I remember in my 2nd year of med school during our neuro/psych class we were handed a list of famous artists and writers in the past who were thought to have suffered from bipolar or depression. The topic was creativity and mental illness, especially bipolar. The list included all the usual suspects--Virginia Woolf, Van Gogh, Hemingway, etc. I'm just wondering when a famous person's mental health problems become part of the public knowledge, because clearly, in the case of many famous people, it already has. I can't imagine most of those people on the list we got had been evaluated properly and/or given the chance to sign some kind of confidentiality waiver during their lives.
The concept of the "psychiatric autopsy" is slightly different and implies something even more different when it comes to public figues. One can speculate if Abraham Lincoln had Marfan's syndrome, for example, but since he is a public figure, the law sees this as more "fair game." However, if a physician publicly asserted that Tom Cruise had a paranoid personality disorder, for example, that might be open to a slander or libel lawsuit.
Does the APA position on this have a parallel in internal medicine or family practice? For example, what about physicians who speculate publicly about Kennedy maybe having Addison's disease, or an obvious one, like FDR having polio and being paralyzed?
It's less commonly believed, but likely more accurate that FDR had Guillain-Barre syndrome. This, again, is based on public assertion, and is not a specific claim made by a physician attesting to a particular diagnosis. It seems similar, but there is a difference.
Are psychiatrists beholden to the APA code regarding medical issues in people they haven't themselves examined? Or does the APA code not apply outside psychiatry? In that case, what does apply?
If I understand your questions correctly, I can say that the APA ethics code asks that a diagnosis or speculation not be made about a particular person which one has not examined. There is a similar standard (I believe) which applies to physicians in general. I don't think one could ethically claim, for example, that Oprah has diabetes since she has trouble controlling her weight.
I can think of living people as well where these discussions come up. Or what about a political candidate and their age? I guess age is a vital stat or identifying feature so it's fair game? I know it sounds silly, but many aspects of a person's medical record could also be seen as very reasonable information for the public to have, and it seems contrived to prohibit psychiatrists from discussing those facts. You could take it to an extreme and say, we cannot discuss whether Castro is alive or dead because we haven't examined him and assessed his mental status! Same goes for Elvis!
Age is not a disease, and in fact, there is great
speculation as to whether public official health records should be released at all, and if this should have bearing on voting outcomes. McCain, for example, has released all records regarding his 3 melanoma removals, but refuses to release his psychiatric records. There is further speculation that there are lingering PTSD symptoms which may interfere with his ability to govern effectively. Psychiatric records, for better or worse, are often held to a higher standard of confidentiality than other medical records. The most obvious example of this is the doctor-patient confidentiality privilage which was borne out of the therapist/patient relationship.
There must be exceptions too, I'd think. What if you are a psychiatrist, and your neighbor is standing on their apartment window ledge, threatening to jump? Of course you must be allowed to advise them to get off the ledge and try to lead them to safety. That's still giving "advice" even if they haven't been examined.
This falls under still a different standard, and involves (in most states) a Good samaritan situation. Some states actually have a rarely-enforced sort of 'opposite' of that law under the same name, which
requires a bystander to offer help to someone in imminent danger.