Should psychiatrists be allowed to publicly comment on mental health of public figures?

1. Gold Water Rule
Should psychiatrists be allowed to publicly
comment on mental health of public figures?
Barry Goldwater Martha Mitchell
Nellie Bly

2. Introduction
• The Goldwater rule is section 7 in the American
Psychiatric Association's (APA) Principles of
Medical Ethics,
• Which states that “it is unethical for psychiatrists
to give a professional opinion about public figures
whom they have not examined in person, and from
whom they have not obtained consent to discuss
their mental health in public statements”.
• It is named after former US Senator and 1964
presidential candidate Barry Goldwater.

3. Principles of Medical Ethics

4. US Senator and 1964 presidential
candidate Barry Goldwater

5. Introduction
• The issue arose in 1964 when Fact published
the article "The Unconscious of a
Conservative: A Special Issue on the Mind
of Barry Goldwater".

6. Goldwater v. Ginzburg

7. Introduction
• The magazine polled psychiatrists about US
Senator Goldwater and whether he was fit
to be president.
• Goldwater sued magazine editor Ralph
Ginzburg and managing editor Warren
Boroson, and in Goldwater v. Ginzburg
• (July 1969) received damages totaling $75,000
($512,000 today)

8. The Unconscious of a Conservative: A Special
Issue on the Mind of Barry Goldwater

9. Goldwater sued magazine editor Ralph Ginzburg and
received damages totalling $75,000 ($512,000 today)
Editor Ralph Ginzburg

10. Description
• Section 7, which appeared in the first edition
of the American Psychiatric Association's
(APA)
• Principles of Medical Ethics in 1973 and is
still in effect as of 2018,

11. American Psychiatric Association's
(APA)

12. Description
• On occasion psychiatrists are asked for an
opinion about an individual who is in the
light of public attention or who has disclosed
information about himself/herself through
public media.

13. On occasion psychiatrists are asked for an opinion
about an individual who is in the light of public
attention

14. Description
• In such circumstances, a psychiatrist may
share with the public his or her expertise
about psychiatric issues in general.
• However, it is unethical for a psychiatrist to
offer a professional opinion unless he or she
has conducted an examination and has been
granted proper authorization for such a
statement

15. It is unethical for a psychiatrist to offer a professional opinion
unless he or she has conducted an examination and has been
granted proper authorization

16. American Psychological Association
• The APA Ethics Code of the American
Psychological Association, a different
organization than the American Psychiatric
Association, also supports a similar rule.

17. American Psychological Association
• American Psychological Association President Susan
H. McDaniel published a letter in The New York
Times in which she stated:
• Similar to the psychiatrists' Goldwater Rule, our code
of ethics exhorts psychologists to "take precautions"
that any statements they make to the media "are
based on their professional knowledge, training or
experience in accord with appropriate psychological
literature and practice" and "do not indicate that a
professional relationship has been established" with
people in the public eye, including political candidates.

18. American Psychological Association
President Susan H. McDaniel

19. American Psychological Association
• When providing opinions of psychological
characteristics, psychologists must conduct an
examination “adequate to support
statements or conclusions”.
• In other words, our ethical code states that
psychologists should not offer a diagnosis in
the media of a living public figure they have
not examined

20. ethical code states that psychologists should not offer a
diagnosis in the media of a living public figure they
have not examined

21. American Medical Association
• In the fall of 2017, the American Medical
Association's Council on Ethical and
Judicial Affairs wrote new guidelines into the
AMA Code of Medical Ethics, stating that
physicians should refrain "from making
clinical diagnoses about individuals (e.g.,
public officials, celebrities, persons in the
news) they have not had the opportunity to
personally examine."

22. Physicians should refrain "from making clinical diagnoses
about individuals (e.g., public officials, celebrities, persons in
the news) they have not had the opportunity to personally
examine."

23. 'Goldwater Rule'
• Psychiatrists are increasingly being contacted
by the media to comment on persons whose
violent acts have captured national attention.
• It is alarming and an embarrassment for our
profession to have reckless assertions of this kind
disseminated by the media.
• But they do serve the purpose of raising
important questions about our professional
conduct.
• How should our profession respond to requests
for media interviews?

24. 'Goldwater Rule'

25. Gold Water Rule
• Psychiatrists are bound by the ethical code of the
medical profession, specifically defined in The
Principles of Medical Ethics of the AMA and in APA.
• These Principles are “standards of conduct that
define the essentials of honorable behavior for the
physician.”
• Within these Principles can be found clear direction on
the ethical requirements for communicating with the
media.
• Section 5 and Section 7 speak most directly to this
issue:

26. Gold Water Rule

27. Gold Water Rule
• Section 5
• A physician shall continue to study, apply, and
advance scientific knowledge, maintain a
commitment to medical education, make
relevant information available to patients,
colleagues, and the public, obtain consultation,
and use the talents of other health
professionals when indicated.

28. Gold Water Rule
• Section 7
• Psychiatrists may interpret and share with the
public their expertise in the various
psychosocial issues that may affect mental
health and illness.

29. Gold Water Rule
• Educating the public about psychiatric
matters and human behavior is not only
ethical but laudable and encouraged by the
Principles.

30. Gold Water Rule
• There is still general misunderstanding
about mental illness, and public education
not only addresses this area, but also the
associated stigmatization of persons who are
mentally ill.

31. “Goldwater Rule.”
• Section 7.3
• On occasion psychiatrists are asked for an opinion
about an individual who is in the light of public
attention or who has disclosed information about
himself/herself through public media.
• In such circumstances, a psychiatrist may share with
the public his or her expertise about psychiatric issues
in general.
• However, it is unethical for a psychiatrist to offer a
professional opinion unless he or she has conducted
an examination and has been granted proper
authorization for such a statement.

32. Goldwater Rule

33. Gold Water Rule

34. Gold Water Rule
• When commenting on individuals in the public
eye, psychiatrists should be governed by
concerns for the potentially inflammatory and
harmful consequences of their statements.
• The reputation of the public figures involved,
their own credibility, and the dignity of our
profession are at stake.
• Only after performing an examination and
receiving an appropriate waiver of
confidentiality should psychiatrists comment
on persons in the light of public attention.

35. Gold Water Rule

36. Gold Water Rule

37. Gold Water Rule
• Goldwater rule has come into focus – the
convention that psychologists should not
give an opinion about the mental state of a
person they have not examined.

38. Gold Water Rule

39. Where does the Goldwater rule come
from?
• In 1964 the Arizona senator Barry Goldwater ran as
the Republican candidate for the presidency against
the serving president Lyndon B. Johnson.
• Goldwater’s political career was marked by a series of
tough battles, from succeeding as a markedly
conservative senatorial candidate in a Democrat-
leaning state, to a bruising primary campaign to win the
1964 candidacy.
• Goldwater lost the presidential race for a number of
reasons – his aggressive rhetoric against the USSR
and his restrictive fiscal policies troubled even his
own party – but a large factor was an article that
appeared in a US magazine.

40. Where does the Goldwater rule come
from?

41. Gold Water Rule
• During the campaign, Fact magazine published an
article entitled “1,189 Psychiatrists say Goldwater is
Psychologically Unfit to be President!”. The figure
came from an informal poll of US psychiatrists, and
included the many comments about Goldwater’s
emotional stability and fitness to serve.
• The Goldwater campaign sued the magazine, which
was found to have defamed the senator. The court
fined the editors and publishing company of Fact an
eye-watering $75,000. Subsequently the APA
introduced its rule on speculative diagnosis.

42. Gold Water Rule

43. Why is the Goldwater rule valuable?
• The Goldwater rule protects us all against
prurient speculation about our mental health.
In order for us to succeed in life, or to succeed
in public office, we must command the trust of
people around us.
• Undermining the faith we must have in other
person’s mental state carries with it the
implication that we should be wary of their future
actions, or in their ability to persevere when gets
tough.

44. Why is the Goldwater rule valuable?

45. The Future Of The Goldwater Rule
• The Goldwater rule is binding only for the
members of the American Psychiatric
Association.
• However, it is an example of a guiding
principle that reminds practitioners of the
limits of their knowledge.

46. The Future Of The Goldwater Rule

47. The Future Of The Goldwater Rule
• Professional practicing and academic
psychologists should be encouraged to speak
publically about mental health, for the benefit
of us all.
• But to speak about the mental state of a public
figure, without having met that person, is a
violation of professional ethics.
• Goldwater is a rule that protects us all.

48. The Future Of The Goldwater Rule

49. Famous People Who Were Successful Despite
Their Mental Health Issues
• Research shows that harmful stereotypes about
mental illness often prevent people from seeking
treatment or speaking out at all.
• Luckily, in recent years, we’ve seen a shift in the way
people view and talk about these issues.

50. Famous People Who Were Successful
Despite Their Mental Health Issues
• According to mental health experts it really
helps to talk about this stuff.
• In fact, when public figures open up about
their own mental health struggles, it can help
break down stigmas, and even inspire
people to go get help and seek treatment.

51. According to mental health experts it
really helps to talk about this stuff

52. When public figures open up about their own mental
health struggles, it can help break down stigmas, and
even inspire people to go get help and seek treatment

53. Isaac Newton
• Most famous mathematician of the 17th Century
was responsible for many scientific discoveries we
take for granted today such as the "corrected”
Gregorian calendar date.
• Newton’s greatest mathematical discovery was the
gravitational relationship between the earth and
the moon, and of centrifugal force

54. Isaac Newton

55. Famous People Who Were Successful Despite
Their Mental Health Issues
• He suffered from several “nervous
breakdowns” in his life and was known for
great fits of rage towards anyone who
disagreed with him which some have labeled
Bipolar Disorder which was unknown at the
time.
• In 1705 Newton was the first Scientist to be
knighted by Queen Anne for his great
scientific contributions.

56. Isaac Newton

57. Abraham Lincoln
• 16th President of U.S. suffered from severe
and debilitating and on occasion suicidal
depressions, as recorded by Carl Sandburg in
his comprehensive six-volume biographical
analysis of his life.

58. Abraham Lincoln

59. Abraham Lincoln
• The most amazing part of his story was the
sheer determination with which he willed
himself to over come his serious affliction
and still achieve all he was able to achieve.

60. Abraham Lincoln

61. Vincent Van Gogh
• Famous painter and artist was labeled
peculiar with unstable moods most of his
short life.
• He suffered from epileptic seizures some
believe from excesses of absinthe, very strong
liquor.
• Popular among talented people for inspiring
greater creativity

62. Vincent Van Gogh

63. Winston Churchill
• Prime Minister of Great Britain who, as one of
the “Big Three”(Churchill, Roosevelt and
Stalin) to lead the world to the defeat of Hitler
in WWII, told in his own writings of suffering
from “black dog” Churchill’s term for severe and
serious depression.
• Like so many other famous people with a
mental illness, he was able to make the great
contribution he did through sheer personal
determination

64. Winston Churchill

65. Virginia Woolf
• The British novelist, born of privilege,
experienced the mood swings of bipolar
disorder her entire life.
• She wrote to make sense out of her mental chaos
and gain control of madness; and was greatly
admired for her creative insight into human
nature.
• She was tolerated by friends and family,
receiving great care and understanding during
her entire life and because of this, never had to
face institutionalization, the only medical
“treatment” in those days.

66. Virginia Woolf

67. Linda Hamilton
• Actress, has gone public with her diagnosis
of bi-polar disorder diagnosed at a young
age.
• Hamilton, well known for her part with Arnold
Schwarzenegger in “The Terminator” movies
explains how helpful medication has been for
her and that she understands she will have to
be on medication for the rest of her life.

68. Linda Hamilton

69. Judy Collins
• Singer and song writer, has written a book
titled “Sanity and Grace: A Journey of
Suicide, Survival and Strength,” (2003).
• The book chronicles her journey as a survivor
of depression after the suicide of her 33-year-
oldson in 1992.

70. Judy Collins

71. John Nash
• Nobel Prize Winner in mathematics, has faced
a life long battle with schizophrenia.
• He was known as the “Phantom of Fine Hall” at
Princeton where his reclusive, ghost like figure
could be seen roaming around, leaving messages
of his mathematical genus on the boards of empty
classrooms.
• His struggle was well documented in the book
“A Beautiful Mind,” by Sylvia Nasar which
was later made into a movie by the same name.

72. John Nash

73. Terminology
• Armchair Diagnosis
• Armchair diagnosis is a term used when
professionals or non professionals diagnose
someone they have never treated.

74. Personality Disorder
• A deeply ingrained pattern of behaviour of a
specified kind that deviates markedly from
the norms of generally accepted behaviour,
typically apparent by the time of adolescence,
and causing long-term difficulties in personal
relationships or in functioning in society.

75. Personality Disorder

76. Grandiosity
• In the field of psychology, the term grandiosity
refers to an unrealistic sense of superiority,
characterized by a sustained view of one's self
as better than other people, which is expressed
by disdainfully viewing them as inferior.

77. Grandiosity

78. Empathy
• Empathy is the capacity to understand or feel
what another person is experiencing from
within their frame of reference, that is, the
capacity to place oneself in another's position

79. Narcissism
• Narcissism is the pursuit of gratification from
vanity or egotistic admiration of one's
idealised self image and attributes.
• This includes self-flattery, perfectionism,
and arrogance

80. Narcissism

81. Gas Light
• Manipulate (someone) by psychological means
into doubting their own sanity.

82. Celebrity Worship Syndrome
• Celebrity worship syndrome (CWS) is an
obsessive addictive disorder in which a person
becomes overly involved with the details of a
celebrity's personal and professional life.

83. Celebrity Worship Syndrome

84. Schizophrenia
• Schizophrenia is a chronic and severe mental
disorder that affects how a person thinks, feels,
and behaves. People with schizophrenia may
seem like they have lost touch with reality.
Although schizophrenia is not as common as
other mental disorders, the symptoms can be
very disabling.

85. Schizophrenia

86. Schizophrenia

87. Bipolar Disorder
• Bipolar disorder is a mental illness marked by
extreme shifts in mood.
• Symptoms can include an extremely elevated mood
called mania.
• They can also include episodes of depression.
• Bipolar disorder is also known as bipolar disease
or manic depression.

88. Bipolar Disorder

89. Martha Mitchell Effect
• The Martha Mitchell effect is the process by which
a psychiatrist, psychologist, other mental health
clinician, or a medical professional, labels the
patient's accurate perception of real events as
delusional and misdiagnoses accordingly.

90. Martha Mitchell Effect

91. Martha Mitchell Effect
• According to Bell et al., "Sometimes, improbable
reports are erroneously assumed to be symptoms of
mental illness", due to a "failure or inability to verify
whether the events have actually taken place, no matter
how improbable intuitively they might appear to the
busy clinician".
• Examples of such situations are:
• Pursuit by organized criminals
• Surveillance by law enforcement officers
• Infidelity by a spouse
• Physical issues

92. Martha Mitchell Effect

93. Rosenhan Experiment
• The Rosenhan experiment or Thud experiment was
an experiment conducted to determine the validity of
psychiatric diagnosis.
• The experimenters feigned hallucinations to enter
psychiatric hospitals, and acted normally afterwards.
They were diagnosed with psychiatric disorders and
were given antipsychotic drugs.
• The study was conducted by psychologist David
Rosenhan, a Stanford University professor, and
published by the journal Science in 1973 under the title
"On being sane in insane places"

94. Rosenhan Experiment

95. Psychologist David Rosenhan,
Stanford University Professor

96. “Being Sane in Insane Places”
The Rosenhan Experiment

97. 10 Days in a Madhouse
• Nellie Bly
• Elizabeth Cochran Seaman, better known by
her pen name Nellie Bly was an American
journalist who was widely known for exposé
in which she worked undercover to report on a
mental institution.
• She was a pioneer in her field, and launched a
new kind of investigative journalism.

98. 10 Days in a Madhouse

99. 10 Days in a Madhouse
• 10 days in a Madhouse is a 2015 American
biographical film about undercover journalist
Nellie Bly, a reporter for Joseph Pulitzer's
New York World who had herself committed
to the Women's Lunatic Asylum on
Blackwell's Island to write an exposé on
abuses in the institution

100. 10 Days in a Madhouse

101. The Goldwater Rule: talks with Maria A.
Oquendo, MD, PhD
• https://youtu.be/d36hZ7fyZN4

102. The Goldwater Rule - A Conversation
Between Dominic A. Sisti and Jonathan D. Moreno
• https://youtu.be/kdx-iF6dxkA

103. References
American Psychological Association (APA)
• https://www.apa.org/
APA’s Goldwater Rule Remains a Guiding Principle for Physician Members
• https://www.psychiatry.org/newsroom/news-releases/apa-goldwater-rule-remains-a-
guiding-principle-for-physician-members
Famous People and Mental Illnesses
• http://www.mentalhealthministries.net/resources/flyers/famous_people/famouspeople.pdf
Goldwater rule
• https://en.wikipedia.org/wiki/Goldwater_rule
Goldwater Rule’s Origins Based on Long-Ago Controversy
• https://www.psychiatry.org/newsroom/goldwater-rule
Goldwater rule? Should psychiatrists be allowed to publicly comment on mental health of
public figures?
• https://www.sciencedaily.com/releases/2017/12/171205115957.htm
Mental Health Experts Urge Revision of the Goldwater Rule
• https://www.psychologytoday.com/us/blog/psychiatry-in-society/201806/mental-health-
experts-urge-revision-the-goldwater-rule
The Goldwater rule: why commenting on mental health from a distance is unhelpful
• https://www.theguardian.com/science/head-quarters/2017/jul/28/the-goldwater-rule-why-
commenting-on-mental-health-from-a-distance-is-unhelpful

106. Thanks…