Dr. Phil profiles a clearly psychiatrically troubled Shelley Duvall on his wildly popular talk show and drives ratings ever higher. Dr. Drew Pinsky offers a steady stream of advice over the television airwaves to drug-addled celebrities with the dulcet but uncompromising tones of unquestionable authority. And pundits too numerous to count wield their MDs and PhDs like searing branding irons, stamping politicians of every stripe, from Trump to Clinton and from Obama to McCain, with every psychiatric diagnosis under the sun, causing the question whether psychiatric diagnoses of celebrities are acceptable.
In the unrelenting spotlight of the 24 hour media cycle, psychiatric banter is as ubiquitous as the screens on which it appears, and from the proliferation of psychiatric “experts” proffering opinions as though they were incontrovertible truths, it would seem that even the most complex of psychiatric disorders was as easy to spot from a distance as jade green eyes or a balding pate.
The Goldwater Rule
The question of whether psychiatrists should comment on the mental health of media figures they have not examined and who have not given consent to such commentary is not a new one. The so-called “Goldwater Rule” refers to a stringent set of guidelines first issued in 1973 by the American Psychiatric Association in response to flagrant ethical violations perpetrated against Sen. Barry Goldwater that same year. The presidential candidate was publicly diagnosed with an array of mental disorders by psychiatrists participating in the infamous Goldwater Survey, who responded anonymously with their diagnoses based solely upon media representations of the senator but with no one-on-one experience, let alone a comprehensive clinical examination, of the man (Oquendo, 2016). To prevent what the APA considered a breach of professional conduct from happening again, it issued a rigorous set of restrictions forbidding psychiatrists from commenting publicly on the mental health of media figures.
However, these proscriptions are not without controversy. Some critics of the Goldwater Rule view this regulation as an infringement upon free speech rights. Others argue that this violates the public’s right to know, to glean insight into public figures who, by virtue of their public persona, have forfeited the privacy rights that ordinary citizens enjoy.
Dr. Phil, the darling of televised psychodrama, asserts that his profiles, of the famous, the infamous, and the ordinary alike, are “teaching tools,” shining a spotlight on the suffering that millions endure in shame and in silence.
To this extent, he is correct: the stigma of mental illness is real and it is devastating, shattering families and taking lives. The power of celebrity within this context may, indeed, provide a powerful anodyne for the judgment, misunderstanding, and condemnation too often heaped upon those with mental illness. We love our celebrities, after all. We invest in them. We feel, legitimately or not, that we know them. So when we see them facing a struggle similar to our own, for some of us, it makes recognition and acknowledgment easier—and those are the first steps to speaking out and seeking help.
It is also true, likewise, that great power in the hands of those with untreated illness, whether physical or psychiatric, can be a very dangerous thing. There is, after all, a reason that presidential candidates release their medical records and sitting Presidents disclose the results of their annual physicals.
The Damage of Improper Diagnoses
However, we tread a very dangerous path when we toss about psychiatric diagnoses as glibly as we comment on the weather or repeat last night’s baseball scores. For better or worse, those letters after a psychiatrist’s or psychologist’s name carry tremendous power in our medico-scientific culture. For some audiences, such credentials alone are sufficient to lend an air of infallibility to the pronouncements of those who hold them. And that means that an improper diagnosis has the capacity not merely to tarnish the reputation of a noble profession but also to, utterly and irretrievably perhaps, destroy a person’s life.
While the Goldwater Rule, applied too rigorously as a de facto gag order on the psychiatric profession, may indeed violate First Amendment rights and compromise the public’s ability to make informed decisions, the spirit of the law, if not the letter, must be honored. Psychiatrists, psychologists, and other mental health experts must exercise their authority with extreme care, upon pain not merely of reputation loss but of professional sanction should a pattern of flagrant misconduct emerge. The line, undoubtedly, is a murky one and such a case of willful ethical violations would be challenging in the extreme to prove.
Are Disclaimers and Consent Sufficient?
However, a helpful benchmark—or at the very least a strong starting point—would be to ensure that media commentary on public figures be prohibited without the full disclosure of the expert’s professional background, any political or personal affiliations which might color this commentary, and, perhaps most important, the nature and extent of the expert’s dealings with the subject—including disclaimers in those most common of circumstances where the expert has spent little to no time with the subject. Responsible practice, both within psychiatry and the media, should always provide subjects with the opportunity for rebuttal. Further, anyone who provides consent for their condition to be publicly discussed, whether a public figure or private citizen, must be adjudged competent to provide this consent by independent third parties.
Media and psychiatry are a potent combination. Together, they can be a breathtaking force for good. Yet their power to exploit, manipulate, and abuse is equally vast. Psychiatrists should not be gagged, but they should most certainly be checked.
Oquendo, M.A. (3 August 2016). The Goldwater Rule: Why breaking it is unethical. American Psychiatric Association, President Blog. Retrieved from https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/08/the-goldwater-rule