Since the election of President Donald J. Trump in 2016, a renewed debate of sorts has emerged – or re-emerged – about the practice of clinical psychologists, psychiatrists, and other mental health professionals (MHPs) diagnosing public figures, such as the President of the United States, celebrities, and the like, with a mental health disorder.

Just recently, George Conway, husband of the President’s advisor, Kellyanne Conway, tweeted out snapshots of the definition of several mental health disorders taken from the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) with the implication that Trump may have one or several of these disorders. Conway, a lawyer, is not a practicing clinical psychologist, but his message was clear: Trump has a mental disorder in line with DSM-5 criteria.

Was this merely a public relations stunt, or is Conway on to something?

In fact, the debate about diagnosing a public figure with a mental health disorder is not new. Back in the early 1960s, psychiatrists jumped to decry the candidacy of Barry Goldwater by claiming he had a mental health disorder. The problem, of course, was that Goldwater was not personally diagnosed by a psychiatrist. This caused ethical problems within the mental health community, and, since then, attempting to diagnose a public figure with a mental health disorder without examining him or her has become known as “The Goldwater Rule.”

As noted by Judith Lewis Herman and Brandy X. Lee, “If we are mindful of the dangers of politicizing the professions, then certainly we must heed the so-called ‘Goldwater rule’, or Section 7.3 of the APA code of ethics, which states: ‘it is unethical for a psychiatrist to offer a professional opinion [on a public figure] unless he or she has conducted an examination and has been granted proper authorization for such a statement.” The authors continue: “The Goldwater Rule highlights the boundaries of practice, helps to preserve professional integrity, and protects public figures from defamation.”

Yet, although the ethical merits of the Goldwater rule remain sound, some psychiatrists have weighed in in the past three years, putting the Goldwater rule against the ethical “duty to warn.” Brandy Lee, cited above, was one such psychiatrist, and she organized a “Duty to Warn” Conference at Yale University in April 2017. Along with 27 other psychiatrists, Lee proceeded to tease out the Goldwater rule vs. the duty to warn question.

There still isn’t a clear-cut consensus about how to resolve this ethical conundrum. For example, are public appearances, public statements, and behaviors enough evidence to diagnose a public figure with a mental health disorder? If the answer to this question is “Yes,” does this still risk politicizing the profession?

As long as Trump remains in office, questions about the Goldwater rule vs. the duty to warn are going to undoubtedly continue.

References:

Lee, B. (2017). The Dangerous Mind of Donald Trump. St. Martin’s Press, New York, NY.