The Other Ethical Side of the Goldwater Rule Coin: What We in Psychiatry Can and Must Do

All rules have exceptions… is this true of the Goldwater Rule?

It is a pleasure to have received the letter, “Discouraged by the Goldwater Rule,” from James Fleming, MD—an experienced and valued psychiatrist—to consider the Goldwater Rule and the role of psychiatrists. His response provides the other side of the ethical coin to the letters we have received to date. Whereas the others feel that the Goldwater Rule is fine as it is, Dr Fleming conveys that we did not go far enough to refine or revise it.

His reasons resonate with me. For now, I will not comment on our former president of the United States because that would violate the Goldwater Rule. However, I decided to voice my concerns about his administration’s policies because doing so would not violate the Goldwater Rule, and I also coauthored a book chapter on the environmental policies of his administration.1 Clearly, those policies weakened the climate and environmental protection policies of the United States and the world, contributing to a stage that climate scientists now call a climate crisis or emergency—that includes ongoing and increasing psychiatric harm to the public. Of course, many would say that the leader is responsible for his or her policies, though often not exclusively so.

In my last response to a prior letter, “Clarifying the Goldwater Rule and Other Ethical Principles,” I used another example: our current president’s policy and procedure for nominating a new Supreme Court justice. Limiting that choice to Black women justices, as qualified as they may be, seems to me to be too limiting as far as potential social group representation and empathy. I assume that such psychiatric criticism of both administrations suggests a lack of political favoritism. The climate is clearly a health risk to all humanity and living things, and especially to the poor.

Dr Fleming’s second reason is self-evident to me. Unless someone does not know that we are psychiatrists, of course they will think we are giving a psychiatric opinion on societal issues—and we are, regardless of saying it is an opinion of a citizen. We are just fooling ourselves and trying to fool others if we believe otherwise.

It is crucial that the ethics clause he quotes, Section 7.2, be more widely known for its balance to the Goldwater Rule:

“…that psychiatrists ‘may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness.’”

My coauthor, Ronald W. Pies, MD, reminded me that this clause reinforces, in our professional role, our right to comment on political policies, programs, laws, and the like, which we expertly conclude are mentally harmful to the public or patients.

Where I might disagree with Dr Fleming is that I am not so sure that putting a damper on any public commentary by psychiatrists would be bad. Back when Psychiatric TimesTM and I did a poll on who our readership preferred as far as the race between Hillary Clinton and Donald Trump, many comments bordering on inappropriate Freudian “wild analysis” emerged, not unlike those which precipitated the Goldwater Rule in the first place. Thankfully, those comments did not come out to the public.

What might be the solution to that problem and tendency? Have the American Psychiatric Association develop an ad-hoc task force of experts in political psychiatry, without pertinent conflicts of interest (especially financial ones), who would be available to talk to the public and media not only about societal issues, but, on rare occasions, about the public figures who are intimately tied into psychiatrically detrimental policies because, as Dr Fleming writes, they “may have the most to offer society in terms of expertise on crucial and political determinants of mental health”? It is a role that would require special expertise and the deftness to reach all sides of a societal psychiatric challenge. Potentially, there is great sums of coins—that is, money and resources—involved because of the funding of our governments for mental health care. No one in our field wants that funding jeopardized, but rather increased. The first psychiatrist I would nominate for such a role would be Dr Fleming.

What we all must remember and emphasize, and what seems to have been forgotten or ignored by most of us and the media with the Goldwater Rule prohibiting any professional commentary on a public figure not examined and not giving permission, is that we can—and ethically must—still engage with public issues of psychiatric relevance. Education of the media, public, and colleagues is needed now for clarification of our professional ethics in this matter, especially with another presidential election around the corner. So, perhaps both sides of the letters that we received are correct. Allowing for a rare exception to the rule, as is the case with most any rule, the Goldwater Rule may suffice enough as long as we do not forget the affirmative: what we as individuals and as psychiatric organizations can still do in the political and societal arenas.

Dr Mofficis an award-winning psychiatrist who specializes in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is retired from his tenured professorship at the Medical College of Wisconsin.

Reference

1. Van Susteran L, Moffic HS. The age of Thanatos; Environmental consequences of the Trump Presidency. In: Lee B, ed. The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President - Updated and Expanded with New Essays. Thomas Dunne Books; 2019.