This is the first book to explore an ethical dilemma that psychiatrists increasingly face in the age of Donald Trump: is it ethical to comment on the mental health of public figures? Psychiatrists may intervene when a patient is unsafe, but what is their role when a politician appears ill and is a risk to the country? The APA’s Goldwater Rule declares that when a psychiatrist is asked for an opinion on a public figure, it is unethical to comment – yet controversy rages on the issue. Diagnosing from a Distance probes the dramatic history and complex ethics of the issue. With accessible style yet scholarly substance, this book begins with Adolf Hitler; traces the debate over Barry Goldwater, including Goldwater’s libel suit against Fact magazine; explores the rise of professionalism in the formation of the Goldwater Rule; documents errant CIA profiling during the Nixon years; and examines the controversy over President Trump. In light of this history, this book proposes a humane alternative to the Goldwater Rule. Based on original interviews and archival sources, Diagnosing from a Distance will change the way you think about the First Amendment, the media, and psychiatric ethics.

In the 1960s and 1970s, consensus was growing about the need for professionalism and ethical standards in medicine and psychiatry. Using the APA’s archives, I show that the Fact episode of 1964 concerned the APA greatly. Not only did the APA write to Ginzburg and object to his special Fact issue on Goldwater, but it followed Ginburg’s subsequent career closely. The group adopted the Goldwater Rule in 1973 in order to prevent episodes like the Fact debacle. After the Rule’s adoption, disagreements over it emerged within the APA. Members wrote in apparent confusion to the APA Ethics Committee, seeking guidance on how the Rule applied to their work. The APA never contemplated applying the Rule to forensic psychiatry, to the work of psychiatrists in insurance companies, or to the practice of psychological profiling for the FBI and CIA. It was comment in the media, and the risk of damage to psychiatry’s public image, that concerned the APA. The result was the appearance of a double standard: individual psychiatrists are banned from commenting on public figures, while psychiatrists working for organizations and government agencies may comment without interview or consent.

This chapter examines the controversy over psychiatric comment on Donald Trump. In 2016, Trump’s election led many psychiatrists to grow concerned for the country’s safety and to argue that when the country is unsafe, commenting on a public figure’s mental health is in fact an ethical obligation. The APA, on the other hand, held firm to and even strengthened its ban on such comment. For my narrative and analysis, I draw on original interviews with APA officials – including medical director Saul Levin and ethics chair Rebecca Brendel – and with critics of the APA, including Bandy X. Lee, Judith Herman, Robert Jay Lifton, and Leonard Glass. Using this new material and looking at the age of Twitter, this chapter presents the first sustained analysis of the controversy and its importance for psychiatry, ethics, and journalism in the age of Trump. As I note, in recent years, several prominent figures have argued for a revision of the libel standard articulated in New York Times v. Sullivan. These figures include the late Justice Antonin Scalia, current Justice Clarence Thomas, and President Donald Trump himself – leaving the future of libel law contested, as it has been since 1964.