security, one could reasonably defend it even if it violates
the profession’s code of ethics and is personally damaging
to that individual. In a controversial psychobiography of
President George W. Bush, Frank, a psychiatrist, charac-
terized the president as a “paranoid megalomaniac” and “un-
Although these are clearly clinical and
diagnostic labels that appear to violate the Goldwater Rule,
Frank’s view is that his book is a scholarly psychobiogra-
phy, not “expert opinion” and, as such, is outside the pur-
view of APA ethics guideline.
Still, the line between a careful psychiatric profile and a
casual off-the-cuff diagnosis of a public figure is not so clear.
Even if the intent of the mental health professional in both
situations is very different—understanding the psychology
of the person (psychobiography) or assailing the character
of a disliked political candidate (the Goldwater case)—
both share a similar ethical problem: unauthorized psychi-
atric assessment of a person who is not examined by the pro-
Mental health professionals can play a valuable role in the
discussion of public figures and their mental health. Their
comments should be geared toward general information
about mental illnesses and their treatments. Those profes-
sionals who offer their knowledge for public discourse should
remember that their role is not to give an unsolicited or un-
authorized professional opinion about an individual but to
educate the public.
Robert Michels, MD (Department of Psychiatry, Weill
Medical College, New York, New York), provided thoughtful comments on this
topic. Dr Michels received no compensation for his contribution.
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The Principles of Medical Ethics: Principles
With Annotations Especially Applicable to Psychiatry.
Arlington, VA: American
Psychiatric Press Inc; 2008.
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