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Should Psychiatrists Render Opinions on Political Candidates' Mental Fitness?

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Since 1974, the American Psychiatric Association has held it to be a violation of medical ethics for psychiatrists to make public statements about public figures whom they have not formally evaluated. For this reason, we American voters cannot turn to psychiatrists to help us judge the character of American political candidates. Fortunately, we do not need the psychiatrists' help.

This rule against making psychiatric diagnoses of public figures is called the Goldwater rule. In 1964, the editors of Fact magazine reportedly asked more than 12,000 psychiatrists to render an opinion about whether the Republican candidate, Barry Goldwater, was psychologically fit to serve as President of the United States. More than 2000 psychiatrists reportedly responded. Many of the respondents concluded that Goldwater was mentally unfit for the Presidency. Some even argued that Goldwater had a psychosis, such as paranoid schizophrenia. However, it should have been clear even to a lay audience that Goldwater was not schizophrenic.

People with schizophrenia often have auditory hallucinations, which means that they hear voices when no one is speaking. People with schizophrenia may suffer from paranoid delusions, which are false and illogical beliefs, such as the idea that their mind is being controlled by a radio transmitter that a dentist has implanted in one of their fillings. People with schizophrenia also suffer from a general incoherence of thought, and they have problems with motivation and organization. Goldwater had none of those problems.

People with schizophrenia often find it hard to hold any sort of a job or to maintain social relationships. In contrast, Goldwater had been successful in many areas of life. After his father's death, Goldwater successfully managed his family's business (an upscale department store in Phoenix, Arizona). He served as a transport pilot in the U.S. Army Air Forces during World War II. He retained a commission in the U.S. Army Air Force Reserve for many years afterward. He had twice been elected to the U.S. Senate. (He was later re-elected to the Senate three more times.) That is not the resume of someone with paranoid schizophrenia. As Wilbert Lyons, MD, of Sellersville, Pennsylvania, put it, "I served as a flight surgeon in the USAF. I speak with authority when I say that Sen. Goldwater could not be a jet pilot if he were emotionally unstable." Thus, it was silly for psychiatrists to offer such a diagnosis for Goldwater.

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By offering these nonsensical diagnoses of Goldwater, many psychiatrists presumably hoped to make Goldwater look bad. Instead, they made psychiatry look bad. Back in the 1960s, psychiatric diagnoses were often based on what the psychiatrist imagined was going on in a patient's subconscious mind. Thus, two psychiatrists could come up with wildly different diagnoses when presented with the very same patient. This problem stemmed from flaws in the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-I). The second edition (DSM-II), issued in 1968, was not much better.

By the early 1970s, it had become obvious that the DSM-II was practically useless. To be useful, a diagnostic label has to be reliable and valid. Reliability means that different psychiatrists would be likely to give the same diagnosis to the same patient for the same problem. Validity means that the diagnosis is useful for some practical purpose, such as guiding treatment decisions. A system of diagnostic labels can be reliable but invalid. For example, psychiatrists might all agree that the patient is a Capricorn, but that information is not useful medically. On the other hand, any system that is unreliable is automatically invalid. If the diagnoses are being handed out by sheer luck of the draw, then the diagnoses are meaningless.

In the mid 1970s, the APA attempted to solve this problem by rewriting the DSM. The purpose of the DSM-III was to provide a system of diagnoses that would be reliable and valid and that would be useful to government employees (especially those at the Food and Drug Administration) as well as to psychiatrists. For this reason, the DSM-III and subsequent editions of the DSM have included clear diagnostic criteria in plain English. Of course, once you read those criteria, you will realize that a shockingly large number of public figures would qualify for a diagnosis of antisocial or narcissistic personality disorder.

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To decide whether to support a political candidate, you do not need to be a psychiatrist. However, you do need to be a good judge of character and public policy. You need to be able to tell whether a candidate has a track record of supporting policies that are actually good for the public. To his credit, Goldwater was generally clear about what he was against and what he was for. Goldwater was against the legacy of the New Deal and against the Civil Rights Movement. He hated labor unions. He wanted to undermine Social Security. Goldwater voted against the Civil Rights Act, and he opposed the creation of Medicare. In contrast, he was for the use of tactical nuclear weapons in Vietnam. Fortunately, most Americans liked Social Security and were horrified by the prospect of nuclear war. In 1964, the incumbent President Lyndon Johnson was talking about expanding civil rights and eradicating poverty. As a result, Lyndon Johnson won the election in a landslide.

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Laurie taught herself to read at age 4 by analyzing the spelling of the rhyming words in Green Eggs and Ham, by Dr. Seuss. She has worked as an editor in medical and academic publishing for more than 25 years. She is the author of five books: (more...)
 

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