One reader argues against the limits of the Goldwater Rule.
FROM OUR READERS
This article is a response to the articles “The Mental Health Implications of Dictatorships” by H. Steven Moffic, MD.
I appreciated H. Steven Moffic, MD’s timely article, “The Mental Health Implications of Dictatorships,”1 but noticed it did not focus on the unique situation of the United States, a country founded as a reaction to an oppressive monarchy, a dictatorship of its own sort. The idea that our Republic with its democratic institutions and checks and balances to prevent one branch of government from having excessive power, that this great idea of America, could—with election of one person as president—be transformed literally overnight into a dictatorship, should be unthinkable to every American. If a new dictatorial president starts locking up perceived enemies or critics, tries to use the military to suppress peaceful protests, sends massive numbers of immigrants or other “undesirables” to internment camps, the level of societal disruption is almost unimaginable.
The focus of every American who cherishes our democratic Republic and all it stands for should be doing all we can to educate our fellow citizens about the risks we face. But psychiatrists have a problem in this regard: the so called “Goldwater Rule” which, in my view, has constricted the free speech of psychiatrists for far too long and its relevance is being questioned more and more.
Not actually a rule or law, the Goldwater Rule, now 51 years old, asserts that it is unethical for psychiatrists to express any type of psychiatric opinion about public figures without an exam and consent to release information from the person in question. It is technically Section 7.3 of the American Psychiatric Association’s (APA) Ethics Code and is an annotation to the overall Section 7, one of several “annotations applicable to psychiatry.” These were added a full 9 years after a minority of psychiatrists responded to a survey soliciting psychiatric opinions about the fitness for president of then candidate Barry Goldwater. This was back in 1964, decades before instantaneous availability of vast amounts of behavioral data via the internet, including media reporting and social media. Ironically this prohibitive guideline stems from an affirmative duty, namely Section 7 which states that physicians, including psychiatrists have an “ethical responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.”2
Regarding the question of whether Section 7.3 is still relevant, it is crucial to understand that the various ethical principles and guidelines in the APA’s Code of Ethics are not intended as rigid rules or laws; the preamble to the ethics code clearly states that the “annotations are not designed as absolutes and will be revised from time to time so as to be applicable to current practices and problems.”If there was ever a time to consider revising the applicability and relevance of the Goldwater Rule, it is now. Many current and former government officials and political leaders from various parties are sounding the alarm and ideally organized psychiatry will step in and help meet the challenges our democracy is facing.
Fortunately, we do not have to wait for APA to announce modifications in Section 7.3 for psychiatrists to begin lending their expertise to help Americans understand and deal with the risks of massive societal disruption, chaos, and violence due to the behavior and speech of desperate, potentially dangerous, authoritarian leaders. First, no psychiatrist has ever been expelled from the APA for violation of the Goldwater Rule, let alone prosecuted by any court. Moreover, the March 2017 Opinion of APA Ethics Committee mentions several exceptions to the Goldwater Rule including the psychological profiling of “historical figures,” provided that appropriate standards of academic scholarship are followed. Leaders in positions of prominence and power (such as the US President) clearly become figures of historical interest even before entering office. In this regard, psychiatrists would do well to study the work of academics like Ruth Ben-Ghiat.3
One final point: there are other aspects of our Code of Ethics that favor psychiatrists speaking out in the interest of protecting and improving upon public health (Section 1.2 and Section 5 of the Ethics Code) and these are no less important as ethical guidelines. But perhaps the most powerful indictment against remaining silent in the face of oppression was expressed by Nobel Prize winning author and holocaust survivor Elie Wiesel: “We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented. Sometimes we must interfere.”4 It is high time we remove the gag on our free speech, take stock of what we have to offer and help our fellow citizens sound the alarm; for ourselves, our patients, and our society.
Dr Fleming is an integrative psychiatrist in Kansas City, MO.
1. Moffic HS. The mental health implications of dictatorships. Psychiatric Times. December 7, 2023. https://www.psychiatrictimes.com/view/the-mental-health-implications-of-dictatorships
2. Ethics. American Psychiatric Association. Accessed February 7, 2024. https://www.psychiatry.org/psychiatrists/practice/ethics
3. Ben-Ghiat R. Strongmen: Mussolini to the Present. WW Norton & Company; 2020.
4. Wiesel E. Nobel Peace Prize acceptance speech. 1986. Accessed February 7, 2024. https://www.nobelprize.org/prizes/peace/1986/wiesel/acceptance-speech/