Dear Leadership of the American Psychiatric Association (APA):

 

We, members of the National Coalition of Concerned Mental Health Experts, respond to the American Psychiatric Association’s January 9, 2018, call for an end to “arm-chair psychiatry” and the use of psychiatry for “political or self-aggrandizing purposes.”

We unequivocally agree that “arm-chair psychiatry” is irresponsible and share an abhorrence of using psychiatry for political or self-aggrandizing purposes. We oppose both, and make it as a condition of joining the Coalition that all members comply with ethics, including remaining apolitical and non-partisan in their professional assessment.

 

We agree with the principle of “the Goldwater Rule,” which prohibits psychiatrists from diagnosing public figures whom they have not personally examined. Even though we are not all psychiatrists, we abide by it as a basic rule of good professional practice.

 

We simply understand that, as experts in human behavior, it is our ethical obligation to society to share our special knowledge. In contrast to arm-chair diagnosis, we believe that there can be a benefit to describing well-documented and publicly observed behavior patterns that the professional literature has shown to indicate dangerousness. Rather, we believe that silence in the face of danger to public health and well-being goes against our overarching commitment to the basic ethical obligation as health professionals. When a man who has the sole authority to initiate a nuclear strike shows signs of dangerous mental instability, we believe that our profession fails in our ethical duty if we remain silent.

 

Both laypersons and professionals recognize that diagnosis is irrelevant when it comes to dangerousness. For example, if someone is at the rails of a bridge attempting to jump, you do not have to know the diagnosis before being convinced that it is important to intervene. In addition, you would not rely on the suicidal person to take the necessary steps to prevent one’s own self-harm, since self-awareness at the moment may be lacking. It does not take a mental health professional to understand these basic concepts.

 

We therefore strongly disagree with the APA’s March 16, 2017, expansion of “the Goldwater Rule” to prohibit any form of commentary on public figures, including in cases where mental health professionals may be more attuned to dangerous, impulsive, or reckless behavior than the lay public. We believe that this new rule, or decree, creates a dangerous and unethical restriction on APA members and sets a misguided example for all mental health professionals. A decree takes away an essential aspect of ethical deliberations: the ability to exercise a careful weighing of sometimes competing guidelines to meet the requirements of the situation. To have a rule without limits or countervailing rule, regardless of the consequences to humanity, we believe handicaps agency that is at the heart of ethical decision-making.

In summary, we have no diagnostic agenda, as it is beside the point. However, we believe that, when numerous and repeated behaviors pointing to dangerousness are observed in a person with vast means to undermine public safety, commentary is not only appropriate but ethically mandated. The psychological professions fail in their duty to the public if they remain silent.

 

As concerned members of diverse mental health professions and organizations (the American Psychiatric Association, the American Psychological Association, the American Psychoanalytic Association, the National Psychological Association for Psychoanalysis, the National Association of Social Workers, the American Association of Psychoanalytic Social Workers, the American Counseling Association, the International Association for Forensic Psychotherapy, the World Psychiatric Association, and others), we call upon the APA to reconsider its recent expansion of the “Goldwater Rule.”

 

We hope that the APA will, during this critical time in our country’s history, uphold its own laudable vision statement, which declares of the organization as “the voice and conscience of modern psychiatry.”

 

Sincerely,