Background on Ethics of Commentary on Public Figures

 

 

ETHICS OF COMMENTARY ON MENTAL HEALTH OF PUBLIC FIGURES FOR PSYCHIATRISTS, PSYCHOANALYSTS AND PSYCHOLOGISTS

 

  1. BACKGROUND

In 1963, during the presidential campaign between Lyndon Johnson and Barry Goldwater, a large number of psychiatrists were surveyed by Fact magazine (now defunct) about Senator Goldwater’s mental fitness for political office.  The interviewed psychiatrists were quoted as offering diagnostic impressions such as that Goldwater was psychotic or paranoid.  Obviously none had had any personal contact with the Senator.  Senator Goldwater successfully sued Fact Magazine for libel.

Following the Goldwater episode the American Psychiatric Association its ethics code to prohibit such commentary on public figures.  The American Psychoanalytic Association issued a strongly worded and tightly reasoned position statement directing its members to avoid commenting on public political figures.  This statement calls impressions derived from distant observation of a public figure are unverified and may be regarded as authoritative and scientific when in fact they are not.  The 1964 Statement cautions that a sense of social responsibility that an analyst might feel does not abrogate his or her responsibility to follow these constraints. The authors of the statement state clearly that psychoanalytic observations about public figures necessarily cannot be assumed to have legitimacy.   They write,

Professional  judgments regarding  the  mental  stability  of  any  person  have  to  be  based  on  carefully  evaluated psychological  data  which  must  be  secured  through  a  detailed  review  of  the  life history  and  a  thorough  clinical  examination.  Such  information  is most  reliable when  obtained  in  a  therapeutic  relationship  in which  there  is  the  expectation  of confidentiality  and  the wish  to  be  relieved  from  emotional  suffering  as  a  motivation for  self-revelation. (1)

 

Strong feelings about political issues may be expected to impair with the psychoanalyst’s objectivity. And, Drs Kohut, Anderson and Moore, authors of the 1964 APsaA statement, point out that severe mental illness in a politician will not escape public notice.  Beyond this gross assessment of impairment, they argue, psychoanalysts have no basis to claim scientifically sound judgments. It is important to note that the Kohut et al opinion is based on the issue of professional competence, rather than an arbitrary prohibition.  They insist that psychoanalysts knowledge about an individual can only derive from a personal clinical assessment in a confidential environment.  By definition, these conditions are not present when “diagnosing” a public figure.

When viewed from the angle provided by the issue of competence, the rule for psychoanalysts is analogous to codes of conduct common in other professions.  One is expected to practice ones profession only within ones area of competence.  For example, in the American Bar Association’s ethical code, the requirement of competence (possessing sufficient knowledge and skill to represent a client) is the first rule.

2. AMERICAN PSYCHIATRIC ASSOCIATION ETHICS CODE

 

In the wake of the Goldwater affair, the American Psychiatric Association added the following rules to its ethics code (I believe this preceded the APsaA 1964 statement but I’m not entirely sure; in any event psychoanalysis dominated psychiatry at the time and vice versa).

 

http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards/Principles-of-Medical-Ethics-2010-Edition.aspx?FT=.pdf

  1. Psychiatrists should foster the cooperation of those legitimately concerned with the medical, psychological, social, and legal aspects of mental health and illness. Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government. A psychiatrist should clarify whether he/ she speaks as an individual or as a representative of an organization. Furthermore, psychiatrists should avoid cloaking their public statements with the authority of the profession (e.g., “Psychiatrists know that ”).
  2. Psychiatrists may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness. Psychiatrists should always be mindful of their separate roles as dedicated citizens and as experts in psychological medicine.
  3. On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

3.  FULL TEXT OF AMERICAN PSYCHOANALYTIC ASSOCIATION POSITION STATEMENT 1964

 

Following the APA ethics code addition the American Psychoanalytic Association approved the following position statement written by then President Heinz Kohut, Russell Anderson and Burness Moore.  (APsaA has not added this to our ethics code as the APA’s did, but relies on the position statements, which do carry the force of the professions consensus judgment.   As far as the ethics code is concerned it was considered to be covered by more general statements about professional behavior. I personally disagreed with this decision but lost that fight.)

A  STATEMENT  ON  THE  USE  OF  PSYCHIATRIC  OPINIONS  IN  THE  POLITICAL  REALM

BY  THE  AMERICAN  PSYCHOANALYTIC ASSOCIATION

Comments  solicited  from  psychiatrists  have  been  used  in  a  recent  article  to support  conclusions  about  the  mental  stability  of  a  political  candidate.  The American  Psychoanalytic  Association  views  with  concern  such  use  of  professional opinion;  unverified  impressions,  when  offered  by  specialists  in  any  field,  may  be regarded  as  authoritative  and  scientific when  in  fact  they  can  be  neither.

It  is  understandable  that  some  members  of  the  professions  dealing  with  mental illness might  wish  – out  of  a  sense  of  social  responsibility  – to  share  their  knowledge  with  the  public  in  order  to  make  a  contribution  to  one  of  the  most  important activities  in  a  democracy:  the  choice  of  a  leader.  However,  professional  judgments regarding  the  mental  stability  of  any  person  have  to  be  based  on  carefully  evaluated psychological  data  which  must  be  secured  through  a  detailed  review  of  the  life history  and  a  thorough  clinical  examination.  Such  information  is most  reliable when  obtained  in  a  therapeutic  relationship  in which  there  is  the  expectation  of confidentiality  and  the wish  to  be  relieved  from  emotional  suffering  as  a  motivation for  self-revelation.  These  conditions  do  not  exist  in  a  political  campaign.  Not  only are  the  available  data  about  the  emotional  stability  of  a  public  figure  different from  those  with  which  the  psychiatrist  and  psychoanalyst  usually  work,  but  the  strong feelings  aroused  impair  that  objectivity  which  is  necessary  for  scientific  assessment  of  behavior.  Psychiatrists  and  psychoanalysts,  no  less  than  other  people,  are subject  to  the  insecurities  and  emotions  which  may  distort  judgment  and  are  inevitably stirred  up  during  a  political  campaign.

Although the  presence  of  severe  and  crippling mental  illness  is,  of  course, disqualifying,  these  conditions  do  not  escape  public  recognition.  Apart from such  instances,  however,  there  are  no  valid,  well  established  psychological  criteria which  can  be  applied  in  the  evaluation  of  the  personality  of  a  political  leader.  It is not the presumed underlying  bases  of  behavior  which  count,  but  how  these  are  resolved  in  final  aims  and  actions.  At the present state  of  our  knowledge,  therefore, judgments  about  a  political  candidate  must  be  based  on  his  views,  the  political company  in which  he  moves,  his  past  opinions  and  actions,  and  those  aspects  of  his character which  are  open  to  the  scrutiny  of  all,  rather  than  on  an  assessment  of his  emotional  conflicts  and  idiosyncrasies.

Like  other  citizens,  the  psychiatrist  or  psychoanalyst  has  the  right  to  take sides  in  public  affairs  and  to  express  his  opinions,  privately  or  publicly,  about the  candidates  competing  for  office.  In  so  doing  he  will,  of  course,  draw  from  his personal  experiences,  predilections  and  biases  as  well  as  from  his  scientific knowledge.  The  American  Psychoanalytic  Association  is  convinced,  however,  that such  private  views  must  not  be  regarded  as  scientific  inferences  that  are  derived from  valid  and  secure  observations.  It  believes  that  the  use  of  such  views  about the  psychological  fitness  of  a  candidate  during  an  election  campaign  serves  no constructive  purpose  in  the  political  life  of  the  nation  and  is  potentially  damaging to  science  in  general  and  to  psychiatry  and  psychoanalysis  in  particular.

10/5/64

 

Heinz  Kohut,  M.D.,  PreSident,  The  American Psychoanalytic Association

  1. Russell Anderson,  M.D.,  Secretary

Burness  E.  Moore,  M.D.,  Chairman,  Committee  on Public  Information

 

4. EXCERPT FROM AMERICAN PSYCHOLOGICAL ASSOCIATION CODE OF ETHICS

(I don’t know the date of this plank)

Standard 5.04

5.04 Media Presentations

When psychologists provide public advice or comment via print, Internet, or other electronic transmission, they take precautions to ensure that statements (1) are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice; (2) are otherwise consistent with this Ethics Code; and (3) do not indicate that a professional relationship has been established with the recipient. (See also Standard 2.04, Bases for Scientific and Professional Judgments.)

 

9.01 Bases for Assessments (a) Psychologists base the opinions contained in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings. (See also Standard 2.04, Bases for Scientific and Professional Judgments.)

(b) Except as noted in 9.01c, psychologists provide opinions of the psychological characteristics of individuals only after they have conducted an examination of the individuals adequate to support their statements or conclusions. When, despite reasonable efforts, such an examination is not practical, psychologists document the efforts they made and the result of those efforts, clarify the probable impact of their limited information on the reliability and validity of their opinions, and appropriately limit the nature and extent of their conclusions or recommendations. (See also Standards 2.01, Boundaries of Competence, and 9.06, Interpreting Assessment Results.)

 

Ethical Principles of Psychologists and Code of Conduct

2010 Amendments

http://www.apa.org/ethics/code/?item=13#1001b

 

5. EXCERPT AMERICAN BAR ASSOCIATION MODEL RULES FOR PROFESSIONAL CONDUCT

 

(I include this to demonstrate that professions regularly limit “scope of opinion” on the principle of properly derived knowledge)

American Bar Association

Model Rules of Professional Conduct 2010

 

Client-Lawyer RelationshipRule 1.1 Competence

A lawyer shall provide competent representation to a client. Competent representation requires the legal knowledge, skill, thoroughness and preparation reasonably necessary for the representation.

 

Prudence Gourguechon, M.D.

June 7, 2015