For more than a year, many United States citizens have been expressing unease when it comes to talking about whether our country’s president has a personality disorder or is behaving in a way that isn’t healthy and should get attention from people who can alter it. However, regardless of whether someone has a state-issued mental health professional license or membership in a mental health-related professional association, each of us deserves the latitude to apply our experience and where present, education, to a political situation without the kind of controversy being kicked up by the assertion of the Goldwater Rule. The reality is that most states have laws that impose a duty to warn or protect on mental health professionals that requires them to assess risk of a certain level, and this duty as applied to concerns about the president, should override the Goldwater Rule now more than ever.
The American Psychiatric Association, the American Psychological Association and the American Psychoanalytic Association among other organizations mentioned in Goldwater Rule discussions are distinct professional organizations, with distinct memberships and distinct statements about whether their members should address the mental health of people they do not treat. But one thing they all have in common is that their position on that topic does not state the position as a mandatory rule, nor is it a rule that is enshrined in state law as mandatory, as the duty to protect is in several states.
Furthermore, these organizations use the term “diagnose” not “opine”. Experts of all sorts have been used in courtrooms for decades as a standard way to give professional opinions to juries and judges. They often do so in hypotheticals, if they have no direct experience of a person. So why should a mental health professional’s expression of opinion be curtailed when they’ve not had direct experience of a person, and are not offering it under oath but in a magazine, online or in an interview?
While this point might seem too meta, the term “diagnosis” also has a very specific intent. Appropriately, I was taught in social work school that licensed independent social workers and licensed independent clinical counselors cannot “diagnose”. But social workers do treat clients based on education, experience, observation and licensure. They also often participate in interdisciplinary settings where they might never meet a client personally but still have their professional opinion solicited and considered.
As to whether non-professionals likewise should be dissuaded from expressing their view on the president and his mental state, interventions with family members or friends in order to combat damaging behavior is not always led by licensed professionals but rather lay people. Do we believe they should be prevented from helping?
I’ve often analogized people who refuse to examine the president’s behavior to people who don’t want to go on the record as believing climate change is man-made, but are willing to address the effects of trends they admit they see in weather-related disasters and problems: we don’t have to commit to or name a diagnosis of the president’s behavior in order to acknowledge and respond to its effects.
Which brings us full circle to the duty to warn, the linchpin for not just allowing but pleading for clinicians to speak out. The Goldwater Rule is not binding law on anyone. Duty to warn is. And it is a serious one. Back in the 1990s, I taught hundreds of mental health professionals their obligations under Ohio’s then-brand new legislative rubric mandated to be used to avoid liability when people challenge their assessments of whether they had a duty to protect.
It is long past time to move past the Goldwater Rule, before we are instead saying, we should have known and then must hear professionals say, we tried to tell you. Rather than focus on or publish more analyses of why no one should be “diagnosing” the president unless he’s their patient, we need to examine, discuss and apply the statute-based professional expectations around mental health professionals’ duty to warn and duty to protect. Doing so would allow us to both have the needed, honest conversation about the president’s behavior – a conversation that so far has been marginalized – and more importantly, openly assess its risks which pile up by the tweet.