Increasingly, members of the psychiatric profession are expressing their concern about President Donald Trump mental health status. In a recent letter to the New York Times, two prestigious psychiatrists, Judith L. Herman and Robert Jay Lifton seriously question his grasp of reality and say, “Soon after the election, one of us raised concerns about Donald Trump’s fitness for office, based on the alarming symptoms of mental instability he had shown during his campaign. Since then, this concern has grown. Even within the space of a few weeks, the demands of the presidency have magnified his erratic patterns of behavior.”

They are clear that they are not making a diagnosis but just expressing their concern, saying, “We are in no way offering a psychiatric diagnosis, which would be unwise to attempt from a distance. Nevertheless, as psychiatrists we feel obliged to express our alarm. We fear that when faced with a crisis, President Trump will lack the judgment to respond rationally.”

As a base for these carefully stated considerations is the Goldwater Rule. In 1964, the magazine Fact published the article “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.” The article included the results of a poll among psychiatrists questioning them if then Senator Barry Goldwater was fit to be president. Of the 2,147 who responded, 657 said that he was fit and 1,189 said that he was not.

In addition to the responses to the question about Goldwater, the article included a series of quotations from the respondents, various facts and observations about Goldwater. Goldwater sued the editor-published of the magazine, Ralph Ginzburg, who had edited some of the quotations from articles and even from some of the psychiatrists interviewed. Goldwater sued him and won $75,000 in damages, since the judge found that Ginzburg had acted with malicious intent.

Before the publication of the article, the medical director of the American Psychiatric Association had warned Ginzburg that the responses were not valid without a “thorough clinical examination” of Goldwater, according to Jonathan D. Moreno, an American philosopher and historian.

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In 1973, the American Psychiatric Association (APA) made that policy official and established what became known as the “Goldwater Rule.” The Rule, which appeared in the first edition of the APA’s code of ethics and is still in effect now, says: “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.”

Although there are some positive aspects to the Goldwater Rule, it presents some conflicting issues. The rule still prevents the unethical misuse of the psychiatric profession: i.e. it may be tempting to come to a diagnostic conclusion on a public figure when politically convenient, even in the face of a paucity of data. The rule should allow, however, for psychiatrists and other health-related professionals to voice their concerns regarding the mental stability of high office holders.

In our culture we need a psychological clearance for people working in intelligence, in the FBI, in the police. Should not we demand a clean bill of mental health for the person who is going to literally control our lives? For as long a such needed regulation does not exist, should responsible professionals remain silent, obediently abiding by a rule that in this case protects what many consider a manifestly dangerous character at the helm of the world? One should also consider the ethical obligations to protect public health imposed by the psychiatric profession.

In a letter to the New York Times, 37 psychiatrists, psychologists and social workers alerted on the dangers imposed by President Donald Trump’s mental health status. According to these professionals, the silence imposed by the Goldwater Rule “…has resulted in a failure to lend our expertise to worried journalists and members of Congress at this critical time.” And they conclude, “We believe that the grave emotional instability indicated by Mr. Trump’s speech and action makes him incapable of serving safely as President.”

Professional impressions could be mild or strong but they are not the same as diagnosis; they can still warn and educate the public preventing potential harm. Such rule should be applied wisely and judiciously but not at the expense of similarly important ethical obligations imposed by the psychiatric profession. Therefore, while it should be respected, the Goldwater Rule should not gag the psychiatric profession from protecting the public at large.