The Ethical Psychiatrist’s Role in Public Elections

Presidential elections are intense and may lead some observers to speculate about the mental health of the candidates. People are curious about psychiatrists’ diagnostic opinions of politicians and other public figures. This is a sufficiently common phenomenon that APA added an annotation to the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry in 1973, commonly referred to as the Goldwater Rule, prohibiting psychiatrists from offering public opinions about people they have not personally evaluated.

Section 7, Article 3, of the Principles 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.”

Why is it called the Goldwater Rule? During the 1964 presidential election, Fact magazine published the results of a survey it had mailed to 12,356 psychiatrists. Of the 2,417 respondents, 1,189 replied that Sen. Barry Goldwater was not psychologically fit to be president. For a detailed account of the responses, see Henry Pinsker, M.D.’s “Goldwater Rule History” in Psychiatric News. Sen. Goldwater successfully sued Fact for libel and was awarded $75,000 in punitive damages.

APA responded to this very public ethical misstep by a large number of psychiatrists with the annotation above, and periodically the Goldwater Rule is recapped in APA publications (“Ethics Reminder Offered About Goldwater Rule on Talking to the Media,” and in the national media (“Should Therapists Analyze Presidential Candidates?).

Beyond a reminder about the rule, it may be helpful to understand some of the ethical concepts behind it. Virtue ethics emphasizes the personal characteristics that society expects physicians to embody. Among these virtues are respect for others, humility, and adherence to diagnostic processes according to the standards of our field. If we venture a diagnostic impression about a person we have not examined, we trample upon these virtues.

In addition to inviting a lawsuit for libel or slander, a potential consequence of psychiatrists breaching these virtues is a diminution of public confidence in psychiatrists. If we will speak to the media about the possible psychiatric diagnosis of a person we have not evaluated, will we also reveal the identities and diagnoses of our patients? We must guard against undermining the protective cloak of confidentiality, without which people may refrain from seeking mental health treatment.

Political campaigns are brutal. Even a psychologically healthy person needs extra support if engaged as a candidate in an election. Because of stigma, that candidate needs to be assured of the utmost privacy and confidentiality if he or she is to enter treatment. If we are hazarding guesses about politicians’ diagnoses in the media, we will lose the opportunity to provide treatment to our political leaders, which is perhaps one of the most effective ways to ensure a mentally healthy leadership while simultaneously eroding the stigma attached to our field.

Psychiatrists can play an important role in elections, but it is mostly silent. ■