No, the American Psychoanalytic Association didn't just junk the 'Goldwater rule'

Topics: Providers, Physicians, Care Delivery, Mental Health

By Heather Bell, managing editor

The Twittersphere was abuzz Tuesday about a STAT News article that suggested the American Psychoanalytic Association (APsaA) was breaking with a longstanding policy that bars psychiatrists from commenting on a public official's mental health. There's just one problem: APsaA has never formally adopted that policy.

Confused? You're not alone.

What is the 'Goldwater rule'?

The Goldwater rule is a policy that the American Psychiatric Association (APA)—a distinct organization from the APsaA—adopted in 1973. The policy states that it is unethical for APA's members "to offer a professional opinion" about an individual's mental health without the individual's consent and a standard examination. In an email to American Health Line, APA clarified the Goldwater Rule only applies to the association's 37,000 members, it does not apply to "other groups, non-members, or non-physicians." The policy grew out of a 1964 Fact Magazine article, which published a now-discredited survey that asked a large group of psychiatrists their opinions on the mental state of former Sen. Barry Goldwater (R-Ariz.), who was the Republican Party's presidential nominee that year. Goldwater ultimately lost the election and later successfully sued the magazine for libel. 

According to a 2012 APsaA statement, "several of the major mental health organizations altered their ethics codes" in response to the incident, "adding a prohibition against commenting on public figures one has not personally interviewed."

However, APsaA said it did not adopt such a policy. Instead, its then-president issued a position statement saying "the conditions for psychoanalytic inference about an individual's emotional stability did not exist in a political campaign" and "warned of the likelihood of bias and distortion on the part of the psychoanalyst, who could be assumed to have a personal preference in the campaign."

APsaA Director of Public Affairs Wyle Tene told NPR's "The Two-Way" that, under this policy, members "have always been free to comment on public figures, but have been cautioned against diagnosing."

What sparked the confusion?

The recent confusion surrounding the Goldwater rule began with a STAT News article titled "Psychiatry group tells members they can defy 'Goldwater rule' and comment on Trump's mental health."

Citing a July 6 member email from APsaA's executive committee, STAT News' Sharon Begley wrote the email "explicitly stated for the first time that the organization does not subscribe to the rule." She added that the email "represents the first significant crack in the profession's decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians' behavior."

However, Begley never quoted directly from the email, and instead quoted an anonymous psychoanalytic association member, as well as the APsaA's past present Prudence Gourguechon;
Lance Dodes, a psychiatrist in Los Angeles; and Leonard Glass, a psychiatrist at Harvard Medical School who has been outspoken against the APA's Goldwater rule.

So what is APsaA's actual policy?

APsaA released a statement in response to the article, clarifying, "Our leadership did not encourage members to defy the 'Goldwater Rule,' which is a part of the ethics code of a different mental health organization, the American Psychiatric Association (APA). Rather, it articulated a distinct ethics position that represents the viewpoint of psychoanalysts."

The association also shared the full contents of the July 6 email, which states: "The American Psychiatric Association's ethical stance on the Goldwater Rule applies to its members only. APsaA does not consider political commentary by its individual members an ethical matter. APsaA's ethical code concerns clinical practice, not public commentary."