Trump’s Brain: What’s Going On?

In late May the science and health news site STAT ran a provocative article titled: “Trump wasn’t always so linguistically challenged. What could explain the change?

Not surprisingly, the piece went viral.   After all, aren’t most of us wondering whether something is up with the President’s—how shall I say it—state of mind, psychological status, character, personality, and yes, mental health?

For over a year, there’s been speculation about this. Most of the talk is loose and politically inflected. But substantive reflections by mental health professionals and serious commentators are on the rise.

At first, media outlets were very careful. They didn’t want to say the president was “lying” let alone possibly crazy.   Their caution was grounded mostly in journalistic ethics and policies. But that caution was also attributable to a thing called the “Goldwater Rule,” which warrants explaining because it infuses this whole issue.

Barry Goldwater, the Republican nominee for president in 1964, successfully sued a now-defunct magazine called FACT (for $50,000) after the magazine ran a pre-election special issue titled “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.”

The two main articles in the magazine contended that Goldwater was mentally unfit to be president.   According to Wikipedia, the magazine “supported this claim with the results of a poll of board-certified psychiatrists. FACT had mailed questionnaires to 12,356 psychiatrists, receiving responses from 2,417, of whom 1,189 said Goldwater was mentally incapable of holding the office of president.”

The other 1,228 psychiatrists declined to render a judgment. Most of them cited a de facto rule among mental health professionals that speculating about the mental health status or diagnosis of people not in their own care—and especially public figures—was unethical and very unwise.

Though it took a few more years, the American Psychiatric Association in 1973 codified this practice by adding what is now called the Goldwater Rule to its ethics guidelines.

So, to be clear, the Goldwater Rule applies to mental health professionals, but because of the successful lawsuit came to apply to media as well. Idle chatter or speculation about the mental health of public figures was to be generally avoided.   And it was, for many years.

Fast forward to spring 2016. The presidential campaign is in full swing and Trump is saying and doing some very strange, unconventional things. In response, a small band of psychiatrists and clinical psychologists, under the banner of an ad hoc group called “Duty to Warn,” decided to violate the Goldwater Rule.

In articles and blogs, the group claimed that Donald Trump displays “an assortment of personality problems, including grandiosity, a lack of empathy, and ‘malignant narcissism.’” Separately, the group’s leader, psychologist John Gartner, said Trump “has a dangerous mental illness.”

The media and social media, of course, picked up on this, and commentaries begin to appear. Most were online but some found their way into the mainstream media. Most notably, on March 7, 2016 The New York Times publishes an essay titled, “Should Therapists Analyze Presidential Candidates?” by Robert Klitzman, a professor of psychiatry at Columbia University.

Klitzman’s conclusion: mental health professionals and the media should stand firm on the Goldwater Rule and not speculate on the mental health of presidential candidates, including Trump. Four days later, on March 11, 2016, in letter to the Times, the president of the American Psychological Association agreed.

As Trump’s chances of electoral success seemed remote to everyone, the discussion subsided. Then, surprisingly, Trump wins the Republican nomination and the presidency.

And much of the nation is in shock.

The issue of whether Trump is mentally (clinically) afflicted in some way is no longer academic, or a fun pastime subject.   Millions of people – the vast majority of them Democrats, of course—think something is seriously wrong with the man. And they talk about it all the time. At home and around the proverbial water cooler, in bars, and on the web.

Indeed, Trump commentary and jokes quickly becomes a national pastime, as the president-elect and then president fails spectacularly to honor his pledge to “become really presidential, so presidential” or conform to behavioral norms. Much of the commentary and humor is tinged with the implicit or explicit talk of Trump’s mental stability. This become a meme, if you will.

As the months go by, idle chat becomes more formal and liberal op-ed columnists—especially those affiliated with the Times and The Washington Post—are less and less restrained in suggesting President Trump suffers from a clinical disorder.

The words narcissism and “instability” are invoked over and over. But there’s also reference to the president’s erratic behavior, aggression, malevolence, lying, paranoia, impulsiveness, inconsistency, poor judgment, and self-destructive behavior.  And, of course, there’s that painful-to-watch inability to form coherent thoughts when not scripted. (Yes, we are getting back to that and the STAT story in just a minute.)

But first, fast forward again to Feb. 13, 2017 when in response to a column in the Times by Charles Blow, Dr. Lance Dodes and 34 other psychiatrists, psychologists and social workers publish a letter in the Times.   It said:

“Silence from the country’s mental health organizations…. has resulted in a failure to lend our expertise to worried journalists and members of Congress at this critical time. We fear that too much is at stake to be silent any longer.   Mr. Trump’s speech and actions demonstrate an inability to tolerate views different from his own, leading to rage reactions. His words and behavior suggest a profound inability to empathize. Individuals with these traits distort reality to suit their psychological state, attacking facts and those who convey them (journalists, scientists).

In a powerful leader, these attacks are likely to increase, as his personal myth of greatness appears to be confirmed. We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.”

Following that, on April 5, 2017, Rolling Stone magazine (which has had its troubles lately) bucked the Goldwater Rule with an article by Alex Morris titled “Why Trump Is Not Mentally Fit to Be President” and the subtitle “Diagnosing the president was off-limits to experts – until a textbook case entered the White House.

The article concludes that Trump fits all the criteria for “narcissistic personality disorder,” a formal diagnostic entity in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In May, psychologist John Gartner, Duty to Warn’s founder, re-entered the fray with an op-ed in USA TODAY.   I guess you could say USA TODAY entered the fray, too.

Mincing no words, Gartner said Trump was “psychotic” and suffered from “malignant narcissism.”   He claimed that more than 53,000 people, including thousands of mental health professionals, had signed a petition stating Trump should be removed under the 25th Amendment because he is “too mentally ill to competently serve.” (Of note: Gartner is the author of In Search of Bill Clinton: A Psychological Biography.)

One politician is also not mincing words about Trump. And he’s a doctor. Virginia Democratic gubernatorial nominee Ralph Northam, a pediatric neurologist, at campaign events and in TV ads routinely calls Trump a “narcissistic maniac.”

“We want to be medically correct,” he recently quipped in a radio interview, according to an article in the Washington Post.

The STAT Analysis

Now, back to the STAT analysis of Trump’s speech patterns and communication style. Veteran science and medical journalist Sharon Begley and her colleagues gathered decades of Trump’s old unscripted on-air interviews and compared them to interviews and unscripted speeches and media Q&A sessions since his inauguration. They then asked experts in neuro-linguistics and cognitive scientists, as well as psychologists and psychiatrists, to carefully compare the clips and samples.

“The differences are striking and unmistakable,” Begley writes. The experts she tapped, from both political parties, agreed there was marked deterioration.

In interviews, even lengthy ones, from the 1980s and 1990s, Begley says Trump more often than not “spoke articulately, used sophisticated vocabulary, inserted dependent clauses into his sentences without losing his train of thought, and strung together sentences into a polished paragraph, which — and this is no mean feat — would have scanned just fine in print.”

By comparison, Trump’s speech in recent interviews is fragmented, even incoherent or disoriented at times, and uses much simpler words. In addition, he frequently repeats the same point, words or phrases and routinely strays into tangential points or unrelated topics.

Begley cites several examples, including this one from an interview with the Associated Press in April 2017:

“People want the border wall. My base definitely wants the border wall, my base really wants it — you’ve been to many of the rallies. OK, the thing they want more than anything is the wall. My base, which is a big base; I think my base is 45 percent. You know, it’s funny. The Democrats, they have a big advantage in the Electoral College. Big, big, big advantage. … The Electoral College is very difficult for a Republican to win, and I will tell you, the people want to see it. They want to see the wall.”

We have all noticed this. Some of us are bothered by it, others not so much. What Begley then brings to the table is a solid discussion of the possible causes of this particular Trump impairment, if indeed it is one. To her credit, she doesn’t speculate on whether this impairment is linked to Trump’s overall mental health, or other possible diagnoses.

Her experts—some clearly with the Goldwater Rule in mind—agreed that the changes in Trump’s speech patterns and language likely reflect cognitive decline. But they differed on the key point of whether that decline is due to “normal aging” or something more serious, even the beginnings of dementia or other neurodegenerative disease.   Some also noted that linguistic decline is commonly triggered by stress, anxiety, frustration, anger, or just plain fatigue and lack of sleep.

As I was writing this piece I happened upon a Q&A interview in TIME magazine with Sir Harold Evans (June 12, 2017 issue, page 60).   An esteemed editor and writer for decades, Evans has written a new book titled Do I Make Myself Clear.

The interview has this interesting exchange (edited slightly for length):

Q: Which presidents have been the least clear in their writing, and where does Donald Trump rank?

A: Donald Trump can actually be very clear. But the thought is zero, virtually.   The real problem with him not the clarity of language.

Q: You talk about the seduction of Trump’s “insistent certainty”….

A: Exactly, It’s very seductive…..Trump has an ability to be clear when he wants to be and is aware surely of the immortality of falsehoods. “We’re going to stop immigration” We’re going to have a wall.”

Evans is not the first to suggest that Trump’s simplistic rhetoric and repetitive speech is quite intentional.   That brings to mind H.L. Mencken’s quip: “No one ever went broke underestimating the intelligence of the American public. Nor has anyone ever lost public office thereby.”

Summing up

The Goldwater Rule makes all kinds of sense—morally, ethically, and legally. But we are in uncharted waters with President Trump on so many levels. At the very least, the mental health community, ethicists, philosophers, media professionals, and legal scholars should engage in a wider discussion of the points raised by the Duty to Warn folks.

At the same time, a serious public debate seems warranted about (a) whether candidates for president should receive a more formal vetting as to their health, including mental health, and (b) whether an age cut-off should be imposed for the presidency.

Yes, I know, both those suggestions may appear shocking, even laughable. But we’ve had two presidents in the past 50 years—Nixon and now Trump—whose mental health (or character, forged in part by possibly unsound mental health, in the case of Nixon) has been called into serious question.

And we’ve had one president—Reagan—who was very likely cognitively impaired in his final years in office.

Research is clear on cognitive decline with age. We may be wiser at 70 or 75 but none of us are as sharp, mentally agile or energetic at that age as we are at 50 or 60. And, recent studies suggest, for a growing number of seniors that decline lies somewhere between the minor deterioration associated with “normal aging” and the more-serious decline of dementia.

Neurologists call this mild cognitive impairment, or MCI. Online sources define MCI as “problems with memory, language, thinking and judgment that are greater than normal age-related changes.”

Of course, none of this means that seniors—with or without MCI—can’t be productive members of society, or continue working. Maybe just not as President of the United States.

Both areas—mental health status and age—together and apart, are tough and fraught subjects. I wouldn’t even hazard a guess as to what public opinion polls would reveal on these subjects, or where a robust public debate would end up.

In fact, it’s quite feasible we’d end up with this tacit or default approach: there’ll always be a risk we’ll get mental and character-challenged bad apples as presidents (or members of Congress or governors) because there’s no way to prevent that in an open democracy like ours, and/or because we think such bad apples reflect society as much as good apples do.

For now, I’m just saying we ought to be having the discussion.

[Addendum: STAT also published a “reporter’s notebook piece by Sharon Begley on May 25 about how her piece on Trump came about.

Trump’s Brain: What’s Going On? published first on


Author: wmcerda

I am the founder and medical director of Drug Test Exit since 2003. A former physician in drug test, I am known as the "Pioneer of Drug Test Care" with expertise in travel medicine, sports medicine, and diving medicine. I have provided drug test services in many sports events, competitions, and championships and have handled large corporate events throughout the United States, United Kingdom, South Africa and around the world. Served as an Olympic drug text specialist for 8 years, I am also the medical doctor for many leading sports channel and takes care of many high profile athletes. getpocket

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