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Wednesday, October 10, 2018

Attributes of the APA's "gag order"

In her introduction to The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President (2017), Bandy X. Lee briefly discusses the American Psychiatric Association's (APA) recent reassertion of what is known as the Goldwater Rule. According to the APA, the Goldwater Rule states that

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.
Lee argues that when the APA reaffirmed that rule in March 2017, it "essentially placed a gag order on all psychiatrists and by extension all mental health professionals." [p. 11 of Kindle edition]

She goes on to explore some of the good and bad of the rule. She then makes an argument for a countervailing rule. That argument deserves more attention than I'll give it in this blog post, but I want to admit that while I choose now to focus right on her "gag order" language, I'm neglecting the meat of what she's really arguing.

In what ways is the APA's rule actually a "gag order" and in what ways is it just hyperbole?



Standard #1: What are the professional consequences for violating the "gag order"?


Are people who violate the Goldwater Rule subject to professional discipline? If so, then in what ways are they so subject?

Are they in danger of losing their license? Are they subject to official censure from whatever professional organization which they must join in order to advance their careers? Are they dis-invited from conferences or is their research refused publication in journals?

If the answer to any of those questions is yes, then I'll say the "gag order" language has merit. It especially has merit if those subject to discipline act otherwise responsibly, say, if they refrain from imposing their views on their clients.

And for all I know, the answer is yes, at least sometimes.

Standard #2: Professional discourse


I can think of another, less literal way in which someone might be justified in believing that the Goldwater Rule, as reaffirmed by the APA, is a "gag order": By reaffirming the rule, the APA discourages public speculations about public figures' mental health. Maybe mental health professionals are still free from discipline, but perhaps now conferences decline to host panels about, for example, the mental health of a certain public figure. Or if they don't decline outright, those panels are given the Sunday morning, 8am slot in the hidden corner of the hotel that no one wants to go to.

That is "gag order" worthy, in a sense. That rule, if extended so unrelentingly, would strongly discourage members of a discipline or profession (in this case, the mental health) from exploring the boundaries of their profession. A rule that encourages such exploration is to be preferred over one that discourages it.

But there's no right not to be criticized


If someone uses the Goldwater Rule as a basis to criticize another mental health professional's speculations, that is not "gag order"-worthy. Airing ideas means people might criticize those ideas or might criticize the extent to which you are exceeding established norms in voicing those ideas.

That point extends doubly to those mental health professionals who offer solutions beyond their professional competence. It's one thing to say that so and so acts like, and therefore likely is, a "malignant narcissist" and to base that assertion on one's study of narcissism or on one's work with clients who suffer from narcissism.


It's another thing for someone to say, as one mental health professional supposedly did, that then President Obama should have prevented then President-elect Trump from assuming office pending some sort of mental health review. That "solution" fails to take into account the lack of any laws (to my knowledge) or constitutional provision that empower someone to deny the presidency to a winner of the election. It also fails to account for the precedent such a move, if successful, could set whenever someone of the opposite party of the sitting president wins the presidency.
There might be some defense for that proposition. If someone wishes to advocate for that, then they should be allowed to. But that person is arguably no longer speaking as a mental health professional, but as a citizen or (perhaps) a student of politics or history. "Arguably" does a lot of work, but if they are claiming their professional competence extends to such policy considerations, they should be prepared to bake that cake and not complain if the kitchen gets too hot.


Yes, it depends on the criticism. Take the following hypothetical situation. The president of the APA publicly calls out someone who has just gotten their PscyhD and thereby damages that person's professional prospects. In that case, the rule is more like a "gag order." I suppose there are other hypothetical cases that while not so extreme, may very well operate that way. But we should balance those cases with the acknowledgment that people have no right to be free from others criticizing their views.

What I'm saying and what I'm not saying

I don't wish to be misunderstood. I'm not saying mental health professionals have no prerogative to voice their concerns about a public official's mental health and to base those concerns on their professional competence. I used to say that, but I have changed my mind.

I am, however, saying two things.

First, I urge mental health professionals to be more even tempered about how their profession supposedly limits their prerogative to speak. Calling the Goldwater Rule, and the APA's reaffirmation of that rule, a "gag order" probably is hyperbole. I seriously doubt those who contribute The Dangerous Case of Donald Trump face any very severe professional consequences beyond opening themselves to public criticism. Maybe I'm wrong and maybe there's a darker, more unrelenting "gagging" going on. I'll need to see the proof first, though.

Second, mental health professionals should exercise some epistemological humility when engaging in their public speculations. That humility means acknowledging what they don't know and cannot know for sure from their vantage point. If, as one person I've read says, Mr. Trump "won't change [and] can't change," that person should explain how they know he really "can't" change, or at least explain at what point the "can't" language is speculation.

Epistemological humility also means someone should be clear when they're speaking as professionals and when they're speaking as citizens or students of politics or history. I don't mean they have to draw so sharp a distinction as to write two separate blog articles, one from a "therapist's perspective" and the other from a "citizen's perspective." It does mean, however, writing, say, a paragraph, or at least a sentence, from one perspective and one from another, clearly marking when one is speaking about what one knows and what one doesn't.

I'll close by saying I believe those mental health professionals who see something disordered or mentally disturbed in Mr. Trump's behavior are probably right. And while I still doubt the value of their saying so because I don't think it gets us much closer to a resolution, I can see the case for "warning" us about what his behavior means. Finally, I should take epistemological humility to heart and acknowledge that I'm not a mental health professional at all and I have a lot of respect for the very people I'm criticizing in this post.

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