In 1964, the magazine Fact published the article "The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater." The article included the results of a poll among psychiatrists questioning them if then senator Barry Goldwater was fit to be president. Of the 2,147 who responded, 657 said that he was fit and 1,189 said that he was not. In addition to the responses to the question about Goldwater, the article included a series of quotations from the respondents, various facts, and observations about Goldwater. Goldwater sued the editor and publisher of the magazine, Ralph Ginzburg, who had edited some of the quotations from articles and even from some of the psychiatrists interviewed. Goldwater sued him and won $75,000 in damages, since the judge found that Ginzburg had acted with malicious intent. Before the publication of the article, the medical director of the American Psychiatric Association (APA) had warned Ginzburg that the responses were not valid without a "thorough clinical examination" of Goldwater, according to Jonathan D. Moreno, an American philosopher and historian. In 1973, the APA made that policy official and established what became known as the "Goldwater Rule." The rule, which appeared in the first edition of the APA's code of ethics and is still in effect nowadays, says: "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." Although there are some positive aspects to the Goldwater Rule, it presents some conflicting issues. The rule still prevents the unethical misuse of the psychiatric profession: i.e. it may be tempting to come to a diagnostic conclusion on a public figure when politically convenient, even in the face of a paucity of data. The rule should allow, however, for psychiatrists and other health-related professionals to voice their concerns regarding the mental stability of high office holders. In our culture we need a psychological clearance for people working in intelligence, in the FBI, in the police. Should we not demand a clean bill of mental health for the person who is going to literally control our lives? For as long as such needed regulation does not exist, should responsible professionals remain silent, obediently abiding by a rule that in this case protects what many consider a manifestly dangerous character at the helm of the world? One should also consider the ethical obligations to protect public health imposed by the psychiatric profession. In a letter to the New York Times; 37 psychiatrists, psychologists, and social workers rang the alarm bells on the dangers imposed by president Donald Trump's mental health status. According to these professionals, the silence imposed by the Goldwater Rule "...has resulted in a failure to lend our expertise to worried journalists and members of congress at this critical time." And they conclude, "we believe that the grave emotional instability indicated by Mr. Trump's speech and action makes him incapable of serving safely as president." Professional impressions could be mild or strong but they are not the same as diagnosis; they can still warn and educate the public preventing potential harm. Such rule should be applied wisely and judiciously but not at the expense of similarly important ethical obligations imposed by the psychiatric profession.
Orlando Garcia, MD Psychiatrist Cesar Chelala International public health consultant
