The Goldwater Rule

I do try to observe the Goldwater Rule, which is generally respected by mental health professionals. During the 1964 presidential campaign, the now-defunct FACT magazine asked more than 12,000 psychiatrists whether they believed Barry Goldwater was psychologically fit to be President. At the time, there was already considerable public speculation about Goldwater’s mental state. His campaign slogan was, “In your heart, you know he’s right.” The informal retort was, “In your guts, you know he’s nuts.”

The psychiatrists’ responses were overwhelmingly negative and, in many cases, harsh. One wrote, “I believe Goldwater has the same pathological makeup as Hitler, Castro, Stalin, and other known schizophrenic leaders.” He did have defenders among the polled psychiatrists, but the publication of the magazine's story on Goldwater's mental health added to concerns among the electorate, and Lyndon Johnson won handily. Goldwater sued and won a monetary judgment against the magazine.*

This incident led to the establishment of the Goldwater Rule for psychiatrists, which later became an ethical guideline for other mental health professionals, including psychologists. A pithy summary of the rule is: Don’t make public statements about public figures whom you have not formally evaluated. It’s a pretty good rule—normally.

Enter Donald Trump. In 2017, The Dangerous Case of Donald Trump, a book edited by Dr. Bandy X. Lee, a forensic psychiatrist, was published and became a bestseller. This compilation includes essays from psychiatrists, psychologists, and mental health experts who commented on the mental health of then-President Trump.

I doubt that any of the contributors believed the Goldwater Rule isn’t normally a good rule. But the authors—and others—have suggested that it should be weighed against another ethical guideline: the “duty to warn.” This principle holds that if an individual poses a serious danger to others or to the community, a mental health professional may be ethically obligated to speak out. It is unlikely, however, that there’s sufficient precedent to apply the “duty to warn” to something as complex as public commentary on a sitting President.

There is, however, a reasonable argument to mitigate the Goldwater Rule. The rule turns on whether the professional has personally evaluated the individual. Fair enough. But it may be entirely ethical for a professional to conduct a brief interview, let’s say in a jail cell—for, say, an hour—and then comment on the person’s mental health if patient-doctor privilege does not apply. One could ask: How much more data does a professional who closely follows the news about Donald Trump have than they would on someone they interview briefly at a county jail? Answer: a lot more.

That said, any reader of this post can decide for themselves how they feel about the Goldwater Rule—generally, or as applied to Trump.

Perhaps a public diagnosis by a psychologist or psychiatrist isn’t essential. Diagnostic labels are useful for organizing what we know about a person’s signs and symptoms. But they only matter insofar as they help us understand the person’s behavior—and, in the case of public figures, we can already see that behavior. People at the highest levels of public life have their lives scrutinized, their expressions dissected, and their speech heard by millions.

I don’t need to name a particular disorder as long as I observe that, for example, some individuals display a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy for others. They may have an inflated sense of self-importance and a deep craving for attention and validation. They often exaggerate their achievements, believe they are superior, and expect special treatment. Despite outward confidence, they may be highly sensitive to criticism and react with rage, shame, or humiliation when slighted. Their relationships are often shallow and exploitative. Such individuals can be ambitious and successful, but their underlying emotional difficulties often lead to problems in relationships, at work, and in their general well-being. The more deviant and extreme these traits are, the more harm they can do—especially when the individual holds significant power.

Thanks,

Dale

*To be fair, there were many reasons it was wrong for FACT to conduct and publish the poll. While they stated they surveyed over 12,000 psychiatrists, only a little over 2,000 actually responded. They also ignored protests from psychiatrists and psychiatric organizations who objected to the poll and warned against its publication.