Psychoanalytic Association Clarifies Position on Goldwater Rule Equivalent

Maybe it was all just a misunderstanding, but the American Psychoanalytic Association (APsaA) recently found itself in a public tangle over whether it did or did not give its members a green light to comment on the mental health of public figures.

Interest in such professionally informed commentary has risen over the last year. For psychiatrists who are members of APA, offering a professional opinion about a public figure’s mental health without an examination and without consent violates Section 7.3 of APA’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, known informally as the Goldwater Rule. Other organizations and other professions may set their own standards for such discourse.

News coverage of the issue was spurred by a July 6 email sent to APsaA members from its Executive Council reaffirming that the “organization will speak to issues only, and not about specific political figures.”

The Executive Council was responding to calls from some members to take a stand on President Donald Trump, explained APsaA President Harriet Wolfe, M.D., a clinical professor of psychiatry at the University of California, San Francisco, and a training and supervisory analyst at the San Francisco Center for Psychoanalysis.

The policy of focusing on issues was an accurate reflection of APsaA’s existing position, formalized most recently in 2012, which states the following: “Never make a definitive statement about the personal psychodynamics or diagnosis of a public figure.”

However, the email also said, “[I]t is important to note that members of APsaA are free to comment about political figures as individuals.”

That sentence caught the attention of the online magazine STAT, interpreting it as a move to unbar the doors. STAT posted an article on July 25, headlined “Psychiatry Group Tells Members They Can Ignore ‘Goldwater Rule’ and Comment on Trump’s Mental Health.” Other news outlets picked up the story as well.

The headline stumbled in several ways. APsaA says that its members “include psychiatrists, psychoanalysts, psychologists, psychotherapists, and social workers.” In addition, the Goldwater Rule only applies to members of APA and not to other organizations, and President Donald Trump was not mentioned at all in the email.

APsaA does have an ethical code but it only addresses clinical practice, not public commentary, said Wolfe in an interview.

“It speaks about competence, truthfulness, scientific responsibility, and personal integrity,” she said. “If a member speaks publicly about a public figure and appears to be making a psychodynamic or diagnostic statement, it would be unprofessional and alarming but not an ethical violation.”

For its part, APA immediately reaffirmed its own stance in a July 27 statement.

“The American Psychiatric Association stands firmly behind the Goldwater Rule,” said Rebecca Weintraub Brendel, M.D., J.D., a consultant to APA’s Ethics Committee and an assistant professor of psychiatry at Harvard Medical School. “Our position has not changed. The Goldwater Rule applies to the 37,000 physician members of the American Psychiatric Association, not other groups, non-members, or non-physicians. The rule represents sound psychiatric ethics, preserves the integrity of the profession, and respects the patients that our members serve.”

Voters get to decide who governs them, said Brendel in an interview. “The 25th Amendment [covering presidential disability and succession] addresses a president’s ability to govern, but a public figure can’t be diagnosed from afar.”

APsaA issued a clarifying statement on July 25: “In an email to association members, our leadership did not encourage members to defy the ‘Goldwater Rule’ … Rather, it articulated a distinct ethics position that represents the viewpoint of psychoanalysts. The field of psychoanalysis addresses the full spectrum of human behavior, and we feel that our concepts and understanding are applicable and valuable to understanding a wide range of human behaviors and cultural phenomenon.”

Wolfe said she found the whole uproar to be puzzling.

“Maybe there was some hope that someone would have something to say that would change the political situation,” she said. “But this is a political issue, not a mental health issue, and the solutions need to be political, not based on commentary by mental health professionals.” ■

The American Psychoanalytic Association statement on the Goldwater Rule can be accessed here. APA’s position statement from 2012 regarding commenting on public figures is available here.