Donald Trump's presidency is opening a schism within the psychiatric profession. The American Psychoanalytic Association recently sent out an email advising members not to consider themselves constrained by the American Psychiatric Association's "Goldwater Rule" from commenting on the President's mental health. Readers may recall that some professionals have demanded a loosening of this regulation, instituted after Barry Goldwater sued a magazine for publishing a statement by psychologists questioning his sanity during the 1964 presidential campaign, because they consider it their patriotic duty to challenge President Trump's mental competence. The Psychiatric Association's position remains that "it is unethical for a psychiatrist to offer a professional opinion about an individual based on publicly available information without conducting an examination." The Psychoanalytic Association continues to respect the Goldwater Rule insofar as it discourages members from attempting a diagnosis of Trump without an examination, but declares members free to "comment about political figures as individuals" and "does not consider political commentary by its individuals an ethical matter." As an organization, the Psychoanalytic Association "will continue to speak to issues about which it has something relevant to say." Representatives of the Psychoanalytic Association claim that their position was misrepresented in news articles implying that members were now free to question Trump's sanity, but a loosening of restrictions is implicit in the whole exercise. Who believed that psychiatrists had no right to comment on political issues -- to say, for instance, that Trump's healthcare agenda is bad for the country? To assume that such a restriction ever existed is absurd. The only context for this controversy is the Goldwater Rule.
The Psychiatric Association issued a report last March upholding the Goldwater Rule and addressing longstanding or more recent objections to it. The authors deny that the Rule limits freedom of speech, making a distinction between member's right to their opinions as citizen and their responsibilities when preparing professional opinions touching on mental health. They note that some psychiatrists want to "render professional expertise in matters of national security," and answer that, as when psychiatrists act as profilers for the police, experts should offer professional advice in such matters only when asked and authorized, not on their own initiative. They respond to critics who see a professional duty to "render an opinion regarding public figures" analogical to that asserted in the "Tarasoff Doctrine," which defines psychiatrists' duty to "warn and/or protect" people when their examination or treatment of a patient reveals a risk to those people. In the case of politicians who haven't been examined professionally, the psychiatrist has no more information than already exists in the public domain, and may have less information than law enforcement agencies. In short, the Psychiatric Association upholds a strict professional code against the potential politicization of their profession. The Goldwater Rule serves to protect the profession from itself, or from political interventions that could easily backfire on them. No matter how incomprehensible Donald Trump's behavior seems to many professionals and academic, probably the worst thing they could do in this populist age is label such behaviors "crazy" when millions of Americans most likely see them as similar to what they'd do as President. Many of those may well think that the real problem with the country is that we're getting not too much but not enough of the Trump personality they voted for. You can call that feeling unsophisticated, ill-informed, authoritarian or just plain stupid, but to call it insane would be impolitic to say the least, if not insane in its own right. I'm not a psychiatric professional, so I can say that with impunity.