The American Psychiatric Association urged members of its profession to uphold its decades-long principle that psychiatrists should never offer diagnostic opinions about people they haven't personally examined, in light of President Trump's impending medical exam and questions about his mental fitness.
"We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable news appearances, books, or in social media," the group wrote. "Arm-chair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical."
The rebuke came Tuesday as politicians and members of the media were ratcheting up their rhetoric about Trump's mental health. Earlier in the day, Pennsylvania Democratic Rep. Brendan Boyle unveiled legislation that would require presidential candidates to have a medical exam and publicly disclose the results before the general election. Joe Scarborough also has said on his MSNBC program "Morning Joe" that Trump has dementia, and more than a dozen lawmakers have discussed Trump with a Yale University psychiatrist who said that Trump was “going to unravel, and we are seeing the signs.” The psychiatrist, Dr. Brandy Lee, who has not examined Trump, edited The Dangerous Case of Donald Trump, which includes testimonials from 27 psychiatrists and mental health experts.
But the association reminded its members that one of its core principles, known as the "Goldwater Rule," has been in place since 1973 and states that psychiatrists should not publicly issue medical opinions about people they haven't personally examined in a medical context.
“The Goldwater Rule ... makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement,” Dr. Saul Levin, the group's CEO and medical director, said in a statement. “APA stands behind this rule.”
Questions have surfaced about Trump's medical health and whether a psychiatric exam will be included as part of his routine medical exam scheduled for Friday.
A routine medical exam like the one Trump is facing tends to focus more on a general assessment of a person's physical well-being. Assessments of memory, function, depression, and anxiety are typically conducted for people over age 65, using a questionnaire by a primary care provider, however.
It is not clear whether these assessments will be included for Trump, who is 71, and if they are, whether they will be made public. As with previous administrations, a president must consent to which medical information is made public. Past presidents have chosen to omit some information, whether about the physical itself or about past medical history.
The association noted that if Trump's physician finds concerns with his mental health, he can refer him to a psychiatrist, who also must abide by patient confidentiality and privacy rules.
The APA noted that diagnosing someone for a mental illness was an involved, medical assessment.
"A proper psychiatric evaluation requires more than a review of television appearances, tweets and public comments," the group wrote. "Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease. The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status."
The American Psychiatric Association has 37,000 members, and noted that it could enforce the Goldwater Rule only with its members, but urged other psychiatrists to abide by the same principle.
"Using psychiatry for political or self-aggrandizing purposes is stigmatizing for our patients and negatively impacts our profession," the group wrote.
Trump denied recent claims questioning his mental stability while calling himself “really smart” and a “genius” in a series of tweets sent early Saturday morning.