Before Donald J. Trump came on the electoral scene, not a lot of people had heard of the Goldwater Rule. By now many surely have. The eponymous rule was established by the American Psychiatric Association, my own guild organization. It stipulated that no psychiatrist should make a diagnosis of a person he or she has not examined face-to-face and who has not given consent to discuss his mental health publicly.

While do-it-yourself diagnosing of a certain presidential candidate has become a cottage industry in this election—the consensus about Donald Trump is that he might have a severe case of Narcissistic Personality Disorder—psychiatrists have been understandably reluctant to weigh in, even as people have clamored to say that they deserve to know everything possible about a potential president’s mental fitness.

How did the rule come to be? In the lead up to the 1964 election, Fact magazine surveyed over 12,000 psychiatrists about the personality traits of Sen. Barry Goldwater, the Republican nominee. Only a modest percentage of the psychiatrists responded but of those that did, almost half felt the candidate was psychologically unfit to be president.

They savaged Goldwater, judging him “warped,” “narcissistic,” “impulsive” and a “paranoid schizophrenic” who harbored unconscious hatred of his Jewish father and was scarred by his rigid toilet training. One respondent saw him as “a frightened person who sees himself as weak and threatened by strong virile power around him—and that his call for aggressiveness and the need for individual strength and prerogatives is an attempt to defend himself against and to deny his feelings of weakness and danger.” Even his supporters came in for unfavorable psychoanalysis.

In the aftermath, two things happened. First, Goldwater, who lost the presidency in a landslide, sued Fact for libel and was awarded $75,000 in punitive damages. He deserved to win the suit. The psychiatrists’ intra-psychic assessments were deeply intrusive, disrespectful, and basically meaningless. Warmed-over Freudianism is no way to foretell one’s actions in office. Second, the APA issued the Goldwater Rule, which meant to prohibit such distant assessment.

The American Psychiatric Association still stands by the Goldwater Rule and no psychiatrist can go wrong by following it. Of course, many can easily skirt around it—it’s thanks to the rule that modern-day assessments of celebrities’ mental health are couched with the “I have not personally examined this person, but … ”

But the assessment of mental disorders changed to a more objective system of taxonomy in 1980 with the publication of the DSM-III. A number of diagnoses are now made largely on a person’s observable behavior or what can reasonably be inferred from it.

So it is now possible to make a psychological assessment from afar. The question remains of whether it is appropriate. One of the biggest concerns about armchair diagnosing is that it’s a drive-by affair: Quick pronouncements are made based on a single transgression or a glimpse of erratic behavior. But even when a clinician conducts a formal interview it may not pick up a lot. In an hourlong interview, a savvy politician could easily present as better adjusted than he or she actually is—in some cases, such impression management might go undetected, even by experienced examiners. continue….

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