Of what value are mental health ethics if when they’re tested they crumble under the whims of political pressure?

It can hardly be coincidence that President Trump’s election has sparked debates from certain members of the American Psychiatric Association (APA) about eliminating the Goldwater Rule. The rule was the consequence of a 1964 article in Fact magazine that published the results of a survey they’d given 12,356 psychiatrists asking whether Sen. Barry Goldwater was fit to be president.

The response was modest, but telling. Of the 2,417 respondents, 1,189, or less than half (49 percent), affirmed Goldwater was indeed unfit for office. The survey was part of an exposé on the senator entitled, “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.”

Goldwater later sued the magazine editor Ralph Ginzburg for libel, and was awarded $75,000. It seems what some psychiatrists deemed a necessary call, nay, an obligation to diagnosis from afar, turned out to be libelous. In 1973 the APA remedied this embarrassing display of amateurism by adding section 7.3 to their “Principles of Medical Ethics,” now known as the Goldwater Rule. The rule states:

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.

A Timeline of Degrading Standards

A Google search (a lodestar for informational trends) lays out a timeline that shows almost to the day when substantive opposition to the rule started. A 2015 Vanity Fair article published shortly after Trump announced his candidacy showed where opponents were heading. Not unlike the Fact article a half century before, several therapists were interviewed about Trump’s mental fitness. The responses varied from intrigued to genuine alarm.

“Textbook narcissistic personality disorder,” said clinical psychologist Ben Michhaelis. “He’s so classic that I’m archiving video clips of him to use in workshops because there’s no better example of his characteristics,” added clinical psychologist George Simon. Yet history does actually provide equally, if not more illustrative, examples of narcissism than Trump.

Others were a little more measured in their assessment. Robert Klitzman, a professor of psychiatry, remarked, “I have never met Donald Trump and so cannot comment on his psychological state. However, I think that, in general, many candidates who run for president are driven in large part by ego. I hope that does not preclude their motivation to govern with the best interests of the public as a whole in mind. Yet for some candidates, that may, alas, be a threat.”

It wasn’t until June 2016, the same time Trump became the Republican nominee for president, that articles questioning the efficacy of the rule surfaced in full force. In response, APA President Maria Oquendo issued a statement reassuring the public of the organization’s continued commitment to the rule.

This hasn’t stopped mental health professionals from strongly and publicly opposing the rule. The same month the Republican nominee was announced, an article was published in The Journal of American Academy of Psychiatry and the Law, called “The Ethics of APA’s Goldwater Rule,” wherein authors Jerome Kroll, and Claire Pouncey list scientific and practical concerns about why the rule was instituted. Their argument in favor of removing the rule is lengthy. Its main point is essentially that the Goldwater rule was a reflexive attempt to right a wrong from an unfortunate situation, but on the whole fails to meet the standard for an ethical rule, and is better suited to be “one guideline among many.”

Furthermore, the authors feel very strongly the rule fails to take into account their unique qualifications as experts, and violates their ability to exercise their professional and moral obligations to warn. “Psychiatrists are well trained to be public educators, but the Goldwater Rule denies an individual psychiatrist’s responsibility to speak up about political leaders’ behaviors that strongly suggest psychopathology.”

Weaponizing Credentials Is Precisely the Point of the Rule

The authors’ assumptions here are concerning, to say the least. First and foremost, the rule is cautionary to help prevent intellectual sloth, personal bias, and suborning reasoned and practical therapeutic judgment to an inflated view of professional importance. Suggesting otherwise is arrogance run amuck. The rule serves a dual purpose: it protects the mental health practitioner, and the public. It preserves professional credibility, and protects public figures from being maligned by professionals using their credentials as weapons.

Furthermore, the statement that “psychiatrists are well trained to be public educators” has no basis in fact, and as a blanket statement is patently wrong. It asserts psychiatrists as a whole should be considered credible regardless of topic or point of view. That’s just hogwash. Nothing better illustrates this point than the authors’ own words. “We want to make an even stronger claim. We believe that the Goldwater Rule is itself unethical if it suppresses public discussion of potentially dangerous public figures.”

Except the rule doesn’t suppress public discussion. “A psychiatrist may share with the public his or her expertise about psychiatric issues in general.” Mental health practitioners are free to express, in broad terms, any concerns they may have about any public figure’s mental fitness. Many mental health professionals have done so in numerous articles over the course of the past year and a half. Suffice it to say the public has been sufficiently notified. It wasn’t the amount of warning that was the problem. Perhaps it was the credibility of the messenger.

The Double Standard Is Clear to the Public

Lastly, Trump is the precise reason the Goldwater Rule exists. One cannot help but notice the absence of applying this rule to progressive liberal politicians, media pundits, or other public figures, placing opponents squarely into the category of “special pleading.” It’s a form of fallacious argument that attempts take issue with the accepted rule by creating a double standard advocating for one point of view over the other.

To suggest Trump is so exigent a circumstance that an otherwise sound rule should be downgraded to a “guideline among many,” thus eliminating any danger of professional reprisal, effectively gives psychiatrists license to act with professional impunity. It fails the test of reasonableness.

If the APA determines to remove the rule, it will be a devastating blow to professional credibility. Of what value are ethics if when they’re tested they crumble under the whims of political pressure? Furthermore, eliminating the rule will not make it any less wrong to diagnose the mental fitness of an individual a therapist hasn’t seen in person. Removing the words makes it no less immoral to do so.

This is really a slippery slope, with as strong a meaning of that phrase as can be understood. If the mental health profession starts down this path, they risk losing credibility for whatever counsel they provide.