Do White Supremacy and Male Superiority Explain ‘the Goldwater Rule’?

If you want to know who controls you, look at who you are not allowed to criticize. - Voltaire

The Connecticut Society for Psychoanalytic Psychology was one of the first organizations to form a “psychoanalysis in society” group in response to the exceptional presidency of Donald Trump. After speaking there a couple years ago, I was invited back with my esteemed colleague, Dr. Kevin Washington, former president of the Association of Black Psychologists, which remains to this day the only mental health association that issued a direct statement about the psychological dangers of this presidency. This time the invitation was for a “Black Lives, In Mind” series, under the title: “Healing Begins Where the Wound Was Made,” echoing the words of renowned author Alice Walker.

Reflecting on the entirety of American history, its legacy of slavery that contradicts its democratic identity, and the desire for nativism that defies the immigrant status — indeed, invasion — of its founders, our ongoing crisis came into perspective.

When we as psychiatrists held our first conference at Yale School of Medicine in April 2017, we felt we had a professional obligation to inform the public of our critical concerns about the new American president. A few months later, we rushed publication of our public-service book, The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President, in which we tried to warn the nation of the extreme dangers of entrusting such an unstable man with presidential powers and responsibilities. The book was an unprecedented New York Times bestseller of its kind, and we donated all proceeds from it to remove conflicts of interest.

When we held our major conference at the National Press Club in Washington in March 2019, we stressed over and over the dangers our country was facing with such a president. When in March 2020 we issued our first “Prescription for Survival,” we foresaw and predicted what was coming with the pandemic and how urgent it was to take authority out of the hands of a mentally impaired president.

Our warnings all proved valid. But since they were not acted upon, the United States came to have by far the greatest death toll of any nation of the world, in fact nearly of most other countries combined.

We were extremely careful to keep with all professional and ethical standards, including “the Goldwater rule,” and we made sure our assessments were sound. This did not stop the American Psychiatric Association (APA) from engaging in aggressive public campaigns to denounce us as “unethical” — with one of its past presidents going so far as to lie about us — intervening with the New York Times and other media to stop our coverage. This hampered, and soon stopped, our efforts in their tracks: we went from being the number one topic of national conversation to total blockage from the major media within two weeks in January 2018, never to be revived. The public experienced it as a “switch turning off” on us.

Meanwhile, the APA did nothing to sanction or even comment on its own former officers who actually broke “the Goldwater rule,” diagnosing in great detail by ruling out multiple conditions and diagnosing the president with “incipient dementia,” or definitively diagnosing as not having a specific disorder (ruling out is as much a diagnosis as ruling in). Indeed, ethical principles did not seem to matter at all but only that the president be cleared of serious problems and therefore be allowed to continue in the presidency. Not all APA officers were privileged: when its rare, African-American woman president wished to grant a foremost “Goldwater rule” scholar the opportunity to chair a commission reexamining the “rule”, she was blocked.

Hence, we had a situation where an American president was to kill more Americans in less than one year than all the “terrorists” and foreign enemies in one hundred years! Yet so many were complicit, not the least of which was the APA. Indeed, the most shocking experience of my career has been to observe the APA thus contribute to harming the public’s health, when it was in charge of protecting it, even though the ensuing crises were all predictable. At least we predicted them, with remarkable consensus and precision: we stated that there would be social, cultural, geopolitical, and civic dangers if his psychological dangers were not contained, and we were correct about timing as well as magnitude. We did not know there would be a pandemic, but we stated that, faced with a crisis, Donald Trump would make it far deadlier and more devastating than necessary, as we outlined in our blow-by-blow account.

The APA’s interpretation of “the Goldwater rule” never made sense to me, even as I decried the APA’s hypocrisy in taking financial rewards from the federal government. I knew that Dr. Allen Frances had pharmaceutical-industry conflicts of interest, the way the APA had, and Dr. Jeffrey Lieberman was abjectly projecting when he likened us to Nazi and Soviet psychiatrists. However, just how ordinarily rigorous thinkers such as Drs. Paul Applebaum and Alan Stone — especially the latter, who seemed to pride himself for being innovative and iconoclastic — could accept its intellectually indefensible inconsistencies and injustices, I could not understand.

Then, a message from a member of the public illumined the situation better than any other explanation I came across since 2016:

I wanted to ask if either you, or any of your associates, have ever considered if institutional sexism or racism could be a root cause (or at least contributing factor) in inhibiting medical professionals from diagnosing public figures as dangerous or as exhibiting sociopathic behavior? I’ve read a few other articles about the Goldwater rule and understand the ethics behind limiting one’s professional credentials and opinion in the political sphere, so as to not create more bias and influence in public opinion. However, I am also wondering — if it were a woman or person of color back in the sixties that had been treated the same during the presidential campaign,… would the Goldwater rule still have been created?

I know that’s speculation and not something that can be tested — but I guess what I am getting at is that a lot of dangerous behavior has been allowed by Donald Trump and other white men with similar status, and the Goldwater rule seems like a flawed ethics rule that needs to be amended so that scientific knowledge is used to serve people and populations by limiting violence, and violent behavior, and not limiting speaking up or acting against this behavior. I can’t help but wonder that a group of male professionals in the seventies may have had significant implicit bias against making a more robust, or thoughtful Goldwater rule for the APA because this same group made a rule that stops others from questioning public figures (which were probably predominantly white men), simply because it might then also allow for people like them to be questioned.

If these people that made the APA rule were also predominantly white men, it can be simply out of self-preservation that the nuance for limitations on speaking out against despots like Trump was lost, because of their own ingrained sexist or racist beliefs about the capabilities people in power, because these powerful people may be people that look just like them — so they don’t dare to question “their own” too far.

[A]s diversity grows in more professional fields,… we have a responsibility to also look back at some of these old rules (written and unspoken), and unpack them and any possible biases that they were made with, so that we can use knowledge to always serve people, well-being, and educational progress, and not social norms that have not been working for a majority of us.

One does not have to hypothesize: President Barack Obama was repeatedly described as a “narcissist” by right-wing psychiatrists during his tenure, and the APA did not once bring up “the Goldwater rule.” It was a “rule” that was considered so obscure, many psychiatrists did not even know of it — until it became necessary to speak about a very real and serious condition in a white (and male) president that was putting the nation in clear danger. This is when the APA went on public campaigns to silence truth-tellers, making this obsolete guideline more familiar to the public than the profession’s foremost responsibilities to public health and safety. It did so instead of following proper ethics investigations, since this would not even be possible for the 94 percent of mental health professionals who do not fall under its guild rule, including myself. (An inescapable question is, had I not been a colored woman, leading the same mental health professionals to speak up about this president, would it have dared to rebuke so harshly and almost irrationally?)

After four years of personal puzzlement, this perspective finally answered for me the “why” of “the Goldwater rule”: to shield the racist and sexist power structure from accountability. This is why the APA prohibited for the public what it has regularly performed for the CIA on foreign leaders (full evaluations from a distance — what it calls “armchair psychiatry” — and even diagnoses, without personal examination or consent) for seventy years. It is essentially saying, “our” leaders are off-limits, no matter the dangers they pose to the nation they are supposedly serving. The APA only strengthened its prohibitions when the need to provide for public education, public health, and ultimately public safety and survival became more compelling — and avoided rebuttal by refusing any discussion about its decisions. And finally this rationale is why it was acting more as an arm of the government than an independent professional organization, for truly medical ethics were of lesser concern than that it protect “its own” and not place a powerful political figure at a disadvantage, no matter how inaccurate the diagnosis.

Returning to the theme of “Black Lives, In Mind” and “Where the Wound Was Made,” it becomes clear how this entire presidency has been about white supremacy and male superiority taking precedence over any error, incompetence, or mental incapacity. Indeed, the more egregious and damning his deficiencies, the more forcefully he is demonstrating before the world the triumph of his whiteness and maleness over any other rational, practical, moral, or meritorious considerations. It is all about demanding deference to power, no matter the medical findings, and the uniform whiteness and maleness of all principal defenders of “the Goldwater rule” further corroborate this unspoken order. Applying this hypothesis, all the pieces of the hitherto unremitting puzzle fall into place, and no enigma remains. This is how even the best minds were blinded, and an “ethics guideline” became not about ethics at all.

Addendum (1/7/2021): Upon hearing of the violent attack on the U.S. Capitol by a deadly mob, I cannot help but identify with the Capitol police. While psychiatry and law enforcement have distinctly different roles in society, it is not difficult to draw parallels: the police officers were on their own to fulfill their professional duty to protect public safety, where the police leadership failed, and in fact was colluding with the white supremacist government leadership. With the leadership abandoning professional duty, the defense was easily overcome, the People’s House desecrated, and one Capitol police officer even killed. None of this had to be.

Forensic psychiatrist, violence expert, president of the World Mental Health Coalition (worldmhc.org), and editor of "The Dangerous Case of Donald Trump.”

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