The Perils of Diagnosing Politicians

You are a mental health professional (MHP) and a friend asks for comment on whether a particular politician has dementia. A journalist asks you to provide your clinical impression on whether a candidate for Congress has bipolar disorder, narcissism, sociopathy, or some other mental health condition. A client asks you for your opinion on whether a city councilor is experiencing depression or post-traumatic stress disorder. In each of these situations, you are being asked to provide a clinical diagnosis of someone that you have not met.

Even if you have received the appropriate training, supervision, and experience to provide DSM diagnoses, it may be perilous to provide such a diagnosis without having gathered appropriate information from the person being diagnosed, and perhaps from family members, employers, or others who could provide relevant information.

For psychiatrists, section 7.3 of the “Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry,” advises:

• "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."

This provision, widely known as the Goldwater Rule, was enacted by the APA in 1973 in response to a controversy following publication of a 1964 news article that publicized a survey of psychiatrists’ views on the mental fitness of Senator Barry Goldwater, a Republican presidential candidate (McLoughlin 2022).

Diagnosing a politician without a personal evaluation poses several dangers:

• The public might suspect that the diagnoses are influenced by political bias rather than objective application of DSM criteria, potentially eroding trust in mental health professionals (MHPs).
• Before diagnosis politicians, MHPs should obtain their consent and then gather sufficient information to ascertain whether they meet the criteria for particular diagnoses.
• MHPs risk defamation lawsuits if they are accused of deliberately disseminating false statements that damaged a politician’s reputation.
• Even with consent to diagnose the politician, MHPs are still be required to uphold the confidentiality of the diagnosis unless the politician explicitly authorizes disclosure.

Critics of the Goldwater Rule argue that all people, including MHPs, have constitutionally protected freedom of expression. They also have a right to participate in political discourse. Shouldn’t a MHP be permitted to share their opinions about the ability of a candidate to serve, particularly given their mental health status? Wouldn’t the public benefit from the expertise of MHPs rather than formulate their own opinions without the benefit of their expertise? If MHPs are permitted to provide diagnostic information, couldn’t this prevent the country from electing a government official that could cause significant harm to the United States or other countries?

Although some people may argue that MHP have a “duty to warn” when there is a serious, imminent risk of harm, this duty stems from work with clients. There is no legal duty for MHPs to warn the public about the risks that a politician poses, particularly when the MHPs have not met with the politician to conduct a proper evaluation.

While the Goldwater Rule restricts MHPs from diagnosing politicians without evaluating them, it does not preclude MHPs from all participation in public discourse about mental health issues and candidates for office. MHPs are certainly allowed to help educate the public about mental health concerns generally. For instance, they may explain conditions such as schizophrenia or dementia without attributing them to a particular politician.

When educating the public, MHPs should do so in a professional manner, providing factual information, citing their sources of information, and using language that shows respect for the dignity and worth of people with mental health conditions. They should not use stigmatizing or sensational language.

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They may also explain why their profession should avoid providing diagnoses for people whom they have not personally met. MHPs need to stay within their areas of competence and consider how their public statements may affect public perceptions of MHPs. Ultimately, MHPs should be guided by the ethical principles of integrity, professional competence, beneficence (doing good), nonmaleficence (not causing harm), and respect for the dignity and worth of all people.