James L. Fleming, MD

The suggested refinements by Alan D. Blotcky, PhD; Ronald W. Pies, MD; and H. Steven Moffic, MD,

 to Section 7.3 of the American Psychiatric Association (APA) Ethics Code—known as the Goldwater Rule—are reasonable, but in my view insufficient. I believe so for 2 reasons: 1) The extreme actions of the former US president and the party he still seems to largely control present a clear and present danger to the core functions of our system of government and call for stronger action from every responsible citizen, more so from those with knowledge and expertise in the workings of human behavior; and 2) the APA’s most recent defense of the Goldwater Rule

 does not adequately detail how a psychiatrist can both comment on the behaviors (“public actions”) of political figures and avoid rendering a “professional opinion,” given the unusually broad definition this entails (ie, any wording that “draws on the skills, training, expertise, and/or knowledge” inherent in our practice of psychiatry).

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

Alan D. Blotcky, PhD, Ronald W. Pies, MD, H. Steven Moffic, MD

We could try to stipulate that we are not speaking as psychiatrists or simply not mention anything about our profession, but either approach would seem both disingenuous and ineffective, if not impossible. Imagine the case of a prominent psychiatrist such as a faculty chair or a well-known author, or a psychiatrist in a small town or rural setting where every medical professional is well-known in the entire community. For all of us, once our identity as a psychiatrist is known, whatever we say or write will be inextricably tied—in the mind of the public—to our professional training and expertise.

The Blotcky article encourages psychiatrists 

 to express their political views in the interest of fulfilling other aspects of the APA Ethics Code, which calls on physicians to “participate in activities contributing to the improvement of the community and the betterment of public health.” However, even with guidelines on how to separate our status as private citizens versus psychiatric professionals, concerns about being called up on ethics violations will likely continue to put a significant damper on 

public commentary by psychiatrists. Section 7.2 states that psychiatrists “may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness.” Unfortunately, these 

 ethical guidelines from Section 7 of the Ethics Code seem to have been stymied by the 

I strongly agree with the last line of the Blotcky article that “our representative democracy functions best when all its citizens are active, vocal, and assertive.” But the sad, even tragic, impact of repeated assertions and reminders about the prohibitive Goldwater Rule without an equal emphasis on other affirmative ethical guidelines is that psychiatrists—the very citizens who may have the most to offer society in terms of expertise on crucial social and political determinants of mental health—are discouraged from expressing themselves. A potential solution is for the APA Ethics Committee to review these issues again and provide some concrete guidelines which allow psychiatrists to feel reassured about their ability, indeed their duty, to express their opinions—both as private citizens and as psychiatric physicians—in ways that do not violate existing ethics guidelines including the Goldwater Rule.

is a psychiatrist in Kansas City, Missouri.

The Goldwater Rule is fine, if refined. Here’s how to do it.

2. American Psychiatric Association Ethics Committee Opinion. American Psychiatric Association Ethics Committee. March 15, 2017. Accessed February 9, 2022. 

https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/APA-Ethics-Committee-Goldwater-Opinion.pdf

Articles

This doctor believes the Goldwater Rule discourages psychiatrists from expressing themselves. 

Discouraged by the Goldwater Rule

I was inspired to write a poem while I was preparing for a “Deep Dive” virtual weekend retreat with the 

Steering Committee of the Climate Psychiatry Alliance (CPA)

. I was reflecting on an article about the fires in the Mohave and invasive grasses, which had been one more trigger for my own sense of climate dread. The article in question originally appeared in the November 2, 2020 

I was also inspired by insights I have received from my Black psychiatric colleagues, who have helped put the climate crisis into proper perspective as a result of their resilience in the face of the disproportionate adverse environmental impacts and threats to their very survival, both individually and collectively. Addressing the climate crisis is inextricable from the fight for social justice, including systemic racism and health care inequities, which have been become more obvious than ever during the coronavirus pandemic. As environmental and health care organizations, as well as other socially conscious movements, awaken to the interconnectedness of these problems, they also need to tap into the wisdom of indigenous cultures that have always had a respectful, interconnected relationship with the natural world. The impact of industrial society’s relationship to the environment is now placing extreme strain on both the ecosystem and the societal structures that depend on it. It is also important to remember despair—in the words of former Vice President Al Gore—“is just another form of denial.” We are all connected and need each other to meet the daunting challenges we all face.

Burning up every Joshua tree for God knows how long

But the brome grasses, the fake bromes and the other invaders, squeezing out the natives, burning at super hot temperatures, incinerating the native seeds, drying out the land, opportunists creating More of themselves!

So the dream shifted and I realized (again) that I could fly

You just will it and turn and you move as you will

So now we’re all flying, feeling so free

“Departments of Science,” bringing back scientists

That Tidal Wave already dousing the flames

The wave wasn’t high enough—not nearly!

Carbon neutral by 2050? 30 years, really? Are you kidding?

     California wildfire refugees last summer

And as we glide down, floating now, gently touching down

In Houston and New Orleans I hear my black and brown brothers and sisters say: “This is nothing!”

“We know our earthly home is burning, drowning, toxifying, and

We will survive this too! (As we always have)

Yes! we will walk together, learn from each other

And we will gather our native sisters and brothers building strength

is the chair of the American Psychiatric Association’s Caucus on Climate Change and Mental Health, member of the APA’s Committee on Climate Change and Mental Health, and member of the Steering Committee on Climate Psychiatry Alliance.

A psychiatrist reads the news and responds with art. 

James L. Fleming, MD

Articles

Discouraged by the Goldwater Rule

Personal Reflections on Climate Change