Transmitting psychiatric knowledge

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I appreciate the important concerns expressed by David T. Springer, MD, and would like to address some of the key issues he raised.

“One individual’s ‘misinformation’ is another’s truth.”

In my view, this is truly a postmodern notion that undermines the goals of medical practice and medical science. Someone who claims, for example, that “Laetrile cures cancer” is spreading misinformation – there is no “other truth” to the matter. There are analogous lies being dispensed in the field of psychiatry – for example, “Conversion therapy cures homosexuality” – and it is our responsibility to expose such misinformation. Of course, I agree that political, philosophical, and cultural/aesthetic questions don’t usually give rise to such stark true-false statements.

“The hypothetical examples given by the authors, in essence, obliterate Goldwater’s rule. Even if the information is communicated indirectly and with the caveats given, the public will correctly conclude that the psychiatrist is in fact talking specifically about the public figure in question.

It is certainly possible that some members of the general public incorrectly conclude that the psychiatrist is talking specifically about the public figure in question. But it’s just not a result that we can directly control. The public might also interpret a psychiatrist’s complete silence, or refusal to address the issue, as hiding something really serious about a public figure. Having had many interactions with the media over the past 40 years, I also believe that some reporters and journalists will inevitably find someone – often without psychiatric training or on the fringes of psychiatry – who will comment very easily (and inaccurately) a number.

I believe it is best for well-trained psychiatrists to approach the problem in question with accurate information, as long as it is framed in terms of general differential diagnosis of signs and symptoms-never one particular person. The examples in our article, in my view, do not “erase” Goldwater’s rule, since, in essence, they are academic discussions of diagnostic possibilities, not referring to a particular person. I believe the examples in our article are consistent with the principles set forth in the American Medical Association’s Code of Medical Ethics Opinion 8.12 (Ethical Conduct of Physicians in the Media).1

That said, I would point out that an appropriate response to a reporter’s question is not always or necessarily the the wisest response, which is sometimes a simple disclaimer – for example, “I can’t comment on this public figure because I haven’t personally reviewed it.” This is a perfectly acceptable alternative to the kind of differential diagnosis examples in our article. And, in my opinion, it is often the preferred response of psychiatrists who are uncomfortable or unfamiliar with the media and their questions, because journalists sometimes have an agenda that is antithetical to our professional goals.

Our article clearly shows that being very vocal about any the mental stability of a public figure, in the absence of professional scrutiny, is unethical.

Finally, speaking out on public policy is a totally different matter from commenting on public figures, and the two should not be confused. American Medical Association Section 7 Principles of medical ethics states that “A physician shall recognize the responsibility to participate in activities contributing to the betterment of the community and the improvement of public health”.2 Similarly, the American College of Physicians’ Code of Ethics states that

“Physicians should help the community and decision-makers recognize and address the social and environmental causes and determinants of health, disease and disability, including human rights concerns, discrimination, poverty and violence. »3

The American Psychiatric Association (APA) regularly and rightly speaks out on public health issues and policies that affect the well-being of the general public and our patients, and, in my view, all psychiatrists should do the same. For example, the APA addressed “how systemic racism can affect occupational, residential, educational, nutritional, safety, and health care options and outcomes for minorities in the United States.”4 In my opinion, this type of public advocacy represents a mode of transmission of psychiatric knowledge, even if it can influence political decision-making.

Dr Pies is Emeritus Professor of Psychiatry and Lecturer in Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor Emeritus of Psychiatric timeMT (2007-2010).

The references

1. Ethical conduct of physicians in the media. American Medical Association. Accessed February 2, 2022. https://www.ama-assn.org/delivering-care/ethics/ethical-physician-conduct-media

2. WADA Principles of Medical Ethics. American Medical Associations. Accessed February 2, 2022. https://www.ama-assn.org/about/publications-newsletters/ama-principles-medical-ethics

3. Sulmasy LS, Bledsoe TA; CPA Ethics, Professionalism and Human Rights Commission. American College of Physicians Ethics Handbook: Seventh Edition. Ann Medical Intern. 2019;170(2_Suppl):S1-S32. https://www.acpjournals.org/doi/10.7326/m18-2160

4. Town Hall – APA tackles structural racism, part 5: annual update. American Psychiatric Association. Accessed February 2, 2022. https://www.psychiatry.org/psychiatrists/meetings/addressing-structural-racism-town-hall

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