Yale psychiatrist dismantles the Goldwater rule for preventing mental health experts from speaking out about Trump
President Donald Trump (MSNBC)

On CNN's Reliable Sources Sunday, host Brian Stelter did a segment on the media’s responsibility to bring on mental health experts to help understand the growingly erratic mental state of the president.

Raw Story spoke with one of them: Dr. Bandy X. Lee is a forensic psychiatrist and violence expert at Yale School of Medicine. She was one of a handful of psychiatrists to consult with the World Health Organization on its launch of a public health approach to global violence prevention and is author of the textbook, “Violence.” At the onset of the current presidency, she held an ethics conference on the importance of mental health professionals to speak up and compiled the public-service book, “The Dangerous Case of Donald Trump.” More recently, she prepared a mental health analysis of the Mueller report and convened a working group on an expert panel that can perform fitness-for-duty tests on presidents and presidential candidates (more information at: dangerouscase.org).

Raw Story: You were on a CNN segment that drew a lot of controversy. Can you tell us about it?

Bandy X. Lee: Brian Stelter had us on his show, Reliable Sources. It was a brave and patriotic thing to do, and, probably like most mental health experts, he knew he was placing his own personal safety at risk. Those who choose to bring serious light on the mental health of the president are viciously attacked with death threats and insults, and this alone should illustrate the dangers of this presidency. The only regret I have is that he had to pit me against Dr. Allen Frances, who did not even seem to understand the topic of discussion, being so eager to advance his political views—and now he has given our opponents ammunition through his sloppy Hitler comment. Mr. Stelter did not even notice because it was so outside the point of the discussion. Experts are not consulted for their political views.

In my view, psychiatrists who speak in areas outside their expertise worsen the problem: Drs. Paul Summergrad and Jeffrey Lieberman, for example, have continually stated that psychiatrists should not be involved in speaking about the president because the 25th Amendment is a political process. Well, to state that psychiatrists should or should not be involved in a specific political procedure, unlike simply offering medical observations, is itself intervening in politics. When I had a chance to converse with the drafter of the Amendment, he did not agree with their view at all! He said that mental health professionals need to speak their concerns, for otherwise the 25th Amendment alone would not be sensitive enough to allow the political process to begin. And, of course, even a political process should gather facts and consult expertise, like court proceedings, if it wished to avoid becoming a partisan game.

Raw Story: You have cautioned against psychiatrists intervening in politics in the past. How is it different from what you are doing?

Lee: I alerted early on that the American Psychiatric Association’s gag rule was politically-driven, since it was instituted with this presidency, and that it would have the result of shaping discourse. Even though the APA is only one of many psychiatric organizations, not to mention mental health, their highly public announcements and public attacks of those who would speak up had a chilling effect on the entire profession. By preventing most mental health experts from speaking up about a national mental health issue—professionals fear for their careers when their own professional organization opposes them—it was able to shape the national discourse.

It has attacked me publicly, since it cannot discipline nonmembers. I resigned from the APA 12 years ago, as it was taking a third of its funding from pharmaceutical companies—and, indeed, it changed from strongly advocating patient rights to promoting chemical therapy over patient interest. Now, fearing loss of federal funding, it chooses to advocate for the government instead of public health and safety.

While we were organizing our interdisciplinary conference in March, dozens of media outlets told us they could not cover us because of “the Goldwater rule,” or at least this was the excuse they gave. I personally have been booked over 50 times, by all the major network and cable programs—there is hardly any I have not been invited to—with 100 percent cancelation before airing. We also learned that much of the public thought the gag rule was some kind of law, when even licensing boards cannot adopt it because it comes in conflict with the First Amendment.

Protecting public health is part of our professional responsibility. To keep quiet because the problem happens to be in the political arena is itself placing political considerations over medical ones.

Raw Story: Can you explain, what is the Goldwater rule?

The APA calls its current policy “the Goldwater rule,” but it is not. The original rule, instituted in 1973, was an affirmative obligation. In its entirety, it says: psychiatrists have a responsibility to society as well as patients (Preamble). They are expected to participate in activities that improve the community and better public health (Section 7). When they are asked about a public figure, they should educate the public in general terms and not diagnose (Section 7.3). Even though I am exempt from this rule as a forensic psychiatrist, as I may be asked to diagnose minor public figures without examining them, I have still supported and kept it for over 20 years.

Raw Story: How is the new rule a problem?

Since I have never diagnosed the president but alerted against his dangerousness, I would not be breaking the original Goldwater rule. The new rule, however, prohibits any utterance about any aspect of a public figure—even in a national emergency. This way, the current gag rule forces us to place a public figure above society, when the only reason to speak cautiously about public figures, with which I agree, is because of our duty to society. Since ethical rules are supposed to be guidelines that require independent thinking and deliberation against exceptions, making the rule absolute turns it into a decree and not an ethical rule at all.

An overwhelming majority of psychiatrists disagree with current APA policy, according to an informal poll, but the APA adamantly refused to reopen any discussion and declared the issue closed. It has not done a poll of its own or held a vote, as members demanded, and now even high-ranking officers have resigned. The public needs to know about this, since experts and the free press are the first to be silenced in a tyrannical regime. This is because they are checks on power—and what does it mean when those who are trained to spot a tyrant are the first to be gagged?

For this reason, we are inviting foremost scholars from around the country to speak at Yale Law School this fall on the importance of mental health experts to be a part of national discussion. More information is forthcoming.