The Obligation to Speak Out

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FROM OUR READERS

I very much appreciate Charles S. Burke, MD’s, thoughtful comments on my article about Russia and the notion of “paranoid government disorder.”¹ I received several comments from readers who saw strong parallels between my comments on Russia and the matter of the so-called “Goldwater Rule.”1 However, I believe the deep structures of these issues are fundamentally different—roughly summed up as the difference between social psychiatry (observations on Russian society) and armchair psychiatry (comments on public figures we have not personally evaluated).

Dr Burke provided a partial quote from the article I coauthored with James L. Knoll IV, MD, in which we clarified the psychiatrist’s responsibility to assess dangerousness.² The complete quote is as follows: “In short, the crux of the problem is the misapplication of psychiatric labels in order to vent displeasure at a public figure.”

Our article in no way advocated restrictions on psychiatrists venting displeasure with specific policies or practices of public figures and elected officials, or their administrations—only on what psychiatrists may ethically say about the mental state of living public figures they have not personally evaluated.

By the same token, Dr Knoll and I did not argue against psychiatrists expressing their views regarding “political and social issues,” nor did we wish to imply that such views should “only be expressed privately to the appropriate civil authorities, congressional representatives, or magistrates,” as Dr Burke seems to have inferred. After all, the American Psychiatric Association regularly expresses its views on such issues as structural racism³ and climate change⁴ and their effects on mental health. Some might call these political and social issues, but these issues clearly have implications for mental health and wellness. Psychiatrists have every right—indeed, an obligation—to speak out on such matters.

I believe the restrictions promulgated by the Goldwater Rule raise entirely different ethical issues than psychiatric commentary on societal trends and tendencies, such as undue suspiciousness (paranoia) and feelings of victimization within specific societies. I see such commentary as well within the purview of social psychiatry, which may address the “mental health needs of the international communities.”⁵

In sum, I believe Dr Burke and I fully agree that “psychiatrists may be in a unique position to offer valuable commentary on political and societal concerns...” I would simply add: so long as such commentary adheres to the guidelines of the Goldwater Rule.

Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of Psychiatric Times™ (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.

References

1. Burke CS. Valuable insights to share with the psychiatric community. Psychiatric Times. June 8, 2022. https://www.psychiatrictimes.com/view/valuable-insights-to-share-with-the-psychiatric-community

2. Knoll JL IV, Pies RW. Psychiatry, “dangerousness,” and the president. Psychiatric Times. February 16, 2018. https://www.psychiatrictimes.com/view/psychiatry-dangerousness-president

3. Structural Racism Task Force. American Psychiatric Association. Accessed June 7, 2022. https://psychiatry.org/psychiatrists/diversity/governance/structural-racism-task-force

4. How extreme weather events affect mental health. American Psychiatric Association. November 2019. Accessed June 7, 2022. https://psychiatry.org/patients-families/climate-change-and-mental-health-connections/affects-on-mental-health

5. Aims and scope. International Journal of Social Psychiatry. Accessed June 7, 2022. https://journals.sagepub.com/aims-scope/isp