Whenever I read an article about someone diagnosing a person from afar, inevitably the journalist will mention the “Goldwater rule.” This is an ethical guideline created by the American Psychiatric Association in 1973 in reaction to a claim that arose from a magazine article that surveyed psychiatrists about presidential candidate Barry Goldwater’s mental health.
Journalists roll this “rule” out to try and explain why mental health professionals shouldn’t make statements about celebrities and politicians in the public eye. Unfortunately, they generalize an ethics rule for one small profession onto the whole of mental health professionals — a rule that is outdated and archaic.
The History of the Goldwater Rule
The Goldwater Rule’s attack on the 1st Amendment rights of psychiatrists came about because a popular magazine of the day called Fact conducted a survey of 12,356 psychiatrists as an inquiry into presidential candidate Barry Goldwater’s mental health. The survey elicited many strong responses, both for and against his emotional stability and ability to serve as president.
The American Psychiatric Association was aghast that many of its members had been the subject of a survey they felt was demeaning and unscientific. And they let it be known:
“[S]hould you decide to publish the results of a purported ‘survey’ of psychiatric opinion on the question you have posed, the Association will take all possible measures to disavow its validity,” wrote APA Medical Director Walter Barton, M.D., in a letter to the magazine’s editors on October 1, 1964.
I’m not sure why they put “survey” in quotes, since indeed that’s exactly what the editors conducted. It took them a full nine years (hardly an emergency there, eh?) to come up with an ethical guideline in response to the survey. The new guideline, approved in 1973, prohibits APA psychiatrist members from offering their professional opinion about anyone they have not personally interviewed or examined:
7. 3. On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
This rule is now 46 years old.
No Other Profession Has This Rule
It’s important to understand that in the U.S., there are over 550,000 mental health professionals. Of that more than half million professionals, only a tiny fraction — 25,250 — are licensed psychiatrists. And of that number, only XX percent are members of the American Psychiatric Association (ApA). As you can guess, ApA ethical guidelines generally only apply to its members — not to non-members. And certainly not to other mental health professionals.
For instance, despite its insistence that it does, the American Psychological Association (APA) does not have a similar ethical guideline in its Ethical Principles. Instead, it simply says:
5.04 Media Presentations
When psychologists provide public advice or comment via print, Internet, or other electronic transmission, they take precautions to ensure that statements (1) are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice; (2) are otherwise consistent with this Ethics Code; and (3) do not indicate that a professional relationship has been established with the recipient.
This rule is far more lax than the psychiatrists’ guideline, because it does not prohibit psychologists from making public statements about celebrities’ or politicians’ mental health. Instead, it just admonishes them to ensure they make such statements based upon their professional training and experience, and they must indicate they have no professional relationship with the person they’re talking about. This is far different than psychiatry’s rule. And again, this rule applies only to APA members — not all psychologists, and not all mental health professionals.
In my opinion, the American Psychological Association’s ethics code today does not bar me from making public statements about celebrities or politicians. I just need to be clear I’ve never met or interviewed the person I’m talking about, if indeed that is the case.
Social workers’ and other professions’ codes of ethics are mute on this issue. Meaning they can say whatever they want about the mental health of celebrities and politicians. And other organizations have actively told their members to ignore the rules altogether.
Of course the Goldwater rule doesn’t apply to non-professionals giving their opinion about others’ mental health. It doesn’t even apply to most mental health professionals.
Old Rules Need Not Apply
It’s perfectly fine, although not particularly wise, for a professional organization to limit the free speech of its members. Clearly the Goldwater incident upset the American Psychiatric Association enough in the 1960s that they felt like they needed to come up with their rule. But make no mistake about it — it is a limit on member’s 1st Amendment rights to free speech, to express opinions that they hold and want to share with others.
I think that most ethical guidelines can stand the test of time. Principles about confidentiality and protection of private health information of patients is important and valuable. But rules about what a member can and cannot say suggest that members don’t have enough professional judgment to act on their own in a respectful and appropriate manner. It is old-school medical paternalism, rearing its ugly in the 21st century.
Is it particularly a good idea to comment on the mental health of a person you’ve never met? Maybe, sometimes, under the right circumstances and for the right reasons. For instance, nowadays many celebrities share their mental health challenges with the world in order to help reduce the stigma, discrimination, and prejudice that commonly accompany these concerns. Nobody questions whether a professional should share such stories with our their own followers or readers.
But diagnosis from afar is tricky business and can backfire spectacularly, as the efforts with President Trump have demonstrated (as nobody seems to much care if he’s not entirely mentally healthy). Such efforts may mistakenly paint mental disorders themselves in a stigmatizing light, as though a person with a mental disorder couldn’t aim or achieve the pinnacle of success having been diagnosed with such a condition.
The Goldwater rule is an outdated, archaic ethical guideline that applies only to psychiatrists who are members of the American Psychiatric Association — and no one else. The media would do well to educate and inform themselves moving forward, and understand the paternalistic, outdated reasoning behind the rule. Trotting it out as though it were a widespread and well-accepted ethics guideline is a farce and factually incorrect. It clearly is not.
If they want to remain relevant and be an important part of the ongoing conversation, the psychiatric profession — and especially the American Psychiatric Association — would do well to re-evaluate this rule in keeping up with the changing times of society.