So yesterday, the American Psychoanalyst Association (APsA—not to be confused with the APA—American Psychiatric Association) relieved its members of what’s known as “the Goldwater rule” against making statements about the mental health of public figures.
I think that was a bad move.
But first, what’s the Goldwater rule?
Named after Barry Goldwater, an American presidential candidate unfortunate enough to be declared mentally unfit via a poll of psychiatrists in 1964, the rule states:
…that Psychiatrists may share expertise about psychiatric issues in general but that it is unethical for a psychiatrist to offer a professional opinion about an individual based on publicly available information without conducting an examination. Section 7.3 of The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. Full document here (PDF).
It’s a good rule, and I don’t think Trump is reason enough to cancel it. And not for any lack of appeal to the prospect. But that it’s so appealing is the more reason to consider it more carefully. Professionals aren’t simply magpies chasing shiny things, after all.
So yes, it certainly is tempting to offer an opinion on Trump (and while we’re at it, on Nigerian politicians). But overall, it’s more harmful. What could I hope to achieve by declaring my opinion? What is the point of making a diagnosis if I have no power to provide treatment?
To better explain this, allow me to say something about how medicine works.
Doctors are like detectives
A good way to better understand this is to think of medicine as very much like detective work, with health conditions as the crimes and your body as the crime scene. You are the main witness, and the physical examination and lab investigations are all in search of clues.
But there’s one thing any good detective knows: you don’t name suspects as criminals without proper trial.
In medicine, “proper trial” is via the medical consultation. And to offer “diagnoses” or other kinds of “professional opinions” without that consultation is to risk turning the highly educated guesswork that medicine requires into just... guesswork.
And this is in a world where it’s already typical for people to make pronouncements about their mental health all the time (I’m so OCD, I act so bipolar, and such). We also very freely make declarations about the mental health of people we don’t like (he’s such a retard, she’s so schizophrenic), and of public figures (like, say, Kanye). But even setting aside the danger from normalising these “professional” opinions, dropping the Goldwater rule as an ethical guideline puts us all at risk of three great dangers.
Danger #1: Overconfidence
If public figure diagnosing becomes a thing, best believe the media will increasingly request it. In fact, they already do, but to a limited degree. Removing the limits means you may expect full diagnoses, complete with predictions about outcomes and things. The present exception will become the future norm.
It’s not like we don’t talk about public diagnoses in private, but not with some sense that it’s all speculation. Put a media spotlight on that and you can be sure that sense will start to fade, because, human nature. And the reluctance to diagnose at a distance that every doctor learns early on will be replaced by a confidence in their ability to do so.
But remember we’re like detectives. A detective too eager to incarcerate suspects as criminals, without trial, is a potentially dangerous detective. (Except you’re Batman.)
Danger #2: Stigma
It’s bad enough how people just use one symptom to label people (including themselves): self-diagnosed “OCD”, “anxiety,” and such are everywhere, in our movies, music and real life. But lack of validity of these “diagnoses” aside, there is a more subtle danger: underlying them is the misconceived idea that psychiatric diagnoses are obvious, something anyone can identify with a bit of knowledge.
Think about it: how readily do people pronounce others to have physical health conditions? Not so much, because there’s a sense in which the average person understands that it’s not that easy. But perhaps because mental health problems often have behavioral components, there’s a sense of popular comfort with making them, and thereby labelling people.
Which is basically what stigma is all about.
But the behavioral components are exactly why this should be avoided, because behaviors in themselves are often nonspecific: they can be influenced by anything and mean anything.
So freely offering “professional” opinions will only reinforce an idea that any detective worth their salt knows and avoids: the idea that it’s okay to skip trial and just shoot suspects on sight based on what you “know.”
It’s not. (Unless, again, you’re Batman.)
Danger #3: Disrepute
Perhaps worst of all: this can only discredit mental healthcare as a profession. Some historical context is necessary here. Psychiatry as a medical field is fairly new (dating only to about mid-19th century), whereas the history of stigma against mental illness is older than medicine itself. So it’s hardly surprising that the early days of the specialty were tragically marked by the use of psychiatrists to label people who were in disfavor with larger society or the ruling powers.
The labeling itself wasn’t new: what was new was the possibility of adding a professional veneer to it. And psychiatry is inherently prone to this kind of abuse by virtue of being the only specialty requiring involuntary admission of people. The line is thin, and we don’t need to blur it out any further. On top of that, all the work psychiatry has done to become more scientific has yet to grant it full recovery in the public eye from the stain of its shady history (more at Wikipedia’s political abuse of psychiatry article).
And we want to risk throwing all that away just because of Trump? Fine. Keep in mind, though: it might be Trump today.
But what if the tables turn tomorrow? What then?
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