One #RESIST shrink is really upset about the Goldwater rule

You might remember Ivy League psychiatrist Dr. Bandy X. Lee, who once briefed congressional Democrats on how the President might be insane. She was smacked down for that decision by the American Psychiatric Association (APA), who told her to stop practicing “armchair psychiatry.”

You might think that having the nation’s largest professional association in your field call you out on the carpet would slow your roll, but not in the case of Dr. Lee. She’s back with yet another editorial in the Boston Globe this week, railing against the Goldwater rule, claiming that the APA is putting a muzzle on those who would speak out and provide warnings about a dangerous medical condition… or something.

The group of mental health professionals (which includes us) was not breaking the Goldwater rule as it was written and as the APA had interpreted it prior to Donald Trump’s election. We were merely fulfilling our obligation to the public by calling attention to a dangerous situation that happened to involve the political sphere.

This followed an unprecedented expansion of the Goldwater rule last March to include not just diagnosing but making any comment on any observable aspect of a public figure’s expressed emotion, speech or behavior, even in an emergency. The expansion ran so afoul of the ethical principle the rule fell under (that we contribute to public health) and the very principles of medical ethics (that human health and safety come first), that members resigned in droves, and the APA has been flooded with protest letters for modifying a rule without consulting its membership.

As it turns out, what Dr. Lee and her collaborators are actually doing is pitching their new book, The Dangerous Case of Donald Trump. (If you really want a link you can go Google it yourself.) She goes on at length about their “heightened concern about the dangers of Trump’s proximity to weapons of mass destruction.”

It’s a not terribly clever bit of wordplay, using the guise of concerned mental health professionals to provide a public service in the form of enlightening the public about people “who constitute a danger to others.” But you don’t need to be a board-certified psychiatrist yourself to see the two major flaws in this argument.

First of all, if a clinical psychologist treats a patient who they have evaluated and begun working with, and determines that they represent a real threat to others, they can and often do break the normal doctor-patient privilege. But they don’t publish a book about it or tell a reporter. They report it to law enforcement under very guarded conditions, assuring the patient’s privacy as much as possible while allowing law enforcement to investigate and determine if a valid threat exists.

But even more to the point, that only happens when they have conducted an examination themselves. That’s the entire basis of the Goldwater rule which Dr. Lee wildly distorts in her obviously political manifesto. You can’t diagnose a patient for anything without doing all of the required, standard testing. If a dermatologist sees a congressman on television who has a mole on their nose, should they go tell the Washington Post that the person has skin cancer? The prospective patient may very well be in danger. Or they could just have a benign mole. But stoking the public’s fears about the health of the elected official without getting them in for a biopsy is malpractice, plain and simple.

Dr. Lee has declared war on President Trump for reasons unknown, and she’s no longer acting in any way which can be justified under standard professional protocols. If she wants to make a few bucks off of her fifteen minutes of fame by publishing a book, so be it. But she shouldn’t expect to be taken seriously by anyone at this point.

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Jazz Shaw 1:01 PM on December 09, 2022