Donald Trump’s ADHD Pours Cold Water on the Goldwater Rule

For the past two years, mental health experts and society at large have debated whether it is appropriate to talk about Donald Trump’s mental health. The discussion has focused on claims of violations of confidentiality and of potential harm to the country. These topics highlight the ethical principles of autonomy (patients have the right to make decisions about their health care, including not revealing information to others), beneficence (doing good for the patient or society), and non-maleficence (minimizing harm to the patient or to society). The ethical principal of veracity — that all commentary is true and accurate — has lurked silently in the background of this conversation — a particular irony in the Age of Trump. Organized psychiatry maintains that psychiatrists should not comment on the mental health of public officials without a personal evaluation and the individual’s consent, a decree known as the Goldwater Rule. We need to discuss veracity because it undergirds the Goldwater Rule.

The Goldwater Rule was created in response to the election of 1964, when several hundred psychiatrists answered an opinion poll regarding Arizona Senator Barry Goldwater’s fitness for the presidency. Fact magazine, which instigated the poll, published numerous quotes from psychiatrists, cloaked in psychoanalytic and psychiatric terminology, which were patently personal and political attacks on the candidate. Goldwater sued Fact’s editor and won a sizable judgment for libel, a decision that was unsuccessfully appealed to the U.S. Supreme Court. Interestingly, Goldwater himself claimed to have been more traumatized by the slurs on his masculinity, and the implication that he was homosexual, than by accusations that he was a “megalomaniac” or “a paranoid schizophrenic”.

The Goldwater Rule was appended to the American Psychiatric Association’s (APA) Principles of Medical Ethics in 1973 and does address real and important ethical issues. However, professional embarrassment was also a major factor in motivating organized psychiatry to proclaim this rule. The public statements about Senator Goldwater made psychiatrists sound judgmental, petty, silly, inconsistent and unscientific. Our lack of veracity created a bigger negative impression on the public than our lack of probity. Because the Goldwater Rule was at least…