Free Speech in Psychiatry

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Sometimes I am surprised when I check the research on a given topic and find one of my own columns for Psychiatric Times. I guess I should not be surprised, given how many columns I have written, but I am. This time around in regard to free speech and psychiatry, I found (or it found me) “A Psychiatric Perspective on Therapeutic Speech” from 12/11/23, at a time of a different presidential administration. It started with:

“I don’t know about you, but I’m pretty bewildered about the current societal uproar about what free speech, hate speech, and the first amendment mean.”

Human nature does not change in a year or 2, if ever.

To take human nature and its ensuring risks into account, our first constitutional amendment on free speech does have its societal limits in regard to harm. A well-known one is that of Oliver Wendell Holmes, Jr. in Schenck v United States (1919): “A clear and present danger,” that is, a risk or threat to safety or to other public interests that is serious and imminent.¹

In many senses that definition fits the 4-book series on The Dangerous Case of Donald Trump that the psychiatrist Bandy Lee has edited. Lee has been concerned about the risks to society from her expertise on violence on anticipated actions of Donald Trump as President. How “imminent” the danger has been is open to interpretation, though.

My chapter in the latest volume brings up the influence of the organized psychiatrist ethical “Goldwater Rule,” which in fact had been muzzling our free speech to discuss public figures in public using our expertise.² I recommend revision of the rule, though with ongoing attention to the other side of the risk coin, the “wild analysis” that Freud warned against and was the basis of the Goldwater Rule because of the wild comments of some psychiatrists during his 1964 run for President.

However, there is not any wild comments—just sober analysis—involved in the press release put out yesterday by The Committee to Protect Public Mental Health, a model group of very varied and prominent psychiatrists.³ It calls for:

“The Committee to Protect Public Mental Health joins national medical, scientific, and public-health organizations in calling for the removal of Robert F. Kennedy, Jr. as Secretary of the U.S. Department of Health and Human Services.”

This press release, with a brief commentary, was picked up by NPR as one their important news items.

Many physicians and psychiatrists recently seem to be ignoring the rule, especially in regard to Robert F Kennedy, Jr. President Trump himself seemed to medically prescribe that Tylenol should not be used during pregnancy, and although he may have intended the best from his point of view, he has no medical background. On the contrary, as a colleague suggested, there is wild analysis in such policies and comments that begin to destroy the public trust in medicine, one of our country’s great achievements. Many of the most vulnerable people are especially at increasing risk.

It is becoming increasingly apparent that free speech is relevant to social psychiatry and psychiatry’s role in society, is it relevant for clinical care? Yes, of course, although we may take that for granted. In fact, it is a psychological sanctuary for patients to discuss their personal issues that they have kept to themselves or are not even yet aware of yet.

The basis of Freud’s historical influence on psychiatry psychotherapy was based on a kind of free speech. In the recommended “free associations,” patients should say anything on their mind during psychoanalysis. Even if modern psychotherapy makes less use of this process, it is still important. And there are limits, including perceived judgment that the patient is dangerous to others, self, or the therapist. As the Tarasoff legal ruling conveys, that necessitates action on the part of the therapist to break confidentiality and get needed intervention for the risk.

There then seems to be a parallel process between clinical care and societal conflict. Free speech is important for mental health under the right circumstances, but has its limits in terms of risk to others. Whenever it is difficult to draw a line, our Hippocratic Oath to “do no harm” would seem to come down on possible psychological and physical safety. That means that psychiatrists should find ways to therapeutically speak out publicly about societal risks to mental health just like we strive to make therapeutic interpretations to increase a given patient’s mental health.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Schenck v United States. 1919. 249 U.S. 47

2. Lee B, ed. The Much More Dangerous Case of Donald Trump: 50 Psychiatrists and Mental Health Experts Warn Anew. World Mental Health Coalition, Inc; 2025.

3. Committee To Protect Public Mental Health. Psychiatrists call for Removal of Robert F. Kennedy, Jr. as Health Secretary. News release. September 29, 2025. Accessed September 30, 2025. https://www.protectpublicmentalhealth.org/press