Imparting Psychiatric Knowledge

Public advocacy represents one mode of imparting psychiatric knowledge.

I appreciate the important concerns expressed by David T. Springer, MD, and would like to address some of the key issues he has raised.

“One individual’s ‘disinformation’ is another person’s truth.”

In my view, this is really a postmodern notion that undermines the aims of medical practice and medical science. Someone who asserts, for example, that “Laetrile cures cancer” is dispensing disinformation—there is no “other truth” to the issue. There are analogous falsehoods that are dispensed in the realm of psychiatry—for example, “Conversion therapy cures homosexuality”—and it is our responsibility to call out such disinformation. Of course, I would agree that political, philosophical, and cultural/esthetic issues usually do not yield such clear-cut true-false assertions.

“The hypothetical examples given by the authors, in essence, obliterate the Goldwater Rule. Even if information is imparted indirectly and with the given caveats, the public will correctly conclude that the psychiatrist is, in fact, talking specifically about the public figure in question.”

It is certainly possible that some in the general public will incorrectly conclude that the psychiatrist is talking specifically about the public figure in question. But that is simply not an outcome we can directly control. The public might equally interpret a psychiatrist’s complete silence, or refusal to address the issue, as hiding something really serious about a public figure. Having had many interactions with the media over the past 40 years, I also believe that some reporters and journalists will inevitably find somebody—often with no psychiatric training or on the fringes of psychiatry—who will comment very readily (and inaccurately) on a public figure.

I believe it is preferable that well-trained psychiatrists address the issue at hand with accurate information, so long as it is framed in terms of a general differential diagnosis of signs and symptoms—never of a particular person. The examples in our article, in my view, do not “obliterate” the Goldwater Rule, since, in essence, they are academic discussions of diagnostic possibilities, not referring to a particular person. I believe the examples in our article are consistent with the principles articulated in the American Medical Association’s Code of Medical Ethics Opinion 8.12 (Ethical Physician Conduct in the Media).1

That said, I would emphasize that an appropriate response to a reporter’s question is not always or necessarily the wisest response, which is sometimes a simple disclaimer—eg, “I cannot comment on that public figure because I have not personally examined them.” That is a perfectly acceptable alternative to the sort of differential diagnosis examples in our article. And, in my view, it is often the preferred response for psychiatrists who are uncomfortable with, or unaccustomed to, the media and their queries, since reporters sometimes have an agenda antithetical to our professional goals.

Our article makes clear that being highly vocal about any public figure’s mental stability, absent a professional examination, is unethical.

Finally, speaking out on public policies is an entirely different issue from commenting on public figures, and the 2 should not be conflated. Section 7 of American Medical Association’s Principles of Medical Ethics states that, “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.”2 Similarly, the Code of Ethics of the American College of Physicians states that

“Physicians should help the community and policymakers recognize and address the causes and social and environmental determinants of health, disease, and disability, including human rights concerns, discrimination, poverty, and violence.”3

The American Psychiatric Association (APA) regularly and rightly speaks out on public health issues and policies that affect the well-being of the general public and our patients, and, in my view, so should all psychiatrists. For example, the APA has addressed “how systemic racism can affect occupational, residential, educational, nutritional, safety, and health care options and outcomes for minorities in the United States.”4 In my view, this type of public advocacy represents one mode of imparting psychiatric knowledge, even as it may influence political decision-making.

Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of Psychiatric TimesTM (2007-2010).

References

1. Ethical physician conduct in the media. American Medical Association. Accessed February 2, 2022. https://www.ama-assn.org/delivering-care/ethics/ethical-physician-conduct-media

2. AMA principles of medical ethics. American Medical Associations. Accessed February 2, 2022. https://www.ama-assn.org/about/publications-newsletters/ama-principles-medical-ethics

3. Sulmasy LS, Bledsoe TA; ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians ethics manual: seventh edition. Ann Intern Med. 2019;170(2_Suppl):S1-S32. https://www.acpjournals.org/doi/10.7326/m18-2160

4. Town Hall - APA addresses structural racism, part 5: annual update. American Psychiatric Association. Accessed February 2, 2022. https://www.psychiatry.org/psychiatrists/meetings/addressing-structural-racism-town-hall