Is It Time to Reconsider the Restrictions of the Goldwater Rule?

Should we be more accepting of mental health professionals offering opinions about political figures based upon vast amounts of data and well-founded, applicable theories of psychopathology?

FROM OUR READERS

While I read out of curiosity Ronald W. Pies, MD’s, commentary on Russia and the applicable label of paranoid government disorder (PGD),1 I found myself concerned that physicians, and perhaps especially psychiatrists, believe we have much to offer mankind that goes far astray from our chosen area of expertise. Had the author offered opinions about Russia’s president, the Goldwater Rule of the American Psychiatric Association (APA) might have constrained him. Ironically, psychiatrists have been informed that offering opinions about public figures without conducting an interview and having consent to disclose information is unethical. However, a highly esteemed colleague may venture into offering speculative opinions about nation states by applying the psychological understanding of individuals, which was never intended to replace sociology and political science, and the resultant assessment is worth publishing.

Psychiatrists at times have offered opinions about public figures and have received criticism from their colleagues for doing so. When Senator Goldwater ran for president, a number of psychiatrists warned their fellow citizens about that candidate’s character and potential recklessness. More recently, psychiatrists and psychologists warned Americans about our most recent past president having dangerous mental illness at a Yale University conference held in 2017. While there was much information available in the public domain, there was criticism of those mental health practitioners for violating the Goldwater Rule. Similarly, a now deceased colleague, Jerrold Post, MD, published in 2019 his last book, Dangerous Charisma: The Political Psychology of Donald Trump and His Followers,2 which raised ethical concerns. While well researched, that analysis of a president’s character was critiqued for offering opinions in a manner that violated the Goldwater Rule. Why is it that there are ethical concerns about psychiatrists offering professional opinions on public figures based upon extensive published accounts, while a colorful analysis about a world power as “paranoid” deserves the front page in Psychiatric Times™?

I found the opinions offered by Dr Pies to be worth considering, yet psychiatrists should be careful about using our understanding of individual human behavior to develop formulations of governmental bodies. If Dr Pies may offer his perspective on Russia having PGD, then maybe we should be more accepting of mental health professionals offering opinions about political figures based upon vast amounts of data and well-founded, applicable theories of psychopathology. I suggest it is time for the APA to reconsider its restrictive Goldwater Rule. (As an effort toward full disclosure, the author resigned as a fellow in the APA because of the resurfacing of the Goldwater Rule during the Trump presidency.)

Respectfully submitted,

Robert C. Larsen, MD, MPH

Dr Larsen is director of the Center for Occupational Psychiatry and a retired clinical professor at the UCSF School of Medicine.

References

1. Pies RW. Does Russia suffer from “paranoid government disorder”? Psychiatric Times. 2022;39(4).

2. Post J. Dangerous Charisma: The Political Psychology of Donald Trump and His Followers. Pegasus Books; 2019.