The Psychoanalysis of public figures, a subset of Applied Psychoanalysis, has a rather checkered history. In 2004, Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute, wrote an Op-Ed for the New York Times on The Perils of Putting National Leaders on the Couch. She described an occasion where Psychiatry was seriously misused:
In 1964, a few months before the presidential election, Fact magazine, now defunct, surveyed the membership of the American Psychiatric Association about the personality traits of Barry Goldwater, the Republican nominee. The psychiatrists savaged Goldwater, calling him "warped," and a "paranoid schizophrenic" who harbored unconscious hatred of his Jewish father and endured rigid toilet training.
Such forays into applied psychoanalysis have not been immune to criticism. After the Fact survey, the psychiatric association issued the so-called Goldwater Rule, advising members that it is "unethical for psychiatrists to offer a professional opinion unless he/she has conducted an examination and has been granted proper authorization for such a statement."
In 1998, questions arose about the ethics of publicly making diagnostic and professional assessments of Bill Clinton, in light of his behavior with Monica Lewinsky. In POTUS and the Goldwater Rule, past President of the American Psychiatric Association, Herbert S. Sacks, M.D., wrote:
"We are reminded of the 1964 Goldwater-Johnson election, when 1,189 American psychiatrists responded to an inquiry for their opinions of the candidates by a now defunct magazine. The bulk of the political responses, couched in psychiatric terminology, were so unfair and so outrageous to Goldwater that he sued and won a substantial settlement. APA issued public statements decrying such analyses and in 1973, when the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry were drafted, Section 7.3, stated: 'On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention, or who has disclosed information about himself/herself through public media. It is unethical for psychiatrists to offer a professional opinion unless he/she has conducted an examination and has been granted proper authorization for such a statement.' The Canadian Psychiatric Association has a parallel ethical standard."
After the most recent Sanity Squad Podcast, The Sanity Squad on Clinton and that "nice little conservative hit job", "Greg" commented:
Armchair diagnoses bring both the practitioner and the profession of psychology into disrepute. Good job guys.
That's why the APA considers it unethical to give "professional opinions," without actually examining the person. Opinions like narcissistic.
His comments raise serious questions for PsychBloggers. How does one draw the line between responsible commentary about public figures and public affairs and the irresponsible misuse of Psychiatric and Psychological expertise?
There have been Psychiatric "hit jobs" performed on the current President, which purport to explain his policies and positions as resulting from his early experiences. Justin Franks, MD, is a member of the American Psychoanalytic Association and the author of Bush on the Couch: Inside the Mind of the President. Needless to say, Franks has never interviewed the President let alone put him on the couch, yet his book takes extreme liberties with various published sources to skewer Bush. On the Amazon site is an except from Publishers Weekly, which includes this:
Bush Administration policies are not only a "great catastrophe" but the products of a disturbed mind, according to this provocative blend of psychological case-study and partisan polemic. Psychoanalyst Frank sifts through family memoirs, the writings of critics like Al Franken and David Corn and the public record of Bush’s personal idiosyncrasies for clues to the President’s character, interpreting the evidence in the rigidly Freudian framework of child psychoanalyst Melanie Klein. He finds that Bush, psychically scarred by an absentee father and a cold, authoritarian mother, has developed a galloping case of megalomania, characterized by a Manichaean worldview, delusions of persecution and omnipotence and an "anal/sadistic" indifference to others’ pain, with removal from office the only "treatment option."
Franks blogs about this himself in What to Do With an Unreachable President?, at the Huffington Post and exposes, as if we needed further evidence, the depths to which he is willing to sink to attack a President whose policies he opposes:
It is clear that he was never disciplined as a child, that he got away with everything, from wetting his bed until he was 11 to setting fires until he was 14 (two things told to me in private after the book came out and that I never before mentioned in public), to shooting at his siblings with a bee bee gun, to drinking himself into oblivion, to being arrested for DWI, and on and on. He was always rescued by his father, by friends of his father, by his money, by his personal charm (when sober). Now he expects the next president to rescue him from Iraq.
Applied Psychoanalysis has traditionally been done on historical public figures or as an instrument for understanding larger cultural and population trends. Publicly Psychoanalyzing living individuals, especially when the Psychoanalysis is conducted from an antagonistic position is always potentially troublesome. When done properly, with the utmost respect for the historical figure, our goal is to add to our understanding of historical figures and enrich our sense of who they were and how they made their contributions. On a larger scale, the goal is often to explain the behavior of different cultural groups and facilitate our interaction with them.
Franks fails the ethical test on several different levels. He adds details from an anonymous source of highly questionable provenance. He starts with an inference that is derived from his own political positions, that the "Bush Administration policies are not only a "great catastrophe" but the products of a disturbed mind" and finds or invents historical data to support his pre-conceived notions. This kind of pseudo-psychoanalysis is exactly what was objectionable in the case of Goldwater in 1964 and in much of the commentary about Bill Clinton in 1998. By suggesting that their current policies and behavior are the result of early childhood determinism, the authors attempt to destroy the legitimacy of their opponent's political positions and short circuit political discussion. This does no one a favor, including the opposition.
How is this different from the kind of statements made on the Podcast? In the last Sanity Squad Podcast, comments were made addressing Bill Clinton's furious attack on Chris Wallace. As far as I could tell, from re-listening to the Podcast, we made no speculations about Clinton's childhood or about his unconscious dynamics. We did describe his behavior as narcissistic (with a small "n".) This has been a fairly consistent description, including from Clinton's friends and associates and is not a new idea. It has never required any Psychiatric expertise to recognize how self-involved Bill Clinton is. What we attempted to add was a fuller description of some aspects of Narcissism, in the sense of a Narcissist's inability to take a self-reflective position and their sensitivity to anything resembling criticism. (If you listen to Clinton's interview with Wallace, it is striking how many references he makes to himself; it is all about "I" rather than the country and the people he was elected to serve.) We may have approached too close to the line in speculating on the diagnosis of Narcissistic Personality, rather than simply pointing our that his behavior was consistent with someone who feels narcissistically vulnerable (which can occur in anyone and is not necessarily diagnostic.) If we did step too close to the line as delineated by the Goldwater Rule, we should endeavor to be more careful in the future.
The American Psychiatric Association ethics statement includes this:
On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his/her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he/she has conducted an examination and has been granted proper authorization for such a statement.
Confusion has arisen by taking the second sentence above and not connecting it to the first sentence as was intended. It is common for forensic experts to offer opinions as was done according to the question. Further, it would be too great an extension of the Goldwater Rule to say that a person, by being a defendant in court, has entered into "the light of public attention." This annotation was developed to protect public figures from psychiatric speculation that harms the reputation of the profession of psychiatry and of the unsuspecting public figure. (September 1983)
The balance between talking about Narcissism, in general, and the predictions theory makes about the Narcissistic character, and diagnosing a public figure with Narcissistic Character is a difficult balance to find.
As with any professional who uses his or her expertise to comment on the world via a Blog, the PsychBlogger must walk a fine line between using professional expertise to illuminate and using such ability as a weapon. I do not think the Sanity Squad crossed the line. We stayed close to the manifest behavior of our subject, did not use his psychological make-up (real or imagined) to attack him, but in an attempt to understand why he did what he did, and did not use our knowledge to discredit his political positions. We all must remain mindful of the risk of stepping over the line and, as with most issues, look for our readers and listeners to remind us when we, from time to time, approach too close to the line. To that end, Greg's comments would have been more helpful had they been more specific, and perhaps he will provide us with such assistance in the future.
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