In 1964, Fact Magazine produced a special issue entitled "The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater," specifically addressing the mental health of then-Republican presidential candidate Sen. Barry Goldwater.  As would be expected, the magazine did not pronounce Goldwater with a clean bill of mental health.  Rather, it essentially pronounced him unfit for office and speculated into the inner workings of his mind.  Goldwater sued the editor of the magazine for libel and was awarded $75,000.

In response to this incident, in 1973, the American Psychiatric Association (APA) produced a code of ethics specifically applicable to psychiatrists that contained a provision that is now widely known as the Goldwater Rule.  This rule states that it is unethical for a psychiatrist to speculate about the mental health of a public figure unless the psychiatrist has examined the public figure personally and has permission from the public figure to share his opinions.  The rule reads:

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 rule remains in effect today.

The rule technically applies only to psychiatrists who are members of the APA, but by convention it has applied to all psychiatrists and to mental health professionals in general.  While not formally codified, the general sentiment also conventionally applies to all physicians and health care professionals in general with regard to all medical conditions, not just mental health conditions, although mental health conditions are often understandably more sensitive.

There was a lot of speculation during the campaign about Hillary Clinton's medical condition, some of it coming from professional sources and not just armchair diagnosticians, and I was not comfortable with that, either, even though I was not a Hillary supporter.  I had a few people who know I am a physician asked me what I thought was wrong with Hillary after her much publicized collapsing episodes, but I refrained from making any statement publicly.

Non-mental health medical professionals can perhaps be forgiven for their oversight, because the rule is not emphasized as greatly outside mental health circles, although it seems to conform to an intuitive sense of propriety even without a formal rule.  But mental health professionals have no such excuse, because the Goldwater Rule is not an obscure guideline in our circles.

The existence of the Goldwater Rule notwithstanding, the candidacy and election of Donald Trump has brought out the crazy (in the non-professional sense, of course) in some of my fellow mental health professionals, and I have been alarmed by the blatant flouting of the Goldwater Rule that I have observed.
 

Most conspicuous, perhaps, is Dr. John Gartner, a psychologist, who, in addition to his private practice in psychotherapy, speaking, and consulting, bills himself as a psycho-journalist, a term he coined "for his innovative method of combining investigative journalism with psychological expertise." He even wrote a "psychological biography" of Bill Clinton.

Dr. Gartner has been vocal in his public speculations about Donald Trump's mental health and has even started a Change.org petition, and encouraged other mental health professionals to sign it, asserting that President Trump is mentally ill and should be removed from office under the provisions of the 25th Amendment.  The petition reads as follows:

We, the undersigned mental health professionals (please state your degree), believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And we respectfully request he be removed from office, according to article 4 of the 25th amendment to the Constitution, which states that the president will be replaced if he is "unable to discharge the powers and duties of his office."

This is not just violating the Goldwater Rule; this is throwing it on the ground and trampling all over it and encouraging others to do so as well.  As of the time of this writing, 29,542 have overstepped their ethical bounds, assuming they are all actually mental health professionals, and signed the petition.  I tweeted my concerns about the Goldwater Rule to Dr. Gartner, but he did not reply.

Dr. Gartner might object that he is not covered by the Goldwater Rule because he is a Ph.D. psychologist, and he would be technically correct, but the Goldwater Rule has traditionally been applied to other mental health professionals in the same way it has traditionally been applied to psychiatrists who aren't dues-paying members of the APA.  Most mental health professionals are not psychiatrists, and most psychiatrists are not members of the APA, so technically, the Goldwater Rule applies to only a minority of a minority of mental health professionals.

But is this really the way we want to apply ethical rules?

It should be noted that speculating about the mental health of high-profile political figures is not confined to the left.  People on the right speculated about Barack Obama and Bill Clinton's mental health and the mental health of liberals in general (see second review).  Some amount of this is likely the inevitable product of our modern culture, which is both highly polemicized and highly psychologized.  In addition, the internet allows everyone to become an expert in his own mind, and blogs and social media give people a platform to let the world know what they think on any given matter.  However, the speculations about Clinton's and Obama's mental health seemed more confined to non-professionals engaging in armchair diagnosing, which is tacky but not ethically prohibited.  I do not recall a significant organized effort by mental health professionals to label Clinton or Obama mentally ill and invoke the 25th Amendment.

While both sides can play this game, attempts to portray politicians as mentally ill should especially concern conservatives, because the mental health professions trend liberal.  As an openly and vocally conservative psychiatrist, I know this all too well.  While I was insulated from this reality to some degree in my training, since I did my psychiatric residency in the Air Force, it is a dynamic that has certainly not been lost on me since leaving the Air Force and joining the "real world."

This tendency toward liberalism is evident among rank-and-file mental health workers but is likely worse among academic mental health professionals who are more likely to be called upon to speculate publicly about the mental health of political figures.  The liberal media are also more likely to countenance questions about the mental well-being of conservative politicians.  With the media's undisguised hostility to Trump throughout the campaign and since his election and its willingness to openly advocate for its anti-Trump agenda, it is no longer credible to claim that the press is just a disinterested third party in these matters.

The left also has a disturbing history of attempting to use psychology to smear its opponents on the right.  A notorious example is the 1950 publication of The Authoritarian Personality, which essentially attempted to demonstrate that everyone who isn't a leftist is an incipient fascist.  The first author of The Authoritarian Personality was Theodor Adorno, who wasn't a trained mental health professional or psychometrician.  He was a philosopher and a composer who was perhaps best known as a music critic before the publication of The Authoritarian Personality.  Notably, Adorno was a member of the Frankfurt School, which arguably brought us the phenomenon of Cultural Marxism.  The publication of The Authoritarian Personality is perhaps ground zero in its genesis.

So again, while both sides can and do call the other side crazy, because of the nature of the mental health professions and the existence of a hostile media willing to amplify the left's narrative, dueling charges of crazy are a numbers game that it would be unwise for the right to play.  The right, and civil discourse, for that matter, would be better served by a renewed respect for the wisdom of the Goldwater Rule and holding leftist mental health professionals accountable to it.