How have courts and professional associations responded to clinicians publicly commenting on Trump's psychological traits?
Executive summary
Courts and professional associations have responded to clinicians publicly commenting on Donald Trump’s psychological traits by reaffirming ethical limits while leaving room for debate: courts’ precedents shaped the boundary between “duty to warn” and public commentary, and major professional bodies—most notably the American Psychiatric Association—have enforced or defended the Goldwater rule that bars remote diagnosis, even as alternative organizations and dozens or hundreds of clinicians have openly challenged that restraint [1] [2] [3].
1. The legal precedents that created the dilemma: Goldwater’s lawsuit and Tarasoff’s duty
The APA’s prohibition on diagnosing public figures at a distance grew out of a 1964 controversy and subsequent litigation in which a mass survey of psychiatrists about Barry Goldwater’s fitness drew a libel suit that ultimately persuaded psychiatry leaders to curb off-the-cuff professional judgments; that history underpins the modern “Goldwater rule” [2] [1]. By contrast, courts have also created a separate legal doctrine—Tarasoff—holding that clinicians may have a duty to warn identifiable victims when a patient poses an imminent threat, and some proponents of public commentary on Trump have invoked Tarasoff as moral justification for warning the public about perceived dangerousness, even though Tarasoff governs clinicians’ obligations to patients, not public figures [4] [5].
2. Professional rulemaking: the Goldwater rule and allied guidance
The American Psychiatric Association’s Goldwater rule—codified as an ethical restriction against offering professional opinions about public figures without personal examination and consent—remains the central institutional barrier to psychiatrists publishing formal diagnoses of Trump [1]. Other professional codes are more fragmented: the American Psychological Association lacks an identically worded Goldwater prohibition but signals caution through related ethics provisions, and medical organizations including the AMA issued guidance urging physicians to refrain from making clinical diagnoses about public figures they have not examined [1].
3. Enforcement, rebukes, and internal debates within psychiatry
When Bandy X. Lee and contributors published The Dangerous Case of Donald Trump, APA leaders publicly criticized the effort as violating the Goldwater rule and argued such public diagnoses are irresponsible and stigmatizing—statements reflected in prominent commentary and subsequent critiques of Lee’s approach [6] [4]. APA officials and prominent psychiatrists warned that speculative diagnoses could harm individuals, undermine the profession’s credibility, and deter patients from seeking care [4] [2]. At the same time, some forensic psychiatrists and contributors defended public alarm as a civic duty, framing warnings as citizens’ expertise rather than clinical diagnosis and urging debate over whether the APA’s rule should be reinterpreted in extraordinary circumstances [5].
4. Collective clinician actions and the limits of institutional reach
Despite the APA’s stance, sizable numbers of clinicians have spoken publicly: organized petitions and open letters—ranging from the “Duty to Warn” group to hundreds of signatories alleging “malignant narcissism”—have argued clinicians must alert the public when a leader’s behavior presents danger, illustrating the limited ability of professional rules to silence dissenting practitioners and the different norms across specialties [1] [3]. Journals and legal scholars have hosted that dispute, with some asserting that the duty to warn or civic responsibility can justify public commentary and others insisting that ethics codes protect both patients and the profession from politicized diagnosis [5] [7].
5. The current balance: rules, reputational risk, and ongoing contestation
The result is a contested middle ground: courts supplied a narrow, patient-focused duty to protect (Tarasoff) while historical litigation led to institutional rules curbing public diagnosis (Goldwater origins), and professional associations have largely defended the restraint even as alternative voices and advocacy campaigns press for exceptions when public safety is invoked [4] [2] [5]. Reporting and scholarly commentary show the debate remains unresolved—professional bodies emphasize ethical prohibitions and reputational risk, proponents of public warnings emphasize civic duty and danger—but the formal rules continue to shape mainstream psychiatric and medical responses to clinicians commenting about Trump’s mental health [1] [5].