Latest / Millennial Mental Health Channel / Dr. Mark Mullen Schools Us on the Goldwater Rule

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Dr. Mark Mullen Schools Us on the Goldwater Rule · Millennial Mental Health Channel

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Hello there, loyal listeners. So very nice to have you back to day.
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We are talking the Goldwater Rule with doctor Mark Mullen, but we wanted
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to give you a quick bio before we jump right into the episode. He
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is actually a friend of mine and someone that I really respect, which is
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the reason why I wanted to have him on the show. We did our
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residency together, and even though he was a couple of years behind me,
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I was always blown away by his intellect, his ability to speak, and
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his unique insights. Currently, doctor Mullen is a fourth year Psychiatry resident and
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the Chief Resident for Academics at Creighton University School of Medicine. He will be
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the first graduate of the programme's Medical Educator Tract. He grew up in Saint
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Louis, Missouri, and completed his bachelor's degree from spring Hill College in Mobile,
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Alabama. He then returned home to complete medical school at Saint Louis University.
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After residency, he's going to return to Saint Louis University as Assistant Professor
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of Psychiatry. He'll be directing the Psychiatry clerkship and seeing patients on the consult
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Liaison service at SSM Health Saint Louis University Hospital. He's also the creator and
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host of Psychiatry boot Camp, a podcast designed to ease the transition to residency
1:12
for psychiatric learners. So if there are any residents listening to this episode,
1:17
check out Psychiatry boot Camp. It's a super awesome tool and something I'm really
1:21
excited about. Intonsis without further ado, here's doctor Mullen. This is Millennial
1:29
Mental Health Channel. I'm doctor Justin Romano, a Child and Adolescent Psychiatry fellow,
1:33
and I'm Adikourio, a licensed clinical therapist. Our podcast is here because
1:37
we wanted to start a much need to conversation about mental health. Our goal
1:41
is to teach you as much as we can by sharing our own experiences and
1:45
interviewing experts in the mental health field. We will discuss topics like mood disorders,
1:49
psychotic disorders, substance use, personality disorders, and many more. Millennial
1:53
Mental Health Channel buy Millennials for everyone. We hope you enjoyed today's episode.
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He is a production of Spreaker from iHeartMedia Me. I hear mark. It's
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good to see you man. How you doing I'm doing well. Yeah,
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it's been a minute how are you. I'm doing well, and we'll probably
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talk a little bit about this in the intro. But Mark and I have
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been doing residency or did residency together, and so he had contacted me saying
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that he had just done a grand rounds at Creighton University for the Goldwater Rule
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and said, Hey, if you want to have me on the show,
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I would love to. And I said, yes, that sounds like a
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great idea. So Mark, tell us, what is the Goldwater Rule?
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Yeah, so you were a couple of years ahead of me. So the
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nice thing about seeing you virtually is you can't stuff me in a locker and
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call me dweb like you would do, you know when I was an underclassman.
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So thank god for the virtual environment and thanks for having me. Yeah,
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And in addition to being a friend, I'm also a listener. So
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I've listened to a lot of your episodes and I thought this would be kind
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of a cool as you give your show. So the Goldwater Rule, it's
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kind of at the intersection of mental health and politics, and really the Goldwater
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Rule is kind of a colloquial nickname given to a portion of the American Psychiatric
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Association's Code of Ethics for Psychiatrists, where they talk about kind of how psychiatrists
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should conduct themselves in terms of giving professional opinions about people in the news,
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celebrities and really most pertinently politicians. So if I were to start making a
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bunch of wild, crazy claims about Joe Biden, that would be breaking the
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code of ethics and say like, hey, that's against the Goldwater Rule.
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Correct, basically yes, And I would say that anybody who's been paying attention
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to the media knows that maybe they're surprised to hear that there's a rule about
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it, because I think this sort of thing happens all the time across the
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political spectrum, whether it's celebrities, yeah, Joe Biden, both of our
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leading presidential candidates. I think there's a lot of questions being asked. In
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fact, if you don't mind, I think I'll share one year just to
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kind of stress that point. And this is really better visually. But it's
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a recent PBS News Hour Mayrist poll that was conducted in like May of twenty
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twenty three, so not that recent, and they asked if voters were concerned
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about Joe Biden's mental fitness for the presidency, and they also asked by Donald
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Trump. So for Joe Biden, thirty six percent of Democrats are concerned about
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his mental fitness for the presidency, so over a third of his own party,
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eighty four percent of Republicans are concerned about his mental fitness for the presidency,
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and sixty nine percent of Independence. Lol. No, I did not
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make that number up. I know. I really am a doctor, I
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promise. And then for Donald Trump, the numbers are also pretty concerning.
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Seventy eight percent of Democrats are worried about his mental fitness, twenty one percent
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of Republicans, and forty eight percent of Independence. And his quote unquote mental
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fitness was a centerpiece of both of his impeachments. Okay, So the Goldwater
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Rule you talked about, like ethics with psychiatry, is it only for psychiatrists?
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Yes, So the Goldwater Rule actually dates all the way back to nineteen
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sixty four presidential election, which we can talk about however, and I'll just
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mention. So, so just some context, you know, the APA American
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Psychiatric Association governed psychiatrists, the American Medical Association governs physicians and general doctors in
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general, and the American Medical Association pressured the APA to make the Goldwater Rule
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back in nineteen sixty four and then fell silent on the issue until twenty seventeen,
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and during the Trump presidency, the AMA made their own version of the
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Goldwater Rule, where they now also say that any physician should refrain from quote
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making clinical diagnoses about individuals, public officials, celebrities, persons in the news
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that they have not had the opportunity to personally examine. So they have their
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own version of the Goldwater Rule now. But I guess technically it's not called
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the Goldwater Rules. As an avid sports fan, I see on Twitter all
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the time and there's actually one specific doctor who used to be like a team
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physician for the Chargers back in the day who will like constantly talk about potential
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diagnoses of like an injury, Like if someone sends them a video, he
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will give his thoughts like is that allowed? Is it frowned on? Like
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where are we at with that complicated answer? I guess one thing is it
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gets to the definition of professional opinion. Surely we can say some things,
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you know, and our professional organizations want us to be engaged to the szens
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engaged with the media. I think people with professional medical training are probably best
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suited to comment on those types of issues. But to give you a really
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direct answer, yeah, you shouldn't be diagnosing someone that you haven't personally at
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the end end, And all of those doctors are absolutely violating their professional codes
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of ethics. And that gets to a really important critique of the Goldwater Rules.
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So the Goldwater Rule is a really, as you can imagine, a
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really controversial topic, significant freedom of speech considerations and social just considerations, and
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one common critique is it's not consistently enforced. There's a psychiatrist who goes on
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Fox News. I think he's full time staff there on their Fox News eighteen,
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doctor Keith Ablow, who just his whole job basically it's a violate of
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the old Water Rule, just to go on and talk about what his professional
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psychiatric opinion is about people in the news. And he's got some really interesting
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takes which we could talk about. But there's no enforcement of it. There
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really isn't. So a major critique is like, why do we have rules
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if we're not going to enforce them. You know, people don't lose their
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license for violent in the Goldwater Rule. There's a famous case recently during the
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Trump presidency where someone lost their position as academic faculty at Yale for violating the
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Goldwater Rule. But you know, you're not hold you're not held criminally responsible.
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You don't lose your medical license. So I think more of a guideline
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than a law, so to speak. Is there any set in stone punishments?
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Is there anything recommended for breaking Goldwater Rule? Yeah, this is a
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really good question. And to be honest, I searched high and low when
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I was learning about this, researching about it, and I wasn't really able
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to find any strong recommendations for how it should be enforced. And again it
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gets to the controversy. It's kind of who has the teeth. So the
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only real enforcement that I came across is you can be removed from the American
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Psychiatric Association because it is their code of ethics, and they can say you
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violate our code of ethics, you broke their rules, you're out. But
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justin as you know, I mean, there's a lot of psychiatrists that have
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good faith disagreements with the American Psychiatric Association, whether it's this issue, other
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issues, and they say, doesn't really bother me. You know, I'm
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going to follow my conscience. I'm going to speak my mind. I'm going
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to write a book about a celebrity and make a bunch of money. There's
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really it really does have just no teeth. Interesting. That is one of
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the reasons too, why on this show MMHC we have refrained from talking and
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postulating on people's mental health issues. We do talk about celebrities who have come
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out and talked and spoken about their own diagnoses, spoking about their own experiences,
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but we don't ever try and say like, oh, yeah, this
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guy for sure has X, Y and Z. And we did a whole
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episode on narcissism and narcissistic personality disorder in the past, you know, if
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you want to go check that out. And we refrained from using any specific
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politicians' names, which I was really proud of ourselves about for a reason because
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I didn't want to break that Goldwater rule, that code of ethics. We
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should probably talk about specific examples. And I've got something that I can give
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you about. Well, let's just get right to it, shall we.
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Yes, So let's just dive in. So the chair of DSM four,
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his name is doctor Alan Francis. He's an author, a speaker and kind
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of turned into a mentor of mine through my podcast, and he wrote a
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book called Twilight of American Sanity. A psychiatrist analyzes the Age of Trump and
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so, as I mentioned, a well known psychiatrist from Yale was very outspoken
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about the Trump presidency and his unfitness for office, and Alan Francis wrote a
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letter to The New York Times. I'll just give you the quote. So
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he directly addressed the issue of does Donald Trump have narcissistic personality disorder? Which
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is what doctor Bandy Lee at Yale was alleging. And if you look her
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up on Twitter, there's plenty there. Let me tell you, you'll be
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strolling for hours. So here's the quote from doctor France's letter to the New
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York Times. Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic
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personality disorder. I wrote the criteria that defined this disorder, and mister Trump
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doesn't meet them. He may be a world class narcissist, but this doesn't
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make him mentally ill because he does not suffer from the distress and impairment required
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to diagnose a mental disorder. Now, of course, doctor Francis did right
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the criteria for narcissistic personality disorder. What he mostly writes about is psychiatric diagnosis
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and how we should use the DSM, And one of his sort of central
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points is psychiatric diagnosis should not be weaponized to label people who are not having
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a significant functional impairment. And I think his argument is pretty simple. If
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you're an elected president of the United States, can we really say that you're
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experiencing a significant functional impairment from your mental disorder? If you're that successful,
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I think we could critique that as well, because we know that mental illness
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certainly does not discriminate no matter how successful you are. But I think that's
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kind of one of his central points. When doctor Francis writes this, who
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is I mean, he's my favorite psychiatrist on planet Earth. He's my psychiatric
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messiah if there were one. You know, he's breaking the Goldwater Rule because
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the APA very clearly says you cannot offer a professional opinion about someone that you
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have not personally examined, and he has not personally examined Donald Trump. And
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it is a professional opinion not only to diagnose Donald Trump, but also explicitly
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in the APA's guidance to say that someone does not have a certain mental disorder.
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So actually, in this case, he's defending the Goldwater rule while Simon
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paneously breaking it. And you know, I'm glad that he is your favorite
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psychiatrist after doctor Ramana. Yes, yes, well psychiatrist. You know,
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I don't know. Okay, fair, okay, no, you got your
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rank order there. I like it. But yeah, good point that it
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gets really tricky talking about these things, and people seem to break this rule
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all the time even though they're not supposed to, and they're very self aware
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about breaking this rule. And we went through some of your Grand Round presentations
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and I got the you. They started in nineteen sixty four, and it
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started politically as well. Take us back because it was Goldwater, the Lyndon
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Baynes Johnson correct didn't know his milan, I don't. I only knew about
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to be Yeah, Lyndon Baines Johnson, that's right, Yes, nineteen sixty
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four. So yeah, let's start there. Let's start with why it was
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created. So, you know, presidential election, Barry Goldwater, Lennon Johnson
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and an editorial periodical I should say called fact mat magazine sort of a liberal
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leaning Political magazine got a hold of the APA's mailing list, and they mailed
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questionnaires to three hundred and fifty six psychiatrists on this mailing list, and they
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asked them a single question, do you think that Barry Goldwater is psychologically fit
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to serve as President of the United States? Now? Fact Magazine, wanting
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to make sure that all of the psychiatrists had all of the necessary context to
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make such an important determination, generously provided a description of Goldwater before asking that
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question, where they referred to Goldwater's public temper tantrums, occasional outbursts of profanity,
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and allege quote unquote nervous breakdowns, which were consistently denied by Goldwater.
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And they said, you know, hearing all this, do you think that
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Goldwater is psychologically fit to serve as president of the United States? So what
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did the psychiatrists say? So? Fact Magazine received over twenty four hundred responses
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from Board certified psychiatrists, and they published forty one pages in what they said
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was the most intensive character analysis ever made of a living human being. So
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the media has not changed. So the psychiatrist said eighty nine said that Goldwater
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is psychologically unfit to be president, and that was sort of the cover that
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they ran, you know, that was the big number. Twelve hundred psychiatrists
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say Goldwater's unfit to be president. They did get some that said he was
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psychologically fit. Six hundred and fifty seven said that he was psychologically fit.
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And this is to me, this is actually the most interesting thing that I'm
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going to say today. Five hundred and seventy one psychiatrists declined to weigh in.
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So the fewest number of psychiatrists said, you know, maybe we don't
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know enough about this person that we've never met to make a determination about his
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mental fitness to be president. I mean, isn't that just amazing the hubris
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that even psychiatry, You know, I just think that's human nature for you
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right there. So the fewest number to client to weigh in. I think
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I can only do this justice by ridding a couple of quotes that they published
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to give you an idea of kind of the tone that a lot of these
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psychiatrists took when opining on Goldwater's mental fitness. Quote Barry Goldwater's mental instability stems
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from the fact that his father was a Jew while his mother was a Protestant.
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Quote from TV appearances, it is apparent that Goldwater hates and fears his
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wife. Quote he is a mass murderer at heart and a dangerous lunatic.
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And any psychiatrist who does not agree with the above is himself psychologically unfit to
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be a psychiatrist. I mean, talk about hot take. They didn't even
15:45
have Twitter. They called him an anal character, a counterfeit figure of a
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masculine man. They said he had a grandiose manner and a godlike self image,
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and a stronger identification to his mother than to his father, which all
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rendered him psychologically unfit. And I'm hoping that we can all agree that this
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was really embarrassing for psychiatry as a profession to be put on blast like this
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in front of the whole country. I mean, forty one pages, goddamn
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Like that's like they they found some type of way about Goldwald gold I was
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like, what the fuck I was trying to You know what I've learned with
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my own psychiatry podcast is that psychiatrist spend so much time listening that when you
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give him your chance to speak, you never know. You never know what's
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going to come out. Oh man, I have a question and I don't
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know if this is the right time to ask it, but I'm just gonna
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ask it. Is there any guidelines around what is considered to be like celebrity
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or like powerful figure status, because I don't know if you guys have watched
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the show Love Is Blind, but I just finished season six, first time
16:52
I've ever watched it. Right, I'm only on episode four, do not
16:56
spoil it. For spoil it, I won't spoil it, ye, Like,
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do those people count as like people that you should not comment on?
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Because I've seen a lot about specific people on the show of like, oh,
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they have this in this issue, or obviously they've had these things in
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the past, or so and so has daddy issues like things like that,
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Like is that celebrity status enough to not comment on them? Or is there
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where's the line? Is there a line? A great question, and that's
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it's very central and I'm going to answer it in two different ways. The
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first is by you know, what you're getting at is kind of why does
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the Goldwater rule exist? Like what exactly are we trying to avoid? Yeah,
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and so, one of the rationales that the APA lays out and they
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publish an opinion clarifying this in twenty seventeen is two really important things here.
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One, we should not offer a psychiatrist. We should not offer professional opinions
17:49
without consent of the person. In fact, you can constitute an assault to
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do so if you go in and perform an examination on a patient that you
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don't have consent to do. I mean we can. It's not hard to
18:00
imagine how that's the case for surgeons, right if they go and perform a
18:03
procedure on someone where they don't have any consent to do so. It's also
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true of psychiatrists who are practicing a different type of medicine. So if we
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don't have a patient's consent, we should not be offering a professional opinion on
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them. So that's one part of the rationale. The other is there's a
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certain standard of care that we need to uphold in psychiatry. You know,
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what does it mean to have a psychiatric opinion, a true professional opinion?
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And this is where it would be different for someone who doesn't have any psychiatric
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training to levy comments about the people on Love is Blind. But when you
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do have professional psychiatric training and when you speak, it has a little more
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weight and you're implying that you're relying on something that actually is based on your
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training, then you really need to pause a lot more, because the standard
18:44
of care in psychiatry is a comprehensive psychiatric interview that is the gold standard for
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psychiatric diagnosis. So, Eddie, the answer to your question is, as
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psychiatrists, we shouldn't be offering opinions about anyone if we don't have their consent,
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and we're deviating from the psychiatric standard of care when we offer professional opinion
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without doing a comprehensive psychiatric interview. So that's the first way I'm going to
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answer your question. The second one's a little more practical, and I think
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this is probably something that you guys will both be able to relate to.
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As people in the field, we're often asked our opinions about family members,
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friends, friends of friends, moms, friends, sisters, ex dog owners,
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so and so, you know, and what do you think about this?
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They got put on this drug? What are your thoughts on that?
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And you know, the API doesn't explicitly say this, but I'm going to
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argue that when we're put in those types of positions, we should really think
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about the Goldwater rule as a tool to help us navigate those conversations and say,
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you know, I'm a little bit limited about kind of what I can
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say about that because they're not my patient. I don't want to take on
19:52
that responsibility. I haven't evaluated them. It's really not my place. And
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I think I've personally found it to be helpful in navigating those conversations, and
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I take it as kind of a personal moral guiding principle in addition to a
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professional standard. I like that because, yeah, we are asked to weigh
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in a lot of the time, and sometimes it's nice to say we're not
20:14
not questioned or not talk about diagnoses and go more in the direction of Okay,
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it sounds like we need to start here. We need to start with
20:21
going and seeing a psychiatrist. We need to go and start by seeing a
20:23
therapist. That's a good place to start for anyone in those types of situations.
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Or it's like, yeah, it feels like this would be a good
20:30
time to start that process of trying to find the right provider for you.
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And I'm really glad in terms of the love is Blind thing that just sitting
20:38
in my living room talking to my wife doesn't break the gold Water rule because
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I am all the time analyzing those people on especially Love is Blind. It's
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hard not to I would say that obviously I'm not going to break the Goldwater
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rule right now, but I'd say probably a lot of them could benefit from
20:56
some therapy. I think most people in America of it from some therapy too.
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So I have no further comments at this time. You're ound or thank
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you to your point. Mark. Look of so many examples as you're sharing
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all that of people celebrities who come up with like and I guess the hard
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part is, say someone like Kanye West or Donald Trump or like spears memoir.
21:25
You bet I got some thought on that. Yeah, yeah, that
21:27
one. Jeanette mccurty's memoir is a little more niche. But like, as
21:33
a Las Vegas Raider fan, we had Chandler Jones who was released from the
21:36
team, who was very clearly suffering from some type of mental health struggles and
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seeing I guess the hard part is and still we need to like fall back
21:45
on like professional ethics, but seeing people give their thoughts left and right,
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as like non professionals like who have kind of no idea what's going on and
21:55
only know certain words and being like completely wrong and off base and like just
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needing to understand that, like we just kind of kind of keep our thoughts
22:03
to ourselves and we just got to deal with it. Like there's no there's
22:07
no real like wiggle room with it, and I think you touch it.
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Another really important thing, which is a common critique of the Goldwater Rule,
22:14
and some people call it a gag rule for psychiatrists, is does it infrings
22:18
on our freedom of speech? And then if everybody's going to be commenting on
22:22
this stuff, especially you know, it's one thing to talk about love is
22:25
blind, which I'd love to do more of, but it's another thing to
22:27
comment on the candidates for president, you know, et cetera, something that
22:32
really matters someone who's going to have access to the nuclear codes. If we're
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going to be having these conversations, wouldn't it be helpful for people with the
22:41
adequate training to be the ones commenting on it? And the Goldwater Rule is
22:45
preventing us from doing that. And I think in the age of social media,
22:48
it's even more pertinent anybody can fire off a hot take. As psychiatrists,
22:52
we're not supposed to. And so as we watch the conversations just devolve
22:59
and into not sense. And as misinformation and disinformation is spreading on the internet
23:04
deliberately by bad actors, at times, do we have an ethical responsibility to
23:10
say something, to say, whoa, whoa, whoa? I actually know
23:12
some I know what I'm talking about here. You know, I have a
23:15
lot of training in this. This is there's some science behind this that I'd
23:18
love to share with you. And it's a really fine line. And that's
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a really common critake of the Goldwater rule is if everybody's talking about it,
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shouldn't it be us? Because with social media, with influencers, people are
23:29
giving more and more and more hot intakes and there is little to no regulation
23:34
of that. It seems like social media companies want those hot takes because that's
23:38
what gets more clicks, that's what gets more views. But that's also what
23:41
spreads a lot of misinformation out there too. So I know a lot of
23:47
times in the past we have talked about how we have to start holding social
23:51
media companies accountable for the addiction that they're giving children in this country and adults
23:55
for that matter. Do we feel like it's going to be on the social
23:59
media compan needs to start regulating some of this stuff in terms of professional opinions
24:04
that should not be given and even just misinformation by professionals. I think you
24:11
have to learn how to crawl before you can learn how to run, you
24:14
know. And certainly that's you know, probably a bit beyond my scope,
24:18
but I think they're doing. Social media companies are having a lot of trouble
24:22
even regulating things like hate speech and promotion of straight up violence, you know.
24:26
And I think to think that these companies would know their asks from their
24:30
elbow in terms of enforcing the Goldwater Rule is a joke. I mean,
24:34
it's just we're just not there yet. But I think the other thing is
24:38
in the Goldwater Rule. So I'll read the exact text of what most people
24:42
mean by the Goldwater Rule and then I'll give you the full context. So
24:45
this is section point seven point three at the APIs Medical Ethics, with annotations
24:49
especially applicable to psychiatry. Quote, it is unethical for a psychiatrists to offer
24:53
professional opinion unless he or she has conducted an examination and been granted proper authorization
25:00
for such a statement. Okay, pretty straightforward. Like I said, you
25:03
know, don't offer these opinions of people you haven't evaluated, but listen to
25:07
the sentence before that, two sentences before that. On occasion, psychiatrists are
25:12
asked for an opinion about an individual who is in the light of public attention
25:15
or who has disclosed information about himself or herself through public media. In such
25:22
circumstances, a psychiatrist may share with the public his or her expertise about psychiatric
25:26
issues in general, and then they give, you know, the gold Water
25:30
Rule. So the APA wants us to be engage citizens, and the two
25:34
sections that precede that are all about how we should be civically engaged promote anti
25:41
stigma work. I think for me, you know, working with populations of
25:45
severe and persistent mental illness, it's really important for me to be a strong
25:48
advocate because I think that people who struggle with these issues are treated horribly in
25:52
American society. I mean, I think America is one of the worst places
25:56
on earth to have a severe and persistent mental illness. Most of these people,
26:00
a lot of these people, they don't have access to the care they
26:03
need. There aren't the institutions in place to offer any sort of I don't
26:07
want to use the word coercive, but to be more insistent short of just
26:11
locking people up, and that's not treatment, you know, and a lot
26:15
of these people do wind up in prisons and private prisons at that. So
26:19
I think advocacy work is really important for psychiatrists. If we're not doing that,
26:22
we're not doing our full job. We're not being good citizens, we're
26:25
not being good psychiatrists, We're failing our patients. But then it's a really
26:29
good question about you know, where do you draw the line between quote,
26:33
sharing your expertise about psychiatric issues in general end quote and violating the Goldwater Rule
26:38
to some extent, Because the APA defines a professional opinion really, really broadly.
26:45
It's not just don't make a diagnosis. It's don't offer any opinion about
26:48
a person that relies on your professional training as a psychiatrist. Do we have
26:53
any major public figures that are psychiatrists. I'm trying to think of any.
26:57
None are really really coming to mind. I can't think of any. Do
27:02
we have a Neil Degrass Pison of mental health. It's tough, though,
27:06
too right, because the therapeutic alliance is so important, and when you're a
27:10
polarizing figure like that, it becomes more difficult to build your therapeutic alliance,
27:14
and so I think we're a bit conflicted when doing things like that. Yeah,
27:18
anyway, I will be launching my campaign for congress in about six months.
27:22
You donate there. I just like I'm stuck on like the disinformation part,
27:29
like the or the misinformation with like especially with like social media, and
27:33
like your point mark of like we want to be engaged with the community and
27:38
we want to be like advocates for our profession and professions, but if we
27:42
can't comment on misinformation or like there's like that fine. I guess what I'm
27:48
really stuck on is like there's a lot of like influencers or people who get
27:52
a big following right now, you guys, I don't know if you see
27:55
it too, but like the big hot button or hot topics is h or
28:00
are like autism and ADHD. So you get like many or micro influencers who
28:07
like will sell themselves as autism and ADHD coaches, and it's like they'll say
28:12
all these things as if they are experts when they're not. They're they're just
28:15
speaking from their own experience, which is totally fine, But then it's like,
28:18
do we have to then keep our mouths shut of like these things are
28:22
incorrect or these things only fall for these people, Like where do we?
28:26
I don't know, that's the part that I'm stuck on of, like yes,
28:30
be good advocates for psychiatry, and also shut the hell up, don't
28:36
be like that's what I'm stuck on. It keeps me up at night,
28:41
Eddie. I mean, it does, you know, and I it's honestly,
28:45
I can feel my blood pressure rising just thinking about this, because I
28:48
too will scroll on these pages and I see it too, and I think,
28:55
you know, promoting evidence based information about diagnoses in general APA would sa
29:00
great. Applying it to an individual person bad, but it's also just exhausting
29:07
to try to combat this. And again, you know, I want every
29:14
single human being who might consider seeking mental health treatment to feel safe coming to
29:21
my office and to feel safe opening up to me and to give me a
29:26
chance to try to listen to them and understand them and help them. And
29:30
so, you know, a lot of my future patients might be engaging with
29:33
these pages, and I always think to myself, if I were to engage
29:37
with that page as well in a different way, am I pushing people away
29:40
that I would really like a chance to build a relationship with But for me
29:42
personally, you know, the place to build that relationship is not is not
29:45
TikTok. And I have a lot of respect for those professionals who do kind
29:49
of wade into those really difficult spaces and have the guts to do that.
29:55
It's just not something that I do. I get tense when I like autos
30:00
coach or ADHD coach or like those kinds of things where it's like, I
30:03
think sharing your personal experience is great, it helps to normalize things, but
30:07
normalize things, but then once you consider yourself for advertise yourself as an expert
30:11
to people who may be listening or watching, when really you're only an expert
30:15
in yourself. And this gets right at sort of where I ended my presentation
30:19
that I gave to our program, which is kind of my personal take on
30:22
the Goldwater Rule, which is not from some journal but really what I think
30:26
and what I you know, you're getting at psychiatric diagnosis and the power of
30:30
psychiatric diagnosis, and psychiatric diagnosis is an extremely powerful tool. We are a
30:37
culturally sanctioned profession with you know, society has entrusted us with a very important
30:44
responsibility of helping people to live well and to live meaningful lives. And one
30:48
of the most important tools we have in our arsenal to help people do that
30:52
is psychiatric diagnosis. And we have to be really careful with what we do
30:56
when we're using that tool. And so the way that I like to use
31:00
as your diagnosis, the way that I strive to use it, is to
31:03
help someone understand that they're having a problem that we have a lot of experience
31:07
with. They're having a problem that we have a lot of studies about,
31:11
we have evidence about things that can help them. There are other people who
31:15
have also had this same problem, and we have studies about how they have
31:18
gotten better. And you're not alone, right This diagnosis is something that can
31:22
help you to understand yourself and help me to get you better. But if
31:26
you look at the other side of that spectrum, if psychiatric diagnosis is not
31:30
done with appropriate nuance, with taking the appropriate time, if you don't build
31:36
a good relationship, build a good bridge before walking over it. At its
31:40
worst, psychiatric diagnosis is stamping a person with a label and saying this is
31:45
the problem that you got, and here's a prescription for it. You're fixed
31:49
or worse. Here's a problem that you got and your brain's broken, and
31:52
good luck living with it, you know. And so I think that we
31:56
have to appreciate that how you take so much traction someone, so much self
32:00
at the keyc from someone. If they come to your office, you give
32:04
them a PHQ nine, You talk to them for five minutes. You tell
32:07
them, great ide your problem. You've got depression. Here's an end to
32:08
deepressant. Get out of my office. They're going to say, oh,
32:13
oh my god, something's wrong with me. All this time I knew something
32:15
was wrong with me. And now I've got this guy who's been in school
32:17
for thirty years. He's wearing a white coat, and even he knows something
32:21
is wrong with me. Rights it's really important that we use psychiatric diagnosis to
32:27
help people. And my argument is that when we violate the gold Water Rule,
32:31
when we use psychiatric diagnosis to opine about persons in the news, we
32:37
are weaponizing psychiatric diagnosis, even if we have the best intentions, and most
32:43
people who violate the gold Water Rule do have the best intentions. Some people
32:46
just want to make a bunch of money, and I admit that, but
32:49
most people are really genuinely concerned about the direction that our country is headed.
32:52
On both sides of the islean, I think it comes we're in a good
32:53
place. But what we're really doing when we violate the gold Water Rule is
32:58
we're pointing a finger at someone. We're saying this person, this person is
33:02
different, this person has mental illness. This person is not capable of doing
33:09
whatever it is that we're opining about. And I think it's a damn shame,
33:14
you know, And it's not the way that I think psychiatric diagnosis should
33:16
be used. I think it should be used to heal people, to make
33:20
them feel like they're a part of the human community, and not to other
33:22
people and make them feel less than. So that's I guess that's my personal
33:25
hot take on the Goldwater Rule. And I think that with the ADHD and
33:30
the autism diagnoses, you know, when people get a label, it can
33:35
be empowering and help them to find tools that help them, but it can
33:37
also put them in a box and think, this is a problem that I'm
33:39
going to have for life, and it can really help it. It can
33:44
make them less mentally flexible to actually feel like they have some control over their
33:47
situation. And I don't think that's really healthy. Great point. I think
33:52
that was like the perfect summation. I'd love the point of we shouldn't be
33:55
weaponizing our diagnoses, especially as a political weapon, and to try and say
34:00
that guy's got this, so that's why you shouldn't vote for him, because
34:04
that's dangerous. All right, Mark, tell us where people can find you,
34:07
because you have your own podcast, especially if you are a resident and
34:12
you are interested in learning about how to transition into residency. You've got the
34:16
Psychiatry boot Camp podcast. So yeah, tell people if you want, if
34:21
you want to share your information, where people can get in touch with you,
34:23
where people can listen to your podcast. You know what we talked about
34:27
with doctor Allen Francis and with psychiatric diagnosis and weaponizing it. We talk about
34:30
a lot of that actually in season one, episode one of the entire series.
34:34
So head on over to Psychiatry boot Camp. Maybe we can put the
34:36
link in the notes. Learn about all those types of fun things with me.
34:38
It's really designed for mental health professionals, specifically people going into psychiatry residency,
34:44
but I think anybody who sees patients as a professional would really benefit from
34:49
listening to the podcast at least I hope so. And it's also there,
34:51
it's in the public domain. It's a patient education tool to kind of learn
34:53
more about the field. And I think it's interesting to listen to Psychiatry boot
34:57
Camp, which is kind of for professionals to think, what is my psychiatrist
35:00
thinking about? You know, how do professionals formulate these types of topics.
35:04
So it's a much different bent than MILLENNIUA Mental Health Channel, But I hope
35:07
you'll give it a try. Thank you so much for being on the show.
35:10
That was awesome, so much good information, such an interesting, unique
35:15
topic. Thanks for having me. How about in the yell too much?
35:16
It's different for me to be a guest, so I can turn down the
35:21
volume. You know, it's no big deal. Yeah, I was really
35:23
hoping you would give, you know a little more personal information, like your
35:27
address, but we will make do with what you gave us. Eddie one
35:31
plas out Mark. Thank you again for joining us. If you've listened to
35:36
this episode, you know where to find us, but will remind you anyway
35:38
on Spotify, on Apple Podcasts, wherever you get your podcasts. On social
35:43
media, you can find us at Millennial Image. See you also go to
35:45
our website MILLENNIALIMHC dot com. Thank you again, Mark, I learned a
35:50
ton today. I feel smarter just from listening to you and everyone who's listening.
35:54
Don't forget take care of all mentals.