Overdiagnosing Trump

Overdiagnosing Trump

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When I first read about neurosyphilis in medical school, I became convinced that Mrs. Thatcher, who I detested intensely because it was fashionable detesting her, had General Paralysis of the Insane. The condition, marked by episodic bouts of temporary insanity, which indicated that the spirochetes were feasting on expensive real estate in the brain, seemed a plausible explanation why she had introduced the retarded Poll Tax.

A little bit of medical knowledge can lead to tomfoolery by the juvenile. I began diagnosing the powerful with medical conditions. I thought the former leader of the Labour Party, Neil Kinnock, who had an odd affect, was both hyperthyroid and hypothyroid – when he spoke he looked myxedematous and when was silent he looked like he had Grave’s Disease. The tacit, but not silent enough, Prince Charles spoke in a tone that seemed a cry for help for acutely thrombosed piles. I also realized that the Prince of Wales –  who is the most compelling evidence for the magical kingdom of elves – wasn’t reducible to a single diagnostic code. Diagnosing Hillary was relatively straightforward. After reading a third of her memoirs, which permanently cured my insomnia, I felt someone had inadvertently given her dextrose without thiamine.

There’s something delightfully empowering, and annoyingly juvenile, about diagnosing the famous with medical conditions. It is also strangely pedagogic. I’ll never forget the symptoms of syphilis, not because I’ve seen patients with them (nor because I have them), but because I’ve templated these symptoms on people who almost certainly don’t suffer from syphilis.

Thus, it’s no surprise that many are keen to diagnose Mr. Trump with a medical condition – my preferred diagnosis would be Kluver Bucy syndrome, but that would expose my juvenile intent. Far removed from childish diagnostic name calling, many serious people seriously believe that Mr. Trump has a neurocognitive condition which is seriously impairing his judgment and decision making.

Analyzing Trump’s speech pattern, experts have questioned what his decline of verbal fluency indicates. Possibly mild cognitive impairment (MCI)? Possibly the first signal of dementia? Possibly normal aging?  STAT News outlines the evidence. STAT has gallantly fought overdiagnosis and overmedicalization. MCI is the mother of overdiagnosed conditions – it’s more capacious than the Pacific Ocean – technically anyone can have it on a bad day, or after opening the 2nd bottle of wine. I hope STAT will do an expose of physician-industry relationships which have lead to overdiagnosis of MCI.

That even Mr. Findlay, a serious journalist with hardly the juvenile disposition that I possess in abundance, has fallen for the medicalization of Trump, begs the question – what gives?

There is, of course, a historical curiosity how pain and disease influence a person’s worldview. Thoreau once said that nothing drives a revolution more forcefully than a man with unfulfilled bowels. Many historians believe that Karl Marx’s hidradenitis suppurativa – painful inflammation of the sweat glands – made him angry about capitalism. Which means that the Bolshevik revolution was conceived, not by the events of Bloody Sunday, but under the smelly arm pits of an unkept Nineteenth Century Londoner.

The analysis of Trump is not historical but in the present and Mr. Trump is certainly no Karl Marx. Even so, there’s little precedence for medicalizing POTUS because of their policies. When Bush Jr. alluded that he spoke to God, no one tried diagnosing him with temporal lobe epilepsy. Even Bill Clinton, the man who once put a preposition on trial, escaped the wrath of DSM.

Why, then, are people so obsessed with giving Mr. Trump an ICD-10 or DSM-5 code?

Many readers will say that conflating Mr. Trump with the flawed, yet genuine leaders that I’ve mentioned is moral relativism. And I’d agree. The Iron Lady was no follower. Bill had several leadership moments, even when he wasn’t alone. Even Bush rose to the occasion – he rose to other occasions when the world might have been better off if he stayed sitting. Even Hillary would, arguably, have been more of a leader than the comically bumbling Trump.

The comically bumbling Trump who could, in a parallel universe, be auditioning for the next Austin Powers, and who seems not to be enjoying his presidency terribly, is the heart of the problem. There’s an incessant attempt at delegitimizing Trump. It was never enough saying “Trump is a joke.” And “Trump is evil” no longer suffices – even though the look on the Pope’s face, when he stood next to Trump resembled the look on Gregory Peck’s face when he saw that his adopted son, Damian, had “666” written on his scalp.

 

 

The medicalization of Trump is part of an emerging phenomenon, thus far innominate, which I’ll call “rational delegitimization,” in which scholars, incredulous of Trump’s behavior, seek biological substrates to delegitimize him. It is an extension of the very legitimate and necessary legitimization of variation we like when we find that the variation has a biological explanation. But this is a very slippery slope.

Researchers have tried to show that conservatives and progressives have different brain structures – apparently, progressives have a larger anterior cingulate gyrus and conservatives have a larger amygdala. I’ll let you guess the abundance of which structure is more desirable.

This type of research can ossify polarization permanently. Already, many believe that their moral high ground shuts debate with opposing worldviews. The last thing you want is for people to believe they have not just the moral, but biological high ground. Tying biology with morality breeds a new class of biological theocrats who make the Ayatollah a libertarian, free love-seeking, cannabis smoker in comparison. Combining tribalism, functional MRI and p <0.05 can spit out BS of a scale one struggles to comprehend.

A colleague of mine hasn’t been herself for a few months. I often put academic blues to the promotion cycle, but she has already made Associate Professor. So, I inquired. With eyes swelling with genuine tears she told me that she was very upset that many “normal” (the air quotes are hers, not mine) people voted Trump.

This gets to the crux of the issue, which is our inability to grasp the broad coastline of what is normal (note absence of air quotes). I said to my colleague, as diplomatically as I could, that she needs to expand her definition of normal – actually, I said she needs to get out more.

It is normal for normal people to disagree about the least worst presidential candidate in 2016. It is normal for normal people to ask of those who disagree with them “how could you be so stupid?” It is normal, though worrying, to shrink the real estate of legitimacy by safe spaces. This is called “having an opinion,” which is what sets us apart from other mammals, notably the duck-billed platypus and, mercifully, the sheep.

The presence or absence of a disease, organic or psychiatric, is conditionally independent of whether someone agrees or disagree with your worldview. To seek biological substrates to delegitimize opposing views risks delegitimizing the already precarious medical sciences. Ideally, normal people politely agree to disagree, but even when they don’t, they’re still normal.

Mr. Trump has a condition which is very prevalent in our society and under diagnosed in 1600 Pennsylvania Avenue. It’s called “ineptness.” It doesn’t have an ICD code, yet. Which is just as well, because if ineptness became a preexisting condition all insurance markets will truly enter an inept death spiral.

History will tell us if Mr. Trump had an unprecedented or, as he put it, “unpresidented” level of ineptness. But even if he does that doesn’t make him diseased. Normal can be aesthetically pleasing, or distasteful. And, for all his faults, and there surely are many, and notwithstanding #covfefe, Trump is probably normal.

About the author

Saurabh Jha is a contributing editor to THCB. He has an abnormally large anterior cingulate gyrus and amygdala

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6 Comments on "Overdiagnosing Trump"


Member
Steven Findlay
Jun 23, 2017

Great piece, Saurabh! Clever writing too. Fun. Thanks for supplementing my piece with these insights, most of which I agree with. I was just raising the issue, and relating some history. Psychiatric (DSM) diagnoses are notoriously problematic for a host of reasons that many THCB readers are likely familiar with. It’s more probable, as you say, that Trump is just a nasty jerk and inept in the political/leadership realm, which as we are learning via him is not same set of skills and aptitude as the real estate/golf/TV/branding-your-name realm.

But I was also raising the question in my piece of whether we really want people like this to be president, no matter what the cause of their behavior. And if some of Trump’s behavioral quirks — such as an inability to speak coherently some of the time — are due to aging, do we want to take a page from the airlines and other industries which, for solid scientific reasons, have mandatory retirement at 65. Just raising that issue given Reagan and now Trump. I was against Hillary running for same reason. I realize there’s a whole other argument there….

Member
Jun 22, 2017

I won’t join in the diagnosis of Trump, but I will offer this bit on why normal people voted for Trump. (I am not one of them–but maybe I am also not normal)

Before Trump ascended, it looked like we were going to be stuck voting either the wife or the son-AND-brother of 3 of our last 4 presidents. How anti-democratic is that? Moreover, during that time, under both parties, a decent segment of our population saw little government action that helped them–at a minimum, in their perception, relative to the “rest of us.” Their self-interest didn’t seem to be served by listening to the usual power brokers of either of these parties, even absent the nepotism.

So they voted “no” and they haven’t yet been convinced they are wrong. They are no worse off–yet. That’s what happens when people perceive there is not much to lose, by trying something else.

BTW, it’s Congress that now worries me the most…

Member
caliguy
Jun 21, 2017

this article appears to be written by a madman, not a physician—and i don’t mean that in a complimentary way.

ultimately, what the author wants to nail home is that the author is a coastal elitist and looks down on Trump and Trump’s ilk AND the author ought to feel good about himself that he was promoted to associate professor. I suppose, but his is a job that virtually no other radiologist in the country would take.

BTW, love the quip at the end criticizing Trump’s grammatical error. I now realize Trump’s a complete imbecile. Way dumber than our affirmative action president.

Member
Steve2
Jun 21, 2017

“It is normal for normal people to disagree about the least worst presidential candidate in 2016.”

Bingo! Two worst candidates in my lifetime. I can truly understand people having a hard time trying to figure out who was worse and should be voted against. I can see, easily, how someone might have thought Clinton might be worse. It is the true believers who don’t make much sense to me, but then I don’t like sauerkraut, and others love it. Big world out there.

Steve

Member
Jun 19, 2017

“When I finds myself
In tweets of trouble,
Mother Russia comes to me,
Singing words of wisdom,
#covfefe…”

Member

Very good Dr. Jha, though your “ineptness” dx seems premature and subjective (the stock market….great consolidator of opinion….seems to disagree).
One should also consider Paglia’s take:

“There seems to be a huge conceptual gap between Trump and his most implacable critics on the left. Many highly educated, upper-middle-class Democrats regard themselves as exemplars of “compassion” (which they have elevated into a supreme political principle) and yet they routinely assail Trump voters as ignorant, callous hate-mongers. These elite Democrats occupy an amorphous meta-realm of subjective emotion, theoretical abstractions, and refined language. But Trump is by trade a builder who deals in the tangible, obdurate, objective world of physical materials, geometry, and construction projects, where communication often reverts to the brusque, coarse, high-impact level of pre-modern working-class life, whose daily locus was the barnyard. It’s no accident that bourgeois Victorians of the industrial era tried to purge “barnyard language” out of English.
Last week, that conceptual gap was on prominent display, as the media, consumed with their preposterous Russian fantasies, were fixated on former FBI director James Comey’s maudlin testimony before the Senate Intelligence Committee. (Comey is an effete charlatan who should have been fired within 48 hours of either Hillary or Trump taking office.) Meanwhile, Trump was going about his business. The following morning, he made remarks at the Department of Transportation about “regulatory relief,” excerpts of which I happened to hear on my car radio that afternoon. His words about iron, aluminum, and steel seemed to cut like a knife through the airwaves”