This panel at the American Psychiatric Association’s annual meeting is a reprise of a similar panel organized two years ago by Dr. Nassir Ghaemi, Professor of Psychiatry at Tufts University and author of A First-Rate Madness. I will be speaking along with Dr. Ghaemi, Dr. Charles Dike from Yale University and Retired Army Brigadier General and psychiatrist Stephen N. Xenakis. Dr. Alan Stone, Professor of Law and Psychiatry at Harvard University.

We will be discussing the Goldwater Rule and the 25th Amendment, as a way to organize various perspectives on the role psychiatrists should or shouldn’t take in contributing to the understanding of fitness for duty in political leaders.

In my remarks, I’m going to open with the story of my own professional relationship with the Goldwater Rule; I was an adamant supporter until the 2016 election campaign. I believe it has become an albatross for Psychiatry and an unfortunate public meme, inhibiting our ability to contribute our expertise in public conversations about the very troubled and troubling behavior of the current president and others. The public is hungry for understanding and it is, I believe, our ethical obligation to contribute what we can as psychiatrists. I’ll touch on my own work devising a way to assess fitness for duty, which is required for the implementation of the 25th amendment in the case of presidential impairment. This approach is detailed in the chapter I wrote in the second edition of The Dangerous Case of Donald Trump entitled, “Is the Commander In Chief Fit to Serve? A Nonpartisan Test from Marrying U.S. Army Leadership Standards with Psychoanalytic Theory.”

I will close with my own speculation about why the American Psychiatric Association chose to double down on the Goldwater Rule, adding to previous understanding that commenting on the behavior or affect of a public figure was unethical (not just diagnosing.) I believe this was a conceptual and organizational error, arising from a model of psychiatry that too often limits itself to an identity with the sole function of diagnosing illness and medicating that diagnosis. With that limited framework, psychiatrists should not join public conversations. But a more expansive view of psychiatry using a bio-psych-social perspective allows and even demands that psychiatrists contribute their knowledge to public discussions.