convinced, and brainwashed. It is difficult for children to know the truth once a parent has coached them extensively. False allegations can involve older children and teenagers as well, but their coaching is more easily transparent and adolescents may even admit to it.

5 Beliefs That Motivate False Accusations of Child Abuse

There are 5 common beliefs that motivate a parent to lodge a false allegation of abuse against the other parent (

). If any of these beliefs are discovered, the allegation of abuse is likely false. Detecting these beliefs in a parent requires careful interviews over several sessions. A parent will never admit to fabricating a false allegation. The clinician must be skilled to see through the defensiveness, deceitfulness, and/or distractions of an offending parent.

Harmful and false beliefs by the accusing parent can also be detected through interviews with the child and the accused parent. Usually, the child or the accused parent will provide critical clues as to the accusing parent’s belief system. Bits and pieces of information will fit together into a detailed narrative that exposes the falseness of the allegation at hand. Remember, the accusing parent generally does not recant nor apologize for their attempts at relationship interference.

Once an allegation of abuse has been declared by a parent, there is a process that should ensue.

First, the judge should appoint a psychiatrist or clinical psychologist to evaluate the child and both parents. This evaluation must include interviews, psychological testing, and a review of collateral data (eg, emails, texts, recordings, pictures, etc). The evaluator should have access to other independent assessments of the allegation, such as Department of Human Resources investigations or a forensic evaluation of the child.

The psychiatrist or clinical psychologist must be experienced in child custody evaluations. Similarly, there should be a wait-and-see attitude about the allegation until the evaluation process has been fully completed. In other words, no assumptions or decisions should be considered until all the facts and information have been collected and assessed. The evaluation by the mental health professional should be aimed at determining the validity of the stated allegation of abuse.

During this time, attorneys should not respond to an allegation of abuse by filing motions for dramatic or extreme action, such as obtaining full custody of the child. However, granting a parent temporary custody until the matter is settled may make sense, especially if the child’s physical safety is of acute concern. Similarly, the attorneys must not try to sabotage the evaluator in order to win their case. The evaluator’s conclusions and recommendations should be given strong weight in the judge’s final decision.

A false allegation of abuse by a parent should be met with firm consequences, such as a fine, supervised parenting time, court-ordered counseling, and/or loss of primary custody. Swift and decisive consequences will dissuade future false allegations of abuse.

The accusing parent may not be appropriate for primary custody. Even shared custody may not be appropriate. A parent’s willingness to fabricate an allegation of abuse against the other parent is a poor prognostic indicator. It is not simply an accident or a mistake. A false allegation is an intentional and purposeful attempt to undermine the child custody proceeding.

Similarly, the false allegation has implications for the future well-being of the child, and a false allegation should be considered a form of parental alienation. This experience, especially if they are asked to take an active role in the allegation, teaches the child to be dishonest, deceitful, manipulative, conflictual, and blaming. Furthermore, the love the child should have for both parents is compromised and potentially destroyed.

A false allegation of abuse is serious, and it must not be tolerated in the court system. Based on the consequences, a false allegation represents a psychiatric emergency. As such, it must be handled and dealt with in a direct and timely manner. A child’s mental health and well-being depend upon it.

is a licensed clinical psychologist in private practice in Birmingham, Alabama. His forensic practice focuses on child custody and alienation cases. He is also a clinical associate professor in the Department of Psychology at the University of Alabama at Birmingham.

False allegations of abuse during a custody battle can seriously harm children. Here's how psychiatrists can separate fact from fiction. 