We as a Society Need to Do Better to Warn Citizens Regarding the Potential Dangerousness of Politicians

The Dangerousness of Donald Trump and the Goldwater “Rule” (which is not a rule but rather an ethical guideline) 

In 2015 and 2016, the APA received a lot of calls and emails from members and the public in regards to Trump and the so-called Goldwater Rule which prohibits psychiatrists from giving public professional opinions about public figures.  

In response to these inquiries, in March 2017, the APA expanded the definition of “professional opinion” to include any references to “affect, behavior, speech” or other aspects of “skills, training or expertise” relevant to psychiatric practice. The APA pretty much sent a chilling message to all of the major television networks and print media. In effect they said that they cannot quote psychiatrists who are commenting on Donald Trump’s dangerousness. They shut down freedom of speech. The new expanded definition is too broadly defined and impractical. 

Dr. James Fleming goes into great detail explaining the history of this rule, the March 2017 expanded definition, and how it is being wrongfully used to muzzle psychiatrists trying to do their due diligence in warning the public. It is named after former US Senator and 1964 presidential candidate Barry Goldwater. The issue arose in 1964 when Fact published “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater”. The magazine polled psychiatrists about US Senator Barry Goldwater and whether he was fit to be president. There was public backlash and Barry successfully sued Fact and won a large award for libel. Jim clarifies that it is not a rigid law or rule but rather is a guideline which, according to the Forward to the APA Ethics Code (available on APA website) “will be revised from time to time so as to be applicable to current practices and problems”.  

The Goldwater Rule is actually section 7.3 of the Ethics Code, an annotation to section 7 which states that physicians, including psychiatrists, have an ethical  “responsibility to participate in activities contributing to the improvement of the community and the betterment of public health”, i.e. it’s not enough for doctors to only take care of their patients but they also should  engage in activities that help society. 

Dr. Lee has experienced great censorship in the media due to the Goldwater rule, which has been wrongfully applied. She is an expert on dangerousness and is not diagnosing. Rather, Trump’s behaviors are dangerous, therefore, he is dangerous. And she has a duty to warn the public. Dr. Lee felt she was meeting the definition of Section 7 by saying this person who was running for (and is now serving as) president is potentially a very dangerous person to be leading our country. 

In April 2019, Lee gathered a panel of independent, top mental health experts that performed a mental capacity evaluation of Trump as a public service. This was made possible through the information that became available, under sworn testimony, in the Mueller report. Likewise, there exists a vast amount of behavioral data on Trump, much more than one would gather in an in-person session. He failed every criterion of mental capacity, making him unfit for virtually any job, but because she was blocked from the media, these damning results, which would predict Trump’s disastrous handling of the pandemic, received little attention.

On October 25, 2020, the Washington Post published an essay by psychologist Mary Trump calling on the APA to allow psychiatrists to help inform voters about the dangers that her uncle, President Donald Trump, would pose in a second term.  

On October 27, one week before the election, the Post published a response by APA President Dr Jeffrey Geller. In addition to attempting to defend the APA’s continued support for the so called “Goldwater Rule” which prohibits psychiatrists from rendering professional opinions on public figures, Dr. Geller called into question Ms. Trump’s ethics, as well as, her patriotism. 

As an APA Life Member involved for many years in various components of the APA in Missouri and at the national level, Dr. Fleming was deeply disappointed by Dr. Geller’s response and believes we can do better. Criticizing a written guideline or commenting on potentially dangerous behaviors of an authoritarian leader is neither unethical nor unpatriotic. Dr. Fleming wrote an open letter to Mary Trump. In it, he addresses several points raised in Dr Geller’s letter while also attempting to shed light on the origins of the Goldwater Rule and some of the problems associated with it as an ethical principle. You can read his letter here: OPEN LETTER TO MARY TRUMP—Another Response to her plea to American Psychiatry.

James L. Fleming, MD, Board Certified Psychiatrist

To give his thoughts about Trump and the Goldwater rule, I invited Dr. Jim Fleming, a lifetime member of the American Psychiatric Association (APA), to discuss over video. Jim and I met by realizing we both contributed chapters to the book Anti-Semitism and Psychiatry: Recognition, Prevention, and Interventions. My chapter was explicitly about hate groups that turn people to become anti-semitic. I wrote about my contribution in a previous blog.

• [Read On: Bio: Narrative]
• Professional Background
• General Bio: Member Spotlight, MPPA-1st-Quarter-2020-Newsletter

Stop the Assault on Experts

There is an assault on experts and institutions, including democratic ones. We care about our country, truth, justice, and the planet. We need to be able to look to experts for support and protection. Mental health professionals need to be able to say publicly their worries and fears. We need to make sure the most powerful person in America, in charge of so many, is sane and functional, when there is a question about fitness (mental and physical).

What can we do?

1. Start by learning more about the issue yourself by reading the resources linked to in this blog.

2. Put pressure on the APA and other institutions to not muzzle experts. The APA needs to uphold their duty to warn and to be concerned about the public.

3. Contact your legislators to inform them about the issue and advocate for legislation to allow for assessments of public leaders.

4. Join and participate in coalitions advocating for related legislation.

5. Make a personal commitment to not stigmatize people or weaponize mental health.

6. Support advocacy groups that work to reduce stigma.

When we look back at what transpired over the last four years, we see that Dr. Bandy Lee and other mental health experts were correct in warning about the dangerousness of Donald Trump. With more exposure, education, and changes, we can prevent this from happening again in the future.

Additional Resources

• OPEN LETTER TO MARY TRUMP—Another Response to her plea to American Psychiatry: Dr. Jim Fleming
• Open Letter to Undecided Voters – 2020 – Dr. Jim Fleming
• An Opinion Piece – Ethics, Advocacy and Presidential Mental Health by Dr. Jim Fleming, pp. 6-9
• Yale Forensic Psychiatrist Bandy Lee Discusses the Dangerous Case of Donald Trump
• Dr. Bandy Lee and Dr. James Gilligan: Do We Surrender Our Moral Compass to Technical Rule?
• World Mental Health Coalition (DangerousCase.org)
• Mary Trump: Psychiatrists know what’s wrong with my uncle. Let them tell voters.
• Is Donald Trump Mentally Fit to Be President? Dr. Bandy Lee Questions Trump’s Capacity to Govern
• Don’t try to diagnose President Trump

Video Interview: Dr. Jim Fleming