There is new evidence that the system works. This we learn from an op-ed in the Boston Globe by Yale University Psychiatry Professor Brandy X. Lee and two colleagues — Edwin B. Fisher and Leonard L. Glass — who for the past year have been attempting to unseat President Donald Trump on the grounds that he is mentally unstable.
As was noted in this space, Lee et al. were treading on thin ice ethically speaking since the American Psychiatric Association is unambiguous on the subject of psychiatrists offering a “professional opinion” about the mental status of a public figure without first conducting an examination.
Apparently the APA found it necessary to reassert itself, according to the Globe op-ed:
Last month, the American Psychiatric Association reasserted its broad interpretation of the Goldwater rule, which states that psychiatrists should not diagnose public figures from a distance. We consider this act to be politically influenced in dangerous ways. It happened not because it was scientifically called for or because a group of psychiatrists were breaking established guidelines. It happened because psychiatrists were bringing to light a politically inconvenient truth. [Emphasis added]
The group of mental health professionals (which includes us) was not breaking the Goldwater rule as it was written and as the APA had interpreted it prior to Donald Trump’s election. We were merely fulfilling our obligation to the public by calling attention to a dangerous situation that happened to involve the political sphere.
This followed an unprecedented expansion of the Goldwater rule last March to include not just diagnosing but making any comment on any observable aspect of a public figure’s expressed emotion, speech or behavior, even in an emergency. The expansion ran so afoul of the ethical principle the rule fell under (that we contribute to public health) and the very principles of medical ethics (that human health and safety come first), that members resigned in droves, and the APA has been flooded with protest letters for modifying a rule without consulting its membership.
On the contrary, Lee and her posse were breaking established guidelines, which likely forced the association’s hands. As for calling the APA’s motivation “political” and their own motivation “scientific,” the authors have that precisely backwards.
Among Lee’s stated concerns were Donald Trump’s egotism, his refusal to heed his advisers, and his inability to learn from mistakes. As we commented in January, Barack Obama exhibited all three of these traits during his eight years in office. He once boasted, for example, “I’m a better speechwriter than my speechwriters. I know more about policies on any particular issue than my policy directors.”
Somehow none of these obvious cries for help reached Lee’s sensitive ears.
Late in the Globe article, Lee and her coauthors write:
Not only is there scant scientific justification for the APA’s expansion of the Goldwater rule, it also runs counter to the trends of research that call for less reliance on in-person individual interviews.
The link takes you to an article at Stat by longtime Newsweek science popularizer Sharon Begley, who writes:
The flaws of psychiatric exams and the usefulness of other data make the Goldwater rule “scientifically indefensible,” said … a psychiatrist at McLean Hospital and Harvard Medical School who was not involved in the new analysis and is a critic of the rule.
But the expert Begley quotes is Leonard L. Glass, one of the authors of the Globe editorial! Talk about “politically inconvenient truths.”
Among the Trump “delusions” Begley cites as motivation for violating the Goldwater rule is his belief “that President Obama had him wiretapped.”