What Can Therapists Say About Celebrities? The ethics of public statements
Curt and Katie chat about whether therapists should make public statements and diagnose public figures. This is our first continuing education eligible podcast, discussing the ethics of speaking out about the mental health of people in the public eye. We explore the origins of the Goldwater rule, a group of psychiatrists who purposefully broke it, and how masters level organizations address this concern. We also provide you with some ideas about how you can make this decision for yourself.
Click here to scroll to the podcast transcript.
Click here to scroll to the podcast transcript.
In this podcast episode we look at the ethics of modern therapists diagnosing public figures
For our first continuing education worthy podcast, we wanted to address something that is becoming more and more prevalent in our field: therapists speaking out about the mental health of public figures.
What is the Goldwater Rule?
- The history of the Goldwater Rule
- The impact of DSM II (and the update to DSM III)
- The original intention of the rule versus the current interpretation of the Goldwater Rule
- Fears from the American Psychiatric Association that seems to have driven the development of (and on-going commitment to) this rule
How the Goldwater Rule (and Similar Ethical Principles) Have Shifted Over Time
- Perspective from one of the original framers of the Goldwater Rule
- Moving from teleological to deontological interpretations
- How the internet and social media has changed the landscape
- The American Psychiatric Association expanding their commitment to the Goldwater Rule, stating reasons psychiatrists should not assess
- The Goldwater “Caveat” or “Principle” versus Goldwater “Rule” or even Goldwater “Doctrine”
- Beyond diagnosis to restricting any comment on the behavior or mental health of a public figure
- The stance on this ethic from American Psychological Association and the large Masters Level Organizations (AAMFT, ACA, NASW, and CAMFT, for example)
The Dangerous Case of Donald Trump – the Public Diagnosis of an American President
- The group of psychiatrists who pushed back on the Goldwater Rule
- The Duty to Warn – does it apply here?
- What are the challenges of accurately diagnosing Trump?
- Where expertise is helpful (and how the public can water down diagnosis)
Current Guidelines for Modern Therapists
- Whether diagnosis is required for a duty to warn
- The tactic of putting forward information without drawing conclusions (and why we don’t like this strategy)
- Specific guidance from the professional organizations on what therapists can and cannot do
- Taking special care in how one decides what they say about an individual in public settings
- Using one’s professional judgement and special care
Cautions When Using Your Professional Judgment
- The potential harm of discussing diagnosis on social media
- Bias, cultural factors, and other information that could make an inaccurate or harmful diagnosis
- Mental health stigma and other concerns related to diagnostic language (ICD-10, DSM-V)
- Speaking outside of your professional expertise
- Questions to ask yourself before making a public statement
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Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide
Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!
Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.
You can find this course here: What Can Therapists Say About Celebrities? The ethics of public statements – a continuing education podcourse
Continuing Education Approvals:
When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information
CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Dr. Ben Caldwell, Psychotherapy Notes: Ethically It’s Fine to Diagnose Donald Trump
For the full references list, please see the course on our learning platform.
Relevant Episodes of MTSG Podcast:
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is a member of the California Association of Marriage and Family Therapists ethics committee, an Adjunct Professor at Pepperdine University, lecturer in Counseling Laws and Ethics at California State University Northridge, a former Law & Ethics Subject Matter Expert for the California Board of Behavioral Sciences, and former CFO of CAMFT. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, with a Master’s degree in Clinical Psychology from California State University, Fullerton and a Bachelor’s Degree in Psychology and Theater from Occidental College in Los Angeles, California. Katie has always loved leadership and began stepping into management positions soon after gaining her license in 2005. Katie’s experience spans many leadership and management roles in the mental health field: program coordinator, director, clinical supervisor, hiring manager, recruiter, and former President of the California Association of Marriage and Family Therapists. Now in business for herself, Katie provides therapy, consultation, or business strategy to support leaders, visionaries, and helping professionals in pursuing their mission to help others. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano http://www.crystalmangano.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Curt Widhalm 00:00
This episode of the Modern Therapist’s Survival Guide is sponsored by Buying Time.
Katie Vernoy 00:04
Buying Time has a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they’ve got you covered. Don’t know where to start, check out the system’s inventory checklist, which helps business owners figure out what they don’t want to do anymore and get those delegated ASAP. You can find that checklist at buying time. llc.com forward slash systems stash checklist.
Curt Widhalm 00:31
Listen at the end of the episode for more information.
You’re listening to the modern therapist survival guide where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 00:49
Hey modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com register for your free profile, purchase this course pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals. Check out moderntherapistcommunity.com
Katie Vernoy 01:22
Once again hop over to moderntherapistcommunity.com for one CE once you’ve listened. Woo hoo!
Curt Widhalm 01:28
Welcome back modern therapists. This is the Modern Therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is our first continuing education eligible podcast and we’re gonna go a little bit long format today. Today we’re going to be exploring an ethical issue around therapists making public statements. And this is becoming what would seemingly be more and more prevalent as more and more of us have access to things like social media outlets. But the underpinnings of a lot of this debate starts back in the 1960s with little story about Arizona Senator Barry Goldwater. Now Barry Goldwater was running for president in the 1964 election. And for those of you American history buffs, you probably know, he did not win. And this, this is partially blamed on the way that the Lyndon Johnson campaign framed Barry Goldwater, in response to Fact Magazine presented a special issue that was titled The unconscious of a conservative a special issue on the mind of Barry Goldwater. This was in response to a play on the words of Barry Goldwater’s book the conscience of a conservative so what fact magazine had done is they had sent out a survey to over 12,000, psychiatrists, of whom about 2400 responded, and this was asking these psychiatrist opinions of the mental health status of Senator Barry Goldwater. The results of the survey range a little bit all over the place. About 27% of the overall people responded, said that Mr. Goldwater was mentally fit, 23% said that they didn’t know enough to make a judgement, and a whole lot said things like Mr. Goldwater is a megalomaniac, paranoid, grossly psychotic, and some even offered specific diagnoses, including schizophrenia and narcissistic personality disorder.
Katie Vernoy 03:49
Oh, my goodness, that sounds pretty familiar.
Curt Widhalm 03:54
Yeah, this has come up recently, in…
Katie Vernoy 03:58
Just a little. Just a little bit.
Curt Widhalm 04:01
And part of the point of today’s episode is where some of this debate has been in the last several years as far as America, how the rules have gotten to where we are, and what this means for us at this point in time. Now, a lot has been said, and we will get into this a little bit later in the episode about some of the more recent publications and recent debates in the field, including books like The Dangerous Case of Donald Trump by Therapy Reimagined speaker Bandy X. Lee and some of her colleagues. We will be discussing her later, and kind of where our responses are as a profession and some recommendations at the end of the episode. So, getting back to Barry Goldwater,
Katie Vernoy 04:50
Must we? I’m joking, I’m joking.
Curt Widhalm 04:54
So Goldwater ended up suing fact magazine and the publishers for libel based on this and Goldwater ended up winning this. Now, in the cases, Goldwater was issued $1 as compensatory damages and $75,000 in punitory damages to the publisher of that magazine, Ralph Ginsberg. And this was upheld by United States Court of Appeals in the Second Circuit, and the Supreme Court’s denied a petition to review it. So, Goldwater ended up prevailing, but at the time, feeling like they have a little egg on their face of all of these psychiatrists making public statements, the American Psychiatric Association said, this is something where this might erode the trust in our professionals, and therefore our profession. We can’t have this. We have a sense of urgency that we need to address this, let’s take nine years to make a rule.
Katie Vernoy 06:03
Nine years for a very important role. Well at least, we can’t say that they didn’t think it out, take time to really consider.
Curt Widhalm 06:11
I point out a little bit of the nine years because what happened at the time is, we were under the guidance of the Diagnostic and Statistical Manual of the American Psychiatric Association’s Second edition. Now, this was during a building towards the DSM three, which was going to come out several years later in 1980. But for those of us who weren’t practicing back in 1964, and answering questionnaires from Fact Magazine, there was a pretty fundamental difference between the DSM two and the DSM three. And that difference was the DSM two was largely based in psychodynamic and psychoanalytic theory, which led to a lot of conjecture and potential bias in evaluating clients. With the DSM three helps move us towards today’s DSMs is created more of behavioral checklist observations. And so what many of these psychiatrist were conjecturing about Mr. Goldwater is assumptions about his upbringing, assumptions about the relationships that he was having, and the underpinnings of wherever they’re believed psychosis and megalomania, diagnostics and observations about him would be based out of.
Katie Vernoy 07:40
so it really switched from being based in more of a clinician theoretical orientation to what we know more at this point with the DSM 3, 4, 5, 5TR that’s coming out that it moves to more of observable and behavioral criteria. Am I hearing that right?
Curt Widhalm 07:59
You are hearing that absolutely correct. And so what the DSM three allowed is, if somebody’s not getting out of bed, that’s a feature of depression.
Katie Vernoy 08:12
Curt Widhalm 08:13
Not based in whatever the DSM two criteria were before. Overall, as far as protecting, you know, diagnostics, making inter-rater diagnostics, a little bit more consistent. This is generally seen as a good thing.
Katie Vernoy 08:29
Curt Widhalm 08:31
But some of the debates in the 60s and 70s, and has continued today is in the APA’s interpretations of the Goldwater principle – I’m emphasizing principle here at this point – is that there’s some fear that if psychiatrists are making statements about political candidates, that if those candidates win, particularly executive offices within the US federal government, there may be fear that the federal government would reduce the reimbursement rates given to (particularly) psychiatrist for their services, under things like Medicare, and Medicaid.
Katie Vernoy 09:16
So it was – there was money – money was talking here.
Curt Widhalm 09:19
Well, not necessarily any direct threats that I can find in my research about the setup of this, but there is the potential fear and who knows there may be a president that might punish particular agencies or sectors of the economy, if they are in fact elected. I don’t know if that could potentially happen, but that’s where the American Psychiatric Association’s concerns seem to have been lying.
Katie Vernoy 09:47
And it seems like they may not have been too far off. So what was the original intention of the Goldwater principle then?
Curt Widhalm 09:58
So in some of our Research here and a lot of our conversation here right now so far as some history that is provided by the British Journal of Psychiatry article called “It is ethical to diagnose a public figure one has not personally examined”. This is a debate written by John Gartner, Alex Lankford and Eileen O’Brien. Now in this, John Gardner had mentioned some personal communications that he had had with Dr. Allen Dyer, who was the last living member of the original APA ethics committee that drafted the APA Goldwater response in 1974.
Katie Vernoy 10:40
Curt Widhalm 10:41
This did lead me to looking at some more information that Allen Dyer has written and fortunately, Dr. Dyer has a blog, where he has written about the evolution of the so called Goldwater rule and ethical analysis.
Katie Vernoy 10:58
Can we put that in our show notes?
Curt Widhalm 11:00
We will include links and or references to everything that we can in our show notes. So this is from 2017 from this “Evolution of the so called Goldwater rule and ethical analysis.” And from Dr. Dyer, I’m quoting here, “the first thing to appreciate about the so called Goldwater rule is that it is not a rule but rather a principle. The APA’s code of ethics is the annotations applicable to psychiatry, of the AMA principle of medical ethics, which explicitly state that the principles are quote, ‘not laws, but standards of conduct, which define the essentials of honorable behavior for the physician.’ end quote – Much of the current discussion applies rule based legalistic thinking to a matter of professional judgment based on principle. In ethical theory, this would be a category mistake, attempting to transform a teleological end-based approach into a deontological or rule-based approach.
Katie Vernoy 12:07
Okay, ethics nerd, I was trying to follow you there. We’ve got teleological, and deontological. I think I’m gonna need a little bit of an explanation.
Curt Widhalm 12:18
Okay. So these are two different ways of looking at ethics and keeping this as kind of a shorter conversation because this isn’t the point of the episode. But I think it helps to clarify what Dr. Dyer is saying here. Teleological is a type of consequentialist ethics. And what that means is that we need to look at the outcome of an action to determine if it was morally good or not. Whereas a deontological approach would be if there is any chance that an action could cause harm, you should not do that action.
Katie Vernoy 12:59
Okay. So if we’re looking at deontological, it would be if something could be harmful, like client’s in crisis in your office, need to be hospitalized? Do you drive them to the hospital or not? It sounds like a deontological deontological?
Curt Widhalm 13:18
Katie Vernoy 13:19
A deontologist, which doesn’t sound like what it is, if a deontologist would say you should never have a client in your car, you should never drive your client to the hospital, you should never manage your client crisis alone.
Curt Widhalm 13:32
Yes, all of all of those lawyers and all of those insurance agents that would say, you know, oh, you got into an accident with with your client in the car, you are at fault for this. That is a deontological way of thinking.
Katie Vernoy 13:48
Okay, and then the teleological way would be that if you believe that you can be safe, you know this client needs to get to the hospital soon. You know, there’s there’s no transportation available, and it’s going to be hours and hours. And this client is decompensating and needs to get to the hospital, but you have a strong relationship, you feel safe, you put them in your car, you get them over to the hospital, because the end justifies the means?
Curt Widhalm 14:15
Close and I guess maybe the the place of clarifying this is with the correct intent that if you reasonably believe that you could help this client get to the hospital and it was reasonably possible and something were bad to happen along the way – It’s kind of more of the Good Samaritan approach that the intentions were correct. The the fallout of it ended up being maybe not ideal, but if there’s the potential to cause good and as long as the intentions were good, you can morally judge that as good.
Katie Vernoy 14:53
Okay, but that still is sounding a little bit like the ends justify the means
Curt Widhalm 14:57
You You You are correct here – In that this is what Dr. Dyer is saying – this was – he saying that this was written as a way of saying, use your judgment. Be, you know, predictably well. This, this subcommittee said, this is teleological. This is consequential. Have some professional judgment in doing this.
Katie Vernoy 15:21
Curt Widhalm 15:23
And what has happened over the last 40 plus years is it has been interpreted through an entirely different and competing moral viewpoint that everyone seems to be taking as well “just don’t do this.”
Katie Vernoy 15:38
Yeah. I see the complexity, though. Because if we’re looking at maybe not exactly the ends justify the means, but something where we are relying on individual professionals to have a good assessment of their motives, to have a good assessment of what the consequence would be for public diagnosis, for example. Do we feel like we can trust our professionals to make that judgment? That the consequences are sufficiently positive and being able to work in that gray?
Curt Widhalm 16:14
And what Dr. Dyer is saying is that the APA says, No, those individual people can’t make that decision.
Katie Vernoy 16:24
So we’re looking at people making something very concrete, black and white, that actually has a lot of gray in it, and it’s supposed to be professional judgment, not this is good, or this is bad.
Curt Widhalm 16:37
Yes. Now, Dr. Dyer goes on to say the second thing to appreciate is that the Goldwater caveat – called rule and understood by many psychiatrist as an absolute prohibition – is, in fact, embedded in an affirmative obligation of physicians to society, quote, “a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.” I take what Dr. Dyer is saying here, as the intention behind this was that psychiatrists should still be looking at improving the overall communities and public health that they work in, that there’s an honor of being a medical professional to serving the greater good of society. And that this Goldwater caveat is that we maybe don’t make diagnostics about people without evaluating them. But maybe when we feel that there is a sense of danger to somebody, we can use our professional – and in their case, medical – knowledge to be able to make communications about that.
Katie Vernoy 17:48
I’m not clear that that’s what the Goldwater rule is being interpreted as now. Right. I mean, it seems like even saying anything has gotten to be taboo, according to the American Psychiatric Association.
Curt Widhalm 18:03
Oh, wait, there’s more.
Katie Vernoy 18:05
Okay, okay. Keep going, keep going.
Curt Widhalm 18:09
Now, we also need to consider what the landscape of 1960s and 1970s world is as far as available information. I grew up in a part of the country at a point in my life, where, with an antenna and good weather, we could get maybe four television stations, the internet did not yet exist. Cell phones were a thing that was only imagined on the Jetsons that
Katie Vernoy 18:40
You and me both buddy, you and me both.
Curt Widhalm 18:43
This was several years after Mr. Goldwater was running for president. So the availability of information back at that time is much different than the landscape that we have today.
Katie Vernoy 18:54
Curt Widhalm 18:55
You know, I in my pocket normally carry a device that has more computing power than the first spaceships that went to the moon. Now, what I choose to do with it is make memes and send videos of cats to my wife. But I could also go and pull up videos of just about any public figure in a variety of different contexts that would allow for me as a mental health professional to at least say, yeah, what you’re doing kind of looks “sus” as the kids who are using the language these days
Katie Vernoy 19:33
It’s like “kind of looks what?” – suspect is that what you’re saying is like for the old people in the audience, it’s suspect that their your, your behavior looks suspect. All right?
Curt Widhalm 19:44
Yes. Now, in the intervening years, this is back to Dr. Dyer’s blog, points out that the 2013 version of the principles and annotations preserves the original language of the 1973 version. But the 2015 APA commentary on ethics and practice takes a more administrative and specific tone. It preserves the affirmative ethical principle, better… of improving the community and betterment of public health through education and evidence based science. But says rather than offering opinions about a specific person, as the best means of facilitating public education, in some circumstances, such as academic scholarships, about figures of historical importance, exploration of psychiatric issues, for example, diagnostic conclusions. May be reasonably provided that it has sufficient evidence-base and is subject to peer review and academic scrutiny. It just means that you don’t just go out as an individual and say, Here’s my opinion. It needs to have a little bit of consensus here. But what the APA ethics committee did, instead, is started to reflect language that psychiatrists should not make any public statements about anybody no matter what. And this was really the beginnings of where the dangerous case of Donald Trump’s how authored by Bandy X. Lee and colleagues ended up being a really big part of the debate here over the last now six years. And what the APA was seemingly trying to do is take the voice out of people saying, “hey, trust me, I’m a doctor. I know what I’m saying.” And there were several questions and published across, you know, a number of different op eds, some that appeared in places like the New York Times that led to many of the professional organizations coming down more strictly on the emergence of the Goldwater rule. And this is where in March 2017, the American Psychiatric Association released a statement saying the APA remains committed to supporting the Goldwater rule.
Katie Vernoy 22:13
Curt Widhalm 22:14
And they gave three main points for the rationale of their opinion. Number one, when a psychiatrist comments about the behavior, symptoms, diagnosis, etc, of a public figure without consent, that psychiatrist has violated the principle that psychiatric evaluations be conducted with consent or authorization.
Katie Vernoy 22:35
So we’re looking at consent as number one,
Curt Widhalm 22:38
Katie Vernoy 22:38
Curt Widhalm 22:40
Number two, offering a professional opinion on an individual that a psychiatrist has not examined, is a departure from established methods of examination, which require careful study of medical history, and firsthand examination of the patient. Such behavior compromises both the integrity of the psychiatrist and the profession.
Katie Vernoy 23:03
So that one sounds the most similar to the original intent, which is don’t diagnose someone that you’ve not evaluated.
Curt Widhalm 23:10
Katie Vernoy 23:10
Right. Okay. And this is saying, don’t do that, because it makes us look bad.
Curt Widhalm 23:18
Katie Vernoy 23:19
Curt Widhalm 23:20
And third, when psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness.
Katie Vernoy 23:29
So we got there’s no consent, it makes us look bad, and increases stigma.
Curt Widhalm 23:36
Katie Vernoy 23:37
Curt Widhalm 23:39
Now, turning this as maybe a question to you. You and I have both listened to a little bit of the news here in the last several years. What have you heard Donald Trump being diagnosed with?
Katie Vernoy 23:56
Malignant narcissism is one. He probably could be diagnosed with ADHD could potentially be diagnosed with psychopathy. I mean, like there’s a lot of – sociopathy, like there’s – which I guess is malignant narcissism, but I’ve heard a lot of different suggestions about what’s possible.
Curt Widhalm 24:17
And I’ve heard some people even suggesting things like dementia on top of that, just to be clear, these are things that Katie and I have heard, we’re not actually
Katie Vernoy 24:28
We’re not saying they’re true. We’re not diagnosing in public people!
Curt Widhalm 24:34
One of the op eds in the New York Times pointed out that in order for things like narcissism to be diagnosed, if you look in the DSM and particularly where we are today, the DSM five, that one of the features for diagnostics is that it has to be disturbing to the patient’s themselves.
Katie Vernoy 24:58
Curt Widhalm 24:59
And therefore is actually an inaccurate use of a diagnostic, let alone the means to actually arrive there. Now, as I was mentioning earlier, there are lots of ways to get indirect observations of people these days. And maybe this calls into question the diagnosis or the diagnostic criteria of personality disorders where, hey, if one of the features of a personality disorder is that they’re not bothered by the fact that they have that particular personality disorder, maybe that needs to be looked at in future DSMs. Maybe we’ll talk to somebody someday about that. But in response to the APA reaffirming this
Katie Vernoy 25:47
for the American Psychiatric Association
Curt Widhalm 25:49
The American Psychiatric Association, in response to a op ed, published on New York times.com on March 7 2016, called “Should therapist analyze presidential candidates” on March 14 2016, the then president of the American Psychological Association – so taking this out of the medical realm and potentially a little bit more specific to providers of more traditional therapy – president of the American Psychological Association at the time, Dr. Susan H. McDaniel, wrote response to the article on whether therapists should analyze presidential candidates. And I’ll read this in its entirety because it’s about three paragraphs. “The American Psychological Association wholeheartedly agrees with Robert Klitzman PhD that neither psychiatrist nor psychologist should offer diagnoses of candidates, or any other living public figure they have never examined. Our association has declined requests from several reporters seeking referrals to psychologists who would make such speculations. Similar to the psychiatrist Goldwater rule, our Code of Ethics exhort psychologists to take precautions that any statements they make to the media are based on their professional knowledge, training or experience in accord with appropriate psychological literature and practice. And do not indicate that a professional relationship has been established with people in the public eye, including political candidates. When providing opinions of psychological characteristics, psychologists must conduct an examination adequate to support statements or conclusions. In other words, our ethical codes state that psychologists should not offer a diagnosis in the media of a living public figure they have not examined.”
Katie Vernoy 27:40
So just diagnosis, it sounds like it also is going further into things that might be within the realm of psychology and not diagnosis. It was saying nothing could be in your professional opinion, unless you’ve done a an evaluation. And then there would be confidentiality issues. So the question that I have is – it just don’t talk about public figures at all?
Curt Widhalm 28:06
That seems to be where both of the APAs are going with this language. Now, according to the Wikipedia article on the Goldwater rule, it is a citation needed statement on there. As you know, we’re citing our references here. And I wasn’t able to substantiate this claim that Dr. McDaniel received a lot of pushback from members of the American Psychological Association about her stance and interpretation of the American Psychological Association direction and intention with this, that apparently, many members of the American Psychological Association felt that this was too specific and restrictive. And that as long as they were framing it within the characteristics of hey, I haven’t evaluated this guy, but based on these statements, and these misapplication of following through on his own things, yeah, this one presidential candidate seems to have this diagnosis. But of course, they were eventually talking about the opportunity to say this about Kanye West. Now, I recognize that most of our audience are probably not psychiatrists, and most of our audience are probably not psychologists. And so I want to create kind of some space as far as where do our other professional mental health associations take stances on these kinds of things. And that would be the American Counseling Association, the American Association for Marriage and Family Therapists, National Association for Social Workers. And Katie and my participation with the California Association of Marriage and Family Therapists, while a state Organization, they have 30 plus 1000 members, we generally give them a say in national discussions as well. But before we jump to more of these masters levels organizations, Katie, what are you feeling as far as – can we be talking about people publicly?
Katie Vernoy 30:16
So what I’m hearing is that you can, it’s pretty clear that you should not diagnose publicly, I think the the folks who wrote The Dangerous Case of Donald Trump would disagree. But most of the time, so far, what you’ve talked about APA and APA, are saying don’t diagnose. It seems like there’s an ongoing discussion around whether we can give opinion on behavior. How are the psychiatrists and other folks about how are we analyzing that piece about… Can we talk about people in public?
Curt Widhalm 30:52
So this is going back to that British Journal of Psychiatry. And back to the point made by John Gartner. He says that you don’t have to diagnose to warn, in some cases, people may use public figures as a way of educating the public about diagnostic criteria, such as narcissistic personality disorder, for example, and let readers draw their own conclusions: ‘Hey, I haven’t evaluated this particular candidate. These kinds of behaviors are generally consistent with narcissistic personality disorder. Once again, I haven’t evaluated this person, they’re not a patient of mine. Make your own conclusions.’ I don’t necessarily like that as a full, you know, greenlight to go ahead and do this. I think that, as you pointed out at the beginning of the episode, that there’s a lot of nuance to this conversation. And as professionals, we have to foresee some of the responsibility of saying, ‘I’m not gonna draw the conclusions for you, but I’m drawing the conclusions for you,’ is not really good discussion of public health. But what Gartner’s argument is, is that in the bottom line is many people may feel the duty to warn, and a duty to warn does not require a multi axial diagnosis. And he uses the example of someone who’s bringing a gun to your house, you only need to know that somebody is bringing a gun into your house.
Katie Vernoy 32:29
Curt Widhalm 32:29
A diagnosis is not needed.
Katie Vernoy 32:31
When the question that I heard posed with it, or I read posed within that debate article, is that – Do we need opinions from psychological experts or psychiatric experts at all? Can we just not view it as a public as a general public? Can we not just view behavior and make our own assumptions and psychiatrists or therapists providing that expert opinion does more harm than good and isn’t required?
Curt Widhalm 33:05
It’s a topic worth diving into, you know, part of where seeing the public really destigmatize mental health in a lot of ways – and we’ve seen this reflected in our practices and the need for mental health services over the last several years – is the public is a lot more open to talking about the challenges they face. But a lot of people misdiagnose without the robust background of training of how to properly assess people. And, you know, how many people are you going to see on social media that’s, you know, complained about, oh, I’m O… I’m so OCD, I need to straighten out the books on my shelf. That’s not really a diagnostic of obsessive compulsive disorder and tends to diminish what actual obsessive compulsive disorder is for those who properly have that condition. It’s something where leaving this discussion out into the public really allows for things to be watered down in such a way that some of these diagnostics tend to lose all meaning. So to answer your question, I think that it’s healthy to have professionals with a background to be able to offer this opinion, it’s a matter of how it’s done that is potentially there. But so far with the information that we’re seeing from the American Psychiatric Association and the American Psychological Association, is that any professional opinion about any public figure seems to be forbidden.
Katie Vernoy 34:41
So we’re stuck with the experts being silenced. But then the guidance around how to actually provide expert opinions to the public seems to be a little bit limiting, at least from the two APAs.
Curt Widhalm 34:56
Katie Vernoy 34:56
What are the master’s level folks saying?
Curt Widhalm 34:59
That is an excellent question and I’m glad that you’re bringing it up. Looking at the four codes of the masters level organizations. This was summarized pretty well in September of 2016 on psychotherapynotes.com by Dr. Ben Caldwell. And I’ll expand on some of this because some of these things have been updated even since this blog post. But starting with the American Association for Marriage and Family Therapy standard 3.11 simply requires that therapists exercise special care when making public their professional recommendations and opinions. There’s no prohibition against diagnosing public figures according to AAMFT. Okay, the American Counseling Association as far as within their ethical code Standard C6C, says that counselors speaking with the media base their statements on appropriate counseling literature and practice to ensure that their statements are otherwise consistent with the ACA code of ethics, and to be clear about the nature of their relationship with those receiving the information. National Association of Social Workers – well, they talk about dishonesty and multiple standards. They also require social workers to protect client confidentiality when dealing with the media that standard 1.7K But they don’t have any parallels to the Goldwater rule.
Katie Vernoy 36:38
Social workers really have no guidance at all, not very much anyway.
Curt Widhalm 36:43
CAMFT – This has been updated since Dr. Caldwell’s blog here, but the CAMFT code of ethics 5.13 Public Statements, marriage and family therapist because of their ability to influence and alter the lives of others exercise caution when making public their professional recommendations, or their professional opinions, through testimony, social media and internet content, or other public statements. CAMFT also goes on to say 5.14 Limits of Professional Opinions, marriage and family therapists do not express professional opinions about an individual’s psychological condition, unless they have treated or conducted an examination and assessment of the individual. Or unless they reveal the limits of the information upon which their professional opinions are based, with appropriate cautions as to the effects of such limited information upon their opinions. Now, how do you take this from the 4 master’s level organizations?
Katie Vernoy 37:45
I mean, it’s a little confusing to me. I think there’s certainly caution that we need to take and not do this lightly, not pop off on our podcast, make sure that we’re not just giving diagnosis willy nilly that we actually are cautious. Use our training, understand our training. And then also I hear- I think primarily from CAMFT but maybe from somebody other ones – that we need to make sure we put forward the limits that of information that we have, so I’ve not assessed this person or this is something I’ve not seen, but my statement is being based on this body of knowledge and this this information that I’ve been given. So it’s a little more guidance, but it still is something where, you know, the rules… Ot just I mean, some of it feels like best judgment, which is a little bit more aligned to the the Goldwater principle. But it’s it’s still hard to know what’s going to be in the best interest of society, of the our professions, of the individuals that are in the spot, the public, public eye that potentially are getting some of this stuff going on. Like it just feels really complex to make a decision around diagnosis or public statements.
Curt Widhalm 39:07
So in April of 2018, the American Counseling Association published an ethics update by Perry C Francis. Credited in counseling today, Perry Francis is a professor of counseling at Eastern Michigan University, and coordinator of the counseling and training clinic and the College of Education clinical suite, member of the American College Counseling Association, and he chaired the ethics revision task force that developed the 2014 ACA code of ethics. And summarizing many parts of the article, he also points to E5 of the ACA code of ethics which says, counselors take special care to provide proper diagnosis mental disorders, and dives into the discussion of what exactly is special care. And, in the description talks about that there’s a list of behaviors and characteristics that make up not the entirety of a whole person. The DSM has been accused of being ethnocentric. And it’s difficult to apply this to other cultures and contexts. Meanwhile, stakeholders like pharmaceutical companies welcome a growing list of diagnosable disorders and overall cautions that professionals who make real world statements might fail to take into account just the ramifications of what these statements might be saying, not only just to the public, but also to other businesses that work in mental health care. Therefore, as counselors according to Perry Francis, we need to take special care to ensure that any diagnosis is made using the most appropriate assessment techniques, including a well planned clinical interview and the most relevant instruments and tests. Part of taking that special care is taking into account the impact of culture on a client’s life, including the fact that a client can live in multiple cultures. Perry Francis concludes this article by saying that the American Counseling Association has released a statement concerning publicly diagnosing the mental state of an individual. And it states in part, when publicly discussing public figures and others, professional counselors should avoid DSM and ICD related terms, especially the words diagnosis and disorder. Counselors should not attach a specific DSM or ICD diagnosis to any individual through messaging or statements in media outlets, or social media. Avoiding public statements that label an individual with a mental disorder is in the best interests of the public. This approach aligns with one of the counseling professions core professional values, as stated in the preamble of the ACA code of ethics, practicing in a competent and ethical manner.
Katie Vernoy 42:14
So that seems pretty clear to diagnosis.
Curt Widhalm 42:17
Katie Vernoy 42:17
Right I mean, it’s not about behavior. It’s not saying this behavior as harmful like that’s I mean, APA, both of the APAs seem to say like, Hey, whoa, whoa, whoa, like anything you say about a person, a public figure is too much, whereas the at least ACA is now saying, as long as it’s not a diagnosis, you’re good.
Curt Widhalm 42:38
That seems that seems to be where the stance is here.
Katie Vernoy 42:42
Okay. So that’s what the professional associations are saying. I mean, I don’t… like I feel like we still need to talk about how someone would make these decisions.
Curt Widhalm 42:55
Well, let’s take this out of the research and the publications here so far. Let’s talk about, you know, what our observations of the landscape of our field is. You and I both know, hundreds, if not 1000s, of therapists at this point, many of whom were connected to on social media. We have lots of friends who are professionals who talk on podcasts and are connected in the media, some who are on TV shows, providing therapy.
Katie Vernoy 43:29
Curt Widhalm 43:30
We see lots of people in these spaces talking about lots of things.
Katie Vernoy 43:34
Curt Widhalm 43:34
What do you see?
Katie Vernoy 43:37
I mean, I see folks who are very open and talking about their own concerns. And so they’re able to put forward their own mental health journey as an example. I see people talking about treatment between, you know, kind of how people treat each other and, and those types of things. I mean, I think the the treating someone on a TV show that feels like that’s a, a demonstration of therapy with, hopefully, appropriate consents. And I don’t I mean, besides our foray into having Bandy on the podcast, I’ve not seen someone, at least directly diagnose someone in public, I’ve seen people express concern about public figures or about the impact of public figures, but it feels a little bit more behavioral. And so kind of along the, this the second line, which is, you know, these behaviors are of concern, and this is why. But I don’t know that I’ve seen a lot of the folks we know, kind of saying, like this person is a malignant narcissist. Like I don’t necessarily see that – although now that I just said it out loud. I think I probably have seen that as well. How about you? What are you seeing?
Curt Widhalm 44:48
Oh, I know a lot of our listeners are, you know, maybe have the same political ideologies as you and I. Maybe they’re not. Maybe they make assumptions that they are. But what I do see is that especially as there becomes more advocacy within communities around a diagnosis – people coming from, for example, ADHD community, doing more to educate people about the things that go along with having ADHD that maybe extra, outside of the things listed within the DSM. Might see this same thing with any number of other diagnostic communities that come together. And what I see is also the inverse of some of these statements. And I particularly remember a time and seeing some discussions around Elon Musk making the claim that he was the first person with Asperger’s to host Saturday Night Live. This is
Katie Vernoy 45:59
Curt Widhalm 46:00
It’s been some time in the past.
Katie Vernoy 46:01
Curt Widhalm 46:02
And many people have some opinions about this statement. And a lot of the commentary that I saw was professionals who also self identified – and I don’t know, their diagnostic criteria – of being part of the Autistic community ended up feeling that either or making statements on their own social media that, hey, Elon Musk isn’t one of us. Doesn’t belong on the spectrum. Now, these are professionals, I don’t, you know, remember, and I don’t I’m not pulling them up here. But I think it’s just as important to caution saying the absence of a diagnosis without evaluating somebody is potentially just as damaging or dangerous as it is that saying somebody is at a certain diagnosis.
Katie Vernoy 46:56
Now that you say that, I think there’s also been an impulse, maybe impulse is the wrong word, but there’s been some of the you’re not, you know, you aren’t representative of us, like you talked about whether it’s Elon Musk, or an original poster. And then there’s also in comments, well, you definitely have this diagnosis, you definitely seem depressed, or you definitely seem X. Like people offering more diagnostic, you know, beyond the like, you should talk to your therapist about this, more of a diagnostic, what you’re describing in this 50, you know, 50 word post suggest to me that you must be X diagnosis. And so to me, I think we are a little fast and loose in the more casual public spaces, like social media groups, and those types of things. But I think there is an element of the inverse diagnosis that’s interesting. Because I hadn’t thought about it that way. Like certainly saying, hey, this person has this diagnosis, that seems pretty clear. But saying this person with a self who self identified doesn’t have a diagnosis, how is that harmful but how do you say, what did you think? Why do you think that’s harmful?
Curt Widhalm 48:12
We haven’t presented somebody with a proper assessment ourselves to publicly comment on what their diagnosis is. If – We may not know their medical or psychological history it may be and not framing it, within the context of where you’re basing that opinion is where these ethics codes are saying that that is unethical behavior. That you may only be making a snap judgment based on, you know, a few clips of a sketch comedy show. You may be incredibly biased based on the types of news outlets that you receive your information from. And particularly, you know, somebody like Elon Musk that doesn’t have quite the number of televised appearances that somebody like Donald Trump might, that the limited amount of available information that you have ends up becoming where if they truly do have this diagnosis, you as a professional are making a statement that invalidates their experience. And one of the main principles of all of our codes of ethics is a stance of nonmaleficence not creating harm.
Katie Vernoy 49:33
Yeah. It’s interesting because I think it’s it’s harder, I think, for some of our audience to be like, well, poor Donald Trump, poor Elon Musk, poor billionaires. Right. And I think, in truth, we actually need to pay attention to that because to me, they’re, you know, although some people might disagree with me, they’re humans too. And they, they could be harmed by the statements that are made. For most of us, I think maybe I’m putting myself too much in that. I think it’s easier to, to look at this as a problem, when it’s someone who is more traditionally oppressed. You know, if someone who legitimately, whether they claim it or not, has a mental health diagnosis, it doesn’t prove them unfit for, for being in a public position, whether it’s, you know, a government official or whatever. Like, if we, if we start making the case that they are problematic. Not only are we potentially breaking the Goldwater rule, but we’re also potentially increasing stigma, as as the APA said, but we’re also potentially harming the ability to have a more diverse representative pool in our legislation. We may be oppressing folks, because we’ve made this our job to try to protect society from folks who are mentally ill. And that feels really bad. I think the arguments against doing this in a more directed way to public figures. That’s where it sits with me as appropriate. Like I, I was celebrating the The Dangerous Case of Donald Trump and I and I don’t know that I would say like, Hey, that was a bad idea. But I think the precedent concerns me if we then use these types of stratagems to try to get folks either not elected or out of office.
Curt Widhalm 51:37
And bringing this back to earlier in the episode, the dangerous case of Donald Trump’s pretty significant portion of that book is the arguments of the needing to step outside of the code of ethics as far as a duty to warn, that does not necessarily focus on the diagnostic criteria, but more so on behaviors that interpersonally end up feeling dangerous to people who have spent their career studying dangerous behaviors.
Katie Vernoy 52:11
Sure, and listening to Bandy speak in our conference, like she was talking about the the problem of violence. And there were specific, very public displays of incitement to violence or violence by Donald Trump that I think was potentially where she based her concern about and her duty to warn.
Curt Widhalm 52:32
And it also comes from a decade’s long history of that being her particular area of study and specialty.
Katie Vernoy 52:40
Curt Widhalm 52:41
Which is quite a bit different in a number of ways of picking a celebrity and a random page in the DSM and going through some sort of BuzzFeed type evaluation and throwing your opinion out on the internet.
Katie Vernoy 52:59
Which is kind of what the original Goldwater thing was right? It was a magazine reaching out to a whole bunch of psychiatrists who were like, “Yeah, I think he’s nuts.
Curt Widhalm 53:11
Katie Vernoy 53:12
It was, I mean, granted, it was a pool of folks. But it sounds like you described it as all over the place. And it wasn’t something where they even necessarily individually, were thinking, oh, this is going to be public record. It was more like, oh, in the aggregate, this is kind of fun. I’m anonymously, putting forward my opinion about a candidate I don’t like.
Curt Widhalm 53:34
And so this does bring to the overall discussion that making public statements as viewed by any of these professional organizations, does include even your own personal social media.
Katie Vernoy 53:48
Curt Widhalm 53:49
And there needs to be the caution. And this is really the emphatic point here. There needs to be the caution of how you’re framing these statements. One of my Facebook memories said recently, was about the day that Donald Trump was inaugurated as the 45th President of the United States. And for listeners of the podcast, I think I’ve described before I was in a pretty serious bike accident about 10 years ago. And one of my social media posts from Inauguration Day was of the presidential limo driving down the streets of Washington, DC, solely in the bike lane. And my response, I mean, they had all the streets closed down his parade, it was not great. But yeah, my statement was, as a survivor of a pretty traumatic bike accidents, this administration is not off to a good start. Now, you obviously get the humor of this, you know, maybe even you know if you were to read too much into my statements – oh is is that trauma speaking is that, you know, that, and I’m talking about my own, you know, experiences and potential mental health here, but you got the humor out of it knowing me?
Katie Vernoy 55:13
Sure. Yes, I do.
Curt Widhalm 55:15
But it was not about Donald Trump, it was about the administration.
Katie Vernoy 55:19
Curt Widhalm 55:20
And there is a crafting that we need to consider in making any of these kinds of statements, we’re all going to have opinions about many different people. And that is fine. Your responsibility as a professional is to know that every statement that you make, that goes outside of the very privacy of your own home, which does include things that you put on the internet, can be taken as fact, as a professional who’s speaking. And that opens you up to ethical and legal liabilities.
Katie Vernoy 55:57
I think that’s really strong. And I think I’d like to get even a little bit more specific on some ideas around this, because to me, there’s an element of public figures that we’ve not talked about yet that I think is important to consider. I know – and I’m sure you’ve had this happen too – that I will meet someone for the first time. And they say, I feel like I know you, I listened to the podcast. And we are small potatoes compared to a President of the United States. I think there’s an element to us feeling like we know public figures based on how they present to the public, and the things that they do. And I think the more time you spend in public, the more of your real self shows up, I think we discount that some people play a role, arguably people will have, the more time they spend in public, the more likely they are to show their real self. But there is a version of this where Trump’s acting all the time, and it is playing a role in order to get what he wants. And does that suggest, narcissism maybe. But if it’s all pretend, can we really diagnose him? You know, and I think with the the limitations of the knowledge that we have, I think we have to be very cautious about what we say. We don’t know someone based on a small snippet of social media, or even sometimes, our long videos of their behavior. I think we do need to be cautious of saying, Well, we have enough information, we can make this diagnosis. We have a whole episode or several episodes on people making assumptions on the internet. So we can link to some of those in the show notes as well. And so to me, I think it comes back to what information do I actually have. Making sure I discussed the limits of the information. And then I think the third thing that is really important is what is my intent. And this is, you know – for all the DBT Folks, this is getting into wise mind – and I think for those of us who are advocates, it’s determining is this strategic? Is this about trying to win an election? Like it was with the Goldwater stuff? Is it about a duty to warn, because society is going down rapidly and we need to call this out and, and name it, or anything else? Like what is the actual intention? Am I angry? Am I scared? How is that impacting my judgment? I think it’s something where if we just speak from a place of seat-of-my-pants, this is what I’m seeing and it’s scary. And it’s awful, because this person is politically different from me, I think we get very, very in a very, very dangerous territory as a society.
Curt Widhalm 58:52
To conclude all of this – I think you’re summarizing it very, very well – is that for many of our professional organizations that we may belong to, at the masters level, there is not a ethical code that necessarily forbids this.
Katie Vernoy 59:11
Curt Widhalm 59:12
You need to really be cautious about framing the information upon how you’re basing your opinions. And in general, I would stop well short of, you know, leaving the trail of breadcrumbs up to a diagnosis, if you do have personal and professional concerns about somebody who may be out there and expressing this, whether you put it on your social media, or what you think is your personal social media. Most professional organizations are still going to look at that as a professional statement. That you very carefully framed the context of where you’re discussing these things from.
Katie Vernoy 59:54
Curt Widhalm 59:54
And I think that in several of these articles that we’ve been citing here – and we willl put the references in our show notes at mtsgpodcast.com – that what has changed since 2016, when this debate really started and why we feel that it’s still a relevant discussion today, is that some of these professional organizations have clamped down even harder in the last few years.
Katie Vernoy 1:00:24
Curt Widhalm 1:00:24
And some of the information that’s available out there or pops up to the top of your search engines is not necessarily the most up-to-date information. It’s important to understand the historical context that where professional organizations are today is not where they started back when the Goldwater principle was first suggested. Some of these articles now we’re calling it the Goldwater doctrine, without necessarily putting it into any sort of ethical rigor to move things from a guiding principle to a absolute gag rule. So our recommendation is, for most of you it’s not forbidden to make public commentary. But really, really make sure that you frame any sort of statements or exaspirations or social media posts in ways that really frame how you are coming to your conclusion and what your relationship (or lack there of) is to the person that you’re talking about. We would love to hear your thoughts on this. You can let us know on our social media or in our Facebook group, the modern therapist group, you can find our Show Notes and references at mtsgpodcast.com. And stay tuned for more information on how to get continuing education for listening to this podcast. Until next time, I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 1:02:02
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.
Curt Widhalm 1:02:17
Once again, that’s modern therapist community.com
Katie Vernoy 1:02:21
Thanks again to our sponsor Buying Time
Curt Widhalm 1:02:24
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Katie Vernoy 1:02:53
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Curt Widhalm 1:03:08
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Katie Vernoy 1:03:33
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