Goldwater Rule: Red Line or Guideline?

McNally

McNally (2017) notes that from the standpoint of network models, mental disorders are no more than their collective features and their bidirectional relations (Borsboom & Cramer, 2013). Setting aside the validity of such models, which is presently a matter of intense debate, diagnoses can indeed provide helpful information beyond their signs and symptoms. This is the case even for highly observable conditions, including some personality disorders.

In this context, Millon (1975) distinguished labels from diagnoses; the former merely describe individuals’ pathological signs and symptoms, whereas the latter supply additional information beyond these features. Take for example the diagnosis of narcissistic personality disorder (NPD), which has been a focal point of recent Goldwater Rule discussions: We can identify three ways in which an accurate diagnosis can afford us with novel information.

McNally (2017) contends that the very cases in which the Goldwater Rule would be most likely to be waived are those in which doing so would be the least helpful. He asks, “who, precisely, are the presumed beneficiaries?” (p. 29). We envision two such constituencies, bearing in mind that formal data on the impact of breaking the Goldwater Rule on laypersons and policymakers’ attitudes toward politicians are lacking. One consists of citizens, such as undecided voters, who are worried about a politician’s mental state but are uncertain whether their perceptions are accurate. Knowing that experts believe a politician does—or does not—meet criteria for a psychiatric condition such as NPD could inform their judgments. A second group comprises politicians who are reluctant to voice their serious concerns regarding a political figure’s mental health but who would be emboldened by the knowledge that experts have corroborated their impressions.

Davis

We concur with Davis (2017) that a diagnosis by itself should rarely if ever disqualify a candidate from office and that many politicians with mental illnesses have served capably, even admirably. Still, some diagnostic information can usefully inform voters’ judgments of politicians’ fitness. For example, the knowledge that a candidate meets criteria for psychopathy should almost certainly weigh into voters’ decisions, given that this condition is marked by deceptiveness, manipulativeness, callousness, and poor impulse control (Hare, 1991/2003).

We agree with Davis (2017) that public figures have a right to privacy, but we believe that this right must be carefully balanced against public welfare. Consider two hypothetical scenarios:

These scenarios impart two lessons. First, although psychologists sometimes possess knowledge pertinent to voters’ and policy makers’ decisions, the Goldwater Rule precludes their sharing of this information. Proponents of the Goldwater Rule might respond that mental-health experts are free to communicate in generic terms about the typical features of psychopathology without referring to a specific public figure (Appelbaum, 2017), but doing so virtually forces them to be vague, evasive, and at times even disingenuous in their pronouncements: “Politician X’s symptoms are entirely consistent with a diagnosis of Y, but I cannot comment on Politician X.” Second, the latter scenario underscores a critical point that Davis (2017) does not address: The Goldwater Rule prohibits experts from offering knowledge that could provide public figures with a clean bill of psychological health. Thus, paradoxically, this rule may prevent psychologists from rebutting unjustified attacks against public figures.

Davis (2017) maintains that the Goldwater Rule protects public figures from slurs. Although we agree wholeheartedly that psychologists should refrain from insults against public figures, the Goldwater Rule does nothing to shield them from such indignities. For example, one of the most vocal advocates of the Goldwater Rule recently wrote of President Trump that his “boorish manners, vulgar speech and abusive actions make him a national embarrassment and the worst of all possible role models” (Frances, 2017, p. 394). It is highly doubtful that a diagnosis of NPD, for instance, would be more stigmatizing to Mr. Trump than these or other affronts.

Davis (2017) contends that psychiatric diagnoses are inherently stigmatizing. Yet most data suggest that stigma derives not from the imposition of diagnoses on mentally ill persons but from negative societal reactions to their behaviors (Gove, 1982). In fact, studies indicate that psychiatric diagnoses usually decrease stigma, probably because they offer observers a partial explanation for mentally ill individuals’ otherwise puzzling actions (Ruscio, 2004).

Finally, we concur with Davis that expressing public opinions regarding the mental health of public figures entails certain risks, including the hazards of false-positive diagnoses, which may be grossly unfair to these individuals. Hence, we reiterate our admonition that psychologists should refrain from such statements unless (a) they have access to a substantial body of high-quality information (e.g., extensive and extended behavioral observations) drawn from multiple data sources and (b) public welfare is clearly at stake, so that the risks of refraining from professional opinions potentially exceed the risks of voicing them (see also Clark, 2017). As Davis (2017) observes, the decision regarding whether public welfare is clearly at stake will invariably be a judgment call on which psychologists can legitimately differ; however, the fact that a line is blurry should not preclude one from drawing it in pressing real-world situations.

Conclusions

Psychologists should typically refrain from proffering diagnostic judgments regarding public figures. Such judgments boost the risk of inaccurate “armchair” diagnoses and of damaging the reputation of public figures and the profession at large. At the same time, there is scant justification for a categorical ban on this practice, especially because psychologists can at times offer diagnostic information that bears to some degree on the question of individuals’ suitability for high public office. We therefore recommend reformulating the “Goldwater Rule” as the “Goldwater Guideline.” Such a change would underscore the wisdom of discretion with respect to statements concerning the diagnostic status of public figures but remind psychologists that such statements can be useful and even advisable within limits.