The American Psychoanalytic Association announced earlier this month that members of the association no longer need to abide by the long-established “Goldwater Rule” named after 1964 presidential candidate Barry Goldwater. The rule, which can be found in Section 7.3 of the American Psychiatric Association’s (APA) Ethics Code, cautions against most psychiatrists and other mental health professionals offering opinions about an individual publicly – including the President of the United States.
In an interview with Fordham News, Dr. Fisher stated, “Revising ethical standards to address a particularly problematic political figure or to condone the publication of a book does not reflect well on the association.The public should be aware that the American Psychoanalytic Association organization does not represent the field of psychiatry per se, but a group of professionals who practice a particular therapeutic orientation within the mental health profession known as psychoanalysis.”
“Responsible diagnosis in psychoanalysis, as in other mental health fields, relies on assessment techniques that are characterized by interactions with and analysis of patient responses to specific established questions. A professionally and ethically responsible diagnosis cannot be determined in the absence of such interactions or assessments.For example, although the American Psychological Association has not adopted a “Goldwater Rule,” the importance of appropriate assessments are intrinsic in its ethics code, which forbids psychologists from providing opinions of the psychological characteristics of individuals if they have not “conducted an examination of the individuals adequate to support their statements or conclusions”. To be sure, the mental health profession can and should share their knowledge with the public, but irresponsible “diagnosis” diminishes the profession and does not serve the public it seeks to inform.”
The American Psychoanalytic Association’s Statement on “Goldwater Rule” can be found on their website.
President Donald Trump’s first week in office was spent signing executive orders regarding the Dakota Access and Keystone XL Pipelines, visa and refugee programs and a wall along the U.S.-Mexico border, all which sparked nationwide demonstrations and protests. Since the beginning of Trump’s campaign and more frequently over the past week, media outlets and select “experts” have been gaining attention by diagnosing Trump with various mental or personality disorders. However, is it ethical for experts in psychology and psychiatry to offer professionals diagnoses of Trump and what are the political implications?
A recent article published in U.S. News & World Report titled, “Temperament Tantrum,” featured a professional assessment of the 45h President from John D. Gartner, a practicing psychotherapist who previously taught psychiatric residents at Johns Hopkins University. Gartner told U.S. News & World Report that Trump has “malignant narcissism,” an incurable narcissistic personality disorder. Despite the Goldwater Rule, in Section 7.3 of the American Psychiatric Association’s (APA) Ethics Code, which cautions against offering a professional opinion about an individual in the public eye who has not been formally evaluated, Gartner argues that in the case of Trump, he can “make this diagnosis indisputably” and the breaking of the [Goldwater Rule within the] ethics code is warranted.
According to Dr. Celia Fisher, Professor of Psychology and Director of the Fordham University Center for Ethics Education, however, such misleading statements by mental health professionals “helps the Trump administration hide their strategic intent to undermine traditional democratic principles under the guise of a President whose impulses often get the better of him.”
Millions of people use websites like WebMD every day to gain insight on a range of medical issues from cancer to mental health. This practice, or “cyberchondria,” is a new digital phenomenon that has resulted from online databases of free, medical information.
With about 74 million users each month, the information on WebMD provides some with clarity for our most intimate and confusing health concerns, but for others, it could be a source of anxiety. In a recent article published in GOOD Magazine, Fordham University Center for Ethics Education Bioethicist Dr. Elizabeth Yuko addressed the “ethical gray area” of web diagnosis and online symptom checkers.
“Websites and algorithms are not held to the Hippocratic Oath. Because WebMD is a media organization, rather than an individual medical professional, it is not held to the same legal and ethical accountability as individual practitioners,” notes Dr. Yuko. Unlike WebMD, other online communities and health professionals must operate under ethics codes and guidelines designed by organizations such as American Medical Association and American Psychological Association.
As far as legal liability is concerned, Dr. Yuko explained that because WebMD’s Terms and Conditions state “This Site Does Not Provide Medical Advice,” the website is not “legally obligated to provide a worst-case scenario” while most health professionals, at least in the United States, are held accountable if they do not provide patients with complete information regarding their health conditions.
Dr. Yuko, however, is most concerned with the use of health care sites as a substitute for obtaining diagnoses because people “can’t afford in-person care.” She stated, “This in itself is an ethics issue, but one from a societal, distributive justice perspective, highlighting the fact that not everyone has access to effective, affordable health care.”
Although the death penalty is on the decline in the United States, the case of James Rhodes highlights the ethical quagmire facing forensic psychiatrists and psychologists whose evaluations contribute whether persons with intellectual disabilities convicted of murder will live or die.
In addition to the increasingly familiar racial biases and legal flaws in death penalty convictions and use of lethal injection, according to Celia B. Fisher, Ph.D. Director of Fordham University’s Centerfor Ethics Education, little attention has been paid to the lack of professional consensus surrounding the validity and reliability of IQ tests in general and for racial minorities in particular, disagreement over the use of absolute cut-off scores to determine intellectual disability, and the inherent fallibility of tests to determine the probability of future violence.
“Professional evaluations are not a panacea for inconsistent, uninformed and often racially biased jury decisions,” notes Fisher, “rather than providing a fair and neutral assessment of mental ability forensic assessments are contributing to inconsistencies that lethally violate the human rights of convicted criminals in capital cases.”
As the 2016 presidential election approaches, psychologists are gaining media attention by diagnosing candidates as having personality disorders, especially for the Republican nominee. But the public should question whether or not offering these diagnoses is professionally ethical or in the service of political agendas.
“Trained mental health practitioners serve the public good by providing diagnoses of individuals based on scientifically and professionally established assessment techniques,” notes Fisher, who chaired the committee that wrote the current American Psychological Association’s (APA) Ethical Principles and Code of Conduct, “however the public and the profession are harmed when psychologists provide opinions based on unsubstantiated information drawn from media reports or other subjective observations.”
There have been claims suggesting that psychologists who offer diagnoses of Donald Trump are doing so for the purpose of national and public interest. According to Fisher, who is the author of the widely read Decoding the Ethics Code: A Practical Guide for Psychologists, “Psychologists who claim that ‘Trumpism’ is a threat to democracy that provides moral justification to offer public diagnoses in the absence of established assessment techniques are deluding themselves into thinking that these unprofessional opinions benefit society.” Fisher further explains that psychologists are actually in “clear violation of the APA Ethics Code and are inadvertently contributing to a political climate based on opinion rather than fact.”
As consumers of the media, it is not uncommon to “diagnose” public figures with various mental disorders, depending on their representation in the press. But for psychologists and psychiatrists, is doing so unethical?
In an op-ed in The New York Times, Columbia University’s Dr. Robert Klitzman explained that for psychiatrists like himself, there is a prohibition from the American Psychiatric Association on providing professional opinions on individuals they have never met or evaluated before.
Troublingly, though, Klitzman mentions that “Psychologists (with Ph.D.s, as opposed to psychiatrists, with medical degrees) argue that this principle does not fully apply to them, and that offering diagnoses of public figures can be in the national interest.”
Psychologists who provide mental health services to adolescents and their families must navigate complex ethical challenges with respect to confidentiality and disclosure decision-making.
How do mental health clinicians develop confidentiality policies that serve to protect minors from serious harm, fulfill professional and legal responsibilities, and preserve the therapeutic relationship with the adolescent and parents/ guardians?