The Goldwater Rule: Raising Questions of Professional Priorities

FROM OUR READERS

I thank Robert C. Larsen, MD, MPH, for his thoughtful letter,¹ in which he raises several important questions. I agree with him that “...psychiatrists should be careful about using our understanding of individual human behavior to develop formulations of governmental bodies...” Indeed, in my article on Russian society,² I asked, “Can whole societies, or their governments, be truly paranoid in the sense that psychiatrists and psychologists ordinarily use that term (ie, as ‘relating to or exhibiting extreme distrust or suspiciousness’)? And does psychiatry have a role to play in helping world leaders understand the psychodynamics of what might be called societal paranoia?” I noted that “the answers are complex, and we should acknowledge at once that societies are not ideologically or psychologically homogeneous...” I also raised the question of our professional priorities, noting that:

“...psychiatry already has its hands full, dealing with pressing problems of untreated serious mental illness, a fragmented non-system of health care, and limited access to psychiatric services. Should we not focus on these urgent matters before getting tangled up in the ambiguities of paranoid government disorder? Aren’t such issues best left to fields like sociology and cultural anthropology—and to professional diplomats?”

But despite these risks and uncertainties, I still believe that psychiatry has important insights to contribute to the resolution of conflicts between countries and societies. This is what psychiatrist David A. Hamburg, MD, had in mind with his concept of “preventive diplomacy.” I highly recommend to Dr Larsen the interview with Dr Hamburg referenced in my article, in which he states³:

“The international community should not wait for a crisis. Ideally, there should be ongoing programs of international help—offered by governments, intergovernmental organizations, and also by nongovernmental organizations. These would build the capacity of groups to address grievances effectively without violence and establish permanent mechanisms for sorting out conflicts peacefully before they become explosive.”

It still seems to me that, to these ends, psychiatrists are well-positioned to serve as consultants to intergovernmental organizations dedicated to conflict resolution. Furthermore, I think it is within the purview of social psychiatry to comment on psychological tendencies within specific societies—such as Russia, China, and others—that predispose these societies to feelings of humiliation, victimization, and unwarranted suspicion. Unhelpful psychological tendencies may be prevalent in American society, as well, so we do not get a free pass in these matters.

I think these societal issues are quite different from those addressed by the Goldwater Rule, which applies to professional statements about specific individuals whom we, as psychiatrists, have not evaluated professionally. As readers of Psychiatric Times™ may recall, I am generally in support of an updated and refined version of the Goldwater Rule.^4,5

Again, I thank Dr Larsen for taking the time to comment on my article.

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 Times™ (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.

References

1. Larsen RC. Is it time to reconsider the restrictions of the Goldwater Rule? Psychiatric Times. April 29, 2022. https://www.psychiatrictimes.com/view/is-it-time-to-reconsider-the-restrictions-of-the-goldwater-rule 

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

3. Dean JW. Making war unnecessary: an interview with Dr. David Hamburg. FindLaw. December 5, 2003. Accessed March 1, 2022. https://supreme.findlaw.com/legal-commentary/making-war-unnecessary.html

4. Pies RW. Deconstructing and reconstructing the “Goldwater Rule.” Psychiatric Times. 2016;33(10).

5. Blotcky AD, Pies RW, Moffic HS. The Goldwater Rule is fine, if refined. here’s how to do it. Psychiatric Times. 2022;39(1).