The cry-in-their-beer plaint in Politico recently by Bandy X. Lee and Leonard L. Glass, co-editors of the anthology The Dangerous Case of Donald Trump, has a tell.  It argues that the mental health professionals in their anthology, in promoting a certain view of the president's behavioral health, are not violating the ethical canons of their profession.  Yet the denial doesn't link to the contested rule – or rather, it links selectively and partially, to a secondary gloss that appears to support the co-editors' position, which is that the mental health contributors to the anti-Trump anthology are righteous rebels against an unreasoning and callous bureaucracy. 

Hardly.  The Goldwater rule – to step back – is a provision in the code of ethics of the American Psychiatric Association (APA) prohibiting member-psychiatrists from diagnosing public figures without personally examining them.  It is designed to prevent psychiatrists from misusing their "science" to propagandize.  If psychiatrists could throw their weight around in political battles, they could sell themselves to the highest bidder.  Not to say they haven't, but the rule puts up an impediment.

That's where Lee and Glass's P.R. comes in.  Psychiatrists on the faculties of Yale and Harvard, respectively, they claim that a March 2017 opinion by the APA unduly expanded the longstanding Goldwater rule.  In direct contradiction to this characterization, the APA said the issued opinion "reaffirms" it.  This is a basic difference. 

Lee and Wolff use the difference to suggest that the authors in their raucously anti-Trump anthology (27 practitioners all told) are acting consistent with their "duty to the public" and that it is management who is deviating from precedent by "gagging" them.  This is uncorroborated and will probably stay so – first, because there is no such thing as a "duty to the public" (more on that below), and second, it isn't unusual for a professional organization to issue opinions like the one the APA published in March fleshing out its specific principles.  If the APA wanted to alter one of its standing rules, presumably, it would have said so.  It could then have ushered in an orderly transition.  The notorious background of the rule's adoption bespeaks the need for special care in this area. 

What is this controversial history that non-specialists know little about?  The rule was established in 1973, after Barry Goldwater won a defamation lawsuit against FACT magazine for an article impugning his mental state and fitness for office.  The armchair diagnosis was assembled with the help of working psychiatrists, who had been sent a questionnaire about their observations of Goldwater's public conduct during his 1964 presidential run.  For the story of how the media destroyed the reputation of a good man and its obvious parallels to Donald Trump, see this excellent piece in City Journal.  What is important here is that the machinations of the defendant in that case, a famous, politically influential editor, were so egregious that Goldwater was able to pull off a win.  Since he was a public figure held to the near impossible evidentiary standard of "actual malice," the odds were against him.

So with Goldwater's victory, with egg on its face, the APA passed the rule as a prophylactic measure.  It has served ever since as an antidote to those free-wheeling professionals who would as soon harm the profession as see their faces in Vanity Fair.  Now a ring of mental health practitioners palpitating for the limelight are flouting the rule to do a hit job on Trump.  They are arguing that Trump's erratic personality presents a special hazard justifying their disobedience, which they refuse to call disobedience because of the alleged unfairness of the "new" interpretation. 

A plain reading of the APA guidance is enough to show that the restraints the APA is imposing on its members are acceptable time, manner, and place speech restrictions.  But even if the Goldwater rule was radically extended last March, there's a case to be made, based on research emerging decades after the Goldwater takedown, that due to psychiatry's long, ignoble and regrettable history of prostituting itself to the power classes, the original Goldwater Rule didn't go far enough.  Far from hampering psychiatrists from doing their civic duty, as it is now claimed, the rule might have had with more stringent limitations to begin with.  It is safe to say the recent clarification and construal by the APA provided a needed supplement.

The research I just referred to is revelant to our historical moment, though it is determinedly ignored by these star psychiatrists acting as high-level apologists for the Trump impeachment movement.  In the early 2000s, a slew of studies came out showing that psychiatrists were the original architects of Nazi genocide through their early philosophical and scientific support of child euthanasia and other moral abominations.  Somewhat later, psychiatrists played a key role in legitimizing Nazi horrors by furnishing medical rationales.  Far from being "passive enablers," as Lee and Glass trendily put it in a reference to the unclean hands of these psychiatrists, they sadistically facilitated and augmented Nazi crimes.  Not so unlike the current group, they claimed that their interventions at the highest level of politics were advantageous to society. 

Further, since World War II, the psychiatric profession's record hardly argues for complete vindication.  Its record of involvement in social engineering, collaboration with the insurance industry to medicalize normal behavior, and rabid factionalism leaves much to be desired.  Internationally, mental health professionals have infamously collaborated in the pathologization of political opponents in the Soviet Union, China, and Apartheid South Africa. 

This spotty past underscores the importance of a robust Goldwater Rule.  Yet the Politico article asks us to credit the appeal of a small group of self-promoters who, even in the view of the heads of the relevant professional associations, are using their clinical experience as an illicit weapon of political intrigue.  The article asks us to accept that they are mavericks breaking free, sacrificing the approval of their betters in order to tell the truth about Donald Trump.  Of course, the group frames its ethical breaches in selfless terms.  What ideologue doesn't? 

This goes beyond psychiatrists providing cover for a political coup.  It risks harm to the doctor-patient relationship.  The APA and other mental health associations have repeatedly voiced concerns about this.  They point out that when laypeople see mental health professionals indulging publicly in irresponsible partisanship, they are likely to have misgivings about the profession as a whole.  Patients and would-be patients might doubt the scientific rigor and personal integrity of the professionals with whom they have occasion to interact.  Indeed, hearing Bandy Lee and Leonard Glass culling data for their assessment of the president from the chintzy tell-all of "the journalist Michael Wolff," who could blame them?

Lee and Glass get around the exposure they're creating for their more prudent colleagues by ignoring it.  Instead, they prate about their duty to the public to expose the imminent threat posed by Trump's behavior to our collective safety and well-being.  Thing is, as mentioned earlier, in the legal realm, no such prescribed duty to the public exists.  The psychiatrists who invoke one are either flattering themselves with a noble-sounding conceit or making their martyrdom up out of whole cloth.  Innkeepers have duties under the law.  So do seatbelt manufacturers and an assortment of others.  Shrinks who write careerist bestsellers do not.

Unable to point to a tort-law basis for this "duty to question" (the exact language of this alleged duty changes with varying presentations), the article references, without citation, a prior "ethics code" that "obligates psychiatrists to 'participate in activities contributing to ... the betterment of public health.'"  Okay, that's fine.  The same could be said to be incumbent upon any good citizen.  But this generalized expectation to work for the public good is a far cry from the Machiavellian gambit of  detecting "signs" of "danger" in one's political enemies and then day-tripping to D.C. to "confidentially" share one's findings with "legislators."  Notably, one of the major researchers in Nazi psychiatry asserts that it was precisely this sort of  intoxicating sense of mission to direct society's fate that led psychiatrists in the Third Reich to lose sight of the welfare of individual patients and spearhead their evil schemes.

No, what we have here is a disgruntled elite longing to recover a sense of its former prestige and authority.  Even the title of the book, The Dangerous Case of Donald Trump, plays on the scientific term case study to paint these authors as having superior perception and judgment.  But it's no use.  The public has already demonstrated its loss of faith in technocrats whose intellectualist tinkering promises perfection but never succeeds in making life better for anybody but the people doing the tinkering in the first place.

As psychiatrists, Lee and Glass should be able to accept the change.  Okay, sure, they are upset under Trump at their loss of imputed omniscience.  We get it.  Still, someone ought to gently counsel them that no amount of grandiosity and magical thinking is going to restore their former glory.