In the late 1950s, a new conservativism – in the form of William F. Buckley’s National Review and of Senator Barry Goldwater – emerged. I trace Goldwater’s response to the Fact magazine case following his 1964 defeat. I show how shocked he was by Fact, and his motivations for bringing a libel suit: a wish to protect future politicians and to counter what he saw as unethical forms of comment. Goldwater was ahead of his time and ahead of his conservative colleagues (Buckley included) in appreciating the political value of lawsuits. I also document the dynamic relationship between Goldwater and his supporters, and the American Medical Association and the American Psychiatric Association, with whom he had a de facto working alliance. Drawing on the trial transcript and on Goldwater’s extensive archives, I narrate the legal contest in all its drama. I provide political and social context, including the impact of the Vietnam War on the debates over ethics and politics but also the role of the media in shaping public opinion on the war and on the case. I also document an effort by Ginzburg’s Avant Garde magazine to survey psychiatrists about Lyndon Johnson’s fitness for office in 1968.

This is the first book to explore an ethical dilemma that psychiatrists increasingly face in the age of Donald Trump: is it ethical to comment on the mental health of public figures? Psychiatrists may intervene when a patient is unsafe, but what is their role when a politician appears ill and is a risk to the country? The APA’s Goldwater Rule declares that when a psychiatrist is asked for an opinion on a public figure, it is unethical to comment – yet controversy rages on the issue. Diagnosing from a Distance probes the dramatic history and complex ethics of the issue. With accessible style yet scholarly substance, this book begins with Adolf Hitler; traces the debate over Barry Goldwater, including Goldwater’s libel suit against Fact magazine; explores the rise of professionalism in the formation of the Goldwater Rule; documents errant CIA profiling during the Nixon years; and examines the controversy over President Trump. In light of this history, this book proposes a humane alternative to the Goldwater Rule. Based on original interviews and archival sources, Diagnosing from a Distance will change the way you think about the First Amendment, the media, and psychiatric ethics.

This chapter examines the ethics of psychological profiling in the CIA. Agency psychiatrists have routinely profiled foreign leaders from a distance – a practice that the APA regards as acceptable and outside the scope of its Goldwater Rule. During the Nixon administration, Agency psychiatrists created – at the request of the White House – a profile of antiwar activist Daniel Ellsberg. As recently declassified CIA documents make clear, CIA psychiatrists had misgivings about producing the profile but participated nonetheless, with the explicit approval of director Richard Helms. Led by Nixon’s aides John Ehrlichman, Howard Hunt, David Young, and Egil Krogh, the push for a profile was closely associated with the burglary of the office of Ellsberg’s psychiatrist Lewis Fielding. I examine tensions within the Agency, media and congressional response to the eventual disclosure, and the work of former CIA psychiatrist Jerrold Post. Post had a role in the Ellsberg profile, but then developed reservations about it. He later wrote “Ethical Considerations,” an article that represents an enduring contribution to the debate over the ethics of psychiatric comment without interview.

In the 1960s and 1970s, consensus was growing about the need for professionalism and ethical standards in medicine and psychiatry. Using the APA’s archives, I show that the Fact episode of 1964 concerned the APA greatly. Not only did the APA write to Ginzburg and object to his special Fact issue on Goldwater, but it followed Ginburg’s subsequent career closely. The group adopted the Goldwater Rule in 1973 in order to prevent episodes like the Fact debacle. After the Rule’s adoption, disagreements over it emerged within the APA. Members wrote in apparent confusion to the APA Ethics Committee, seeking guidance on how the Rule applied to their work. The APA never contemplated applying the Rule to forensic psychiatry, to the work of psychiatrists in insurance companies, or to the practice of psychological profiling for the FBI and CIA. It was comment in the media, and the risk of damage to psychiatry’s public image, that concerned the APA. The result was the appearance of a double standard: individual psychiatrists are banned from commenting on public figures, while psychiatrists working for organizations and government agencies may comment without interview or consent.

This chapter examines the controversy over psychiatric comment on Donald Trump. In 2016, Trump’s election led many psychiatrists to grow concerned for the country’s safety and to argue that when the country is unsafe, commenting on a public figure’s mental health is in fact an ethical obligation. The APA, on the other hand, held firm to and even strengthened its ban on such comment. For my narrative and analysis, I draw on original interviews with APA officials – including medical director Saul Levin and ethics chair Rebecca Brendel – and with critics of the APA, including Bandy X. Lee, Judith Herman, Robert Jay Lifton, and Leonard Glass. Using this new material and looking at the age of Twitter, this chapter presents the first sustained analysis of the controversy and its importance for psychiatry, ethics, and journalism in the age of Trump. As I note, in recent years, several prominent figures have argued for a revision of the libel standard articulated in New York Times v. Sullivan. These figures include the late Justice Antonin Scalia, current Justice Clarence Thomas, and President Donald Trump himself – leaving the future of libel law contested, as it has been since 1964.

This chapter reviews the material presented in this book, including the history of novel legal doctrines; the use of libel law for political purposes; the interrelationship between politicians, media, and political followers; and the recurring debates over the ethics of comment from a distance. Goldwater was so far ahead of his time in understanding the political value of lawsuits that he anticipated the conservative legal movement of the 1980s. I then propose an alternative approach to the Goldwater Rule, drawing on the work of philosophers James Madison, John Rawls, Jacques Mauritain, and Martha Nussbaum to argue for a more liberal and tolerant guideline for psychiatric comment on public figures. The APsaA, in response to the Fact episode of 1964, adopted such a guideline under President Heinz Kohut. The result was a respectful and ethically coherent stance that has stood the test of time. Instead of banning comment outright as the APA’s Goldwater Rule does – a form of coercive paternalism in the sense described by philosopher Sarah Conley and others – I argue that the psychiatric community should respect the conscience of the individual psychiatrist acting in good faith.

In this chapter, I show how the infamous Fact magazine episode of 1964 began. What motivated Ralph Ginzburg to publish his “survey” of psychiatrists and to create a psychological profile of Barry Goldwater? I reassess Ginzburg’s controversial but now almost forgotten career as a provocateur and alleged pornographer (a charge that conservative politicians made loosely, based on his conviction for distributing the highbrow Eros magazine). Ginzburg remained committed to free speech and journalistic freedom in an era when television, newspapers, and direct mail advertising were flourishing. But was the survey ethical? Was Goldwater mentally ill and a danger to the country, as Ginzburg and many psychiatrists claimed? I make use of rarely explored sources, including the transcript of the Goldwater v. Ginzburg libel case, Ralph Ginzburg’s papers, and an original interview with Fact managing editor Warren Boroson. In an era when the Supreme Court decision in New York Times v. Sullivan had dramatically loosened libel law and established a new standard for libel called “actual malice,” Ginzburg had every reason to believe he might prevail in the courts, and in the court of public opinion.

The losing side in Goldwater v. Ginzburg appealed, then asked the Supreme Court to review the appeals court verdict. The decision to file writ of certiorari (a formal request for the Court to review the case) was not an empty exercise. In the wake of New York Times v. Sullivan (1964), no one knew exactly how the new doctrine of libel – “actual malice” – would be applied or what its limits might be. This chapter looks at how the Supreme Court viewed Ralph Ginzburg and Fact magazine and shows how at least some of the justices reasoned about hearing the case. I trace Ginburg’s hope that he could loosen libel law at the highest level and Goldwater’s hope that he could protect future public figures from libel even under the dramatically loosened standard represented by Sullivan. The Court’s decision was the occasion for some of Justice Hugo Black’s most eloquent words. As I show, throughout the process the media and Goldwater’s supporters took a keen interest in the outcome, just as Goldwater had hoped.