Goldwater Violation

[G Sheb]

Interesting discussion here.

I'm curious how people think there is a clear answer to something as fraught as this. Bandy Lee was kicked out from Yale only after she made some comments about Dershowitz and not Trump. Dershowitz of course is an Emeritus Professor at Harvard, so it seems that the decision was more political than anything else.

I do think there is merit to the Goldwater rule and psychiatry is very vulnerable to politicization. However, Trump is so extreme, the case against him is perhaps fairly clear that there WAS a duty to warn based on the grandiosity, paranoia, belligerence we all have seen. To stay mum about all of this is perhaps the extreme thing to do. In a way, the historical record is on Lee's side as we saw what happened on January 6th. In addition, Lee argued that she has not given a diagnosis but rather an assessment of dangerousness and ultimately recommended a psychiatric evaluation to resolve it.

There was a recent New Yorker review on this issue: https://nymag.com/intelligencer/202...fired-for-tweeting-about-alan-dershowitz.html .

There is all kind of politics involved here, and it seems Lee and a past president of the APA have gotten into a brutal fight. This person actually seemed to have violated the Goldwater rule in a much more brazen way, and even astonishingly wrote the following:

"Based on these, we posited that President Trump came from a stable intact family, had a non-traumatic upbringing and normal development, during which he sustained no serious illness. He was intelligent, gregarious and had a strong, exuberant personality. While he was willful, headstrong, and self-important, he tolerated the discipline and graduated from the military school and college to which he was sent. Throughout his life he has been dedicated to his family, his three marriages notwithstanding, and, regardless of what one might think of his business practices and achievements, he has been professionally successful. He is hardworking, possesses great energy and stamina, and is rumored to be a "short sleeper" (someone who constitutionally requires less sleep than their peers). These assets have served Trump well throughout his life."

These Experts Think Trump May Actually Have Dementia

They went through six possible diagnoses and here's where they ended up.

www.vice.com

He basically cleared him of any 'DSM diagnosis', and speculated that he might have dementia. Minding proving a negative is so much harder than proving a positive when all you have is public data.

Regardless whether you agree with Lee or not, this is an extremely important debate that has been shut off (or attempted to) from public discourse for political reasons.

At a time when are seeing very 'interesting phenomena', such as widespread conspiracy theories with QAnon, covid conspiracy theories, anti-vaccine conspiracy theories, election conspiracy theories, all that seem to have much in common with paranoid delusions we see in the clinic (you could credibly call it psychotic phenomena imo), I think Lee has something very useful to contribute. It's a shame we're shutting down these voices instead of fostering an academic debate.

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[G Sheb]

I'm always confused by what the APA would expect a clinician to find in a "personal evaluation" that would somehow mitigate or make inaccurate diagnostic criteria that are clearly demonstrated in public behavior. Concur that Yale can do whatever they want as a private institution. There are plenty of jobs out there. State medical boards, however, should not ever be regulating speech unless it is directly and clearly harmful to the public and even then, with the utmost of caution. Saying a public figure meets the criteria for NPD based on public behavior doesn't even come close to that bar.

I think it's important to note that Lee never made a diagnosis. She said he's dangerous (from her expertise in psychiatry) and we need to make concrete steps to evaluate him/limit his influence.

 

[birchswing]

dedicated to his family, his three marriages notwithstanding

This part made me laugh—it feels like everything else was a straight foil for that bit of humor.

You can't be dedicated to family—singular—when you have three of them.

and is rumored to be a "short sleeper" (someone who constitutionally requires less sleep than their peers). These assets have served Trump well throughout his life.

Unipolar hypomania?

I'm not saying it is, but just pointing out you could speculate something just as negative from the same rumor. I had no idea "short sleeping" was a virtue.

I'm not surprised Dershowitz was a more proximate cause to someone being fired. He's a very shadowy figure. The things he has chosen to defend speak for themselves. And I'm not talking about Trump.

 

[Mass Effect]

"Based on these, we posited that President Trump came from a stable intact family, had a non-traumatic upbringing and normal development,

Ditto and how does one even know the above?

 

[whopper]

And maybe Trump is actually a necrophiliac? Prove he isn't! After all, as someone mentioned above we have years of media (of course from fake-reality based TV shows, a books written by a ghost-writers, him getting 10 second sound bites of course this is valid and can be used to substitute professional based standards....not).

We go there anyone can diagnose based on anything. From saying Biden has dementia cause he paused for a few seconds to saying that Biden's wife has M.D.-envy because she calls herself a doctor. We already have physicians talking about demon-sperm. Adding even more doctors the bully pulpit to say their opinions without evidenced-based will not be good for us or the public.

I would have no problem if Lee chose to criticize Trump but left her psychiatric credentials out of it, but the problem is she used the credentials to sell herself including going onto the talk/radio/streaming circuit while selling media and frankly no one would've listened to her if she hadn't added the credentials. Even with them people were hardly listening to her. Everything she said was so obvious. It'd be like Stephen Hawking trying to convince me 1+1=2. Really doc? (response in robotic voice), "but Dr. Whopper you have to listen to me because I'm the Isaac Newton chair and professor." Dr. Hawking-I'm already convinced 1+1=2. "But Dr. Whopper buy my book where I say 1+1=2."

I had as much problem with her doing it as psychiatrist Keith Ablow did pushing Biden had dementia when he ran as Obama's VP on Fox News. If you really want to waste time dig into my posts from years back where I criticized Ablow on this forum. This isn't a partisan thing-I don't like Trump, and it's blatantly obvious several people trying to defend Lee are doing so merely because they don't like Trump and have bought into the black and white thinking dictating their judgments. Anything against Trump-embrace it, anything for Trump hate it.

Fox’s Dr. Keith Ablow Diagnoses VP Biden: He May Have Dementia (Or Maaaybe Abuses Alcohol)

Fox News' go-to psychiatrist, Keith Ablow, appeared on Fox & Friends Weekend to discuss Joe Biden's debate performance. Given that Biden's laughter, smirks, and malarkeyisms had been dissected pretty thoroughly by the time Sunday rolled around, Ablow had his work cut out for him. How, he must...

www.mediaite.com

And on a side note it's blatantly obvious Dr. Oz violated several professional guidelines, with several of his colleagues at Columbia calling for his removal, but do you see Columbia trying to get rid of him? I don't. The entire medical profession is losing core ethics. I don't know the specifics but I speculate (but will not waste my time so someone feel free to dig here and correct me) that Columbia is getting some profit off of his media exposure. Most universities have agreements with their professors to get a cut off of profits made while the professor is a part of the institution.

However, Trump is so extreme, the case against him is perhaps fairly clear that there WAS a duty to warn based on the grandiosity, paranoia, belligerence we all have seen.

As another psychiatrist put it, the case was so extreme there wasn't anything that psychiatrist had to say or do within an expert context in a duty to warn as if other people couldn't tell.

Anyone post on this forum for several months to years? How about I say that person is an alcoholic and I got posts for months or years to back it up. "Notice how they put a grammatical error there. That has to be substance abuse."

If people want to go there, let's analyze Bandy Lee. Let's see now, to get promotions you need publications. So instead of doing a real publication with evidence base-oh yeah now there's the easy way. Play media gossip. Now you can get easy publications while having fun at it instead of hard work and years of dedication needed for a real publication. (But Dr. Whopper you're violating the Goldwater Rule!-EXACTLY MY POINT!)

 

[G Sheb]

And maybe Trump is actually a necrophiliac? Prove he isn't! After all, as someone mentioned above we have years of media (of course from fake-reality based TV shows, a books written by a ghost-writers, him getting 10 second sound bites of course this is valid and can be used to substitute professional based standards....not).

We go there anyone can diagnose based on anything. From saying Biden has dementia cause he paused for a few seconds to saying that Biden's wife has M.D.-envy because she calls herself a doctor. We already have physicians talking about demon-sperm. Adding even more doctors the bully pulpit to say their opinions without evidenced-based will not be good for us or the public.

I would have no problem if Lee chose to criticize Trump but left her psychiatric credentials out of it, but the problem is she used the credentials to sell herself including going onto the talk/radio/streaming circuit while selling media and frankly no one would've listened to her if she hadn't added the credentials. Even with them people were hardly listening to her. Everything she said was so obvious. It'd be like Stephen Hawking trying to convince me 1+1=2. Really doc? (response in robotic voice), "but Dr. Whopper you have to listen to me because I'm the Isaac Newton chair and professor." Dr. Hawking-I'm already convinced 1+1=2. "But Dr. Whopper buy my book where I say 1+1=2."

I had as much problem with her doing it as psychiatrist Keith Ablow did pushing Biden had dementia when he ran as Obama's VP on Fox News. If you really want to waste time dig into my posts from years back where I criticized Ablow on this forum. This isn't a partisan thing-I don't like Trump, and it's blatantly obvious several people trying to defend Lee are doing so merely because they don't like Trump and have bought into the black and white thinking dictating their judgments. Anything against Trump-embrace it, anything for Trump hate it.

Fox’s Dr. Keith Ablow Diagnoses VP Biden: He May Have Dementia (Or Maaaybe Abuses Alcohol)

Fox News' go-to psychiatrist, Keith Ablow, appeared on Fox & Friends Weekend to discuss Joe Biden's debate performance. Given that Biden's laughter, smirks, and malarkeyisms had been dissected pretty thoroughly by the time Sunday rolled around, Ablow had his work cut out for him. How, he must...

www.mediaite.com

And on a side note it's blatantly obvious Dr. Oz violated several professional guidelines, with several of his colleagues at Columbia calling for his removal, but do you see Columbia trying to get rid of him? I don't. The entire medical profession is losing core ethics. I don't know the specifics but I speculate (but will not waste my time so someone feel free to dig here and correct me) that Columbia is getting some profit off of his media exposure. Most universities have agreements with their professors to get a cut off of profits made while the professor is a part of the institution.


As another psychiatrist put it, the case was so extreme there wasn't anything that psychiatrist had to say or do within an expert context in a duty to warn as if other people couldn't tell.

Anyone post on this forum for several months to years? How about I say that person is an alcoholic and I got posts for months or years to back it up. "Notice how they put a grammatical error there. That has to be substance abuse."

If people want to go there, let's analyze Bandy Lee. Let's see now, to get promotions you need publications. So instead of doing a real publication with evidence base-oh yeah now there's the easy way. Play media gossip. Now you can get easy publications while having fun at it instead of hard work and years of dedication needed for a real publication. (But Dr. Whopper you're violating the Goldwater Rule!-EXACTLY MY POINT!)

But her credentials were exactly important in her assessment of his dangerousness. BTW in the book she published there were contributions of many renowned psychiatrists, including a distinguished fellow of the APA. (Some are faculty at Columbia and Harvard, of course not touched because they didn't cross Dershowitz).

I also have seen every psychiatrist and their mother give their opinion on Trump in public, including people like Otto Kernberg and others (nothing wrong imo).

I also don't agree that everyone saw it. First of all, his supporters most of them didn't. The rest, some opted to call him a 'jerk', some a 'narcissist'...etc. But it's her credentials as a forensic psychiatrist here is the important criteria in her assessment of his mental disturbance and propensity for violence. As an expert her words weigh and resonate very differently. Of course it doesn't mean people will necessarily be convinced.

The reality is that public figures can also be mentally disturbed to the point of putting everyone else in danger. Arguing that psychiatrists should shut up regardless makes no sense.

I think the bigger issue is that kicking her out and shutting the debate is extremely dangerous and seemed to be wholly motivated by political reasons (corruption?). It's not at all a clear cut case, which makes their actions appear even more authoritarian.

 

[Mass Effect]

And maybe Trump is actually a necrophiliac? Prove he isn't!

Well if that isn't a histrionic response....

After all, as someone mentioned above we have years of media (of course from fake-reality based TV shows,

...for which he was executive producer and called the shots.

a books written by a ghost-writers,

...for which he narrated and told his story.

him getting 10 second sound bites

...or 2 hour long rallies that were shown in their entirety on television.

We go there anyone can diagnose based on anything. From saying Biden has dementia cause he paused for a few seconds to saying that Biden's wife has M.D.-envy because she calls herself a doctor. We already have physicians talking about demon-sperm. Adding even more doctors the bully pulpit to say their opinions without evidenced-based will not be good for us or the public.

As said above, Lee didn't diagnose Trump.

I would have no problem if Lee chose to criticize Trump but left her psychiatric credentials out of it,

Except that it's her credentials that taught her the red flags she mentions about Trump.

but the problem is she used the credentials to sell herself including going onto the talk/radio/streaming circuit while selling media and frankly no one would've listened to her if she hadn't added the credentials.

I mean, duh? There were a lot of yahoos giving their hot takes. Some of them rose to fame/infamy and some didn't. But being credentialed in the thing you're speaking about? Well that's just blasphemy? Stop the presses.

Even with them people were hardly listening to her. Everything she said was so obvious. It'd be like Stephen Hawking trying to convince me 1+1=2. Really doc? (response in robotic voice), "but Dr. Whopper you have to listen to me because I'm the Isaac Newton chair and professor." Dr. Hawking-I'm already convinced 1+1=2. "But Dr. Whopper buy my book where I say 1+1=2."

Disagree with your perception of what went down 100%. It clearly wasn't obvious and especially not from the very early days.

This isn't a partisan thing-I don't like Trump, and it's blatantly obvious several people trying to defend Lee are doing so merely because they don't like Trump and have bought into the black and white thinking dictating their judgments. Anything against Trump-embrace it, anything for Trump hate it.

For someone who isn't a fan of snap judgments and forming opinions of others based on their own words, you sure do do it a lot. Just sayin.

As another psychiatrist put it, the case was so extreme there wasn't anything that psychiatrist had to say or do within an expert context in a duty to warn as if other people couldn't tell.

Um, they couldn't.

Anyone post on this forum for several months to years? How about I say that person is an alcoholic and I got posts for months or years to back it up. "Notice how they put a grammatical error there. That has to be substance abuse."

Isn't that what you just did above about Trump haters?

If people want to go there, let's analyze Bandy Lee. Let's see now, to get promotions you need publications. So instead of doing a real publication with evidence base-oh yeah now there's the easy way. Play media gossip. Now you can get easy publications while having fun at it instead of hard work and years of dedication needed for a real publication. (But Dr. Whopper you're violating the Goldwater Rule!-EXACTLY MY POINT!)

What?

 

[Sushirolls]

So fast forward a few years in the life of this thread...

I've been a staunch supporter of the Goldwater rule that we have no business commenting on public figures, and non-patients.

But then a cornucopia of politicians present themselves to the public with glaring deficits. Its putting chinks in my stance, the position of support of Goldwater. But is the issue really the lack of mental health spotting deficits in politicians? Or is it the corruption of political entities just not caring, and a broader symptom of society decay? Or is it more that tribal politics - people don't care? Or is this more of a glass half full scenario, and a positive testament that politics can still relatively function even if the individual politician can't?

 

[mistafab]

I’m a pretty liberal-leaning independent, however I feel the Goldwater rule, as a matter of professional ethics - for psychiatrists/psychologists - had more wisdom than we give it credit for.

I for one think psychiatrists breaking the Goldwater rule are clowns. It detracts from the profession. You can be an MD and have strong political opinions - hell, make them public. But to weaponize your MD against someone publicly, where no consent or patient-doctor relationship exists, deteriorates public trust in doctors and cheapens our reputation.

We don’t need medicine to be used as tool to take down politicians. They do enough disgusting stuff that we have the fodder to burn them on anyway. MDs utilizing their degrees and violating Goldwater are just begging for limelight, no different than strippers on onlyfans. That’s how the public views these folks - political prostitution.

 

[G Sheb]

I’m a pretty liberal-leaning independent, however I feel the Goldwater rule, as a matter of professional ethics - for psychiatrists/psychologists - had more wisdom than we give it credit for.

I for one think psychiatrists breaking the Goldwater rule are clowns. It detracts from the profession. You can be an MD and have strong political opinions - hell, make them public. But to weaponize your MD against someone publicly, where no consent or patient-doctor relationship exists, deteriorates public trust in doctors and cheapens our reputation.

We don’t need medicine to be used as tool to take down politicians. They do enough disgusting stuff that we have the fodder to burn them on anyway. MDs utilizing their degrees and violating Goldwater are just begging for limelight, no different than strippers on onlyfans. That’s how the public views these folks - political prostitution.

It's a good point. But there might be a threshold where educating the public about the personalities of these politicians is actually helpful, especially if it's coming from professionals.
If it's kinda obvious you have narcissitic features, it is useful for the public to know that. You don't need to diagnose them with "narcissistic personality disorder" but the message is sorta the same, and I don't think it's unethical.

 

[mistafab]

I think we give ourselves too much credit for ability to opine on folks we've never met.

How many of us can say we act/behave exactly the same when we are in front of 10,000 people in a rally compared to when we meet one on one with someone? For us to opine on characteristics viewable only within the public eye is hubris, and likely woefully inaccurate. Heck, someone could compile 1000 hours of how I behave in public, during public speaking, and during news interviews - I would wager that it would still portray only a fraction of who I am and would not be an accurate representation of how I behave with my family, friends, or even at a bar with strangers.

Additionally, If we delude ourselves to believe mental illness should bar people from public office, by all accounts, we would have never had Abraham Lincoln as POTUS. The USA could elect a dog for president for all I care - it is a democracy after all. I think we fool ourselves by thinking this is within our scope of practice, and the public is not fooled by it. Utilizing our healing profession to weaponize mental illness in public is harmful for the profession. We speak from both sides of our mouth on this one when we then go on to tell our patients that the diagnosis does not define them, that they transcend the label the diagnosis gives them.

 

[whopper]

Not directly related and I did mention this on another thread.

Bandy Lee IMHO is a ****oo with a chip on her shoulder. Why? I've read her blogs. She gets really overboard unfair and has spread things on these blogs that are just objectively not true with the transparent intent to smear people and push an agenda that Psychiatry is run by a White Supremacist oligarchy. Don't believe me spend about 20 minutes reading it for yourself. Stuff like Jeff Lieberman is a White Supremacist because he was in the same room as Trump BS, or a psychiatrist from the 1940s was in Germany hence White Supremacy in Psychiatry is proven and we have to make it the top priority of our lives and write a public article about it that likely took a dozen hours to work on. WTF.

 

[PikminOC]

So fast forward a few years in the life of this thread...

I've been a staunch supporter of the Goldwater rule that we have no business commenting on public figures, and non-patients.

But then a cornucopia of politicians present themselves to the public with glaring deficits. Its putting chinks in my stance, the position of support of Goldwater. But is the issue really the lack of mental health spotting deficits in politicians? Or is it the corruption of political entities just not caring, and a broader symptom of society decay? Or is it more that tribal politics - people don't care? Or is this more of a glass half full scenario, and a positive testament that politics can still relatively function even if the individual politician can't?

Corruption is correct. Look at how many things the media gives a pass too...

 

[smalltownpsych]

It's a good point. But there might be a threshold where educating the public about the personalities of these politicians is actually helpful, especially if it's coming from professionals.
If it's kinda obvious you have narcissitic features, it is useful for the public to know that. You don't need to diagnose them with "narcissistic personality disorder" but the message is sorta the same, and I don't think it's unethical.

I disagree that we would need to educate people about personality traits of politicians. First time, I saw Trump interviewed, I thought, ”wow, this dude has some narcisstic traits.” Since then I have heard many many non-clinical people see the same thing and describe it in different ways. My comment was more to illustrate an offhand first impression than clinical judgement and I would not share it in the media. Besides, if we excluded people with narcissistic traits or tendencies from politics, would we have any left? I suspect that Trump and his supporters might actually appreciate that he doesn’t pretend to be caring as well as some of the others.

 

[whopper]

I suspect one would have to have at least some extremely good confidence (does that mean narcissism?) to be president. Several personality traits are healthy if in the right zone. It's when they're overboard or not enough where the disorder starts.

 

[Geraltofrivia]

I've only read page 1. I agree with the people that say psychiatrists should not make public statements about public people unless formally requested to do so via an evaluation. By just commenting on whatever, it will 1. Dilute the profession by polarizing people, and 2. Lead to mistrust by polarizing people. Also, people complaining about the APA and their "ethics guidelines" regarding Goldwater Rule or whatever... what are your thoughts on sex with patients? That is also an ethical guideline. The malpractice cases that came downstream came because the APA wrote amicus briefs supporting the ban on sex with patients. You want one, but not another?

I'm out.

 

[comp1]

Who is arguing against ethics guidelines in general? Ethics guidelines are the primary organizing principle of professional societies. The question is whether specific ethics guidelines are appropriate or correct at the current time. So yes, people can indeed be opposed to the APA regulating public statements about clinical diagnoses in public figures and in support of the APA's prohibition on sexual relationships with patients. The two have no direct relationship with each other. Further, ethics guidelines are not revealed divine truth. They change over time. Conversion therapy was once standard of care and it is now prohibited by ethics guidelines. There is significant evidence that support for the Goldwater Rule has been eroding for decades.

 

[clausewitz2]

I have to ask for people who want to relax the Goldwater Rule: in what other circumstance would you be perfectly comfortable suggesting a diagnosis or specific psychopathology for someone you hadn't met or had a chance to talk to for an extended period of time? Is there a single patient you'd be comfortable doing this with, even if it was just for a second opinion?

...I recognize collaborative care done poorly might approximate this but at least there you have more significant records, hopefully.

 

[comp1]

For most public figures, there's a lot more data available than for a standard 60 minute intake appointment. Heck, there's usually more available than for an 8 hour forensic evaluation. You could certainly argue some of it is lesser quality or more biased than what you might get in a clinic appointment, but some of it is much, much better. I guess it's how much one trusts what a patient or public figure reports versus what is observed. You don't get a chance to specifically ask the SIGECAPS questions of the public figure, but I don't necessarily trust every clinic patient's response to those questions anyways. I find the argument that it is harmful to the profession to have providers openly arguing about the diagnoses to be more persuasive than that it is somehow impossible to accurately diagnosis someone based on years of public behavior and statements. Ultimately the DSM only allows for high inter-rater reliability, not some sort of ultimate golden truth about a person's diagnosis. It seems quite frankly implausible to think you couldn't get high inter-rater reliability from decades of public source material. I would love to see a study done on this, but obtaining consent would be quite the challenge. That said, you still can't assume that the inverse is necessarily true. There's no proof of that either. For all we know, we SHOULD be basing all of our diagnoses on publicly available information like Facebook and Instagram, not individual private clinical interviews where a patient gets to put on a very brief show demonstrating specifically what they want to demonstrate to a clinical audience. Maybe reviewing social media instead would actually result in better care.

 

[Merovinge]

For most public figures, there's a lot more data available than for a standard 60 minute intake appointment. Heck, there's usually more available than for an 8 hour forensic evaluation. You could certainly argue some of it is lesser quality or more biased than what you might get in a clinic appointment, but some of it is much, much better. I guess it's how much one trusts what a patient or public figure reports versus what is observed. You don't get a chance to specifically ask the SIGECAPS questions of the public figure, but I don't necessarily trust every clinic patient's response to those questions anyways. I find the argument that it is harmful to the profession to have providers openly arguing about the diagnoses to be more persuasive than that it is somehow impossible to accurately diagnosis someone based on years of public behavior and statements. Ultimately the DSM only allows for high inter-rater reliability, not some sort of ultimate golden truth about a person's diagnosis. It seems quite frankly implausible to think you couldn't get high inter-rater reliability from decades of public source material. I would love to see a study done on this, but obtaining consent would be quite the challenge. That said, you still can't assume that the inverse is necessarily true. There's no proof of that either. For all we know, we SHOULD be basing all of our diagnoses on publicly available information like Facebook and Instagram, not individual private clinical interviews where a patient gets to put on a very brief show demonstrating specifically what they want to demonstrate. Maybe reviewing social media instead would actually result in better care.

But that information/video is with the intention of being a public persona, not as a way of being open/honest with extreme confidentiality protections as in the case of a doctor-patient relationship. There are many people who specifically learn to talk/act a way in public and hone that craft over a lifetime in an effort to further their interests. That's fundamentally different than information given behind closed doors in a intimate 1:1 setting.

I don't discount that AI might know a person is depressed faster/before a psychiatrist does based on their online activity or that this information is not worth learning more about but that again is a very different record where someone is not necessarily putting on a persona where they know they will be observed/recorded.

 

[clausewitz2]

For most public figures, there's a lot more data available than for a standard 60 minute intake appointment. Heck, there's usually more available than for an 8 hour forensic evaluation. You could certainly argue some of it is lesser quality or more biased than what you might get in a clinic appointment, but some of it is much, much better. I guess it's how much one trusts what a patient or public figure reports versus what is observed. You don't get a chance to specifically ask the SIGECAPS questions of the public figure, but I don't necessarily trust every clinic patient's response to those questions anyways. I find the argument that it is harmful to the profession to have providers openly arguing about the diagnoses to be more persuasive than that it is somehow impossible to accurately diagnosis someone based on years of public behavior and statements. Ultimately the DSM only allows for high inter-rater reliability, not some sort of ultimate golden truth about a person's diagnosis. It seems quite frankly implausible to think you couldn't get high inter-rater reliability from decades of public source material. I would love to see a study done on this, but obtaining consent would be quite the challenge. That said, you still can't assume that the inverse is necessarily true. There's no proof of that either. For all we know, we SHOULD be basing all of our diagnoses on publicly available information like Facebook and Instagram, not individual private clinical interviews where a patient gets to put on a very brief show demonstrating specifically what they want to demonstrate to a clinical audience. Maybe reviewing social media instead would actually result in better care.

You may want to look at what the DSM-V field trials showed for inter-rater reliability of MDD. It is...not good. I remain convinced that there is not a very good substitute for the interpersonal, phenomenological field of the clinical interview, even through other measures can certainly supplement and inform it usefully.

But that information/video is with the intention of being a public persona, not as a way of being open/honest with extreme confidentiality protections as in the case of a doctor-patient relationship. There are many people who specifically learn to talk/act a way in public and hone that craft over a lifetime in an effort to further their interests. That's fundamentally different than information given behind closed doors in a intimate 1:1 setting.

I don't discount that AI might know a person is depressed faster/before a psychiatrist does based on their online activity or that this information is not worth learning more about but that again is a very different record where someone is not necessarily putting on a persona where they know they will be observed/recorded.

Very well said.

 

[whopper]

If psychiatrists, including the people here that want the Goldwater Rule relaxed can really substantively read people based on the person's presentation in a news interview, an autobiography which obviously is biased by the author, then answer me this...

Why didn't you figure out Bill Cosby was sexually assaulting people years ago before the woman he assaulted came out?

Reason? , and I'll answer it for you-Cause your skill in figuring out a person's true personality based on news interviews, their autobiography that is pretty much just the author selling themselves, and their acting on a TV show is no better than a layman.

Any of us here who think cause we're psychiatrists, that we can decode people somehow based on a TV show, or whatever 8 second soundbite, is deluding themselves. That if anything would be evidence for narcissism unless you can show evidence to back up we have these special powers.

Our ability to diagnose a specific issue that is more technical, e.g. depression, is not what I'm talking about. I'm talking about a person's personality, and then to take it a step further, and then state that one is fit or not fit to be president based on a personality which itself cannot be easily defined in manner that meets a scientific standard, and there's no such factors in the US Constitution that makes one unfit to be president-you pretty much cannot do this.

 

[G Sheb]

But the argument isn't whether we can diagnose someone with a DSM diagnosis.
It's whether there are certain traits we pick up that we would be useful for the public to know. There's certainly a wealth of information that can be gathered by observing patterns of actions and behavior of public figures. In fact, EVERYONE does this, including journalists.
I think it's absurd to say that psychiatrists should not be allowed to open their mouths on this. Almost authoritarian and oppressive in tendency.
Reeks of corruption.

For Bandy Lee in particular, she never diagnosed him with anything. She said he has shown personality traits that make him outright dangerous. She has very interesting things to say about cult figures and shared psychosis. Let's face it, Yale only got rid of her when she crossed the wrong person... Alan Dershowitz.

 

[whopper]

It's whether there are certain traits we pick up that we would be useful for the public to know.

IMHO that's overgeneralizing if I take your statement literally. Of course there's anything in any field that could be useful for the public to know. Your statement, however reasonably sounding is not specific to Goldwater but a generalized statement word for word. Goldwater is specific to diagnosing people without following a standard, and then making it public without professional consequences.

I think it's absurd to say that psychiatrists should not be allowed to open their mouths on this. Almost authoritarian and oppressive in tendency.
Reeks of corruption.

Journalists could talk about our patients.
We're not allowed to talk about our patients.
Does that reek of corruption, authoritarianism, or oppression?

Let's face it, Yale only got rid of her when she crossed the wrong person... Alan Dershowitz.

We don't know, although you are bringing up something that could've happened and I could see that happening although I don't know. I can tell you, and I mentioned this above, she has a long trail of writing highly inflammatory stuff that is extremely unprofessional, such as pointing fingers and accusing various people of being guilty of several crimes without hard proof, and several of her arguments are objectively and provably wrong such as her accusation that Jeff Lieberman only went out against her and no one on the Right, so therefore he's a White Supremacist (not true and provably wrong, he also went after Keith Ablow for claiming Biden had dementia).

The strange case of Dr. Keith Ablow

<p>The strange case of Dr. Keith Ablow</p>

www.politico.com

I'm no fan of Dershowitz, and can point out a lot of bad stuff he did, but all of the stuff that I think he did that was bad was within his professional ethics such as defending OJ Simpson. I don't think any physician can sincerely say it's healthy for or credits our profession to have someone write a bunch of stuff, much of it provably false, where she pretty much just bashes people using theories based on L-wing conspiracies accusing various figures of being White Supramacists, Nazis, etc without proof. In fact I'll go as far as to say she's guilty of the same poison she's dealing out. All of this stuff is in her online blog where seriously one would question if she's forgotten to take her antipsychotic. Read her blog for 15 minutes.

 

[comp1]

Do we think a psychiatrist interviewing Cosby in a clinical setting for sixty minutes would have had a better chance having sexual assault announced to them? I guess I just don't trust my patients as much as some other providers do. I don't think the veil of confidentiality makes people a heck of lot more likely to be truthful. I do think that if you perform a public persona for decades, as opposed to say for a movie role, that becomes a huge part of who you literally are, even if it's not who you began as. It may not be ALL of who you are, but it's probably more of who you are than someone is going to pick up in a random 60 minute clinical interview. I think the whole family guy thing Cosby had going on was a HUGE part of who he actually was. There are many, many people who stated that. The sexual assaults were not part of the public persona, but I don't think they would have been part of what he reported to a psychiatrist either. Ultimately, we could find out a lot more out about Cosby by public statements than the performance (and trust it would be no less a performance) he gives in any sort of clinical interview. Also...the sexual assaults were behaviors...not diagnoses. They aren't particularly relevant...

 

[whopper]

. I do think that if you perform a public persona for decades, as opposed to say for a movie role, that becomes a huge part of who you literally are, even if it's not who you began as.

And that may be so, but you are now delving into non-evidenced based territory. This is dangerous territory for any medical person to enter without a healthy acknowledgement.

Read up on Park Dietz, the forensic psychiatrist who became the FBI's "expert" and followed his advice to attack the Branch Davidian Compound. I wonder if Dr. Dietz in a healthy transparency declaration openly stated he has no expertise in dealing with similar situations when the event happened.

I'm A BIG Star Trek fan. I have no assumptions William Shatner is Captain Kirk. Of course literally he's not, but several people start to think actors are their characters on a very deep level. George Takei claims Shatner is a big primadonna narcissist, a claim that's been repeated by several who worked with him.

 

[G Sheb]

IMHO that's overgeneralizing if I take your statement literally. Of course there's anything in any field that could be useful for the public to know. Your statement, however reasonably sounding is not specific to Goldwater but a generalized statement word for word. Goldwater is specific to diagnosing people without following a standard, and then making it public without professional consequences.

[/QUOTE]

Right, which is why Goldwater is not relevant here, as Bandy Lee did not diagnose Trump.
But the APA updated its "rules" to go beyond diagnosis to any kind of comment without 1:1 evaluation and then crushed out the debate.

When I make assessments of dangerousness, I sometimes weigh information besides the 1:1 interview much heavier. So the idea that any kind of assessment is entirely useless without sitting with someone is really not professionally accurate. Sometimes I have to make judgements about their mental fitness without any kind of personal evaluation (pt not consenting or unable to). Ultimately it's a judgement call whether you feel that information is worth enough to alert the public about something you feel is important.
There's a ton of information you could gather about someone who's been in the public eye for so long. It starts with their off hand comments, to their actual behavior...etc.
For political leadership, it's probably even more imperative for experts to speak out when they sense something is worth talking about.

Journalists could talk about our patients.
We're not allowed to talk about our patients.
Does that reek of corruption, authoritarianism, or oppression?

I'm not following.
A journalist can write an article in the NY Times warning about someone's fitness for leadership because of their behavior and their personality traits.
But an expert in human behavior cannot?
This has more to do with the APA cozying up to power than standing for ethics.

We don't know, although you are bringing up something that could've happened and I could see that happening although I don't know. I can tell you, and I mentioned this above, she has a long trail of writing highly inflammatory stuff that is extremely unprofessional, such as pointing fingers and accusing various people of being guilty of several crimes without hard proof, and several of her arguments are objectively and provably wrong such as her accusation that Jeff Lieberman only went out against her and no one on the Right, so therefore he's a White Supremacist (not true and provably wrong, he also went after Keith Ablow for claiming Biden had dementia).

The strange case of Dr. Keith Ablow

<p>The strange case of Dr. Keith Ablow</p>

www.politico.com

I'm no fan of Dershowitz, and can point out a lot of bad stuff he did, but all of the stuff that I think he did that was bad was within his professional ethics such as defending OJ Simpson. I don't think any physician can sincerely say it's healthy for or credits our profession to have someone write a bunch of stuff, much of it provably false, where she pretty much just bashes people using theories based on L-wing conspiracies accusing various figures of being White Supramacists, Nazis, etc without proof. In fact I'll go as far as to say she's guilty of the same poison she's dealing out. All of this stuff is in her online blog where seriously one would question if she's forgotten to take her antipsychotic. Read her blog for 15 minutes.

OK sure. Lieberman, the same man who was fired because he called someone a "freak of nature" because she has black skin, and then also wrote an article saying that Donald Trump does not have NPD, thus actually breaking the Goldwater Rule. She's really not that far off.

 

[comp1]

There's no evidence to point to here. That's my point. You can't make the argument that clinical interviews are superior to reviewing public records for really understanding a person based on any evidence. There's no evidence either way. We just happened to pick a lane because clinical interviews are available for most and public records/statements/performances are only available for a select, but important, few.

 

[clausewitz2]

There's no evidence to point to here. That's my point. You can't make the argument that clinical interviews are superior to reviewing public records for really understanding a person based on any evidence. There's no evidence either way. We just happened to pick a lane because clinical interviews are available for most and public records/statements/performances are only available for a select, but important, few.

The thing to bear in mind is the farther we get away from normal clinical procedure the less and less our psychiatric training is reliable and useful. We this get farther away from what we as psychiatrists are actually well-versed in Except people are still going to treat our pronouncements as having the imprimatur of Medical Experts, for whatever that is worth nowaday.

I would actually argue that journalists are probably better qualified in many cases to piece together a picture of someone through publicly available records.

 

[comp1]

I also had thoughts on journalists. They are good at collecting information and even often translating that information for the wider public. But this...is about synthesizing new information. I think it's at least as close to what we do as it is to what journalists do, bordering on both. I do agree that it would be ideal to have people who specialized in this particularly (journalists definitely do not) and that our own training included at least a cursory focus on formal analysis of the behavior of public figures and how it related to mental health. There certainly is a great need. It could even be a fellowship. I'm not entirely convinced that it would be dramatically different than assessing the validity of a person's individual self report, but regardless, that's not going to happen with the Goldwater Rule in place.

 

[whopper]

Also...the sexual assaults were behaviors...not diagnoses. They aren't particularly relevant..

A repeat pattern of this over the course of several years, and these were premeditated would warrant a diagnosis.

 

[whopper]

. I think it's at least as close to what we do as it is to what journalists do, bordering on both. I do agree that it would be ideal to have people who specialized in this particularly (journalists definitely do not) and that our own training included at least a cursory focus on formal analysis of the behavior of public figures and how it related to mental health. There certainly is a great need. It could even be a fellowship. I'm not entirely convinced that it would be dramatically different than assessing the validity of a person's individual self report, but regardless, that's not going to happen with the Goldwater Rule in place.

Aside from Goldwater the APA asked the Supreme Court to not put us in this position. Statements were made to the effect of "we're not crystal-ball readers."

It would seem you're arguing we should go into the crystal-ball territory.

Barefoot v. Estelle - Wikipedia

en.wikipedia.org

Psychiatry Can't Predict Violent Behavior | Prison Legal News

Barefoot v. Estelle, 463 U.S. 880 (1983)

Barefoot v. Estelle

supreme.justia.com

Now I don't find going into the crystal-ball territory wrong if you transparently claim you don't know WTF anymore than the next guy you're talking about and that your MD and psychiatry training pretty much have no weight with your opinions.

And if you do want to go into crystal-ball territory and actually want to claim you know something of what you're talking about you shouldn't do so unless you can actually produce evidenced-based science that backs up your claims. Kind of like this guy did.

Douglas Mossman

Douglas Mossman, MD, until his death in 2018, was Professor of Clinical Psychiatry and Program Director of the Forensic Psychiatry Fellowship at the University of Cincinnati College of Medicine.

www.guilford.com

 

[comp1]

It's sounds like people are advocating for more research in this area. I strongly support that. The first step, I think, is removing the idea that any sort of diagnosis or other clinical commentary from publicly available data is inherently unethical and should never be done. Instead, we should move to the appropriately humble, neutral position that we don't actually know clearly whether a clinical interview or review of various publicly available information by a clinician would provide better information about a given person, either for predicting future behavior or making diagnoses. This would be in contrast to any sort of positive claim either way.

 

[Stagg737]

Right, which is why Goldwater is not relevant here, as Bandy Lee did not diagnose Trump.
But the APA updated its "rules" to go beyond diagnosis to any kind of comment without 1:1 evaluation and then crushed out the debate.

She pretty much did though. She claimed he was a narcissistic sociopath and that he suffered from Folie a Millions with all his followers. There's direct quotes of her saying so in this article/interview:

The 'Shared Psychosis' of Donald Trump and His Loyalists

Forensic psychiatrist Bandy X. Lee explains the outgoing president’s pathological appeal and how to wean people from it

www.scientificamerican.com

 

[G Sheb]

Bandy Lee was ultimately exonerated by the historical record itself. She warned that this man's ego, narcissistic fragility and rage will not stop him even from orchestrating an insurrection so that he doesn't deal with the pain of losing an election. She called it right, at the time many experts were claiming that he 'can't be that nuts'.

Psychiatrists have a lot to contribute to that discussion. We have a lot to say about patterns of behavioral, personality traits and what they mean. Yes, we don't predict the future and we're not the only one who have a say, but if we see something that is clearly ominous, maybe we should say something. The APA shutting us out of the discussion is just cowardice and politics, not ethics.

 

[G Sheb]

She pretty much did though. She claimed he was a narcissistic sociopath and that he suffered from Folie a Millions with all his followers. There's direct quotes of her saying so in this article/interview:

The 'Shared Psychosis' of Donald Trump and His Loyalists

Forensic psychiatrist Bandy X. Lee explains the outgoing president’s pathological appeal and how to wean people from it

www.scientificamerican.com

But this is not a diagnosis. Is there a DSM dx of 'narcissistic sociopathy' and 'folie a millions'? There isn't, because diagnosis is for treatment, and this is not what she's doing here.

 

[Stagg737]

But this is not a diagnosis. Is there a DSM dx of 'narcissistic sociopathy' and 'folie a millions'? There isn't, because diagnosis is for treatment, and this is not what she's doing here.

There are plenty of legitimate diagnoses/constructs not in the DSM and the DSM constructs for personality disorders are some of the most questionable in the whole book. If you're saying she didn't diagnose someone because she didn't make a "DSM diagnosis" then I have a hard time taking what you'd consider a assessment seriously. "Diagnosis is for treatment" is a med student level thought process of how we approach our field and is just a useful tool to give some more concrete definitions to those lacking understanding of the more complex processes that occur in mental health in general.

I fully realize she had no intention to treat, but I argue that's exactly what makes her actions devious. Let's not pretend she was doing this because she was so driven to do "the right thing". Her motives were to accomplish an agenda, and if you look at her actions and statements altogether it's obvious. I have no problem with advocating for evaluations of those sitting in the highest levels of offices in our country, but she and her colleagues who testified in congress went beyond that. You can argue technicalities all you want, but what she did is a great example of why the Goldwater Rule was made in the first place.

 

[G Sheb]

There are plenty of legitimate diagnoses/constructs not in the DSM and the DSM constructs for personality disorders are some of the most questionable in the whole book. If you're saying she didn't diagnose someone because she didn't make a "DSM diagnosis" then I have a hard time taking what you'd consider a assessment seriously. "Diagnosis is for treatment" is a med student level thought process of how we approach our field and is just a useful tool to give some more concrete definitions to those lacking understanding of the more complex processes that occur in mental health in general.

I fully realize she had no intention to treat, but I argue that's exactly what makes her actions devious. Let's not pretend she was doing this because she was so driven to do "the right thing". Her motives were to accomplish an agenda, and if you look at her actions and statements altogether it's obvious. I have no problem with advocating for evaluations of those sitting in the highest levels of offices in our country, but she and her colleagues who testified in congress went beyond that. You can argue technicalities all you want, but what she did is a great example of why the Goldwater Rule was made in the first place.

The whole point of diagnosis is that it’s a formal label within an agreed upon system that allows you to proceed within a specific way. At no point did she formally diagnosed him with anything.
On the other hand it was corrupt Lieberman who convened a panel of 7 “specialists” and saw if he can put a dsm diagnosis from publicly available information. Now that is a clear violation of Goldwater from a man who was pretending to defend it.
Yes, it’s sad we have to repeat school level information which you might have missed.

As for your speculations about her intentions, they sound far more unhinged and baseless than anything she said about Trump. A man who has been clear shown to be impulsive, reckless, prone to grandiosity and paranoia, inciting violence, unable to foresee the consequences of his actions and due to his character almost got us in an international war than a civil one.
Someone who’s a clearly a Publix health danger if he’s ever allowed again in office.

 

[Stagg737]

The whole point of diagnosis is that it’s a formal label within an agreed upon system that allows you to proceed within a specific way. At no point did she formally diagnosed him with anything.
On the other hand it was corrupt Lieberman who convened a panel of 7 “specialists” and saw if he can put a dsm diagnosis from publicly available information. Now that is a clear violation of Goldwater from a man who was pretending to defend it.
Yes, it’s sad we have to repeat school level information which you might have missed.

As for your speculations about her intentions, they sound far more unhinged and baseless than anything she said about Trump. A man who has been clear shown to be impulsive, reckless, prone to grandiosity and paranoia, inciting violence, unable to foresee the consequences of his actions and due to his character almost got us in an international war than a civil one.
Someone who’s a clearly a Publix health danger if he’s ever allowed again in office.

I never said anything about Lieberman, don't confuse my criticisms of Bandy Lee for acceptance of his actions. Pretty pathetic dig with the bolded. I'd expect better from someone that engages in academic conversations, especially if you're a psychiatrist with any understanding of diagnostic nosology and how weak our basis for many of the diagnoses in the DSM often are.

How much of her writings, testimony, and interviews have you actually read? Excluding her work specifically on mental health in prison/incarceration settings, if you've read any significant amount and you can't see a very obvious bias or pattern to how she addresses perceived problems, then Idk what to tell you.

 

[whopper]

OK sure. Lieberman, the same man who was fired because he called someone a "freak of nature" because she has black skin, and then also wrote an article saying that Donald Trump does not have NPD, thus actually breaking the Goldwater Rule. She's really notthat far off.

Lieberman didn't call the person a "freak of nature." He wrote "“Whether a work of art or freak of nature she’s a beautiful sight to behold.” That's different although not very defensible and worthy of criticism.

I wasn't aware (and question) if Lieberman wrote Trump "does not have NPD." Please show a link to that article, cause I question if it even exists, but if it does exist, if he were to say Trump doesn't have NPD, and never evaluated him then yes he would be guilty of violating Goldwater.

Bandy Lee was ultimately exonerated by the historical record itself.

I wouldn't say so, at least by what I'm arguing and several supporting Goldwater are arguing. I've never said Trump IS NOT A NARCISSIST. I don't like Trump. This isn't a we like or don't like Trump argument.

The argument pushed by Lieberman, and myself is that she shouldn't violate Goldwater. The fact that Trump later did terrible things doesn't exonerate her. The question also more fundamentally still isn't do we like or not like Trump. It's that is it within our field's ethics to go against Goldwater and make judgments on public figures especially with very little evidence, and his appearances on The Apprentice don't count as clinical data.

Dr. Bandy Lee didn't state anything already obvious in terms of her analysis (again I don't like Trump). It'd be like a psychiatrist claiming she's got a personal responsibility to warn us that, for example, Putin is a terrible person. (Oh really? Geez thanks for the waste of time, and I must also warn the world that Hitler was a bad person too and only my expertise in psychiatry allows me to pull this off, but because I'm a psychiatrist you got to listen to me say it and not the thousands of photos of concentration camps....). I actually wasted the time and read her BS arguments and book. Seriously she didn't say anything already obvious.

Something real and substantive, which she didn't do is if she were to pull a prescient accusation that no one could've pulled off unless their mental health training actually allowed them to do such as figure out Cosby was a sexual predator way ahead of the time period where evidence and accusations started to to come out of the woodwork. If a psychiatrist or psychologist were to figure that out then that truly would be substantive. Bandy Lee was stating the already obvious and trying to make attention for herself as if this was science. And no, watching The Cosby Show doesn't count as understanding the inner-workings of Bill Cosby, even if you watched every single episode and I-Spy and all of his Jello commercials.

Hence her breaking Goldwater IMHO doesn't exonerate her of anything. She didn't add anything real and substantive to the issue. Everything stated was already known. She didn't convince me of anything that I wasn't already convinced about. Did she drag the profession down? IMHO yes.

Park Dietz claimed he could tell what David Koresh was thinking and feeling, and the FBI used his opinions to attack the Branch Davidian Compound in Waco, TX. Nothing Dietz did was evidenced-based. Psychiatrists can't read minds. IF we could we'd go to a casino all the time and always win. At AAPL conventions several forensic psychiatrists state he dragged the profession down and oversold his abilities.

The only person that I've seen presciently predict things Trump would do was his former attorney of about 10 years Michael Cohen, and you don't have to be a psychiatrist to be able to understand someone when you've worked with that person for dozens of hours a week for years. He called the events of January 6th several months before it even happened.