Call It Like You Hear/See It!


Health Editor’s note:  Have you ever heard someone talking and want to say, “Why are you speaking?”  I certainly have. Guess what!  Even if the person who is speaking is the “now president of the U.S., there can be a resounding “WHY ARE YOU TALKING MOMENT OR TWO.” I do not even think you need to be a psychiatrist/psychologist to make a diagnosis about someone’s mental state.  After all, it can just be your opinion and you are not getting paid for that……..Carol 

‘Goldwater Rule’ Under Fire Again

Psychiatrist calls APA dictum ‘paternalistic’ and ‘outdated’

by Shannon Firth, Washington Correspondent, MedPage Today December 27, 2017

The New England Journal of Medicine rekindled the debate over whether psychiatrists should speak publicly and candidly on the state of President Trump’s mental health, in a pair of articles published Wednesday.

Facing off were Claire Pouncey, MD, PhD, a psychiatrist for Eudaimonia Associates in Philadelphia, and Jeffrey Lieberman, MD, past president of the American Psychiatric Association (APA), which has long promulgated a rule for members strictly forbidding them from commenting on any individual’s mental health without having performed a personal examination.

Technically Section 7.3 of the APA’s code of ethics, it’s often called “the Goldwater rule.” The APA issued it following a successful lawsuit by then-Sen. Barry Goldwater (R-Ariz.) against a magazine named Fact that published an article quoting psychiatrists who gave him mental illness diagnoses based solely on Goldwater’s public statements.

When psychiatrists began openly defying the rule earlier this year, the APA doubled down. It declared that “any opinion on the affect, behavior, speech or other presentation of an individual that draws on the skills, training, expertise and/or knowledge inherent in the practice of psychiatry” can only be provided in the context of a formal, in-person procedure.

In her Perspective article, Pouncey defended another psychiatrist, Bandy Lee, MD, MDiv, of the Yale School of Medicine’s Law and Psychiatry Division, who recently published a collection of essays entitled The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, setting off a new wave of discussion around the issue.

“[T]awdry, indulgent, fatuous tabloid psychiatry:” that was Lieberman’s succinct review of the book in Psychiatric Times.

Pouncey objected. “The APA keeps reiterating that in order to make a formal psychiatric diagnosis, you have to have a sit-down formal diagnostic interview and you have to get a release of information to share the information,” she said.

Such rules are “paternalistic” and tantamount to a “gag order,” she said in a phone call with MedPage Today.

“Everyone uses psychiatric terminology except for us, because the APA says that for us to use it constitutes a formal diagnosis, and I’m saying, ‘No, it doesn’t,” she said.

While her use of diagnostic language carries more weight than that of, for instance, a reporter for MedPage Today, Pouncey said, that shouldn’t preclude psychiatrists from using such terms — and it doesn’t stop them being citizens.

Moreover, she said the association’s rules are “outdated.” Comments to the press, “middle-of-the-night tweets” and public statements, are all sources of information from which psychiatrists and others can evaluate public figures, she said.

While it’s important to be mindful, Pouncey said, “We can’t stop being the people that we are and wearing the various social hats that we wear, and we shouldn’t have to.”

As for the book, Pouncey said, it isn’t about diagnosis at all.

“This book is about dangerousness. What the author is doing is saying these neuropsychiatric patterns show someone who doesn’t have the ability to make safe decisions,” she told MedPage Today in a phone call.

In her NEJM article, she wrote, “I believe that the APA, in the interest of promoting public health and safety, should encourage rather than silence the debate the book generates. And it should take caution not to enforce an annotation that undermines the overriding public health and safety mandate that applies to all physicians.”

Pouncey was not entirely dismissive of the rule, saying it “reminds us to remain humble about the claims we can reasonably make and to present ourselves responsibly for the sake of our patients and our profession.”

But the APA’s continued insistence on the rule contradicts the “moral obligation” language of Section 7 of the American Medical Associations’ Principles of Medical Ethics, which stresses physician’s duty to promote public health and safety, Pouncey argued.

In response, Lieberman, of the Department of Psychiatry for the Columbia University College of Physicians and Surgeons in New York City, firmly backed the APA position.

Lieberman wrote that “brand[ing] elected officials with neuropsychiatric diagnoses” is “political partisanship disguised as patriotism.” He cited historical examples of psychiatrists’ unsavory involvement in politics, including “collusion in Nazi eugenics” and “the involuntary confinement in mental hospitals of dissidents and religious groups in the People’s Republic of China.”

He also noted there is an existing mechanism by which the president can have a psychiatric diagnosis made or ruled out: the 25th Amendment, under which the vice president and cabinet can require it.

While Lee and Pouncey may be acting in “good faith” they espouse a “misguided and dangerous morality,” Lieberman asserted.

For more discussion on “misdiagnosing Trump” see MedPage Today’s exclusive interview with prominent psychiatrist Allen Frances, MD, who led creation of diagnostic criteria for narcissistic personality disorder.


Carol graduated from Riverside White Cross School of Nursing in Columbus, Ohio and received her diploma as a registered nurse. She attended Bowling Green State University where she received a Bachelor of Arts Degree in History and Literature. She attended the University of Toledo, College of Nursing, and received a Master’s of Nursing Science Degree as an Educator.

She has traveled extensively, is a photographer, and writes on medical issues. Carol has three children RJ, Katherine, and Stephen – two daughters-in-law; Suzy and Katie – two granddaughters; Isabella Marianna and Zoe Olivia – and one grandson, Alexander Paul. She also shares her life with husband Gordon Duff, many cats, two rescue pups, and two guinea pigs.

Carol’s Archives 2009-2013

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  1. The Narcissistic Diagnosis: with no mention of Androids …
    Misdiagnosing Trump: Doc-to-Doc with Allen Frances, MD
    Perry Wilson and Allen Frances discuss the president as a mirror on America’s soul
    Allen Frances, MD, is professor emeritus of psychiatry at Duke University and the creator of the diagnostic criteria for narcissistic personality disorder. That condition has been in the news frequently, as many have suggested that President Trump may be so afflicted. In his new book, Twilight of American Sanity, Frances suggests …

    “it’s not Trump who is crazy. It is us”.

    The personality described and diagnosed with “narcissistic” symptoms can very well be a humanoid android, a GMO. DNA modifications are spliced or chemically induced. Use and continued use/ingestion of chemicals such as Diet Coke demonstrate drug dependent personalities, narcissistic drug addiction. In this case we are witnessing the non empathizing narcissist.

    Photo: “12 Diet Cokes a day”

    from The Psychiatrist’s Psychiatrist bench: When a problem is identified it is being dealt with and therefore it no longer exists. And in closing … “ You will find yourself falling in love with me until you get your first bill.”


    • just out …

      Part 21: The Role of the Media: Act I
      Whatever Happened to Investigative Journalists?
      © by Frances T. Shure, 2017

      intro and parts 1-21 are very positive, constructive and educational
      🙂 y eye

  2. This has been brewing since Trump took office and is a legitimate debate. It is absolutely arguable that a persons behavior is a more accurate set of data to work from than their responses in a “session”. A good sociopath or psychopath can breeze through those sessions, and yet go back out and behave in an inconsistent manner. Especially those trained in sales who continuously are able to “negotiate” people out of their money for poor reasons. “To know them by their fruits”, is to watch what they produce. We don’t need excessive analysis if the behaviors are plain. The “Goldwater” rule is the Gold standard of rules in place for the express purpose of protecting politicians. It is a classic sociopathic defense. What is it producing ?

    • We all are aware of how reluctant Phd’s are to endanger their careers, that should add more weight to the situation. If it was one or two, that would be one thing, but it is very much many mucho.

    • David, The Goldwater Rule is producing more idiotic politicians or at least trying to. We see what is going on and will resist and repeatedly ask them, “Why are you talking? and at some point make them stop. Crazy is as crazy does…….Carol

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