What does the Goldwater Rule say about diagnosing public figures, and how has it been applied to Trump?
Executive summary
The Goldwater Rule, adopted by the American Psychiatric Association (APA) in 1973, forbids psychiatrists from offering professional diagnoses of public figures whom they have not personally examined and obtained consent to assess, a prohibition the APA broadened in 2017 amid debate about Donald Trump; that rule has nonetheless been contested, partially skirted by other professional bodies and individual clinicians who argue a duty to warn the public [1] [2] [3]. The Trump era crystallized the conflict: many clinicians publicly speculated about Trump’s mental state, some organized to warn about perceived risks, and APA enforcement remained limited, prompting scholarly critiques of the rule’s practicality and reach [4] [5] [6].
1. The rule’s text and original purpose: restraining “armchair diagnosis”
The Goldwater Rule arose after widespread media solicitations of psychiatrists about Barry Goldwater in 1964 and was formalized as Section 7.3 of the APA’s ethics code in 1973 to guard against irresponsible, stigmatizing, and politically tinged diagnoses of public figures based on hearsay and media reports, on grounds that distant diagnosis is likely to be inaccurate and ethically improper [1] [7].
2. How the APA has interpreted and tightened the rule
In response to renewed public debate during the Trump presidency the APA’s Ethics Committee reaffirmed and effectively extended the rule in 2017 to cover most public psychiatric commentary about public figures without examination or consent, a move framed as protecting scientific integrity and preventing politicized assessments [2] [1] [3].
3. The Trump era rupture: clinicians who spoke and those who organized
Donald Trump’s candidacy and presidency triggered a wave of clinicians who publicly described him using clinical language—labels such as narcissism, malignant narcissism, dementia or worse—producing books, op-eds, and groups like Duty to Warn that argued professional silence risked public harm and that psychiatrists had an obligation to alert the public or lawmakers [4] [5] [7].
4. Institutional pushback and alternative professional stances
Not all professional bodies agreed with the APA’s strictures: the American Psychoanalytic Association told its members they were not bound by the Goldwater Rule and encouraged open commentary, and prominent psychiatrists openly defied or questioned the rule’s relevance during crises, creating a fractured professional landscape [8] [7].
5. Enforcement, consequences, and notable examples
Despite visible rule-breaking in the Trump debate, enforcement was ambiguous; instances like Jeffrey A. Lieberman’s 2017 article diagnosing “incipient dementia” drew criticism but did not result in formal sanctions, and academic critics have argued the APA lacks meaningful enforcement mechanisms, making the rule’s bite largely ethical and reputational rather than punitive [4] [6].
6. Critiques and defenses: public safety vs. professional ethics
Defenders of the rule argue it prevents politicized misuse of psychiatric authority and protects both patients and the credibility of the field, while critics contend that strict silence can be an abdication of responsibility when leaders’ behavior poses clear risks; scholars and clinicians have urged nuance—allowing evidence-based, carefully framed analysis without transmuting professional impressions into formal diagnoses—but consensus remains elusive [1] [6] [3].
7. What the record shows about “application to Trump”
In practice, application to Trump was neither uniform nor decisive: many clinicians publicly offered diagnostic impressions and formed advocacy networks; some professional associations tightened guidance or exempted members; the APA’s rule constrained some voices but did not prevent a robust, often partisan public psychiatric discourse about Trump, leaving the rule’s authority contested and its practical effects limited [5] [8] [9].
8. The larger takeaway and unresolved questions
The Goldwater Rule remains a live ethical boundary: it clearly prohibits formal diagnostic statements by APA-member psychiatrists who have not examined a public figure, yet Trump’s case revealed cracks—other organizations and individuals have judged public risk to supersede that restraint, enforcement is uneven, and scholars continue to debate whether the rule should be revised for the age of social media, disinformation, and high-stakes political leadership [2] [6] [9].