The rationale for the Goldwater Rule — which prohibits psychiatrists from publicly commenting on the mental health of public figures they have not examined in person — does not hold up to current scientific scrutiny, a new analysis finds.
Perspectives on Psychological Science is publishing the analysis, which concludes that the Goldwater Rule is not well-supported scientifically and is outdated in today's media-saturated environment.
"We reviewed a large body of published scientific literature and it clearly showed that examining someone directly is often not necessary if you compile other valid sources of information," says Scott Lilienfeld, lead author of the analysis and a professor of psychology at Emory University.
As examples of those sources, the authors cite interviews with family members, friends and others who know a person well, and extensive public records such as media interviews, biographies, YouTube videos, social media accounts and other material that may reveal a person's longstanding behavioral patterns. The authors also report that direct interviews are subject to a host of biasing factors that are difficult to eliminate, including efforts on the part of interviewees to create positive impressions.
"Even though it is often possible to make a reasonably valid psychiatric diagnosis at a distance, that doesn't necessarily mean that a mental health professional should," Lilienfeld cautions. "Such a diagnosis should only be made with great discretion and after a thorough investigation."
The Goldwater Rule, implemented in 1973 by the American Psychiatric Association (APA), gained new attention after Donald Trump entered the political arena. Some mental health professionals have expressed serious concerns about Trump's mental health, most notably in the new book "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President."
The Goldwater Rule takes its name from an incident during the failed presidential bid of Barry Goldwater. A 1964 article in a now defunct magazine declared, "1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President." Many of the psychiatrists described the candidate in terms such as "emotionally unstable," "cowardly," "grossly psychotic," "paranoid," "delusional" and a "dangerous lunatic." Some of the psychiatrists went so far as to offer diagnoses of Goldwater, including schizophrenia and obsessive-compulsive disorder. Goldwater lost the election to Lyndon B. Johnson, but went on to successfully sue the magazine for libel.
"Many psychiatrists who commented on Goldwater in that article crossed an ethical line," Lilienfeld says. "A lot of unfair statements were made about him that were poorly supported or unwarranted."
The APA later responded by passing what came to be known as the Goldwater Rule, in part to protect public figures from humiliation and in part to safeguard the integrity of the psychiatric profession. The Goldwater Rule may have been more defensible at the time it was implemented, Lilienfeld says, because much less information was available on public figures.
Times have changed, however, particularly with the advent of the Internet and social media.
"If someone is running for the most powerful position in the world, behavioral professionals should be able to speak out if they take the time to properly investigate a candidate," Lilienfeld says. "There should be a high threshold for doing so, but psychologists and psychiatrists should not feel gagged if they want to contribute to a national conversation about a presidential candidate or current president."
While the authors of the analysis recommend abandoning the Goldwater Rule, they add that mental health professionals should avoid making diagnoses of celebrities in general, simply for the sake of prurient interest.
Lilienfeld's co-authors are Joshua Miller from the University of Georgia and Donald Lynam from Purdue University.