In yesterday’s Science Times, my mentor and friend Richard Friedman set out some guidelines for psychiatrists who want to speak publicly about the the mental health of public personalities who are not their patients. In a nutshell, don’t. Summarizing the American Psychiatric Association’s position, he writes that it is “explicitly unethical for [psychiatrists] to offer a professional opinion about an individual without directly examining that person and getting his or her permission to comment.” Moreover, he writes “it is intellectually dishonest for a mental health professional — or any physician — to give a diagnosis without examining the patient. A professional opinion is supposed to reflect a thorough and rigorous evaluation of a patient and all relevant clinical data obtained under the protection of strict confidentiality. Anything short of that misleads the public about what constitutes accepted medical practice and invites distrust of the profession as a whole.” And finally, he notes the danger of damaging another person’s reputation by speculating on their mental health, citing the potential “misuse of medical authority as a political weapon to denigrate an opponent.”
He then provocatively goes on to use his medical authority as a political weapon to denigrate a foreign political leader: “Colonel Qaddafi’s ruthlessness, near-delusional grandiosity and love of absolute power all suggest a severe personality disorder called malignant narcissism.”
The possibilities for quibbling with Friedman are endless – and having had him as a supervisor, I can assure you he likes a good quibble. Is it ethical for a conservative Austrialian psychiatrist to diagnose President Obama? If a political leader publishes an autobiography that contains all the data a psychiatrist would normally want to elicit before reaching a diagnosis, is it ethical to put a name to the syndrome they have described? If the American Psychiatric Association publishes a new set of diagnostic guidelines, and a disease present in previous editions is elminated, is it ethical to say “in the past Mr. Whoshamacallit would have met criteria for syndrome X, which we no longer believe is a syndrome?” What about speculating about a made-up disorder that could plausibly become a disorder – for example, can I ethically diagnose Arnold Schwarzenegger with “Schwarzenegger’s syndrome,” a cigar-induced condition involving political ambition, one-liners and cross-party romance?
However for me the article raises a much more pressing question: Is it ethical to use public-record human behavior – the actions, including the words, of people identified in published articles by reputable sources – to talk about neuroscience? As a neuroscientist, I already think of motor behavior as being neural. Muscles contract when neurons tell them to, and those neurons can be traced back to the brain. So in my view journalism has always talked about neuroscience – in fact, there is nothing else to talk about! From a science standpoint, talking about the brains behind movement isn’t news, and isn’t producing any information not already implicit in celebrity action. But I’m interested in feedback, and to help this thought I would put out my standards of behavior, which leave me feeling – at least for now – comfortable with what I write.
- First, following his standards, I never make psychiatric diagnoses.
- Second, I only use public-record information, and always link to the source
- Third, I only talk about what – generically – we know about the neural roots of the involved behavior.
I’ll be interested to ask Richard what he thinks of this approach. I’ll pick up the philosophical issues in play in later posts. They’re doozies.