Earlier this month the American Psychoanalytic Association’s (APsaA) made a new distinction in regards to a decades-old policy that warned against publicly commenting on the mental health of public figures, without having examined them personally. The executive committee of the group sent a private email to its 3,500 members which noted, "APsaA does not consider political commentary by its individual members an ethical matter. APsaA's ethical code concerns clinical practice, not public commentary."

At the implicit center of the change is, of course, President Trump, whose emergence as a political force came with the shattering of many public and professional norms. One of those shattered norms has been coming in the form of psychiatrists defying what has informally been known as the "Goldwater Rule" to say that Trump may be psychologically unfit for the office of the president.

The rule itself is enshrined in the ethical code of the American Psychiatric Association — to clarify, a much larger guild organization than the American Psychoanalytic Association — as Section 7.3, but its informal name refers to presidential candidate Barry Goldwater who sued Focus magazine after it ran an article that reported nearly 1,200 psychiatrists had said he was psychologically unfit to be president. Goldwater won his libel case and the rule has been in effect for the last 44 years.

During the election, the American Psychiatric Association (APA) urged its members to abide by this code and hold their tongues when it came to publicly diagnosing Trump. But some believe the unique threat posed by Trump calls for a shift in policy. 

“What we’re talking about here is the most extreme and dangerous form of mental illness,” Dr. John Gartner, a practicing psychotherapist and assistant professor of psychiatry at Johns Hopkins University Medical School, said of Trump’s psychological profile, which he likened to “stage four brain cancer” in an interview with ATTN:.

Gartner’s is responsible for creating a petition on Change.org that argued that Trump was mentally ill and that he must be removed from office. It garnered more than 58,000 signatures and led him to organize Duty to Warn, a group of mental health professionals that believe that they have an ethical duty to speak out in the name of the public’s welfare.

Gartner, who has advocated for Duty to Warn at Yale University, noted that the group has already spread to 17 cities across the country.  

He said that Trump suffered from “malignant narcissism,” what he called a sort of “dictator personality disorder” shared by Hitler and Stalin that involved narcissism, antisocial behavior, sadism, and paranoia. Qualities that are on full display in Trump’s bullying tweets and statements, conspiracy theories, and compulsive lying, according to Gartner.

For these reasons, he believes that the Goldwater Rule is an infringement on free speech, which makes psychiatrists unable to fulfill their ethical duty. But others believe the rule should be upheld.

In a statement released to ATTN:, consultant to the American Psychiatric Association’s ethics committee, Dr. Rebecca Brendel said:

“The American Psychiatric Association stands firmly behind the Goldwater Rule.  Our position has not changed. The Goldwater Rule  applies to the 37,000 physician members of the American Psychiatric Association, not other groups, non-members, or non-physicians. The rule represents sound psychiatric ethics, preserves the integrity of the profession, and respects the patients that our members serve.”

The American Psychiatric Association’s executive committee also enumerated their reasons for standing behind the policy and wrote:

1. When a psychiatrist comments about the behavior, symptoms, diagnosis, etc. of a public figure without consent, that psychiatrist has violated the principle that psychiatric evaluations be conducted with consent or authorization.

2. Offering a professional opinion on an individual that a psychiatrist has not examined is a departure from established methods of examination, which require careful study of medical history and first-hand examination of the patient. Such behavior compromises both the integrity of the psychiatrist and the profession.

3. When psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness.

Their final point, concerning the stigmatization of mental illness itself, deserves special attention. It is unclear how psychiatrists and non-psychiatrists alike publicly discussing individuals they have not personally examined would frame the public discourse on mental health. And it is possible that by publicizing mental illness diagnoses in a primarily negative context could increase the already persistent stigma that surrounds mental health disorders.

But it's also worth noting that the American Psychoanalytic Association clarified the email it sent to members by saying it represented no change to longstanding policy and that attempts diagnose public leaders was still not encouraged. As the group's director of public affairs, Wylie Tene told NPR, members "have always been free to comment on public figures, but have been cautioned against diagnosing."