Should there be another review of the Goldwater Rule?
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You likely recall the debates about the American Psychiatric Association’s ethical Goldwater Rule. Strengthened early in Donald Trump’s presidency, not only was diagnosing a nonpatient still deemed unethical, but so were any comments on the mental health of a public figure.
Critics called it a “gag rule.” One of them, psychiatrist Bandy Lee, MD, concluded that a “duty to warn” and a concern for “fitness to serve” preempted the Goldwater Rule. She edited The Dangerous Case of Donald Trump in 2017 and the expanded version of 2019. For self-disclosure, I cowrote a chapter on the environment for the expanded edition, though only on the condition that I would not comment on the President, but rather on the administrative policies.
Now we have some prerelease media comments on the new book Peril by Bob Woodward and Robert Costa, which provides a strikingly parallel process. Apparently, General Mark A. Milley, the chairman of the Joint Chiefs of Staff, soon after a conversation with House of Representatives leader Nancy Pelosi on January 8, 2021, started to warn other military leaders in the United States and China about his concern for Trump’s potential decision making. It is important to note that similar action was taken by Defense Secretary James Schlesinger when he became concerned about then President Nixon’s mental status as he faced impeachment in 1974. Trump and some supporters call Milley’s action “treason.”
Perhaps psychiatrists need not comment as Pelosi apparently told Milley, using stigmatizing language in referring to Trump: “He’s crazy. You know he’s crazy.” But do we really want to leave such an important assessment to politicians? Seems to me that this developing episode may call for another review of the Goldwater Rule.
Stay tuned for General Milley’s planned testimony at the September 28th Senate Armed Services Committee hear on Afghanistan for a follow-up.
Dr Moffic is an award-winning psychiatrist who has specialized 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 an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric TimesTM.