EXCERPT: Twenty-two psychiatrists and psychologists, including some of the field’s most prominent thinkers, are calling on the American Psychiatric Association on Thursday to substantially revise its controversial Goldwater rule, which bars APA members from offering their views of a public figure’s apparent psychological traits or mental status.
In a letter to be delivered to the APA, Dr. Robert Jay Lifton, one of the world’s leading experts on the psychological effects of war and political violence; Philip Zimbardo of the “Stanford prison experiment”; violence expert Dr. James Gilligan; and their colleagues argued that the Goldwater rule, which the APA adopted in 1973, deprives the public of expert opinion on crucial questions, such as the mental health and stability of elected officials. Conitnued: www.statnews.com/...
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By Leonard L. Glass, M.D., associate professor of psychiatry at Harvard Medical School and senior attending psychiatrist at McLean Hospital in Belmont, Mass. He resigned in protest from the American Psychiatric Association in April 2017.
JUNE 28, 2018
Excerpt: Our proposal urging the APA to recognize that psychiatrists have a responsibility to warn of dangers that threaten the community will be presented to the association today by Dr. Lifton, the esteemed psychiatrist who actually did the ground-breaking research on Nazi and Soviet physician collaborators, and Dr. Judith Herman, a renowned expert on trauma.
The main points of our proposal (discussed elsewhere in STAT) are:
- The APA should acknowledge that psychiatrists have a social responsibility to warn the public when they discern a danger to the public’s well-being arising from the mental state of an official who is in a position to cause great harm. This acknowledges the role of psychiatrists as “witnessing professionals.” When doing so, it is important for those commenting to identify themselves as psychiatrists so the public can register that they speak as professionals from their training and experience, and are not speaking casually or from personal bias.
- The APA must recognize that psychiatrists’ duty to use their professional knowledge to educate the public on matters that fall within their areas of expertise does not violate the confidentiality or privacy rights of public figures because such constraints on speech do not apply where there is no bona fide doctor-patient relationship.
- The APA’s assertion that it is unethical for a mental health professional to comment on a public figure’s psychological functioning without an interview rests on shaky scientific ground. In the 45 years since the Goldwater rule was adopted, substantial multidisciplinary research has cast serious doubt on the primacy and necessity of an in-person interview as the sole basis for assessment in all circumstances.
- We affirm the duties of confidentiality in the care of our patients and urge those who speak out to exercise restraint in the use of psychiatric terms to avoid potentially stigmatizing patients who seek and deserve conscientious treatment.
These limited, practical revisions to the Goldwater rule would correct its most severe shortcomings and facilitate psychiatrists’ responsible engagement with our complex society.
Related:
By SHARON BEGLEY
DECEMBER 6, 2017
EXCERPT:
The American Psychiatric Association (APA) defends its “Goldwater rule” by arguing that an in-person psychiatric examination is the gold standard for diagnosing mental illness and psychological traits — given that there are no blood tests or brain scans for psychiatric disorders. In fact, however, numerous studies suggest that the interview-based exam can be misleading, psychologist Scott Lilienfeld of Emory University and colleagues argue in the paper, which will appear in an upcoming issue of Perspectives on Psychological Science.
Patients lie or hide facts, they often have poor self-insight, and psychiatrists err, the authors write. In contrast, the accounts of people who know the individual, plus his or her public behavior, writing, speech — and, yes, tweets — can provide more accurate insights into a public figure’s mind, they contend.
The flaws of psychiatric exams and the usefulness of other data make the Goldwater rule “scientifically indefensible,” said Dr. Leonard Glass, a psychiatrist at McLean Hospital and Harvard Medical School who was not involved in the new analysis and is a critic of the rule. “I sort of believed” that interviews offer the clearest window into someone’s mind, he said. “But I believe that a whole lot less now that I’ve read this paper,” which he called “thoughtful, thorough, and a major contribution.”
Dr. Paul Appelbaum, who is a past APA president of Columbia University said that while there were very real shortcomings of in-person psychiatric evaluations “without them you are very limited in what you can say about someone particularly the person’s innermost thoughts and feelings.” What he didn’t address is that people with narcissistic and antisocial personality often can be charming and manipulative when they need to. Therefore they do not reveal there innermost thoughts and feelings to therapists. This is addressed by experts in depth in the above article.
Duty to Warn therapists like me have said it would be impossible to make a clinical assessment of someone like Trump in a face-to-face interview without the testimony about his behavior from outside observers because of his extreme narcissism and his antisocial personality.
Because of Trump's psychopathology, he cares about no one but himself. He's not going to become another Lincoln or FDR by assuring equal opportunity for all. He’s more likely to become another Putin.