The Shrink at a Dinner Party
Why psychiatrists should avoid public diagnoses—and the stigma they can cause.
Posted June 11, 2025 | Reviewed by Monica Vilhauer Ph.D.
By Kenneth J. Weiss, M.D. and the Committee on Arts & Humanities at the Group for the Advancement of Psychiatry
Many psychiatrists dread being questioned about public figures’ mental health during social events. Lately, such situations come in two flavors—questions about politicians and shooters.
Nevertheless, psychiatrists in social settings (and sometimes in their office practices) are often put on the spot to comment on polarizing current events and people in the news. It is as if psychiatry can explain or fix the problems by assigning DSM labels or claiming all behavioral outliers as its domain.
However, organized psychiatry has spent considerable energy trying to keep psychiatrists out of defamatory situations and overclaims that conflate deviance with mental health issues. Here is some of the history and rationale for these guardrails.
Forensic psychiatrists are permitted to make diagnoses from historical or medical records, especially when an in-person examination is not possible. Members of the American Psychiatric Association, however, are prohibited from diagnosing famous people they have not personally examined. The Association can assess disciplinary actions against members for violations of the rule
The ethics rule, published in 1973, was the result of years of discussion following the publication of psychiatric opinions about presidential candidate Senator Barry Goldwater published in Fact magazine in 1964.
Fact asked psychiatrists whether the Senator was mentally fit to be president. Over a thousand psychiatrists responded in what turned out to be an embarrassing moment for the psychiatric profession. The Senator successfully sued Fact 's publisher for printing the harsh things the psychiatrists said about him and won. Hence, the informal name Goldwater Rule .
However, the story, of course, did not end there. In the last decade, citizens, politicians, and professionals questioned the mental health of President Trump during his first term and of President Biden afterwards. Consequently, some psychiatrists pushed back against the Goldwater rule, suggesting that mental health professionals should be able to break it when public interest demands action out of ethical necessity.
Psychiatrists, as citizens, might understandably take such a position, but what might be the side effects?
In 1924, Sigmund Freud was invited to analyze criminal defendants in a sensational murder case. It was a famous trial of two young men, Leopold and Loeb, who, just for kicks, kidnapped and killed a 14-year-old boy in Chicago.
Their wealthy families hired Clarence Darrow to defend them. As the press went into a feeding frenzy over the trial, William Randolph Hearst, who owned 28 newspapers, wanted a piece of the action. He offered Freud a blank check to weigh in on the defendants’ mental state. The publisher of the competing Chicago Tribune offered Freud $25,000 (almost half a million in today’s dollars) to offer expert commentary.
Freud declined both offers. His reason, succinct and sensible, is a model for ethical behavior today: “In reply I would say that I cannot be supposed to be prepared to provide an expert opinion about persons and a deed when I have only newspaper reports to go on and have no opportunity to make a personal examination.”
A few years later, a young Jewish man was accused of murdering his father by pushing him from a cliff in Tyrolean Austria. Though there was no evidence connecting the son to the death, the antisemitic prosecutor arranged for psychiatrists in Innsbruck to claim that the defendant had an Oedipus Complex . In essence, a psychodynamic truism, in the absence of other evidence, imputed a homicidal motive.
The young man was convicted at two trials and finally released after diplomatic interventions. Freud, in nearby Vienna, could not resist critiquing the reckless use of his concept, writing in a 1930 newspaper article (Weiss, 2012):
"If it had been objectively demonstrated that [the boy] murdered his father, there would at all events be some grounds for introducing the Oedipus complex to provide a motive for an otherwise unexplained deed. Since no such proof has been adduced, mention of the Oedipus complex has a misleading effect; it is at least idle. Such disagreements as have been uncovered by the investigation in the … family between the father and son are altogether inadequate to provide a foundation for assuming in the son a bad relationship towards the father. Even if it were otherwise, we should be obliged to say that it is a far cry from there to the causation of such a deed. Precisely because it is always present, the Oedipus complex is not suited to provide a decision on the question of guilt ."
Psychiatric labels can do harm. Of course, psychiatrists have free speech as individuals, but as professionals, they have an additional duty of vigilance to make sure psychiatric terminology is not used as a weapon.
What is the dividing line between a psychiatric opinion and an opinion held by someone who happens to be a psychiatrist? An analogy would be that a professional boxer’s hands could be regarded as lethal weapons. While a psychiatrist’s statements across a dinner table may be innocuous, the same utterances publicly shared could be defamatory.
There is another facet to this problem, not usually discussed. Using psychiatric labels casually pathologizes behaviors and can potentially increase stigma , both in the identified individual and in people with mental illnesses generally. The entertainment media ’s blurring of the mad/bad boundary already creates such stigma.
The question across the dinner table or cocktail party is, “Don’t you have to be crazy to [act/think that way] or [kill somebody]?” The pressure mounts when the subject is the president or an outlaw/folk hero like Luigi Mangione. It is as if mental health professionals have ownership of deviant or unpopular behaviors. No, thank you very much!
Moreover, unless one knows the political attitudes of the dinner guests (these days, usually), psychiatrists on the attack with DSM labels run the risk of defaming, as “crazy,” others at the table. More importantly, mental health professionals and their patients do not benefit in any way from casual use of diagnoses, and doing so may inadvertently increase stigma.
For example, how does one deal with questions about “that nutcase” who assassinated someone? While the shooter may have had a troubled past, it might be best to take a Goldwater-light ( myth-busting ) approach with something like, “Many people are violent, but that itself does not mean they are mentally ill. Automatically linking violence and mental illness is wrong; that’s a myth.”
With comments about politicians (whom psychiatrists have not examined directly), it is not constructive to use psychiatric terminology as a weapon. Instead, it is worth pointing out that it is wrong to use technical terms when one simply does not agree with someone else’s values, beliefs, or behavior. In doing so, one invites the same treatment of one’s own values.
That is why the Goldwater Rule is an ethical standard; its violation is potentially punishable. Sometimes the better part of valor is to demur on labeling and to educate others about basic facts.
It is not in anyone’s interest (doctors or their patients) to participate in “crazy- shaming .” Professional efforts are better spent on public education , research, and legislation to improve mental health funding.
Weiss, KJ (2012). Bearing false witness: Psychiatric testimony in Nazi-influenced Austria, 1928-1929. J Psychiatry & Law, Vol. 40, Summer 2012. https://ssrn.com/abstract=2183800
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