I had a conversation with a group of PGY2/3 resident psychiatrists about a year ago about Trump. They were all engaging in their pet theories about Trump. It was a fun informal dinner with friends, so nothing professionally problematic.
What did disturb me was not a single person in the room knew anything about the Goldwater Rule or what it was. I, the only non-MD, had to explain the history and consequences. I was kind of shocked something like this was not talked about in their ethics training.
It irked me quite a bit that basic observations of the human condition like "poor memory" were conflated, I think intentionally in this case, with delivering dementia diagnoses. Though it's mostly just a matter of running political interference here, the assumption that everyday statements about personality or behavior either must come in the form a diagnostic entities or are somehow concealing medical implications is not a good turn in the discourse. I've seen similar non sequiturs with psychiatric conditions; Alice says that Bob has been anxious lately, and Carol interjects that anxiety disorders are serious conditions that can't be diagnosed by laypeople. The expectation that psychiatrists can or should provide assessments of public figures when plain observation of their public actions is pretty adequate to assess capacity contributes to this kind of nosological imperialism.
I absolutely love this defence of the Goldwater rule, Martin. Much needed - if not for maintaining the professional standing of psychiatry, then at least for common sense. And beautifully written, too :)
I’ll admit to only skimming this. But I think you’re correct; I don’t see any reason to assume that psychiatrists are less tribal, less susceptible to confirmation bias and so forth, or less human, than other humans.
I’m a longtime disliker of Donald Trump, going back to when he was a Democrat. But I don’t need the blessing of a psychiatrist to draw conclusions about the man whose utterances are more heavily documented than any public figure in modern history. I’d rather have the psychiatric profession trying to maintain its integrity than have a psychiatrist break the Goldwater rule to reinforce what i already believe.
Arguably, it’s a little narcissistic (in the non clinical sense) to ask psychiatrists to do that, and a little narcissistic of a psychiatrist to feel the calling to break that rule. At least in part because we all know that no criticism of Donald Trump means anything to his apologists.
Thank you for this illuminating history and reflection. I smiled in appreciative agreement at your comment, "Personally, I think any psychiatrist criticizing a public figure under the guise of “duty to warn” has come down with an unfortunate case of grandiose-hero-savior-syndrome."
Thank you for a balanced and professional overview of this topic. I was unfamiliar with the Goldwater Rule but it seems to take an authoritative and sensible approach. I am not a psychologist or psychiatrist or anything psych (though my wife occasionally claims I am psychic!). For me, the non-expert, the clincher is your point about how can you make any determination without an examination? Thumbs up!
I am so impressed with the compassion, as well as the clarity, with which you dealt with these issues. You focused on the ethical issues from the clinician's perspective, which of course makes sense. However, you were kind enough not to dwell on voters' susceptibility to claims by authority figures, whether or not made in good faith.
I'd like to add that I found your discussion of a Borderline vs Bipolar diagnosis based on similar presentation to be extremely edifying.
1) Thank you for addressing the issues! I was in 7th grade at the time and my friends & I were very much anti-Goldwater because all of our parents and teachers —in “history & civics classes” —were discussing all of the issues and they were all upper middle class liberals or “country club Republicans.
2) Of course Trump far worse / more dangerous than Goldwater and even Goldwater seemed to have “mellowed” in someways later years as compared with his 1964 version. (As maybe a side issue, of course I remember the famous “daisy” commercial and Goldwater’s slogans about “extremism”.)
3) Once an adult, I always thought that the Goldwater Rule should have led to a “work around” where psych opinions based upon hypotheticals could have been the basis for “fitness” opinions coupled with disclaimers about “opinion given without a subject’s exact medical history and direct exam and so may be in invalid as to them specific person. I think opinions should have been allowed also based upon psych classification elements a la “DSM”.
4) NOW: I think EVERY candidate should be required to undergo a panel exam with a balanced /agreed upon panel chosen by the AMA and the APA based upon both interviews, full neuropsych and physical exams for differential diagnosis, MMPI, criminal and civil, tax, credit bureau, medical and psych and medication records, IRS, school records, national security checks, financial records and conflict of interest checks, military records, bankruptcy checks, social media surveillance and polygraphs required.
5) Any candidate refusing is out and all applications /process for Presidential candidates should be executed under “penalty of perjury” and yearly updates should be required. (And no Montreal or “Mini-Mental” screening exams are adequate.)
6) Over the past 50-60 years any candidate for “police academies”, bar admission, many other kinds of employment and appointments for positions of trust have to undergo similar scrutiny.
7) My background /current involvements—in addition to being an artist & photographer /writer, entrepreneur— lawyer since 1981 with primary specialty in workers’ compensation defense and risk management representing insurance companies, multi-national corporations, municipalities*, hospitals, self insured associations, etc.
The issues of “fitness for duties”, as well as of causation for symptoms, (and accidents and injuries), diagnoses, conditions, their permanence and whether symptoms and conditions were impairments permanently or impairments at all, and credibility of workers’ comp. claimants and their doctor expert witnesses were always issues.
* And their various departments such as police, fire, seaport, transit, etc.
I am in private practice, I appreciate this post. Years ago when Trump was first elected, patient after patient came in crying about the results. I am not exaggerating, they were in tears. I was taken aback that anyone would think this was an appropriate venue for a political discussion. I can't remember how I handled it then. But I still remember it.
Hi, and thanks for writing. No tine right now to answer in detail: Superbowl Sunday!. But your comment re: “medication” caught ny eye.
For example, I know for a fact that in 2022 that the TSA—the Federal guys that examine luggage, among other airport duties—not only asked about meds in general, but also called out candidates for taking certain meds and required not only secondary meduxal exams about certain meds, but also some meds might disqualify a candidate from the get go.
(I can even post a redacted version; i. e., no names or addresses, of their forms to show you what I mean. [Forms from 2022 from a closed case of a lawyer I know so the info back then was authentic.])
It is astounding to me that many people object to knowing more about their Presidential candidates and Presidents.
BTW, I have suffered from a poor memory since childhood— possibly a manifestation of ADHD. I refer to my memory as Swiss cheese— solid for some things and nonexistent for others. Yet I have scored the highest possible score on several standardized tests and obtained a PhD. Despite this, I take weeks to memorize a new phone number and I'm very fuzzy on what year various events occurred in. I'd hate to see what Hur would think of me.
"Does, say, ADHD or narcissistic personality disorder necessarily disqualify someone from leadership?"
If we're going to disqualify politicians on the basis of narcissism then we won't have any politicians. (This is not a joke.)
I had a conversation with a group of PGY2/3 resident psychiatrists about a year ago about Trump. They were all engaging in their pet theories about Trump. It was a fun informal dinner with friends, so nothing professionally problematic.
What did disturb me was not a single person in the room knew anything about the Goldwater Rule or what it was. I, the only non-MD, had to explain the history and consequences. I was kind of shocked something like this was not talked about in their ethics training.
I wonder if you saw this piece in the NYT today? https://archive.ph/FY8e7
It irked me quite a bit that basic observations of the human condition like "poor memory" were conflated, I think intentionally in this case, with delivering dementia diagnoses. Though it's mostly just a matter of running political interference here, the assumption that everyday statements about personality or behavior either must come in the form a diagnostic entities or are somehow concealing medical implications is not a good turn in the discourse. I've seen similar non sequiturs with psychiatric conditions; Alice says that Bob has been anxious lately, and Carol interjects that anxiety disorders are serious conditions that can't be diagnosed by laypeople. The expectation that psychiatrists can or should provide assessments of public figures when plain observation of their public actions is pretty adequate to assess capacity contributes to this kind of nosological imperialism.
I absolutely love this defence of the Goldwater rule, Martin. Much needed - if not for maintaining the professional standing of psychiatry, then at least for common sense. And beautifully written, too :)
This is a great exploration of the issues involved.
Great article explaining all the issues! My question is did Mary Trump violate the Goldwater Rule when she diagnosed Trump as a high-functioning sociopath? https://www.cbc.ca/news/world/trump-niece-book-1.5646052
I’ll admit to only skimming this. But I think you’re correct; I don’t see any reason to assume that psychiatrists are less tribal, less susceptible to confirmation bias and so forth, or less human, than other humans.
I’m a longtime disliker of Donald Trump, going back to when he was a Democrat. But I don’t need the blessing of a psychiatrist to draw conclusions about the man whose utterances are more heavily documented than any public figure in modern history. I’d rather have the psychiatric profession trying to maintain its integrity than have a psychiatrist break the Goldwater rule to reinforce what i already believe.
Arguably, it’s a little narcissistic (in the non clinical sense) to ask psychiatrists to do that, and a little narcissistic of a psychiatrist to feel the calling to break that rule. At least in part because we all know that no criticism of Donald Trump means anything to his apologists.
Thank you for this illuminating history and reflection. I smiled in appreciative agreement at your comment, "Personally, I think any psychiatrist criticizing a public figure under the guise of “duty to warn” has come down with an unfortunate case of grandiose-hero-savior-syndrome."
Thank you for a balanced and professional overview of this topic. I was unfamiliar with the Goldwater Rule but it seems to take an authoritative and sensible approach. I am not a psychologist or psychiatrist or anything psych (though my wife occasionally claims I am psychic!). For me, the non-expert, the clincher is your point about how can you make any determination without an examination? Thumbs up!
I am so impressed with the compassion, as well as the clarity, with which you dealt with these issues. You focused on the ethical issues from the clinician's perspective, which of course makes sense. However, you were kind enough not to dwell on voters' susceptibility to claims by authority figures, whether or not made in good faith.
I'd like to add that I found your discussion of a Borderline vs Bipolar diagnosis based on similar presentation to be extremely edifying.
1) Thank you for addressing the issues! I was in 7th grade at the time and my friends & I were very much anti-Goldwater because all of our parents and teachers —in “history & civics classes” —were discussing all of the issues and they were all upper middle class liberals or “country club Republicans.
2) Of course Trump far worse / more dangerous than Goldwater and even Goldwater seemed to have “mellowed” in someways later years as compared with his 1964 version. (As maybe a side issue, of course I remember the famous “daisy” commercial and Goldwater’s slogans about “extremism”.)
3) Once an adult, I always thought that the Goldwater Rule should have led to a “work around” where psych opinions based upon hypotheticals could have been the basis for “fitness” opinions coupled with disclaimers about “opinion given without a subject’s exact medical history and direct exam and so may be in invalid as to them specific person. I think opinions should have been allowed also based upon psych classification elements a la “DSM”.
4) NOW: I think EVERY candidate should be required to undergo a panel exam with a balanced /agreed upon panel chosen by the AMA and the APA based upon both interviews, full neuropsych and physical exams for differential diagnosis, MMPI, criminal and civil, tax, credit bureau, medical and psych and medication records, IRS, school records, national security checks, financial records and conflict of interest checks, military records, bankruptcy checks, social media surveillance and polygraphs required.
5) Any candidate refusing is out and all applications /process for Presidential candidates should be executed under “penalty of perjury” and yearly updates should be required. (And no Montreal or “Mini-Mental” screening exams are adequate.)
6) Over the past 50-60 years any candidate for “police academies”, bar admission, many other kinds of employment and appointments for positions of trust have to undergo similar scrutiny.
7) My background /current involvements—in addition to being an artist & photographer /writer, entrepreneur— lawyer since 1981 with primary specialty in workers’ compensation defense and risk management representing insurance companies, multi-national corporations, municipalities*, hospitals, self insured associations, etc.
The issues of “fitness for duties”, as well as of causation for symptoms, (and accidents and injuries), diagnoses, conditions, their permanence and whether symptoms and conditions were impairments permanently or impairments at all, and credibility of workers’ comp. claimants and their doctor expert witnesses were always issues.
* And their various departments such as police, fire, seaport, transit, etc.
I am in private practice, I appreciate this post. Years ago when Trump was first elected, patient after patient came in crying about the results. I am not exaggerating, they were in tears. I was taken aback that anyone would think this was an appropriate venue for a political discussion. I can't remember how I handled it then. But I still remember it.
A little too late on the perception as a "captured constituency" front I think, applies to physicians more broadly though.
Hi, and thanks for writing. No tine right now to answer in detail: Superbowl Sunday!. But your comment re: “medication” caught ny eye.
For example, I know for a fact that in 2022 that the TSA—the Federal guys that examine luggage, among other airport duties—not only asked about meds in general, but also called out candidates for taking certain meds and required not only secondary meduxal exams about certain meds, but also some meds might disqualify a candidate from the get go.
(I can even post a redacted version; i. e., no names or addresses, of their forms to show you what I mean. [Forms from 2022 from a closed case of a lawyer I know so the info back then was authentic.])
It is astounding to me that many people object to knowing more about their Presidential candidates and Presidents.
Isn't this the same APA that periodically tries to get pedophilia reclassified as a sexual orientation?
BTW, I have suffered from a poor memory since childhood— possibly a manifestation of ADHD. I refer to my memory as Swiss cheese— solid for some things and nonexistent for others. Yet I have scored the highest possible score on several standardized tests and obtained a PhD. Despite this, I take weeks to memorize a new phone number and I'm very fuzzy on what year various events occurred in. I'd hate to see what Hur would think of me.