Should the Goldwater Rule remain in effect for all therapists?
The “Goldwater Rule”: Why psychologists and psychiatrists need to watch what they say at election time.
He once suggested that “a guy running for office who says exactly what he really thinks would astound a lot of people around the country” 1. He went on to say that most unions were corrupt, social security payments should be voluntary, and that the civil rights act should not be approved. He despised the United Nations, viewing the organization as an enemy of America, and suggested that its headquarters be moved from New York to China. As an alternative, he offered that Nato be given permission to use tactical nuclear weapons which would reduce the need for so many bases to defend Europe. He argued that if their use had been allowed in the Vietnam war, America could have reduced it to “a puddle of mud”. He was infamously quoted as saying “Let’s lob one into the men’s room at the Kremlin”. As for opposition by Democrats closer to home, he proposed “just saw off the eastern seaboard and let it float off to sea”. Regarding troublesome legislation that opposed his ideas, he suggested famously “My aim is not to pass laws, but to repeal them” and argued that “Extremism in the defense of liberty is no vice: moderation in the pursuit of justice is no virtue” 2.
If you think Donald Trump is the most demonized person to have won the Republican nomination for the white house, you might reconsider. One notable contender for this loathsome prize was a much earlier Republican named Barry Goldwater. A popular senator in Arizona in the early 60’s, Goldwater won a hotly contested nomination and went on to alienate many from his own party, particularly more liberal minded Republicans. He was famed for speaking off the cuff, and his supporters argued that this led to his platform and vision being misinterpreted and misunderstood. He was also subject to armchair speculation about his sanity and intelligence. This came to a head shortly before the election in 1964 when Fact magazine ran a special issue titled “The Unconscious of a Conservative: a Special Issue on the Mind of Barry Goldwater”. The editors at Fact mailed thousands of questionnaires to psychiatrists and published a selection of their responses, focusing on those who insisted that he was “unfit to be president”. It was not long before Goldwater’s slogan “In your heart you know he’s right” was parodied by the democrats as “in your guts you know he’s nuts”.
Goldwater and his Republican party experienced a landslide defeat in the election. Oddly enough, despite all the hyperbole he later emerged as a respected thinker who opposed extreme political views and challenged the religious right. He successfully sued Fact magazine and its editor for libel over statements made in their “special issue”, and won. His experience would inspire the American Psychiatric Association to formulate the “Goldwater Rule”, which prohibits psychiatrists from diagnosing or even offering an opinion on the mental status of someone whom they have not personally met and examined. More importantly, as the current head of the APA recently stated, “Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical” 3. In one of its articles, Fact magazine had referred to alleged “nervous breakdowns” experienced by Goldwater in the past – an overstatement of physical exhaustion that at the time was the equivalent of stating that someone was “crazy”. For a time, serious writers would speculate that the Republican party and its adherents were victims of mental illness. The APA rightly recognized that mental health professionals risked becoming pawns in political fights, and more importantly could do real harm by reinforcing the stigma of mental illness and applying it to innocent people.
It is now 2016 and the Goldwater Rule is no less relevant. Donald Trump has become infamous for speaking his mind and making outrageous comments. Every person with democratic leanings seems to be crying out that the sky is about to fall, and even many republicans are showing signs of panic over the potential of Trump as president. In November 2015 Vanity Fair offered its readers the answer to the question “What exactly is wrong with this strange individual?” 4. The article, written by the humorist Henry Alford, quotes psychologists and psychotherapists expounding on Trump’s mental status. Notably absent in this discussion are any psychiatrists. More recently, The Atlantic has published an article by psychologist Dan McAdams titled “The Mind of Donald Trump”, including references to his “narcisissm, disagreeableness, grandiosity”5. It seems that while most psychiatrists are striving to observe the Goldwater Rule, many psychologists and other mental health professionals are weighing in on the armchair speculation regarding Donald Trump’s mental “fitness” and its implications for America.
Therapists have a duty to observe professional standards. Like psychiatrists, they can only responsibly perform their duties by meeting face-to-face with their clients. Due diligence for a therapist includes applying empirically based methods for determining a diagnosis and recommending treatment. Respect for the client is paramount to our work, and anything that we do that suggests bias or fails to observe our professional standards does a disservice to our profession. More importantly, we risk reinforcing the many prejudices associated with mental illness that so desperately needs to be eliminated. As the saying goes, good leaders need to lead by example. With the American election approaching, mental health professionals would be wise to observe the Goldwater Rule. The alternative risks reinforcing the very type of “madness” that is most feared – the act of speaking off the cuff about matters that deserve careful deliberation and good judgment.