Until recently, the debate over our president’s mental health has focused on questions of psychological pathology: Do Donald Trump’s flamboyant narcissism, hedonism, and self-delusions add up to a malignant personality — or a malignant personality disorder?
Scores of psychiatric professionals say the latter. Some of their peers — and a large number of laymen — have insisted that the matter can only be settled by a psychiatrist who has personally, privately evaluated the president. That argument has always struck me as nuts.
There is no diagnostic blood test or brain scan for narcissistic personality disorder; there’s just a list of observable traits. A mental-health professional simply studies a patient’s modes of reasoning and patterns of behavior, and assesses whether they fit the checklist of symptoms for NPD. It’s absurd to believe that a psychiatrist who has spent a couple of hours talking to a patient in an office is qualified to make this diagnosis — but one with access to hundreds of hours of a patient’s interviews and improvisatory remarks, along with a small library’s worth of biographical information and testimonials from his closest confidants — is not. To insist otherwise is to mystify psychiatric practice; it’s to pretend that there is some shamanistic knowledge that mental-health professionals can only access once you provide them with a co-pay.
Further, whether we choose to label any given psychological profile a “disorder” is always, on some level, a value judgement about what it means to function healthily in our society. If an inability to concentrate on tests can qualify one for psychological dysfunction, then it’s hard to see why Trump’s manifest incapacity to subordinate his hunger for affirmation and attention to basic social norms would not. If a middle-school boy displayed Donald Trump’s level of impulse control in the classroom, there is little question that he would be considered psychologically unhealthy.
Regardless, in recent weeks, concerns about the commander-in-chief’s cognition have turned to the more mundane, and objectively determinable, question of neurological decline. The president’s slurred speech when announcing his decision to recognize Jerusalem as Israel’s capital; the exceptional incoherence of his most recent interview with the New York Times; and increasingly erratic (and Freudian) tweets all brought our president’s frontal lobe to the forefront of public discourse.
And then Michael Wolff started telling us what he’d learned while hanging around the West Wing last year. Having won the administration’s trust (possibly with the aid of these horrendous, anti-anti-Trump think pieces) the reporter was given extraordinary access to the president’s closest advisers. On Thursday in the Hollywood Reporter, he added a few new details to the emerging portrait of our president’s mental state:
Everybody [in the White House] was painfully aware of the increasing pace of his repetitions. It used to be inside of 30 minutes he’d repeat, word-for-word and expression-for-expression, the same three stories — now it was within 10 minutes. Indeed, many of his tweets were the product of his repetitions — he just couldn’t stop saying something.
… Hoping for the best, with their personal futures as well as the country’s future depending on it, my indelible impression of talking to them and observing them through much of the first year of his presidency, is that they all — 100 percent — came to believe he was incapable of functioning in his job.
At Mar-a-Lago, just before the new year, a heavily made-up Trump failed to recognize a succession of old friends.
The unanimous assessment of those in Trump’s immediate vicinity is shared by clinicians viewing him from afar. On Wednesday, in response to Trump’s tweet about the size and potency of his nuclear button, 100 mental-health professionals signed their names to a statement reading, “We believe that he is now further unraveling in ways that contribute to his belligerent nuclear threats … We urge that those around him, and our elected representatives in general, take urgent steps to restrain his behavior and head off the potential nuclear catastrophe that endangers not only Korea and the United States but all of humankind.”
On Wednesday, Politico revealed that one of the statement’s signatories recently briefed more than a dozen members of Congress last December (all Democrats, save one unnamed Republican senator), on the (grim) state of Trump’s mental health. Around that same time, Ford Vox, a physician who specializes in brain-injury medicine, provided the following diagnosis of Trump’s condition, in a Stat news column calling for the president to undergo neurological testing:
Language is closely tied with cognition, and the president’s speech patterns are increasingly repetitive, fragmented, devoid of content, and restricted in vocabulary. Trump’s overuse of superlatives like tremendous, fantastic, and incredible are not merely elements of personal style. These filler words reflect reduced verbal fluency … “You call places like Malaysia, Indonesia, and you say, you know, how many people do you have? And it’s pretty amazing how many people they have.”
The president made that remark in response to a question about the ideal corporate tax rate, demonstrating the degree to which his thinking drifts … If I were to make a differential diagnosis based on what I have observed, it would include mild cognitive impairment, also known as mild neurocognitive disorder or predementia … The key distinguishing characteristic between mild cognitive impairment and dementia is whether the decline is starting to interfere with essential daily functioning. In a billionaire typically surrounded by assistants, who is now the president surrounded by more assistants, whether Trump can perform his necessary daily tasks on his own may be difficult to assess.
Wolff’s reporting establishes that Trump’s decline is very much interfering with his daily functioning — and thus, that his cognitive impairment is likely progressing toward dementia. Meanwhile, Vox’s claim that the president’s disjointed, superlative-suffused rhetorical style is no deliberate affectation — but rather, a product of cognitive decline — is readily apparent to anyone who watches decades-old interviews of Trump, in which he displays an equanimity, coherence, and (relative) eloquence wholly alien to his current persona.
For most of his presidency, the conversation about Trump’s mental well-being, and consequent capacity to perform the duties of his office, has been characterized by a willed naïvety. The president’s signs of senility aren’t subtle. His narcissistic self-regard is not mildly delusional; his impulse control is more than a little bit lacking. In October, a Republican senator likened the White House to an adult day-care center; said that he knew “for a fact that every single day at the White House, it’s a situation of trying to contain him”; and insisted that, in private, most of his GOP colleagues shared this assessment. Wolff’s reporting suggests that virtually everyone in Trump’s inner circle has witnessed signs of his mental decline, and believes him to be unfit for office.
As a practical matter, liberals have devoted inordinate attention to the 25th Amendment, a provision of the Constitution that allows for the president to be removed from office for being physically or mentally “unable to discharge the powers and duties of his office,” (as opposed to being found guilty of impeachable offenses). While superficially attractive, the “25th Amendment solution” doesn’t actually get us past the hurdle that’s blocking impeachment: Congressional Republicans do not want to remove Trump from office. A committed Congress would have no trouble finding a credible pretense for impeaching this president; they just don’t want to. And the 25th Amendment would require two-thirds of Congress to vote to remove Trump on grounds of fitness — after a majority of his handpicked Cabinet members publicly express their desire to do the same. Considering the current political climate, it’s delusional to believe that this is a plausible scenario.
And yet, progressives’ fixation on the 25th Amendment is far less deluded than the rationalizations that keep Republicans from invoking it. By all accounts, most GOP Congress members recognize that Donald Trump is a pathological narcissist with early stage dementia and only peripheral contact with reality — and they have, nonetheless, decided to let him retain unilateral command of the largest nuclear arsenal on planet Earth because it would be politically and personally inconvenient to remove his finger from the button.
You don’t need a degree in psychiatry to call that crazy.