Show caption Psychologists once claimed that United States Senator and nominee for president, Barry Goldwater, was psychologically unfit to be president. Photograph: William Lovelace/Getty Images Head quarters The Goldwater rule: why commenting on mental health from a distance is unhelpful Is it okay to speculatively diagnose public figures like Trump? No, says the Goldwater rule – and recent challenges to it could set worrying precedents Nick Davis Fri 28 Jul 2017 11.20 EDT Share on Facebook

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This week the Goldwater rule has come into focus – the convention that psychologists should not give an opinion about the mental state of a person they have not examined. Recently, the American Psychoanalytic Association (APsaA) emailed its members to remind them that they as individual practitioners are not bound by the Goldwater rule (which is a rule of the American Psychiatric Association, APA), and that they should feel free to offer fact-based but non-specific assessments of public figures - figures like Donald Trump.



Where does the Goldwater rule come from?

In 1964 the Arizona senator Barry Goldwater ran as the Republican candidate for the presidency against the serving president Lyndon B. Johnson. Goldwater’s political career was marked by a series of tough battles, from succeeding as a markedly conservative senatorial candidate in a Democrat-leaning state, to a bruising primary campaign to win the 1964 candidacy. Goldwater lost the presidential race for a number of reasons – his aggressive rhetoric against the USSR and his restrictive fiscal policies troubled even his own party – but a large factor was an article that appeared in a US magazine.

During the campaign, Fact magazine published an article entitled “1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President!”. The figure came from an informal poll of US psychiatrists, and included the many comments about Goldwater’s emotional stability and fitness to serve. The Goldwater campaign sued the magazine, which was found to have defamed the senator. The court fined the editors and publishing company of Fact an eye-watering $75,000. Subsequently the APA introduced its rule on speculative diagnosis.

Why is the Goldwater rule valuable?

The Goldwater rule protects us all against prurient speculation about our mental health. In order for us to succeed in life, or to succeed in public office, we must command the trust of people around us. Undermining the faith we must have in other person’s mental state carries with it the implication that we should be wary of their future actions, or in their ability to persevere when gets tough. When certified psychiatrists state that President Trump has a “personal myth of greatness”, we are being asked to question his fitness for office based solely on what might happen in the future.

What does it mean to be unfit for office? The US Constitution includes a mechanism for impeaching a public official for “high crimes and misdemeanours”. However, a crime requires an act – it is not enough to impeach someone based on how we think they may think. The well-established right to freedom of thought allows us all our own private thoughts, however heretical or undesirable they may be. Indeed freedom of thought is a more strongly protected right than freedom of speech, which can be restricted if giving voice to those thoughts may cause harm to others.

Underlying this speculation about another person’s mental health is an unpleasant streak of prejudice. It is estimated that one in four people will experience a period of poor mental health. Yet illnesses such as depression, anxiety, disordered eating and bipolar are stigmatised, and personality traits such as narcissism, neuroticism and psychoticism are used as taunts. Mocking a person for their (supposed) mental condition is no different to mocking someone for their physical disability.

Donald Trump is the latest public figure to have had their mental fitness called into question. Princess Diana and Winston Churchill, Carrie Fisher and Robin Williams, Britney Spears and Genghis Khan have all been the subject of public speculation about their mental health – some of whom have spoken about periods of ill-health. It is trite to suggest that a comedian’s need to make people laugh is a product of deep depression, or that a politician’s ambitious manoeuvres are founded in a need for recognition that they lacked in childhood. These are the statements of pundits, and do not help us to understand the complex roots of complex behaviour.

The future of the Goldwater rule

The Goldwater rule is binding only for the members of the American Psychiatric Association. However, it is an example of a guiding principle that reminds practitioners of the limits of their knowledge. This week we have seen a similar principle at work in the tragic case of Charlie Gard – the presiding judge ruled that a doctor should not give evidence on a case without having examined the patient.