Interest in the Goldwater Rule, a rule prohibiting certain mental-health professionals from tele-diagnosing public figures and publishing their results, has arisen in the wake of a rare bull market in psychiatric opinions. This precipitous rise in demand in an industry reduced to chasing shrinking insurance dollars is fueled by the media’s appetite for anti-Trump psycho-spin.
There’s a civil war in the mental-health establishment between rogue professionals who can’t resist grabbing their 15 minutes of fame and the umbrella associations they belong to, which impose the kind of prudence and impulse control you might expect of those who pronounce on everybody else’s behavioral health. At its core, this in-fighting reflects the Left’s need to recruit the appearance of scientific truth to undo the trauma of its political dethronement.
I Must Break the Rules to Proclaim My Virtue
Mental-health associations regulate practitioners in the same way bar associations regulate lawyers. They set standards. They control outliers in order to save the integrity and reputation (and no doubt economic viability) of the groups they oversee. On their discipline rests the credibility of the science underlying and justifying each group’s practices.
Recently, the major associations have affirmed or tightened their respective versions of the Goldwater Rule. They have determined that the scientific premises of their practices would be compromised by preening practitioners left to their own devices. If you want to be generous, you could also say they were mindful of the crimes psychiatry and psychoanalysis have colluded in committing throughout the twentieth century when they allowed themselves to become politicized and the mouthpieces of powerful interests.
In opposition to their self-restraint and due care, a number of journalists and mental-health professionals have advocated for rescinding the rule. Their arguments portray the rule as a holdover from a famous 1969 Barry Goldwater libel case and in violation of the First Amendment. Muzzling the individual practitioner, they claim, interferes with his or her “duty to warn” the rest of us of the “clear and present danger” (both pseudo-authoritative takeovers of legal terms) of the president’s mental state.
Those who defy their associations are depicted as heroically braving censure for the sake of contributing their clinical brilliance to the “public conversation.” Apparently, we desperately need this to exercise our own political judgment.
The position statements of the American Psychiatric Association, American Psychological Association, and American Psychoanalytic Association, however, reveal a very different picture. The statements carefully enunciate a range of concerns, indeed, a veritable rainbow of unease, at the prospect of members opining at their whim. One mentions, for instance, the feelings of patients forced to watch those in a position to receive their confidences wielding their supposed expertise for political spectacle. Imagine Nancy Pelosi with a prescription pad.
Although the left-liberal attacks on the rule dismiss its present relevance, they often contain the very kinds of inaccuracies and distortions that helped Goldwater win in the Second Circuit his libel case against a publisher who maligned his mental stability, despite the post-Sullivan stringent criteria for finding libel against a public figure.
For example, the American Psychoanalytic Association (APsaA) recently issued a stance on the rule soon followed by a correction to the reaction to that stance. But a more recent article in The New Yorker incorporated the original caricature from the first publication without any acknowledgement of the ApsaA’s intervening extended disavowal and correction. Surely, a faithful portrayal of the considered decisions of the professional associations involved is also relevant to the “public conversation” of which liberals are so solicitous?
If you have a taste for this sort of thing, I recommend reading the Second Circuit decision. Although issued in 1969, it is far from obsolete. In its analysis of the defendant publisher’s distortions, it reads like a contemporary piece smartly eviscerating fake news. So perceptive is the judge’s cognizance of veiled lies and manipulated language, it can be hard at moments to remember that this is a landmark decision that is still good law from one of the most important federal appellate courts in the country.
Is the DSM Fake Science?
It might be helpful to remember that many professional organizations are out there speaking variously for psychiatrists, psychoanalytic physicians, psychologists, psychologists who purport to practice psychoanalysis, psychoanalysts who are neither psychologists nor social workers, cognitive therapists, family therapists, psychiatric nurses, social workers, and “mental health experts” of nebulous origin, all of various stripes and licensure. The organizations’ descriptions of their members, sometimes overlapping, give scant clue as to the complicated and contentious rivalries that exist among them. Oedipal balkanization aside, the APsaA’s diktat about who can say what about whom makes clear it applies only to members of the APsaA.
That should be a good start to setting straight at least the legitimate confusion clouding this issue. But the reason APsaA articulated its “distinct ethics position” now may well be proprietary rather than purely elucidative. The mental-health profession has been swamped with individuals, some with relatively little training, calling themselves analysts or “analysts in training” and clamoring for outlets to advertise their therapeutic wares. Therapists at all levels are under pressure to stake out specialties, sometimes exceedingly eccentric and politicized ones, to underwrite their practice.
Although membership serves as a proxy for scientific consensus, a sampling of commentary from fellow specialists quickly reveals no such consensus exists. Instead, anxiety about branding and “de-skilling” seem to drive both sides. Take the APsaA’s statement, which repeatedly cautions against “wild analysis” that “undermin[es] the basis for psychoanalytic inference.”
In addition to grim economics, there’s plenty to caution against. The basis for forming the “psychoanalytic inference” is free speech between the patient and analyst. But the fate of that speech in our increasingly intrusive PC culture has, in my view based on extensive personal experience, already been severely crippled.
Against this chaos of political pressure, internecine warfare, and scientific posturing looms yet another problem, one we never hear about in all the public lobbying to rescind the rule. It is that we as lay people and health consumers genuflect to the DSM. “The Diagnostic and Statistical Manual of Mental Disorders” is the source psychiatric name-callers customarily draw from. Yet it is at bottom a billing system.
Kate Schechter in “Illusions of a Future,” an in-depth account of the history of the Chicago institute that launched a prominent president of the APsaA, describes the DSM as the mental-health equivalent of the American Medical Association’s procedure codes. Both are “fractionation tools by which insurers can count and commensurate ‘medical episodes’ by time spent and procedure conducted.” Many psycho-therapists she interviewed struggled with even using it. They ultimately capitulated for the sake of getting paid.
So mystical is the DSM’s iterative magic, however, despite its genesis in accounting and information technology, we invoke coding labels like “narcissistic personality disorder” and “depressive disorder” as if that alone admits us into a Platonic realm of exactitude and insight. Classifications like “gender dysphoria” are put forth as apolitical and unchallengeably evidence-based and thereby become weaponized in fights that affect people’s fundamental rights. This has led to the rise of a priestly class of psyche workers with institutionalized entitlements to pass off their quotidian prejudices as worthy of reverence. No wonder so many mental health professionals want in on the action.
The APsaA’s diktat should be read in this context. In the “position statement,” it gives members workarounds with which to express their opinions, as well as weigh in as clinicians on issues, rather than personalities. These guidelines give practitioners plenty of room to comment on current events. They clearly establish their freedom to speak their mind as individuals, without invoking a clinically based expertise that has been gutted of substance by the absence of actual clinical observation and agreed-upon safeguards.
But that is not enough for those seeking to enlist a hodgepodge of scientific abstractions into their campaign to impeach the president and achieve ideological supremacy. They latch onto a First Amendment pretext because they know Americans won’t tolerate repression. Yet they fail to explain that there is no First Amendment cause of action against private organizations. And libel laws would apply, in any event. Indeed, the best thing that could happen would be a defamation action against some of these authors, which would put their diagnostic procedures under a microscope.
Political Correctness by Another Name
In light of the Left’s inroads into our basic protections, ultimate responsibility rests with how we as citizens process allegedly expertized statements. The prevalence of incongruent standards of training and accreditation at all levels of the mental-health profession should alert us to the dangers of a too-willing acceptance of liberal trigger words masquerading as professional judgment or diagnostic speculation.
Can there be any accuracy to the current babble of authoritative-sounding commentary, or is it partisan noise? If the latter, is there any moral hazard in it? In the Soviet Union, psychiatrists and psychoanalysts diagnosed opponents of the Communist Party as per se delusional. Sound familiar? What’s next, stigmatizing supporters of President Trump as not just racists but malignant narcissists?
After Goldwater won his case, in the denial of certiorari by the Supreme Court sealing his victory, Justice Blackmun wrote a two-person dissent. The author of The New Yorker article seems to feel this puts all doubts to rest, as if she doesn’t understand it’s a minority view.
Rather than exculpate the defendant publisher, moreover, Blackmun focused on his total opposition to libel laws. He maintained that even baldly exaggerated and deceptive articles about public officials were warranted in the interest of the First Amendment. Alas, it was a different press then, and perhaps he might have had a point. But today, it is his dissent, not the majority’s refusal to disturb Goldwater’s victory, that is outmoded.
Given the lack of impulse control of today’s majoritarian media, the claims of popularizers of science need to be urgently scrutinized. We should be stingy with the credence we lend their quasi-medical verdicts. We should treat with skepticism clinicians and academics opining on a public figure without proper preparation or coming clean about the fact that they too have skin in the game.
This is not just another sectarian spat or gambit to impeach President Trump now that the Russian collusion story is sputtering out. Psychiatric name-calling is political correctness by another name. Both presume an unrebuttable superiority in divining Truth in matters of complex ethical behavior, in the first case, on the basis of a far-from-infallible professional expertise, in the second, on the basis of victimhood.
Psychiatric labeling and political correctness have other things in common as well. Both reduce nuanced questions of individual conscience to terse, damning, headline-catching phrases. It is no accident that Freudian studies enjoy widespread popularity on America’s college campuses. They are part of the warp and woof of identity politics. Since the 1980s, these studies have been used to humanize leftist criminal violence, including murder.
Worse, proponents of “the psychological science” claim it has the power to predict future behavior. Guess who are the seers? False clairvoyance also underwrites the Left’s contention that violent deeds that haven’t happened are the necessary outcome of expressing “toxic” ideas and thus indistinguishable from them. It is the logical bridge that permits Antifa to accuse journalists who don’t take their marching orders from the group of “perpetuating rape culture.”
So no matter what organizations should rule in the future in response to the all-too-familiar pressure raining down on them, or how individuals game the restrictions that bind them, as increasing numbers of mental-health professionals issue their off-the-shelf evaluations of President Trump and mug for close-ups, we should be wary. As the political scientist Murray Edelman warned in the 1960s, “The magical associations permeating language are important for political behavior because they lend authoritativeness to conventional perceptions and value premises and make it difficult or impossible to perceive alternative possibilities.” Now of all times, impairing society’s power to envision alternatives is not the trend to be abetting.