What Might Prevent Psychiatrists From Speaking in Public About Their Opinion of the Mental State of a Public Figure? The so called Goldwater Rule

What Might Prevent Psychiatrists From Speaking in Public About Their Opinion of the Mental State of a Public Figure? The so called Goldwater Rule

In the United States the first amendment protects our right to free speech. Although I am not an attorney, I do believe that while you can’t be put in jail for expressing negative things about other people, there are laws that protect people from untrue damaging statements.. These laws provide recourse for people who believe that their careers reputations finances and/or health have been damaged by harmful statements. The Supreme Court has weighed in on this issue as recent as 1990 and the criteria involves whether the statements are true and the context in which they are made. Things get even more complicated when the object involves public officials and public figures who are in the public view because the law encourages free speech especially when it involves this category of people

What does all this have to do with psychiatry? In 1964 Barry Goldwater was running for President against the incumbent Lyndon Johnson. A magazine by the name of Fact published an article titled The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater . The magazine polled psychiatrists about American Senator Barry Goldwater and whether he was mentally fit to be President of the United States.Screen Shot 2017-07-07 at 11.24.30 PM In response to this question, 2,417 out of 12,356 responded. Of those, 657 said he was fit, 1,189 said he was not, and 571 said they didn’t know enough to answer the question. In response to the survey some of the comments that were made by the psychiatrists who responded were as follows (as reported in article in THE BLOG by Jonathan Moreno 8/26/16):

“The Presidency should not be used as a platform for proving one’s manhood . . .”

“Inwardly he is a frightened person who sees himself as weak and threatened by strong virile power around him . . .”

“Since his nomination I find myself increasingly thinking of the early 1930s . . .”

“Unconsciously he seems to want to destroy himself. He has a good start, for he has already destroyed the Republican party . . .”

Moreno in his article also made mention that in 1931 there was a debate at the annual American Psychiatric Association whether Abraham LincolnScreen Shot 2017-07-07 at 11.26.19 PM was a “manic schizoid personality whose depressive moods stopped short of mental illness.” The article went on to state that “analysis of the dead is not a legal violation, but nonetheless raises the question of fairness as the dead cannot defend themselves. He went on to say that to analyze a living person without data is not only bad practice, it also runs the risk of making the analyst look foolish if the individual later behaves in a way that was not predicted. The editor of that article about Goldwater was Ralph Ginzberg and he was sued for libel and lost the case and had to pay Goldwater $75,000 in damages which is approximately $579,000 in todays money value.

Several years later in 1973, the American Psychiatric Association issued the first addition of Principles of Medical Ethics which is still in effect as of 2017. I will list Section 7 , 1-5 but it is #3 that has informally known as the “Goldwater Rule” which is most relevant to the topic we are discussing. Screen Shot 2017-07-07 at 11.32.00 PM

Section 7

A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

  1. Psychiatrists should foster the cooperation of those legitimately concerned with the medical, psychological, social, and legal aspects of mental health and illness. Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government. A psychiatrist should clarify whether he/ she speaks as an individual or as a representative of an organization. Furthermore, psychiatrists should avoid cloaking their public statements with the authority of the profession (e.g., “Psychiatrists know that”).
  1. Psychiatrists may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness. Psychiatrists should always be mindful of their separate roles as dedicated citizens and as experts in psychological medicine.
  1. 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.
  1. The psychiatrist may permit his or her certification to be used for the involuntary treatment of any person only following his or her personal examination of that person. To do so, he or she must find that the person, because of mental illness, cannot form a judgment as to what is in his/ her own best interests and that, without such treatment, substantial impairment is likely to occur to the person or others.
  1. Psychiatrists shall not participate in torture.

There are very detailed procedures for filing an ethics complaint and how such a compliant will be evaluated on the local district branch level and then up to the national level which are spelled out in detail and include an appeals process. Potential sanctions to a member of the American Psychiatric Association who has been found to be in violation of one of the ethical rules are reprimand, suspension or expulsion from the national organization.

In a article in the Journal of American Academy of Psychiatry and the Law about one year ago Kroll and Puncey concluded that while some third party assessments are reckless but they do not negate legitimate reasons for providing thoughtful education to the public and voicing psychiatric concerns as acts of conscience. They concluded that the Goldwater Rule was an excessive organizational response to what was clearly an inflammatory and embarrassing moment for American psychiatry. A counter view with which I agree was expressed by  Paul Applebaum, Screen Shot 2017-07-07 at 11.44.22 PMM.D. , a past president of both  the American Psychiatric Association and the American Academy of Psychiatry and the Law in the current issue (2017) of the same journal. He said the following : “Weighing the real harms that can arise from psychiatrists’ comments on the diagnoses and personality traits of persons whom they have never examined against the likely inaccuracies and hence limited value of such endeavors to begin with, I am left with the conclusion that the Goldwater Rule remains a valuable component of the ethics of psychiatry. However, some modification of the Rule may be necessary, to indicate more clearly that it is not meant to cover analyses that are  intended to be shared with the public or works on deceased persons of historical interest.”

As far as I know there have been no sanctions by the APA regarding the Goldwater Rule thus far but this is still a topic which is being discussed both within and outside the psychiatric profession.

Any thoughts are welcome in the comments section below

 

Abolishing Don’t Ask, Don’t Tell

President Obama in his State of the Union Address stated that he wanted to abolish the Don’t Ask, Don’t Tell policy in the military service. Admiral Mullen, Chairman of the Joint Chief of Staff as well as the President of the Americann Psychiatric Association have issued similar statements. The history of this policy in the 20th century was briefly reviewed. In addition the concerns that have been expressed about letting gays serve openly in the military were discussed as was the experience of other countries where gays serving in the military has not been a problem.

President Obama Wants to Abolish Don’t Ask, Dont Tell

alg_obama_dont_askPresident Obama in his State of the Union Address stated that he wanted to abolish policies that prohibited gays from openly serving in the military.  I am also glad to see that just this past month the American Psychiatric Association finally got around to supporting this position. “The U.S. should repeal Don’t Ask, Don’t Tell and allow capable men and women to serve without regard to sexual orientation,” said APA President Alan F. Schatzberg, M.D. Even more important a few days ago Admiral Mike Mullen, Chairman of the Joint Chief of Staff said it was his personal belief that “allowing gays and lesbians to serve openly would be the right things to do.”

I thought this would be a good time to consider the history of this issue and what if any psychiatric implications would there be to such a change.

Early 20th Century – Gays Not Welcome in Military

There is evidence that the US military had a policy dating back at least as far back as pre World War II that recruits were not welcome in the military service if they were homosexual.  There were indications as early as the 1940s that some psychiatrists (in this case Harry Stack Sullivan) tried unsuccessfully to get the US military to accepts gays into military service .

         Harry Stack      Sullivan
Harry Stack Sullivan

No doubt there were gays in the military but it would have to be hidden and secret. The identification of homosexuality would be grounds for discharge. I believe in the earlier years that would have been a dishonorable discharge. During my time serving as a psychiatrist in the Air Force during the Viet Nam War it would have an administrative discharge.

Psychiatrists in the military were in an ethical bind. If they put information about sexual orientation into the  chart the patient could be removed from the military. Should military psychiatrists ask and should they write it in the psychiatric record? Of course during about the first ¾ of the 20th century homosexuality was officially considered a psychiatric disorder that in many cases was thought to be a condition that deserved treatment. Therefore one could understand if military leaders and even a compassionate military medical establishment would not want soldiers who were considered to be ill, to be in the military. Even though there was an increasing amount of understanding that this was a misconception and in fact the overwhelming majority of such soldiers did not feel in conflict and were not in need of therapy.

APA Eliminates Homosexuality from DSM

    Alfred M. Freedman
Alfred M. Freedman

In 1973 the American Psychiatric Association eliminated homosexuality from the official diagnostic manual. The history of how this came about and the implications of it for American psychiatry are quite significant. I had the opportunity to interview Alfred M. Freedman who was President of the APA at that time and he shared with me the behind the scenes activities which can be seen on You Tube in three sections or heard on Shrinkpod in it’s entity.

This acknowledged the changes that were taking place in most of the psychiatric community. It would still be some time before openly gay psychiatrists were accepted into the psychiatric establishment and were allowed to become professors of psychiatry or candidates at psychoanalytic institutes. Things were evolving…but not very much in the military.

President Clinton Officially Establishes Don’t Ask Don’t Tell

In 1993 President Clinton officially established the Don’t Ask Don’t Tell policy which essentially was saying that a gay person was welcome in the military as long as nobody knew about it. It did mean that recruiters were not allowed to ask nor were  military superiors allowed to do so.

It may not be so easy to picture the dilemma that a gay soldier who wanted to serve in the military would still have. They would be forced to lead a secret life and accept that the people around them would view them as a criminal worthy of punishment or at least banishment, should their true identify be known. It reminds me of the Muranos, the secret Jews who lived during the Spanish Inquisition. They had to pretend that they were someone else and would always have the fears of the dire consequences that would occur if they were discovered.

This policy has hit women in the military especially hard. Statistics on members of the military discharged under the ban showed that, though women accounted for just 14 percent of the armed forces in 2007, they made up more than 46% discharges for sexual orientation in 2007. Over all, the number of gay men and lesbians discharged from the military in 2007 rose to 627 from 612 a year before, according to Pentagon statistics.This is all occurring at a time when the military is having difficulty recruiting personnel , especially those with specialized language skills.

What Are the Concerns About Letting Gays Serve Openly in the Military ?

As with any piece of human behavior there can be conscious and unconscious determinants. No doubt some of the opposition to allowing gays into the military comes from underlying homophobia where there is a fear of close proximity to people who are gay. This can very well be based on unconscious latent homosexual impulses. Utilizing this line of reasoning to try to bring about change in US policy would not be very productive and most likely would only harden the resistance to reexamination of it.

However it may be useful to look at some of the rational arguments that have been raised. These concern the idea that soldiers, particularly in combat zones or where there are close quarters would be uncomfortable if they knew their comrades might have sexual attraction to them. This might lead to anxiety, poor morale and less military effectiveness. The same question was raised in regard to women in the military and as far as I know it has not been a problem.

More important there are many other countries which have gays serving openly in the military with no such problems reported. In one report 4 countries were studied in depth and they were Israel, Germany, Canada and Sweden. Military officials in each of these countries stated on the basis of their experience, the inclusion of homosexuals in their military has not adversely affected unit readiness, effectiveness, cohesion or morale. For example Israeli officials said that homosexuals have performed as well as heterosexuals and have served successfully in all branches of the military since 1948. Canada where problems in these areas were predicted said none had materialized

John M. Shalikashvili, a retired army general, who was Chairman of the Joint Chiefs of Staff from 1993 to 1997, spoke out on this issue. He described having  a number of meetings with gay soldiers and marines, including some with combat experience in Iraq, and an openly gay senior sailor who was serving effectively as a member of a nuclear submarine crew. He said that these conversations showed him just how much the military has changed, and that gays and lesbians can be accepted by their peers. He also quoted a Zogby poll of more than 500 service members returning from Afghanistan and Iraq, three quarters of whom said they were comfortable interacting with gay people.

One interesting question has been raised and that is whether or not such soldiers if they acknowledge their sexual orientation while on leave in certain Moslem countries could be subject to criminal prosecution there as some places have quite harsh laws against homosexuality. That reminds me that female military personnel in Saudi Arabia at one point were suppose  must wear black head- to-foot robes called abayas and ride in the back seat when off base. They could only leave base if a man accompanied them. The Air Force’s highest-ranking female fighter pilot sued to overturn this policy.  That is another story and such issues should not determine how the US decides to constitute our military forces. Good judgment obviously needs to be used when visiting  potentially hostile environments.

Conclusion

I do believe that we can take President Obama at his word and expect the Don’t Ask, Don’t Tell policy to be lifted. His Secretary of Defense stated recently that that the President and he can take this process only so far, as the ultimate decision rests with Congress. I believe we will see a change in policy this year and it will go smoothly. We will look back on previous policies as we look back on the history of other prejudices and discrimination, which have existed, in our history.

Barry Goldwater
Barry Goldwater

I don’t find myself in agreement with Senator Lieberman from Connecticut too much these days, but I thought he put it very well when he echoed the words of  Barry Goldwater who said, “It’s not important if you are straight, just that you can shoot straight.”

Your Comments Are Welcome