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Gold Water Rule

  1. 1. Gold Water Rule Should psychiatrists be allowed to publicly comment on mental health of public figures? Barry Goldwater Martha Mitchell Nellie Bly
  2. 2. Introduction • The Goldwater rule is section 7 in the American Psychiatric Association's (APA) Principles of Medical Ethics, • Which states that “it is unethical for psychiatrists to give a professional opinion about public figures whom they have not examined in person, and from whom they have not obtained consent to discuss their mental health in public statements”. • It is named after former US Senator and 1964 presidential candidate Barry Goldwater.
  3. 3. Principles of Medical Ethics
  4. 4. US Senator and 1964 presidential candidate Barry Goldwater
  5. 5. Introduction • The issue arose in 1964 when Fact published the article "The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater".
  6. 6. Goldwater v. Ginzburg
  7. 7. Introduction • The magazine polled psychiatrists about US Senator Goldwater and whether he was fit to be president. • Goldwater sued magazine editor Ralph Ginzburg and managing editor Warren Boroson, and in Goldwater v. Ginzburg • (July 1969) received damages totaling $75,000 ($512,000 today)
  8. 8. The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater
  9. 9. Goldwater sued magazine editor Ralph Ginzburg and received damages totalling $75,000 ($512,000 today) Editor Ralph Ginzburg
  10. 10. Description • Section 7, which appeared in the first edition of the American Psychiatric Association's (APA) • Principles of Medical Ethics in 1973 and is still in effect as of 2018,
  11. 11. American Psychiatric Association's (APA)
  12. 12. Description • 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.
  13. 13. On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention
  14. 14. Description • 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
  15. 15. 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
  16. 16. American Psychological Association • The APA Ethics Code of the American Psychological Association, a different organization than the American Psychiatric Association, also supports a similar rule.
  17. 17. American Psychological Association • American Psychological Association President Susan H. McDaniel published a letter in The New York Times in which she stated: • Similar to the psychiatrists' Goldwater Rule, our code of ethics exhorts psychologists to "take precautions" that any statements they make to the media "are based on their professional knowledge, training or experience in accord with appropriate psychological literature and practice" and "do not indicate that a professional relationship has been established" with people in the public eye, including political candidates.
  18. 18. American Psychological Association President Susan H. McDaniel
  19. 19. American Psychological Association • When providing opinions of psychological characteristics, psychologists must conduct an examination “adequate to support statements or conclusions”. • In other words, our ethical code states that psychologists should not offer a diagnosis in the media of a living public figure they have not examined
  20. 20. ethical code states that psychologists should not offer a diagnosis in the media of a living public figure they have not examined
  21. 21. American Medical Association • In the fall of 2017, the American Medical Association's Council on Ethical and Judicial Affairs wrote new guidelines into the AMA Code of Medical Ethics, stating that physicians should refrain "from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine."
  22. 22. Physicians should refrain "from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine."
  23. 23. 'Goldwater Rule' • Psychiatrists are increasingly being contacted by the media to comment on persons whose violent acts have captured national attention. • It is alarming and an embarrassment for our profession to have reckless assertions of this kind disseminated by the media. • But they do serve the purpose of raising important questions about our professional conduct. • How should our profession respond to requests for media interviews?
  24. 24. 'Goldwater Rule'
  25. 25. Gold Water Rule • Psychiatrists are bound by the ethical code of the medical profession, specifically defined in The Principles of Medical Ethics of the AMA and in APA. • These Principles are “standards of conduct that define the essentials of honorable behavior for the physician.” • Within these Principles can be found clear direction on the ethical requirements for communicating with the media. • Section 5 and Section 7 speak most directly to this issue:
  26. 26. Gold Water Rule
  27. 27. Gold Water Rule • Section 5 • A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
  28. 28. Gold Water Rule • Section 7 • Psychiatrists may interpret and share with the public their expertise in the various psychosocial issues that may affect mental health and illness.
  29. 29. Gold Water Rule • Educating the public about psychiatric matters and human behavior is not only ethical but laudable and encouraged by the Principles.
  30. 30. Gold Water Rule • There is still general misunderstanding about mental illness, and public education not only addresses this area, but also the associated stigmatization of persons who are mentally ill.
  31. 31. “Goldwater Rule.” • Section 7.3 • 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.
  32. 32. Goldwater Rule
  33. 33. Gold Water Rule
  34. 34. Gold Water Rule • When commenting on individuals in the public eye, psychiatrists should be governed by concerns for the potentially inflammatory and harmful consequences of their statements. • The reputation of the public figures involved, their own credibility, and the dignity of our profession are at stake. • Only after performing an examination and receiving an appropriate waiver of confidentiality should psychiatrists comment on persons in the light of public attention.
  35. 35. Gold Water Rule
  36. 36. Gold Water Rule
  37. 37. Gold Water Rule • Goldwater rule has come into focus – the convention that psychologists should not give an opinion about the mental state of a person they have not examined.
  38. 38. Gold Water Rule
  39. 39. Where does the Goldwater rule come from? • In 1964 the Arizona senator Barry Goldwater ran as the Republican candidate for the presidency against the serving president Lyndon B. Johnson. • Goldwater’s political career was marked by a series of tough battles, from succeeding as a markedly conservative senatorial candidate in a Democrat- leaning state, to a bruising primary campaign to win the 1964 candidacy. • Goldwater lost the presidential race for a number of reasons – his aggressive rhetoric against the USSR and his restrictive fiscal policies troubled even his own party – but a large factor was an article that appeared in a US magazine.
  40. 40. Where does the Goldwater rule come from?
  41. 41. Gold Water Rule • During the campaign, Fact magazine published an article entitled “1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President!”. The figure came from an informal poll of US psychiatrists, and included the many comments about Goldwater’s emotional stability and fitness to serve. • The Goldwater campaign sued the magazine, which was found to have defamed the senator. The court fined the editors and publishing company of Fact an eye-watering $75,000. Subsequently the APA introduced its rule on speculative diagnosis.
  42. 42. Gold Water Rule
  43. 43. Why is the Goldwater rule valuable? • The Goldwater rule protects us all against prurient speculation about our mental health. In order for us to succeed in life, or to succeed in public office, we must command the trust of people around us. • Undermining the faith we must have in other person’s mental state carries with it the implication that we should be wary of their future actions, or in their ability to persevere when gets tough.
  44. 44. Why is the Goldwater rule valuable?
  45. 45. The Future Of The Goldwater Rule • The Goldwater rule is binding only for the members of the American Psychiatric Association. • However, it is an example of a guiding principle that reminds practitioners of the limits of their knowledge.
  46. 46. The Future Of The Goldwater Rule
  47. 47. The Future Of The Goldwater Rule • Professional practicing and academic psychologists should be encouraged to speak publically about mental health, for the benefit of us all. • But to speak about the mental state of a public figure, without having met that person, is a violation of professional ethics. • Goldwater is a rule that protects us all.
  48. 48. The Future Of The Goldwater Rule
  49. 49. Famous People Who Were Successful Despite Their Mental Health Issues • Research shows that harmful stereotypes about mental illness often prevent people from seeking treatment or speaking out at all. • Luckily, in recent years, we’ve seen a shift in the way people view and talk about these issues.
  50. 50. Famous People Who Were Successful Despite Their Mental Health Issues • According to mental health experts it really helps to talk about this stuff. • In fact, when public figures open up about their own mental health struggles, it can help break down stigmas, and even inspire people to go get help and seek treatment.
  51. 51. According to mental health experts it really helps to talk about this stuff
  52. 52. When public figures open up about their own mental health struggles, it can help break down stigmas, and even inspire people to go get help and seek treatment
  53. 53. Isaac Newton • Most famous mathematician of the 17th Century was responsible for many scientific discoveries we take for granted today such as the "corrected” Gregorian calendar date. • Newton’s greatest mathematical discovery was the gravitational relationship between the earth and the moon, and of centrifugal force
  54. 54. Isaac Newton
  55. 55. Famous People Who Were Successful Despite Their Mental Health Issues • He suffered from several “nervous breakdowns” in his life and was known for great fits of rage towards anyone who disagreed with him which some have labeled Bipolar Disorder which was unknown at the time. • In 1705 Newton was the first Scientist to be knighted by Queen Anne for his great scientific contributions.
  56. 56. Isaac Newton
  57. 57. Abraham Lincoln • 16th President of U.S. suffered from severe and debilitating and on occasion suicidal depressions, as recorded by Carl Sandburg in his comprehensive six-volume biographical analysis of his life.
  58. 58. Abraham Lincoln
  59. 59. Abraham Lincoln • The most amazing part of his story was the sheer determination with which he willed himself to over come his serious affliction and still achieve all he was able to achieve.
  60. 60. Abraham Lincoln
  61. 61. Vincent Van Gogh • Famous painter and artist was labeled peculiar with unstable moods most of his short life. • He suffered from epileptic seizures some believe from excesses of absinthe, very strong liquor. • Popular among talented people for inspiring greater creativity
  62. 62. Vincent Van Gogh
  63. 63. Winston Churchill • Prime Minister of Great Britain who, as one of the “Big Three”(Churchill, Roosevelt and Stalin) to lead the world to the defeat of Hitler in WWII, told in his own writings of suffering from “black dog” Churchill’s term for severe and serious depression. • Like so many other famous people with a mental illness, he was able to make the great contribution he did through sheer personal determination
  64. 64. Winston Churchill
  65. 65. Virginia Woolf • The British novelist, born of privilege, experienced the mood swings of bipolar disorder her entire life. • She wrote to make sense out of her mental chaos and gain control of madness; and was greatly admired for her creative insight into human nature. • She was tolerated by friends and family, receiving great care and understanding during her entire life and because of this, never had to face institutionalization, the only medical “treatment” in those days.
  66. 66. Virginia Woolf
  67. 67. Linda Hamilton • Actress, has gone public with her diagnosis of bi-polar disorder diagnosed at a young age. • Hamilton, well known for her part with Arnold Schwarzenegger in “The Terminator” movies explains how helpful medication has been for her and that she understands she will have to be on medication for the rest of her life.
  68. 68. Linda Hamilton
  69. 69. Judy Collins • Singer and song writer, has written a book titled “Sanity and Grace: A Journey of Suicide, Survival and Strength,” (2003). • The book chronicles her journey as a survivor of depression after the suicide of her 33-year- oldson in 1992.
  70. 70. Judy Collins
  71. 71. John Nash • Nobel Prize Winner in mathematics, has faced a life long battle with schizophrenia. • He was known as the “Phantom of Fine Hall” at Princeton where his reclusive, ghost like figure could be seen roaming around, leaving messages of his mathematical genus on the boards of empty classrooms. • His struggle was well documented in the book “A Beautiful Mind,” by Sylvia Nasar which was later made into a movie by the same name.
  72. 72. John Nash
  73. 73. Terminology • Armchair Diagnosis • Armchair diagnosis is a term used when professionals or non professionals diagnose someone they have never treated.
  74. 74. Personality Disorder • A deeply ingrained pattern of behaviour of a specified kind that deviates markedly from the norms of generally accepted behaviour, typically apparent by the time of adolescence, and causing long-term difficulties in personal relationships or in functioning in society.
  75. 75. Personality Disorder
  76. 76. Grandiosity • In the field of psychology, the term grandiosity refers to an unrealistic sense of superiority, characterized by a sustained view of one's self as better than other people, which is expressed by disdainfully viewing them as inferior.
  77. 77. Grandiosity
  78. 78. Empathy • Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, that is, the capacity to place oneself in another's position
  79. 79. Narcissism • Narcissism is the pursuit of gratification from vanity or egotistic admiration of one's idealised self image and attributes. • This includes self-flattery, perfectionism, and arrogance
  80. 80. Narcissism
  81. 81. Gas Light • Manipulate (someone) by psychological means into doubting their own sanity.
  82. 82. Celebrity Worship Syndrome • Celebrity worship syndrome (CWS) is an obsessive addictive disorder in which a person becomes overly involved with the details of a celebrity's personal and professional life.
  83. 83. Celebrity Worship Syndrome
  84. 84. Schizophrenia • Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
  85. 85. Schizophrenia
  86. 86. Schizophrenia
  87. 87. Bipolar Disorder • Bipolar disorder is a mental illness marked by extreme shifts in mood. • Symptoms can include an extremely elevated mood called mania. • They can also include episodes of depression. • Bipolar disorder is also known as bipolar disease or manic depression.
  88. 88. Bipolar Disorder
  89. 89. Martha Mitchell Effect • The Martha Mitchell effect is the process by which a psychiatrist, psychologist, other mental health clinician, or a medical professional, labels the patient's accurate perception of real events as delusional and misdiagnoses accordingly.
  90. 90. Martha Mitchell Effect
  91. 91. Martha Mitchell Effect • According to Bell et al., "Sometimes, improbable reports are erroneously assumed to be symptoms of mental illness", due to a "failure or inability to verify whether the events have actually taken place, no matter how improbable intuitively they might appear to the busy clinician". • Examples of such situations are: • Pursuit by organized criminals • Surveillance by law enforcement officers • Infidelity by a spouse • Physical issues
  92. 92. Martha Mitchell Effect
  93. 93. Rosenhan Experiment • The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. • The experimenters feigned hallucinations to enter psychiatric hospitals, and acted normally afterwards. They were diagnosed with psychiatric disorders and were given antipsychotic drugs. • The study was conducted by psychologist David Rosenhan, a Stanford University professor, and published by the journal Science in 1973 under the title "On being sane in insane places"
  94. 94. Rosenhan Experiment
  95. 95. Psychologist David Rosenhan, Stanford University Professor
  96. 96. “Being Sane in Insane Places” The Rosenhan Experiment
  97. 97. 10 Days in a Madhouse • Nellie Bly • Elizabeth Cochran Seaman, better known by her pen name Nellie Bly was an American journalist who was widely known for exposé in which she worked undercover to report on a mental institution. • She was a pioneer in her field, and launched a new kind of investigative journalism.
  98. 98. 10 Days in a Madhouse
  99. 99. 10 Days in a Madhouse • 10 days in a Madhouse is a 2015 American biographical film about undercover journalist Nellie Bly, a reporter for Joseph Pulitzer's New York World who had herself committed to the Women's Lunatic Asylum on Blackwell's Island to write an exposé on abuses in the institution
  100. 100. 10 Days in a Madhouse
  101. 101. The Goldwater Rule: talks with Maria A. Oquendo, MD, PhD • https://youtu.be/d36hZ7fyZN4
  102. 102. The Goldwater Rule - A Conversation Between Dominic A. Sisti and Jonathan D. Moreno • https://youtu.be/kdx-iF6dxkA
  103. 103. References American Psychological Association (APA) • https://www.apa.org/ APA’s Goldwater Rule Remains a Guiding Principle for Physician Members • https://www.psychiatry.org/newsroom/news-releases/apa-goldwater-rule-remains-a- guiding-principle-for-physician-members Famous People and Mental Illnesses • http://www.mentalhealthministries.net/resources/flyers/famous_people/famouspeople.pdf Goldwater rule • https://en.wikipedia.org/wiki/Goldwater_rule Goldwater Rule’s Origins Based on Long-Ago Controversy • https://www.psychiatry.org/newsroom/goldwater-rule Goldwater rule? Should psychiatrists be allowed to publicly comment on mental health of public figures? • https://www.sciencedaily.com/releases/2017/12/171205115957.htm Mental Health Experts Urge Revision of the Goldwater Rule • https://www.psychologytoday.com/us/blog/psychiatry-in-society/201806/mental-health- experts-urge-revision-the-goldwater-rule The Goldwater rule: why commenting on mental health from a distance is unhelpful • https://www.theguardian.com/science/head-quarters/2017/jul/28/the-goldwater-rule-why- commenting-on-mental-health-from-a-distance-is-unhelpful
  104. 104. Thanks…

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