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Psychiatric Ethics & the Goldwater Rule

Posted in MEDICOPOLITICS, ONLINE DEBATE, PERSONAL, PRACTICE, PSYCHIATRY, U.S. POLITICS with tags , , , , , , , , , , , , , , , on January 11, 2018 by drjgelb

The desperation of the Democrats, still baying at the moon over a year since their terrible candidate lost the election, despite her seditious, criminal actions to subvert the will of the American People, is astonishing. We have witnessed a complete refusal by the Democrats and their supporters to allow a smooth and peaceful transition of power. Instead, as each attempt to oust President Trump falls flat on its face, the derangement of his enemies escalates & now we have the absurd scene of highly trained medical specialists attempting to misuse their skills in order to achieve what their compatriots have been unable to pull off. Let me make it very clear to all my colleagues, friends and readers, opining on someone that one has not clinically evaluated, that one has never met, without taking a thorough psychiatric and medical history, conducting a Mental State Examination, including an assessment of Cognitive Function, obtaining a collaborative history from family, friends, involved medical practitioners and allied health and obtaining appropriate special investigations such as blood tests and medical imaging, is MALPRACTICE or put formally, Professional Misconduct. The actions of the psychiatrists supporting the outrageous 25th Amendment Coup attempt are a despicable display of partisan abuse of psychiatry reminiscent of the Soviet Union’s fabrication of the diagnosis of “Slowly Progressive Schizophrenia” used to incarcerate & stupefy hundreds of thousands of political dissidents and enemies of the state. So egregious was the USSR’s behaviour considered that the nation was expelled from the World Psychiatric Association and the psychiatrists that colluded with the regime were ostracised for life. I consider attempts to use our specialty as a political weapon makes the perpetrators the equivalent of War Criminals. At the very least, they don’t give a damn about President Trump’s Human Rights. They bring psychiatry into shameful disrepute and I sincerely hope that those engaged in this shameful, cowardly attack are formally reported to their State Medical Board for ethical investigation and censure. Below are some of the official APA statements regarding this ongoing debacle. You can see that the APA leadership has had to repeat its warning to members more than a few times and has had to head off at the pass several attempts to introduce confounding side issues to the debate.

APA Calls for End to ‘Armchair’ Psychiatry

WASHINGTON, D.C. — Today, the American Psychiatric Association (APA) reiterates its continued and unwavering commitment to the ethical principle known as “The Goldwater Rule.” We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable news appearances, books, or in social media. Armchair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.

The ethical principle, in place since 1973, guides physician members of the APA to refrain from publicly issuing professional medical opinions about individuals that they have not personally evaluated in a professional setting or context. Doing otherwise undermines the credibility and integrity of the profession and the physician-patient relationship. Although APA’s ethical guidelines can only be enforced against APA members, we urge all psychiatrists, regardless of membership, to abide by this guidance in respect of our patients and our profession.

A proper psychiatric evaluation requires more than a review of television appearances, tweets, and public comments. Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease. The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.

“The Goldwater Rule embodies these concepts and makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA stands behind this rule.”

The President is about to undergo his annual physical examination, and APA has confidence that his physician will follow the standard of care in examining all systems, which includes an age-appropriate medical and mental health evaluation. If mental health concerns are raised, the standard of care would result in the examining physician seeking consultation from an experienced psychiatrist who would approach the consultation with objectivity and within the physician-patient confidential relationship.

APA is ready to make recommendations from among our 37,000 psychiatrist members, physicians who have the knowledge, training, expertise, discretion, and objectivity to perform a thorough and apolitical evaluation. Using psychiatry for political or self-aggrandizing purposes is stigmatizing for our patients and negatively impacts our profession.

 

 

Goldwater Rule

by Aaron Levin

Restraint of psychiatrists’ comments on political candidates is grounded in APA’s response to an attempt to question Barry Goldwater’s mental health during the 1964 campaign for President.

“Do you believe Barry Goldwater is psychologically fit to serve as President of the United States?” the editors of Fact magazine asked 12,356 psychiatrists during the 1964 presidential campaign between Goldwater and Lyndon Johnson.

The responses set off a wave of reaction that resonated again most recently after media speculation about the mental status of the current Republican presidential candidate.

Fact published numerous comments questioning Sen. Barry Goldwater’s psychological capacity for office, which ultimately led to the creation of APA’s “Goldwater Rule” in 1973.

A look at the original episode reveals as much about psychiatry’s changes over the last half century as it does about politics then or now.

The harshly negative responses by people who had never even met Goldwater seem astonishing by today’s standards, as a sampling suggests:

“I believe Goldwater to be suffering from a chronic psychosis,” wrote one.

“A megalomaniacal, grandiose omnipotence appears to pervade Mr. Goldwater’s personality giving further evidence of his denial and lack of recognition of his own feelings of insecurity and ineffectiveness,” wrote another.

“From his published statements I get the impression that Goldwater is basically a paranoid schizophrenic who decompensates from time to time. … He resembles Mao Tse-tung,” said a third.

Not wanting to exclude other relevant 20th-century tyrants, another claimed, “I believe Goldwater has the same pathological makeup as Hitler, Castro, Stalin, and other known schizophrenic leaders.”

Others pushed back. In reality, Goldwater had worked in his family’s business, then served as a transport pilot in World War II, and retained a commission in the Air Force Reserve for many years. He was twice elected senator before the 1964 presidential race and would be again in 1968, 1974, and 1980.

It was difficult, said one psychiatrist quoted in Fact, to believe that a man who was “psychotic” or “schizophrenic” would have managed all that.

“I served as a flight surgeon in the USAF,” wrote Wilbert Lyons, M.D., of Sellersville, Pa. “I speak with authority when I say that Sen. Goldwater could not be a jet pilot if he were emotionally unstable.”

Goldwater certainly held very conservative political views and expressed them forcefully. Many of the respondents who declared him “unfit” were likely expressing their own political biases in psychiatric terms. Tellingly, many of them asked that their names be withheld from publication, perhaps hinting at some guilt feelings over their cavalier, remote diagnoses of the candidate.

Nevertheless, many other respondents understood immediately the greater implications of the question for psychiatry’s purported role in the electoral process.

“Your inquiry for a professional opinion regarding Sen. Barry Goldwater’s general mental stability is an insult to me,” wrote Thomas Stach, M.D., in 1964. “An inquiry of this type regarding any individual can only be based on ignorance of the field of psychiatry.”

Stach demanded an apology from the editors to all the psychiatrists who had received the survey.

“It was astounding to me when the survey first came out,” Stach, now retired in Willowbrook, Ill., told Psychiatric News. “It was impossible for a psychiatrist to come to a conclusion like that without a personal examination. The psychiatrists who were baited into giving responses were imprudent.”

Some offered a nuanced statement of their own positions.

“Politically, I heartily disapprove of Goldwater,” wrote Joseph Schachter, M.D., Ph.D., in 1964. “In fact, I find him somewhat frightening. Yet I do not feel I can honestly say he is psychologically unfit to serve as president.”

“I still think that’s a plausible view of the Goldwater situation,” said Schachter, now retired and living in New York City, in a recent interview. “Psychiatrists and psychoanalysts have the right as citizens to comment on elections and candidates and are free to do that, but without selecting a psychiatric diagnosis.”

“Vetting a candidate should be based on his or her position on the issues,” agreed Stach. “The survey betrayed the ignorance of the questioner.”

APA’s initial reaction to the Fact magazine article came swiftly.

“[S]hould you decide to publish the results of a purported ‘survey’ of psychiatric opinion on the question you have posed, the Association will take all possible measures to disavow its validity,” wrote APA Medical Director Walter Barton, M.D., in a letter to the magazine’s editors on October 1, 1964.

APA President Daniel Blain, M.D., denounced the compilation as “a hodge-podge of the personal political opinions of selected psychiatrists speaking as individuals. … [T]he replies to the question have no scientific or medical validity whatsoever.”

Tying political partisanship to the psychiatric profession, continued Blain, “has, in effect, administered a low blow to all who would work to advance the treatment and care of the mentally ill of America.”

APA’s formal response came in 1973 with the adoption of Section 7.3 in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, which became known as the Goldwater Rule.

The rule applies to public figures and states: “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” (see below).

The episode and the subsequent adoption of Section 7.3 appear to have dampened the enthusiasm of most APA members for a repeat performance, leaving psychiatric diagnosis to the media.

Text of APA’s Ethics Annotation Known as ‘Goldwater Rule’

7. 3. 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.

 

APA’s Goldwater Rule Remains a Guiding Principle for Physician Members

ARLINGTON, Va. — The American Psychiatric Association (APA) today released the following statement regarding The Goldwater Rule:

“In the past year and a half, there have been numerous news articles and commentaries on The Goldwater Rule. The Goldwater Rule is an ethics principle that guides our physician members not to provide professional opinions in the media about the mental health of someone they have not personally examined and without patient consent or other legal authority. A personal examination includes ruling out physical causes of or other reasons for a behavior. Nothing about the Goldwater Rule discourages psychiatrists from providing education to the public about mental illnesses; in fact, APA encourages psychiatrists to educate the public about the causes, symptoms, and treatment of mental illnesses and substance use disorders.

The APA would also like to dispel a common misconception about the so-called “Duty to Warn.” The duty to warn is a legal concept which varies from state to state, but which generally requires psychiatrists to breach the confidentiality of the therapeutic session when a risk of danger to others becomes known during treatment of the patient. It does not apply if there is no physician-patient relationship.”

 

APA Reaffirms Support for Goldwater Rule

ARLINGTON, Va. March 16, 2017 — The American Psychiatric Association (APA) today reaffirmed its support behind the ethics guideline commonly known as “The Goldwater Rule,” which asserts that member psychiatrists should not give professional opinions about the mental state of someone they have not personally evaluated.

The APA’s Ethics Committee issued an opinion that clarifies the ethical principle and answers questions that have been posed recently.

Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as “the Goldwater Rule.” The ethics principle is so named because of its association with an incident that took place during the 1964 presidential election. (See APA Blog on Goldwater Rule.) During that election, Fact magazine published a survey in which it queried some 12,356 psychiatrists on whether candidate Sen. Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency. Goldwater would later sue the magazine, which was found liable for damages.

“It was unethical and irresponsible back in 1964 to offer professional opinions on people who were not properly evaluated and it is unethical and irresponsible today,” said APA President Maria A. Oquendo, M.D., Ph.D. “In the past year, we have received numerous inquiries from member psychiatrists, the press and the public about the Goldwater Rule. We decided to clarify the ethical underpinnings of the principle and answer some of the common questions raised by our members. APA continues to support these ethical principles.”

In reaffirming the existing policy, the Ethics Committee explained the rationale behind the rule. For example, offering a professional opinion or a diagnosis of someone they have not thoroughly examined compromises the integrity of the doctor and the profession and it has the potential to stigmatize those with mental illness. Furthermore, when a physician publicly gives a professional opinion on a public figure without consent, it violates the principle that a psychiatric evaluation must occur with consent or authorization.

 

The Goldwater Rule: Why breaking it is Unethical and Irresponsible

August 3rd 2016    

Every four years, the United States goes through a protracted elections process for the highest office in the land. This year, the election seems like anything but a normal contest, that has at times devolved into outright vitriol. The unique atmosphere of this year’s election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible.

Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.

Maria A. Oquendo, M.D.

Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as “the Goldwater Rule,” which prohibits psychiatrists from offering opinions on someone they have not personally evaluated. The rule is so named because of its association with an incident that took place during the 1964 presidential election. During that election, Fact magazine published a survey in which they queried some 12,356 psychiatrists on whether candidate Sen. Barry Goldwater, the GOP nominee, was psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency.

While there was no formal policy in place at the time that survey was published, the ethical implications of the Goldwater survey, in which some responding doctors even issued specific diagnoses without ever having examined him personally, became immediately clear. This large, very public ethical misstep by a significant number of psychiatrists violated the spirit of the ethical code that we live by as physicians, and could very well have eroded public confidence in psychiatry.

We live in an age where information on a given individual is easier to access and more abundant than ever before, particularly if that person happens to be a public figure. With that in mind, I can understand the desire to get inside the mind of a Presidential candidate. I can also understand how a patient might feel if they saw their doctor offering an uninformed medical opinion on someone they have never examined. A patient who sees that might lose confidence in their doctor, and would likely feel stigmatized by language painting a candidate with a mental disorder (real or perceived) as “unfit” or “unworthy” to assume the Presidency.

Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.

The Goldwater Rule is published as an annotation in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. I encourage you all to read the full text of the rule below, and keep it in mind during this election cycle, and other events of similarly intense public interest.

 

 

The Ethical Psychiatrist’s Role in Public Elections

April 7th 2016

Presidential elections are intense and may lead some observers to speculate about the mental health of the candidates. People are curious about psychiatrists’ diagnostic opinions of politicians and other public figures. This is a sufficiently common phenomenon that APA added an annotation to the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry in 1973, commonly referred to as the Goldwater Rule, prohibiting psychiatrists from offering public opinions about people they have not personally evaluated.

Section 7, Article 3, of the Principles states, “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.”

Why is it called the Goldwater Rule? During the 1964 presidential election, Fact magazine published the results of a survey it had mailed to 12,356 psychiatrists. Of the 2,417 respondents, 1,189 replied that Sen. Barry Goldwater was not psychologically fit to be president. For a detailed account of the responses, see Henry Pinsker, M.D.’s “Goldwater Rule History” in Psychiatric News. Sen. Goldwater successfully sued Fact for libel and was awarded $75,000 in punitive damages.

APA responded to this very public ethical misstep by a large number of psychiatrists with the annotation above, and periodically the Goldwater Rule is recapped in APA publications (“Ethics Reminder Offered About Goldwater Rule on Talking to the Media,” and in the national media (“Should Therapists Analyze Presidential Candidates?).

Beyond a reminder about the rule, it may be helpful to understand some of the ethical concepts behind it. Virtue ethics emphasizes the personal characteristics that society expects physicians to embody. Among these virtues are respect for others, humility, and adherence to diagnostic processes according to the standards of our field. If we venture a diagnostic impression about a person we have not examined, we trample upon these virtues.

In addition to inviting a lawsuit for libel or slander, a potential consequence of psychiatrists breaching these virtues is a diminution of public confidence in psychiatrists. If we will speak to the media about the possible psychiatric diagnosis of a person we have not evaluated, will we also reveal the identities and diagnoses of our patients? We must guard against undermining the protective cloak of confidentiality, without which people may refrain from seeking mental health treatment.

Political campaigns are brutal. Even a psychologically healthy person needs extra support if engaged as a candidate in an election. Because of stigma, that candidate needs to be assured of the utmost privacy and confidentiality if he or she is to enter treatment. If we are hazarding guesses about politicians’ diagnoses in the media, we will lose the opportunity to provide treatment to our political leaders, which is perhaps one of the most effective ways to ensure a mentally healthy leadership while simultaneously eroding the stigma attached to our field.

Psychiatrists can play an important role in elections, but it is mostly silent. 

 

 

There are many other similar statements, warnings, reminders and guidelines that have been issued on a regular basis since 1973, as each election cycle strained adherence to the Goldwater Rule but have no doubt, EVERY PSYCHIATRIST IS FULLY AWARE OF THEIR ETHICAL RESPONSIBILITIES IN THESE MATTERS and the public has the right to expect better of its key Mental Health Professionals. 

 

 

 

 

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A QUOTE HITS ME IN THE GUTS

Posted in PERSONAL with tags , , , , , , , , , , , , on May 16, 2014 by drjgelb

“World War I (1914-1918) was a human catastrophe that devastated Western civilization and mocked the hope inherent in “modernism”. The sheer volume of the war’s slaughter was beyond belief. The horror of it all destroyed the trust in science, medicine and technology as the golden gateway to a harmonious and peaceful future for humanity. All that was thought to be good had been twisted to the evil purpose of a global war. A global sense of hopefulness was replaced with a global sense of fear and loathing.”

ANTI-VACCINATION CONSPIRACY THEORISTS BULLY GRIEVING PARENTS!

Posted in ONLINE DEBATE with tags , , , , , , , , , , on May 29, 2013 by drjgelb

I just have to put this link up for all to see. The AVN has outdone itself by cruelly bullying and harassing a young couple whose 4 week old baby died from Whooping Cough…..Pertussis…..due to the presence of the bacteria in the under-vaccinated children of the Anti-Vaccination activists, whose conspiracy theory is that all medical advocates of vaccination are on Big Pharma’s payroll! They are dangerously deluded! Thankfully, Bill Gates was in Canberra, Australia’s Capital, today and at a Press Club Luncheon, he explained how the Bill & Melinda Gates Foundation was gratefully accepting an $80 million donation from Australia to complete vaccination and elimination of the Polio Virus from the last Four countries where the terrible scourge still exists. Gates said he is a champion of vaccination and credits it for saving 5 million lives each year that would otherwise be lost in the third world alone!

http://www.news.com.au/lifestyle/parenting/grieving-parents-speak-out-against-anti-vaccination-extremists/story-fnet08xa-1226650422913

Psychiatry bashing – a common pastime!

Posted in PSYCHIATRY with tags , , , on December 3, 2012 by drjgelb

Below is my response to a post on “The Conversation” Blog stating that Psychiatrists turn everyone into zombies & that psychiatric illnesses are “made up”.

“What rubbish Ian! You clearly have no idea what “modern psychiatry” is about or the fact that modern psychiatric drugs are far less side-effect prone than ever before in the history of psychopharmacology. Medication in private practice is used sparingly & my colleagues & I spend thousands of hours a year listening, counselling, debating & empathising with the real human beings we see. I see my own psychiatrist for PTSD following life-threatening trauma. Don’t tell me that psychiatric illnesses are “made up”. Spend a week in my shoes experiencing the hyperarousal & anxiety attacks that require my attention virtually daily. My medication helps greatly but the most effective & rapid intervention is raising my CO2 levels by rebreathing expired air. In 5mins the hyperventilation switches off & I can proceed with my working day. The mind & brain are one & every brain function is mediated by neurotransmitters. Genes determine much of how our brains function & within 10-15yrs, most of the psychiatric illnesses will be unravelled & their specific causes determined, right down to the gene defects involved. Your claims of made up illnesses are going to look very ignorant & biased then, I predict.”

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