Bill Doherty gave an interview to Minnesota Public Radio last month, cautioning that therapists should avoid issuing diagnoses of Republican presidential candidate Donald Trump. Doherty is certainly correct that diagnosing from afar is dangerous, for a multitude of reasons. But as it turns out, most mental health ethics codes are fine with it.
“I’m very worried that psychological diagnosis will become weaponized in our political sphere,” Doherty said. He noted that therapists could come out every four years for presidential campaigns, throwing diagnoses back and forth. This would ultimately undermine the credibility of diagnosis in general. No argument there — we want the public to trust in mental health diagnosis and understand it as a health care tool, not a political one.
The problem here is that there is no good alternative. If qualified mental health professionals aren’t engaging in public discussion of mental health issues, then unqualified people will lead the discussion instead. They’ll use diagnostic terms, but there is heightened risk that they will use those terms incorrectly. And that could undermine public trust in diagnosis far more than would happen with trained professionals leading the discussion.
The Goldwater fiasco
Psychiatrists are the only mental health professionals who are specifically prohibited from diagnosing Trump from afar. The American Psychiatric Association has a strong ethical standard against issuing a diagnosis of someone the Psychiatrist has never met. As Doherty noted, this ethical standard is rooted in history: In 1964, Fact magazine published an article “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.” The article included results of a poll of psychiatrists who had been asked whether Goldwater, who was then a presidential candidate, was fit to be president. More than 1,000 psychiatrists said he wasn’t. One labeled him a “dangerous lunatic.” Goldwater sued the magazine for libel, and won.
To this day, the American Psychiatric Association includes in its code of ethics what has informally been labeled the “Goldwater rule.” Psychiatrists are allowed to share with the media their “expertise about psychiatric issues in general.” But they can’t provide specific diagnoses unless they have personally examined the person and obtained their consent to share the diagnosis.
Current ethical standards
The other mental health associations have either loose restrictions on diagnosing public figures from a distance, or none at all.
The American Psychological Association requires psychologists’ public statements to be “based on their professional knowledge, training or experience in accord with appropriate psychological literature and practice,” to be otherwise consistent with the APA Code of Ethics, and to be clear about the nature of their relationship with those receiving the information (standard 5.04). That last piece just means making sure readers or listeners know that they aren’t in a professional relationship with the psychologist.
The American Counseling Association frames its standard similarly to the APA standard. It requires counselors speaking with the media to base their statements on “appropriate counseling literature and practice,” to ensure that their statements are “otherwise consistent with the ACA Code of Ethics,” and to be clear about the nature of their relationship with those receiving the information (standard C.6.c).
The American Association for Marriage and Family Therapy simply requires that therapists “exercise special care when making public their professional recommendations and opinions” (standard 3.11). There is no further prohibition against diagnosing public figures. The California Association of Marriage and Family Therapists, an independent group not affiliated with AAMFT, allows public statements about people the therapist has never met as long as the therapist provides “appropriate cautions” about the limited information on which their assessment is based, and “the effects of such limited information upon their opinions” (standard 3.14).
The National Association of Social Workers refers to avoiding dishonesty in multiple standards. They also require social workers to protect client confidentiality when dealing with the media (standard 1.7(k)). But none of the NASW standards parallel psychiatrists’ Goldwater rule.
So can you diagnose Trump?
According to the standards of most mental health associations, yes. If you’re a qualified therapist and are honest about the limitations of your knowledge, you’re free to speculate about whether he (or Hillary Clinton, or any other public figure) might in fact qualify for a diagnosis of mental illness.
Whether you can diagnose Trump from afar and whether you should are different questions, of course. Doherty says that you shouldn’t. His argument, and the history behind it, are compelling. But there’s also a risk that if you don’t, someone else — someone perhaps less qualified and less responsible — will.
Photo credit: Gage Skidmore via Wikimedia Commons [CC BY-SA 3.0]