The Goldwater Rule

[sukumvit boy]

As many of you are undoubtedly aware ,the American Psychiatric Association (APA) has a long standing rule in it's professional code of ethics known as The Goldwater Rule , that prohibits members from publicly commenting on the psyches of living public figures whom they have not personally examined . Additionally , such disclosure would be unethical as it constitutes a breach of patient confidentiality .
https://en.wikipedia.org/wiki/Goldwater_rule
However , psychiatrists are also bound by a rule known as The Duty to Warn , that supersedes Goldwater. That is , if a clinician has reason to believe that the patient is in imminent danger of harming himself or others he must warn the victims .
https://en.wikipedia.org/wiki/Duty_t...and_psychiatry

As recently noted in some circles , including a May 22 oped piece in The New Yorker , The Goldwater Rule is being severely tested due to the actions of " he who must not be named".
So the APA decided to call a meeting to clarify it's position and apparently The Goldwater Rule stands unchanged.
http://psychnews.psychiatryonline.or...i.pn.2017.4a27

But everyone is welcome to their own opinion.

[broncofan]

I remember reading that piece and thinking it would be a good piece to discuss here. I'm not a medical professional and don't have a science background but I think the purpose of the Goldwater rule is to protect against self-serving, reckless diagnoses by professionals who do not have a sufficient basis for their diagnosis. However, I don't think it should be an absolute and maybe should not even require the duty to warn to violate. If psychiatrists say what they believe and provide both the basis of their belief and whatever degree of uncertainty they have, then it might provide useful context for a person's behavior.

It is not necessarily logical to me that in a single person to person consultation a doctor would have more information to make this judgment than they would have in a twenty year documentary record of a public person's life. But the rule should be to protect against prurient speculation meant less to understand someone's unique psychological features than to demonize or defame them.

For instance, if any time there is a quirky figure you have someone on television using their professional credentials to suggest bipolar disorder, or if insensitivity is translated to sociopathy it seems like an abuse of that discipline. But if the doctor is responsible, and states both the basis of their beliefs and the limitations of their methodology, I think it should be okay.

[broncofan]

http://www.medscape.com/viewarticle/881006_1

I thought this was a fairly well written piece about different doctors discussing the usefulness of the Goldwater rule. I realize now there are more issues to consider including consent of the patient, although I am not sure I fully understand that interest in someone who has not personally seen a doctor. I probably have a minority view on this, but this is article contains a good discussion too. I agree with Doctor Pouncey I think.

[sukumvit boy]

Thanks for your very interesting comments broncofan , unfortunately , the link above puts me on a sign-in page for which I have no username or password.
You should understand that the usual initial psychiatric consultation is a half -day affair ,including a bank of standard psychological tests preceding the actual one on one interview . So there is a lot of information to go on from a formal psychiatric evaluation , but as you noted the long history of legal and ethical turmoil following Trump throughout his life is like a text book innovatory of Sociopathic Personality Disorder of the Narcissistic Type.
http://www.mayoclinic.org/diseases-c...s/dxc-20198978

[Stavros]

I think the cardinal rule is to attack the policies. If we attack the person it is because they have put themselves into the public sphere and are fair game up to a point beyond which criticism of politics just becomes personal abuse -but for example, I think there is a difference between arguing the President is incompetent because he has no experience of public office, and is incompetent because he has a narcissistic personality disorder, not least because I cannot verify the latter whereas the brief record in office suggests the former is closer to the truth. Jeremy Corbyn, Ken Livingstone and others on the Labour left in the 1980s were described as 'Loony left' and though the earlier meaning of the term has been lost the implication behind the word 'loony' or lunatic is that the person so described is dangerous and should be locked up, but has no psychiatric or psychological value.

On another level, is it important or relevant that the fathers of Gordon Brown and Theresa May were both vicars? How many successful sportsmen famous for punishing fitness regimes and a near maniacal obsession with winning are trying to compete with or please their fathers? How many who suddenly lose form, can't score goals or baskets or get over the finishing line have problems in the bedroom? Or, to put it more bluntly, how much detail do you want to know? In the end you might ask yourself if a President is successful because of the size of his dick, and the answer might not be the one you expected.

[broncofan]

Thanks for your very interesting comments broncofan , unfortunately , the link above puts me on a sign-in page for which I have no username or password.
You should understand that the usual initial psychiatric consultation is a half -day affair ,including a bank of standard psychological tests preceding the actual one on one interview . So there is a lot of information to go on from a formal psychiatric evaluation , but as you noted the long history of legal and ethical turmoil following Trump throughout his life is like a text book innovatory of Sociopathic Personality Disorder of the Narcissistic Type.
http://www.mayoclinic.org/diseases-c...s/dxc-20198978

Thank you for that. After reading your links and others I realized I was probably wrong, where there are more sensitive interests at stake and it's more difficult to test symptoms without face to face consultation.

But just as an example, what if a senator or public figure was talking about being up for three days gambling and saying stuff like he believed he had special mental powers and speaking very rapidly? Now, there is no doubt that all of us armchair shrinks would say this sounds like bipolar disorder. So the question of whether that person has a psychiatric disorder would already be part of the public conversation. The addition of an expert may create the appearance of certainty when there is none, which is a risk, but even as a perspective based on incomplete information it would be more insightful than everyone else's view.

There is a legitimate question, which I think is kind of raised by Stavros' post of what benefit the diagnosis would have to the public that a simple description of the behavior would not. Diagnostic criteria probably are most useful as a guide to treatment.

Anyway, I'm sure the APA is correct, and probably the risks far outweigh any rare benefits to discourse. Thanks for the interesting thread. I think Donald Trump has Sociopathic Personality Disorder of the Narcissistic Type and is incompetent.

[Stavros]

Even as I write this, BBC Radio 4 is broadcasting a programme in its series, Archive on Four: Dictators on the Coach, drawing on the archives of the CIA and its psychological profiles of world leaders, from Adolf Hitler to Fidel Castro and Saddam Hussein...

For decades psychologists working for the CIA have drawn up psychological profiles of foreign leaders.
Using expertise developed watching the Nazis, the programme presented American Presidents with detailed profiles of their opponents, complete with proposed weak points and personal foibles.
In 1961, prior to a planned summit meeting between John F. Kennedy and Nikita Khrushchev, the CIA profiled the Russian leader, declaring him "an uninhibited ham actor who ...has a truly unusual ability to project the force of his own powerful personality."
The report - which today reads like generalisation of a peculiarly obvious kind - so impressed Kennedy that he became "addicted" to reading analyses of foreign leaders, particularly if they contained details of sexual peccadilloes. The Russians became keen on psychological reports too, commissioning one on Kennedy which questioned whether his liberalism was anything more than skin deep.
Extraordinarily, the CIA unit profiling foreign leaders survived the Cold War, offering such gems as...
"Fidel Castro is not "crazy," but he is so highly neurotic and unstable a personality as to be quite vulnerable to certain kinds of psychological pressure. The outstanding neurotic elements in his personality are his hunger for power and his need for the recognition and adulation of the masses..."
"While Saddam Hussein is not psychotic, he has a strong paranoid orientation..."
Psychoanalyst Daniel Pick explores these extraordinary files, and speaks to psychiatrists about the validity of "distance readings" and foreign policy experts and historians about how they may have influenced the direction of American foreign policy.
And what exactly are the psychiatrists currently saying about today's world leaders?
http://www.bbc.co.uk/programmes/b08tbbmt

[sukumvit boy]

Thanks Stavros , and again broncofan ,for those thought provoking comments .
The most salient feature of a sociopath or psychopath is that they have no "conscience" , empathy is utterly foreign to them.
From an early age they look at the people around them and at TV and movies that depict emotions such honor , loyalty , fidelity and trust and realize that they don't feel those things. which is why they are prone to behaviors to 'fill that void' such as sexual promiscuity ,risk taking or drugs . They demand loyalty and trust in relationships , two emotions which they are utterly incapable of experiencing.
But they soon learn that their loss of empathy also gives them a tremendous advantage. They become expert manipulators of people and exploit others with no regard for right or wrong.
And that is why certain jobs and security clearances do require psychological testing .
But for the highest office in the land?

[sukumvit boy]

By the way Stavros , fascinating radio program link . I'm listening to it now , tks.