POTUS and the Goldwater Rule By Herbert S. Sacks, M.D. APA President

Sensational allegations about the POTUS's [President of the United States) personal behavior in the past few weeks have elicited furious countercharges. Regrettable forces will keep this story in the news. Starr Chamber proceedings compel new examination of the independent counsel statute especially in light of Justice Scalia's 1988 opinion questioning the counsel's inquisitorial role in skewing our delicately balanced constitutional powers and processes. Overheated media coverage of unexamined rumor presented as fact is followed by mea culpa expressions of regret. An unintended consequence of the firestorm engulfing hyperbolic media distortions has been to leave most thoughtful Americans freer to shape their own views. Driving the discussion is our national preoccupation with prudery and prurience.

In recent years presidential historians have written about the extramarital lives of 14 White House chief executives, who constitutionally hold extraordinary powers. Across the board, bad behavior has been no rarity at 1600 Pennsylvania Avenue. Franklin Pierce and Andrew Johnson suffered with alcoholism; George Washington was involved in shady land deals; corruption and graft were hallmarks of Tyler, Taylor, Grant, and Arthur; Nixon covered up crimes; and Ronald Reagan ran an extralegal foreign policy in a calculated climate of "deniable plausibility."

Today our more permissive views on morality and sexual expression have stirred up the citizenry to weigh matters openly, matters that were scarcely kitchen commentary 40 years ago. While adults approach the issues soberly and yet with some levity, teenagers in their own sexual preoccupations create new lewd jokes, and school-aged children in my playroom want explanations of arcane legal terms ("What is suborning perjury, Dr. Sacks?")

Citizens first, invested in the life of the mind, we in psychiatry have joined in the discussions. But even before the present situation unfolded, psychiatrist political partisans pushed their agenda in intemperate public displays of metapsychology, psychodynamics, and omniscience. Psychobabble reported by the media undermines psychiatry as science. In the president's column in the September 19, 1997, issue of Psychiatric News, titled "Faites-Moi Confiance, Je Suis Psychiatre" ("Trust Me, I'm a Psychiatrist"), provoked by the psychopolitical foolishness of one of Canada's most distinguished psychiatrists, I wrote:

"We are reminded of the 1964 Goldwater-Johnson election, when 1,189 American psychiatrists responded to an inquiry for their opinions of the candidates by a now defunct magazine. The bulk of the political responses, couched in psychiatric terminology, were so unfair and so outrageous to Goldwater that he sued and won a substantial settlement. APA issued public statements decrying such analyses and in 1973, when the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry were drafted, Section 7.3, stated: '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. It is unethical for psychiatrists to offer a professional opinion unless he/she has conducted an examination and has been granted proper authorization for such a statement.' The Canadian Psychiatric Association has a parallel ethical standard."

A related guideline recognizes that "[p]sychiatrists 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 experts in psychological medicine."

My cautions to colleagues, certainly valid today, have been overridden by the intensities created by the newest Clinton disclosures. With my strong initiative, APA's Division of Public Affairs, already cranked up to go, took the following speedy actions:

• Prepared a new fact sheet, "Is Compulsive Sexual Behavior a Mental Disorder?," which says emphatically that DSM-IV does not classify compulsive sexual behavior as a psychiatric disorder, and which reminds news media that APA's ethical guidelines do not permit a psychiatrist to comment on specific aspects of a public figure's mental health.
• Publicized the major points and availability on two APA electronic communications list serves: "Member-to-Member" and "PsychIMAGE," which reaches the Public Affairs Network and our media speakers.
• Placed the fact sheet on the CompuServe Journalism Forum, the most popular news source for working journalists.
• Arranged for the fact sheet to be placed on the APAfastFAX and APA's Web site and provided it to the Psychiatric News staff for an article in the February 6 issue.
• Provided the fact sheet to APA's Division of Government Relations for use in responding to Congressional queries.

I responded to a January 26 article in the Wall Street Journal, titled "Bonfire of the Presidency," which cleverly defined the President's behavior as reflecting an antisocial personality disorder and listing several traits. In my letter, which was published on February 6, I cautioned the Journal's readership about the risks of "armchair diagnoses" by editorial writers and noted that psychiatrists would not diagnose based upon news reports and in fact are barred from doing so by the Goldwater Rule (see above).

The POTUS imbroglio has led some colleagues to throw caution to the winds:

• A member psychiatrist on the Eastern seaboard wrote a quasi-scientific piece for the readership of a major newspaper patching together public knowledge of the President's family history, neurophysiology, and psychodynamic formulation-a potent but indigestible porridge, burdened by confusing speculation and blurred science.
• A national weekly news magazine ran a full-page editorial by a nonpsychiatrist who engaged in psychological speculation about Mr. Clinton's predicament. His last paragraph was illuminating, where he writes that he called a psychoanalyst friend to confirm or deny his speculations. Her reminder "was that a trained psychoanalyst ought only to speculate about a patient's vulnerabilities 'in the context of care.' She didn't say so, but I think she applied that caution to everyone."
• A psychiatrist author wrote a full-page column in another national news magazine using the assumption that the President endangered his career for the sake of a sexual encounter as a launching pad for a broad discourse on risk-taking, hyperthermic men, narcissism, and evolutionary psychiatry. Entertaining-yes, but violative of the Goldwater Rule-no.
• A non-APA member psychiatrist political columnist of a national newspaper buttressed his hypotheses about the President's spin-doctoring of a range of linked events, all with legal implications by citing his authority "as a psychiatrist." His column excited an informed exchange across the nation on the APA Member-to-Member list serve.
• A non-APA member psychiatrist, self-identified as a "media psychiatrist," has developed a supplementary career on tabloid television analyzing the penchants and peccadilloes of public figures.

My views on the moral and ethical posture of all psychiatrists, members or not of APA, insist that we conduct ourselves with dignity and professionalism in the public eye. Members are further constrained by the dictates of our ethical principles. Nonmembers be warned that state licensure boards may take notice of perceived excesses of customary and acceptable public behavior by all physicians.

I concluded my September 19 column with words that surely resonate today:

"The heart of the matter is that psychiatrists can speak as citizens on matters that affect the political, social, and economic developments of the day and touch upon mental illness. However, our professional identities are 'epoxied' to our individual personas in the public vision. When we are passionate about the body politic and our national leadership, we cannot hide behind claims of professional objectivity. To do so risks our country's leadership and demeans our chosen field. To do so will enhance public skepticism about our science."