# Tarasoff Rule The Tarasoff Rule is the clinical-legal doctrine — established by the California Supreme Court's 1976 ruling in *Tarasoff v. Regents of the University of California* — that mental-health practitioners have a *duty to warn* (and, in subsequent jurisdictional refinements, a *duty to protect*) identifiable third parties from foreseeable serious harm threatened by their patients. The doctrine carved a specific exception into the otherwise-strict clinical-confidentiality regime that governs psychotherapeutic and psychiatric practice, creating an obligation to breach confidentiality when a patient communicates a credible threat against a specific identifiable target. The doctrine has acquired specific contemporary KB-relevance through the post-2016 *[[Goldwater Rule]]* / *Trump psychiatric assessment* / *duty-to-warn-the-public* discourse — the controversy over whether mental-health professionals' standard prohibition against publicly-assessing public figures they have not personally examined should be modified or suspended when the public figure exercises substantial political power and shows behavioral patterns suggesting potential dangerousness. The two doctrines (Tarasoff and Goldwater) sit on opposite sides of the same underlying question: when does the public interest override the confidentiality / no-public-diagnosis professional norm? ## The Tarasoff case The 1976 California Supreme Court case arose from the 1969 murder of Tatiana Tarasoff, a University of California Berkeley student, by Prosenjit Poddar, a graduate student who had been in psychotherapy with a UC Berkeley counseling-center psychologist. Poddar had told the psychologist of his intention to kill Tarasoff; the psychologist had requested police detention, which was carried out briefly and then released after Poddar appeared rational; the psychologist's supervisor subsequently ordered all records of the detention request destroyed and no further action; Poddar killed Tarasoff approximately two months later. The Tarasoff family sued the Regents of the University of California, the psychologist, the supervising psychiatrist, and the police involved in the initial detention. The California Supreme Court's 1974 initial ruling (*Tarasoff I*) and 1976 revised ruling (*Tarasoff II*) established the duty-to-warn / duty-to-protect doctrine: when a therapist *knows or should reasonably know* that a patient poses serious danger of violence to a specific identifiable third party, the therapist has affirmative obligation to take reasonable steps to protect the intended victim, including but not limited to warning the intended victim and notifying law enforcement. The court's central reasoning: confidentiality protections, while substantial, are not absolute; *protective privilege ends where the public peril begins*. ## The subsequent state-law variation Most US states have adopted some form of Tarasoff doctrine through case law or statute since 1976, but the specific contours vary substantially: - **Identifiable-victim requirement**: most states require an identifiable specific third party (not just generalized dangerousness); some states impose duty when *foreseeable* harm to specific victims can be anticipated - **Standard of foreseeability**: jurisdictions vary on what level of foreseeability triggers the duty - **Mode of fulfilling the duty**: warning the victim, notifying police, hospitalization petition, treatment-intensification — different jurisdictions accept different responses - **Immunity provisions**: most state statutes provide immunity from civil liability for *good faith* breach of confidentiality to fulfill Tarasoff duties - **Texas exception**: Texas has explicitly *rejected* the Tarasoff duty by case law (*Thapar v. Zezulka*, 1999), making it the most-notable jurisdictional outlier in the US The American Psychiatric Association, American Psychological Association, and other professional organizations have substantially incorporated Tarasoff-doctrine reasoning into their ethical-practice guidance, though the specific operationalization remains jurisdictionally-variable. ## The Goldwater Rule and its tension with Tarasoff A specifically-relevant contemporary issue: the American Psychiatric Association's *Goldwater Rule* (adopted 1973) prohibits psychiatrists from publicly offering professional opinions on public figures they have not personally examined and obtained authorization to discuss. The rule was adopted in response to the 1964 *FACT* magazine survey of psychiatrists about [[Barry Goldwater]]'s mental fitness for the presidency — a survey that produced widely-reported and clinically-irresponsible diagnostic claims, contributed to Goldwater's defamation lawsuit against the magazine (which he won), and substantially-embarrassed the profession. The Goldwater Rule has been controversial across multiple political cycles; the controversy intensified substantially during the Trump presidencies (2017–2021 and 2025+). The arguments: **Pro-Goldwater-Rule** position: mental-health professionals lack adequate clinical foundation to assess public figures from public-behavior data; political deployment of psychiatric vocabulary degrades both the profession and political discourse; the *FACT* magazine episode is the cautionary tale **Anti-Goldwater-Rule / Duty-to-Warn** position: when a public figure exercises substantial power and shows behavioral patterns suggesting dangerousness (impulsivity, grandiosity, lack of empathy, paranoid reasoning, indifference to harm), the *public interest* in mental-health professionals' analytical contribution arguably overrides the standard prohibition; the Tarasoff doctrine's reasoning (*protective privilege ends where the public peril begins*) extends naturally to political-power cases The 2017 publication *[[The Dangerous Case of Donald Trump]]* ([[Bandy X. Lee]], editor) — a collection of psychiatric and psychological assessments of Trump by 27 mental-health professionals — was the most-public anti-Goldwater-Rule intervention; it drew substantial professional-association criticism and substantial public attention. Lee was subsequently dismissed from Yale Medical School in 2020 after a series of Trump-assessment-related public statements; the dismissal was itself controversial. The substantive *clinical* questions about Trump (and other contemporary high-power public figures showing comparable behavioral patterns) intersect substantially with the [[Malignant Narcissism]] entry and adjacent /Subjects/Narcissism/ entries. The procedural / professional-ethics questions about *whether* clinicians should publicly assess such figures remain unresolved. ## KB Applications ### The clinical-political-discourse boundary problem The Tarasoff / Goldwater tension is one of the cleanest cases in contemporary American public discourse of a *legitimate professional-ethics disagreement* — both positions have substantive arguments, both have been defended by serious practitioners, and the underlying tension (between confidentiality / non-diagnosis norms and public-interest disclosure obligations) does not have an obvious resolution. The KB tracks both sides of the disagreement rather than adopting one as authoritative. ### The institutional capacity for political-figure mental-health assessment A specific KB-relevant observation: the *institutional infrastructure* through which mental-health professional assessments of political-figures could be performed if the Goldwater Rule were relaxed is largely-absent. The relevant assessments — cabinet-level psychiatric examinations, presidential medical-evaluations including mental-health components — are not currently conducted on the rigorous-clinical basis that would produce defensible duty-to-warn analysis. The institutional-design question of whether such infrastructure *should* exist is itself substantive and contested. ### The 25th Amendment policy connection The Tarasoff / Goldwater discourse intersects with the [[Twenty-Fifth Amendment]]'s *unable to discharge the powers and duties* provisions for presidential disability. The amendment's mental-disability framework presupposes some form of professional assessment infrastructure; in practice the assessment infrastructure has been minimal across the post-amendment period. The 2024–2025 Biden / Trump age-and-acuity discussions surfaced the policy gap with new urgency; whether durable institutional-reform follows is an open question. ## See Also - [[Malignant Narcissism]] — the substantive clinical framework most-frequently-deployed in Goldwater-Rule-controversy contexts - [[Authoritarian Personality Theory]] — the political-psychology research framework adjacent to clinical-assessment-of-political-figures discourse - *(The Dangerous Case of Donald Trump)* — the 2017 Bandy Lee anthology that crystallized the post-2016 anti-Goldwater-Rule discourse - [[Narcissism]] — the broader Subject hub where contemporary narcissism-and-political-leadership work lives in this KB