March 24, 2019
Can a Mental Health Professional Really Diagnose Someone from Afar?

Can a Mental Health Professional Really Diagnose Someone from Afar?

by Jeanine Barone  

Headlines this year have teemed with declarations by mental health professionals that President Donald J. Trump has narcissistic personality disorder or various other mental illnesses. But those claims have met with their share of controversy: At issue is whether such professionals can really “diagnose” someone—even someone whose behaviors are as publicly observable as a presidential candidate or, now, president—without having treated that person.

Critics say no, invoking the Goldwater Rule, a section of the American Psychiatric Association’s code of ethics that precludes psychiatrists from giving a professional opinion about a person they have not examined personally. The rule stems from the 1964 presidential campaign of Senator Barry Goldwater, who ran against President Lyndon Johnson. An article published during the campaign in a U.S. magazine called Fact polled psychiatrists about whether Goldwater was fit to be president, with some stating that he was not. The magazine lost a defamation suit filed by Goldwater over the article, leading to the adoption of the rule by the APA. (Other professional mental health associations, including the American Psychological Association, have not adopted such a rule.)

Other experts have argued that the Goldwater Rule is no longer valid because it was established before later versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)alloweddiagnoses to be made, at least in part, on the basis of observable behavior. One could argue that most people in the country have now observed more of Trump’s behavior than a clinician could during a single office visit. And then there’s the argument that to keep silent is in itself an ethical violation, if a professional believes that a person could pose a real and present danger to himself or others. That may help explain why, as of fall 2017, a book titled “The Dangerous Case of Donald Trump”—in which “27 psychiatrists and mental health experts give their assessments of the president”—was in its third week on The New York Times bestseller list.