This article was written by Aaron Levin and first appeared in Psychiatric News. Read the story here.

Restraint of psychiatrists’ comments on political candidates is grounded in APA’s response to an attempt to question Barry Goldwater’s mental health during the 1964 campaign for president.

“Do you believe Barry Goldwater is psychologically fit to serve as President of the United States?” the editors of Fact magazine asked 12,356 psychiatrists during the 1964 presidential campaign between Goldwater and Lyndon Johnson.

The responses set off a wave of reaction that resonated again most recently after media speculation about the mental status of the current Republican presidential candidate.

Fact published numerous comments questioning Sen. Barry Goldwater’s psychological capacity for office, which ultimately led to the creation of APA’s “Goldwater Rule” in 1973.

A look at the original episode reveals as much about psychiatry’s changes over the last half century as it does about politics then or now.

The harshly negative responses by people who had never even met Goldwater seem astonishing by today’s standards, as a sampling suggests:

“I believe Goldwater to be suffering from a chronic psychosis,” wrote one.

“A megalomaniacal, grandiose omnipotence appears to pervade Mr. Goldwater’s personality giving further evidence of his denial and lack of recognition of his own feelings of insecurity and ineffectiveness,” wrote another.

“From his published statements I get the impression that Goldwater is basically a paranoid schizophrenic who decompensates from time to time. … He resembles Mao Tse-tung,” said a third.

Not wanting to exclude other relevant 20th-century tyrants, another claimed, “I believe Goldwater has the same pathological makeup as Hitler, Castro, Stalin, and other known schizophrenic leaders.”

Others pushed back. In reality, Goldwater had worked in his family’s business, then served as a transport pilot in World War II, and retained a commission in the Air Force Reserve for many years. He was twice elected senator before the 1964 presidential race and would be again in 1968, 1974, and 1980.

It was difficult, said one psychiatrist quoted in Fact, to believe that a man who was “psychotic” or “schizophrenic” would have managed all that.

“I served as a flight surgeon in the USAF,” wrote Wilbert Lyons, M.D., of Sellersville, Pa. “I speak with authority when I say that Sen. Goldwater could not be a jet pilot if he were emotionally unstable.”

Goldwater certainly held very conservative political views and expressed them forcefully. Many of the respondents who declared him “unfit” were likely expressing their own political biases in psychiatric terms. Tellingly, many of them asked that their names be withheld from publication, perhaps hinting at some guilt feelings over their cavalier, remote diagnoses of the candidate.

Nevertheless, many other respondents understood immediately the greater implications of the question for psychiatry’s purported role in the electoral process.

“Your inquiry for a professional opinion regarding Sen. Barry Goldwater’s general mental stability is an insult to me,” wrote Thomas Stach, M.D., in 1964. “An inquiry of this type regarding any individual can only be based on ignorance of the field of psychiatry.”

Stach demanded an apology from the editors to all the psychiatrists who had received the survey.

“It was astounding to me when the survey first came out,” Stach, now retired in Willowbrook, Ill., told Psychiatric News. “It was impossible for a psychiatrist to come to a conclusion like that without a personal examination. The psychiatrists who were baited into giving responses were imprudent.”

Some offered a nuanced statement of their own positions.

“Politically, I heartily disapprove of Goldwater,” wrote Joseph Schachter, M.D., Ph.D., in 1964. “In fact, I find him somewhat frightening. Yet I do not feel I can honestly say he is psychologically unfit to serve as president.”

“I still think that’s a plausible view of the Goldwater situation,” said Schachter, now retired and living in New York City, in a recent interview. “Psychiatrists and psychoanalysts have the right as citizens to comment on elections and candidates and are free to do that, but without selecting a psychiatric diagnosis.”

“Vetting a candidate should be based on his or her position on the issues,” agreed Stach. “The survey betrayed the ignorance of the questioner.”

APA’s initial reaction to the Fact magazine article came swiftly.

“[S]hould you decide to publish the results of a purported ‘survey’ of psychiatric opinion on the question you have posed, the Association will take all possible measures to disavow its validity,” wrote APA Medical Director Walter Barton, M.D., in a letter to the magazine’s editors on October 1, 1964.

APA President Daniel Blain, M.D., denounced the compilation as “a hodge-podge of the personal political opinions of selected psychiatrists speaking as individuals. … [T]he replies to the question have no scientific or medical validity whatsoever.”

Tying political partisanship to the psychiatric profession, continued Blain, “has, in effect, administered a low blow to all who would work to advance the treatment and care of the mentally ill of America.”

APA’s formal response came in 1973 with the adoption of Section 7.3 in the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, which became known as the Goldwater Rule.

The rule applies to public figures and states: “[I]t is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement” (see sidebar).

The episode and the subsequent adoption of Section 7.3 appear to have dampened the enthusiasm of most APA members for a repeat performance, leaving psychiatric diagnosis to the media.