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. http://www.lancedodes.com/new-york-times-letter   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.   https://en.wikipedia.org/wiki/Harold_Evans

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.


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43 replies »

  1. No, Peter, I think he is following up with the method that helped him become President. I’m not happy with the rhetoric, but sometimes people have to defend themselves. You know what the mainstream media has attempted to do to him so you should easily see why his actions will be acceptable to a large number of Americans and the rest will have the chance to see more than one side of the coin.

  2. “If one looks at all the abuse that intolerable pair have thrown at Trump one would understand the need for such a response.”

    Got the email notice of a response. Didn’t even have to guess who it was from Allan.

    Even if what you say is half true then our illustrious president is only playing one half of a mud wrestling match. How grown up.

  3. If one looks at all the abuse that intolerable pair have thrown at Trump one would understand the need for such a response. But you and the Democrats don’t seem to understand. Trump won the Presidency in part because of the way he plays the game.

    Instead of talking about how we could make things better Democrats bash the tweets calling him a mental case. That appeals to the strong left because they will vote on the left no matter what, but for everyone else it demonstrates that the Democrats have no plans for the future of the country while the ecomomy, job situation and salary conditions improve under Trump despite all the rhetoric against him.

    The American public also likes the underdog so Trump gains support just from that alone.

    Look at the words of Susan below, a so called professional, who doesn’t recognize that a physician needs to be close to the bedside to make a proper diagnosis of a significant condition, but what does she care.? When the public sees a physician they know they want to be able to see one face to face and not be diagnosed the way Susan diagnosed Trump.

    Though initially this type of hostile rhetoric against Trump worked gradually people become immune to in and it works in the opposite way intended.

  4. You haven’t provided any solid data on the man yet you chose to formulate a diagnosis. That is known as quackery.

  5. Do you know what is missing from your long lengthy diagnosis via op ed’s? Concrete data about the man and exactly what he did. In other words you are missing a history and exam. You are playing doctor from afar, something that is frowned upon by the psychiatric association, while at the same time you don’t even have the credentials.

    Anyone can copy a sheet of symptoms, copy what the media says and add their own version without knowing squat.

    Let’s hear some solid data and where that data came from. Make sure the data is broadly based.

    I think your missives let us learn a little more about you and your lack of recognition regarding your abilities and mental challenges than about Donald Trump.

  6. George Lakoff is brilliant but he does not fully understand what we have in the Donald. There must be some acknowledgement from experts as to how abnormal he is. See DSM-5 pages 761-765.

  7. By definition, someone with his level of psychopathy should be disqualified as president. Such individuals are plagued by boredom and a tendency to act impulsively in order to alleviate that boredom. The only thing that works is the adulation of crowds, the excitement of triumph and sexual conquests. Academic learning only increases their boredom. They have no time for silly repetitious security briefings and in fact, know very little about the world in general. They reject sage advice because they “know better” than the generals. They are unable to care about the welfare of others. How can such a person adequately or faithfully perform the duties of his office.

  8. There is no agreement in the profession as to whether Malignant Narcissism (aka Psychopathy) should be called a mental illness. It is certainly a profound abnormality but the great researcher Robert Hare has said they may simply be a different type of human who evolved to negotiate the world in a different manner than us. That doesn’t make them any less dangerous.

  9. You are wrong. We have more data on the President than I use to have on the incarcerated sociopaths that I diagnosed in State Hospitals. Red some of my other comments. He meets criteria on three different diagnostic tools. Haven’t you ever wondered why he is so “different” than other people.

  10. I agree. We need massive quantities of data to make a solid diagnosis. We do not have the needed information on his language use, but he has offered all the information needed to draw other conclusions. He has been in the public eye for forty years and there is no doubt what is going on. IS DONALD TRUMP MENTALLY ILL?

    There is substantial and credible evidence that our current president is one of a small group of humans that lack the ability to feel empathy and never develop a conscience. He has provided ample data to study in his biographies, media articles and his own behavior during forty years in the public eye. Such individuals differ dramatically from the rest of the human race in their worldview and motivation, but many live among us undetected for decades. World famous researcher, Robert Hare says “Everything about them seemed to be paradoxical. They could do things that a lot of other people could not do [lie, steal, rape], but they looked perfectly normal, and when you talked to them they seemed okay.”

    There is some disagreement on whether this should be called a “mental illness” but it is definitely a psychiatric disorder. 1) Clinicians whose training emphasizes a psychoanalytic approach tend to call it “Malignant Narcissism” meaning a toxic form of the more much more common narcissism. You can find experts discussing this view on the new “Duty to Warn” Youtube channel. 2) Those clinicians who place an emphasis on observed behavior and understanding the brain biology behind it are more likely to use “Sociopathy” or “Psychopathy”. A discussion of Hare’s Psychopathy Checklist can be found here http://www.cbc.ca/doczone/features/the-hare-psychotherapy-checklist. There is a good Canadian documentary about how psychopaths are integrated into our world on the same site. Mary Stout’ book “The Sociopath Next Door” is also a good reference. 3) Shahida Arabi an author who writes about surviving abuse simply combines all the labels in her popular article http://thoughtcatalog.com/shahida-arabi/2016/06/20-diversion-tactics-highly-manipulative-narcissists-sociopaths-and-psychopaths-use-to-silence-you/. We see many of these strategies being used by the current administration.

    In an attempt to clear up any confusion about how to diagnose the condition, the APA has provided an alternative model for personality disorders in the DSM-5. The term they use is “Anti-Social Personality Disorder with Psychopathic Features”. The full text can be found on pages 761-5 in the manual.
    Some of the signs and symptoms include—
     Egocentrism [It’s all about me]
     Self-esteem derived from personal gain, power, or pleasure
     Associated with failure to conform to culturally normative ethical behavior
     Lack of remorse after hurting or mistreating another
     Use of dominance or intimidation to control others
     Use of seduction, charm, glibness, or ingratiation to achieve one’s ends
     Embellishment or fabrication when relating events
     Anger or irritability in response to minor slights and insults
     Mean, nasty, or vengeful behavior
     Boredom proneness and thoughtless initiation of activities to counter boredom
     Acting on the spur of the moment in response to immediate stimuli
     Difficulty establishing and following plans
     Lack of respect for—and lack of follow through on—agreements and promises
     Low levels of anxiousness and withdrawal
     A bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)
     High levels of attention seeking
    Such individuals can attract large followings even though they are incapable of caring about what happens to anyone else. We see them as cult leaders, dictators, ruthless businessmen, and mob bosses. Although they can be very clever at manipulating others, they usually have no intellectual curiosity and know little about the world outside their chosen sphere. These factors, combined with their impulsiveness skewed judgment, and inability to care about the consequences of their actions, make them erratic and dangerous when they have any power over others.


    As people are becoming more aware of his oddities and abnormalities, speculations about various diagnoses have gotten more press. The first to emerge was Narcissistic Personality Disorder. In general, professionals do not use a lesser diagnosis when a more serious diagnosis better explains what we are seeing (see above). Unfortunately, many professionals have little practical experience spotting this level of malignancy or psychopathy so they defaulted to the lesser diagnosis. There is some evidence that Donald Trump, at least at times, is showing signs of cognitive impairment. That evidence is limited and unreliable so we cannot draw a conclusion without examination by a qualified professional. Factors that could cause this behavior include: an undiagnosed but treatable medical condition, side effects of prescribed medications, misuse of other drugs, the effect of stress on a man with limited stamina, or the onset of dementia. People have also suggested he has ADHD, learning disabilities, functional illiteracy or other similar conditions. Essentially, all of the signs they mention can be accounted for by sociopathy and/or cognitive impairment so drawing such conclusions does not seem warranted at this time especially when it is already confirmable that he has a profound and easily recognized mental disturbance.


    This part of the Constitution was written to allow smooth transfer of power should the president be incapacitated. Those who wrote it assumed it would only apply in the case of coma, continued delirium or another physical problem were to make our leader unfit. HOWEVER, there is nothing in the wording that would prevent removing a president whose ignorance, temperament, impulsiveness, and poor judgment make him unable to adequately and faithfully perform his duties. For this to happen, the Republicans and others in government need to get educated as to the true nature of our President and overcome their denial about the potential consequences to the nation and the world. I believe once they truly understand the error the country has made, they will then take action necessary to protect all American citizens.

    Susan Dawkins, LCSW
    — About me: I am a retired Psychiatric Social Worker with over 30 years’ experience working in public mental health programs. Part of that time was spent in a Criminal Justice setting where I learned to use the Hare Psychopathy Checklist in my assessments. I have always taken a keen interest in phenomenological diagnosis and my current work status has allowed me to do extensive review of Donald’s history and behavior over the past decades. I am proudly joining other professionals in speaking out in the belief that the Duty to Warn overrides any other ethical considerations.

  11. There is a great deal wrong with his brain and it has nothing to do with his political choices. See my post above and understand that such people are missing some of the neural pathways they need to have a conscience.

  12. The Prez. may be experiencing some cognitive decline but since we don’t know his medical health, drug use, etc., It is impossible to draw any conclusions. WHAT IS NOT A MYSTERY IS HIS MAIN DIAGNOSIS. “What’s playing out is a psychological drama, not just a political drama or a legal drama,” said Peter Wehner, who was an aide in George W. Bush’s White House and has frequently been critical of Trump. “The president’s psychology is what’s driving so much of this, and it’s alarming because it shows a lack of self-control, a tremendous tropism. . . . He seems to draw psychic energy from creating chaos and disorder.”(WP article 6/23/17)

    “They exhibit a cluster of distinctive personality traits, the most significant of which is an utter lack of conscience. They also have huge egos, short tempers, and an appetite for excitement — a dangerous mix……Because they have no conscience, they’re natural predators. …Psychopaths love chaos and hate rules, so they’re comfortable in the fast-moving modern corporation.” (Robert Hercz, 2001 on Hare.org)

    DSM-5 section on Alternative Models for Personality Disorders (page 761-5)
     Egocentrism [It’s all about me]
     Self-esteem derived from personal gain, power, or pleasure
     Goal setting based on personal gratification
     Absence of prosocial internal standards
     Associated with failure to conform to culturally normative ethical behavior
     Lack of concern for feelings, needs, or suffering of others
     Lack of remorse after hurting or mistreating another
     Incapacity for mutually intimate relationships
     Exploitation is a primary means of relating to others, including by deceit and coercion
     Use of dominance or intimidation to control others
     Frequent use of subterfuge to influence or control others
     Use of seduction, charm, glibness, or ingratiation to achieve one’s ends
     Lack of concern for feelings or problems of others
     Lack of guilt or remorse about the negative or harmful effects of one’s actions on others
     Aggression or sadism
     Dishonesty and fraudulence
     Misrepresentation of self
     Embellishment or fabrication when relating events
     Persistent or frequent angry feelings
     Anger or irritability in response to minor slights and insults
     Mean, nasty, or vengeful behavior
     Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences
     Boredom proneness and thoughtless initiation of activities to counter boredom
     Lack of concern for one’s limitations and denial of the reality of personal danger
     Acting on the spur of the moment in response to immediate stimuli
     Acting on a momentary basis without a plan or consideration of outcomes
     Difficulty establishing and following plans
     Disregard for—and failure to honor­–financial and other obligations or commitments
     Lack of respect for—and lack of follow through on—agreements and promises
     Low levels of anxiousness and withdrawal
     A bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)
     High levels of attention seeking

    The DIAGNOSIS for someone meeting these criteria would be: Antisocial Personality Disorder with psychopathic features. Clinicians who deal with these folks call this Malignant Narcissism, Sociopathy, or Psychopathy.

  13. I don’t think either of them were very good businessmen. We all have our own particular strengths and weaknesses. Trump is good at details, thinking ahead, and utilizing the talent that others have.

    I don’t think you know very much about Trump and I think most of us are unaware of how he presents himself outside of the political arena. I have never met him myself, but know quite a few that have done business with him. Some didn’t like him, but a lot did, however, almost all thought he was very bright functioning at a higher level than many of his competitors.

    I am amazed at the judgements some make about Trump with so little knowledge.

  14. Lincoln and Churchill both had marvelous vocabularies. They also were very well read. I suspect that part of Trump’s issue here is not so much psychiatric, but the lack of input. Most people develop and reinforce their vocabulary and they way they speak with what they read, or in the case of Trump who brags about not reading, what they watch on TV.

  15. Can’t say how much of Trump’s brain makes him unsuited to be president – beyond his policy goals based on misinformation. But do his supporters have any problems with his serial “alternate fact” statements? Seems something is wrong with character when the truth is just “fake news”. Would they have any qualms about a Democrat saying half of what Trump thinks is truth?

  16. I may have to apologize to you, I’m not sure. I might be confusing you with Joe Flower unless I have previously commented in a similar fashion to you. If so you tell me where and when so I can take a look. I like to be totally above board.

    None-the-less my comments regarding people who practice psychiatry from afar remain.

  17. Trump is quite transparent and such transparency can lead to some of his statements as things around him change. Remember, the big political question about Trump was whether he was a Democrat or Republican. I believe he is neither and is a deal maker (left and right) where both party’s reluctance to deal with him is hurting the American people.

  18. “but just a jerk (there are stronger words) in his behavior and modus operandi. That would not disqualify him from the presidency, nor obviously impede his ability to achieve an amazing amount of success.”

    You might have the perception that Trump is a jerk and no one can argue with perception. You may not be aware of the way those in the construction business in NYC act. You also may not be aware that Trump is a master promoter who in part believes even bad publicity can be utilized as a positive. But, you are correct that his negatives don’t necessarily impede his ability to achieve amazing success. We should get off the bandwagon of character assasination and calling people crazy and start learning to deal with the President whether in fair disagreement or agreement.

    Trump has done remarkable things in NYC, the most well known being Wollman’s rink. NYC spent $13 Million in 6 years and had to start all over. Trump came in an did the job in 6 months for about $2.5 million about $500,000 under budget. He didn’t take a fee for his services and risk only asking that the revenues from the rink repay what amounted to a loan. He even ran the rink the first year or so and the profits from the rink were many times greater than the profits in earlier years when the rink was open. He did this despite charging the lowest price (I think) of any major skating rink in the country. Over the years what he did there and elsewhere has benefited millions of Americans.

    I don’t provide this one example to prove Trump is a good politician rather how inept bureacracies can be. We need a bit of business acumen injected into our government. For the most part both parties are afraid of him for he is an outsider and they wish to protect themselves rather than serve the American people.

  19. “but just a jerk (there are stronger words) in his behavior and modus operandi. That would not disqualify him from the presidency, nor obviously impede his ability to achieve an amazing amount of success. ”

    That is a truism. He can acheve an amazing amount of success. You might perceive him as a jerk because he acts in a way that is frequently needed in the construction industry in NYC. He did amazing things in NYC and the most known example, Wollman’s rink was contructed at a cost of less than 2.5 million in 6 months when NYC had already failed after 6 years and 13 million dollars. In essence he loaned the city $3 million and his payback was from the revenue of the ice skating rink until the $3 million was paid back and then the rest could go to charity or wherever. He ran the rink for a year and it produced revenues of many multiples of what the city had obtained before despite the fact that he kept prices at the lowest rate for any major ice skating rink. That is a benefit to millions of Americans over the year where his time and risk didn’t earn him a penny.

    That doesn’t mean he is a good political actor. What it means is he can succeed where the bureaucracy fails. We need an injection of Trump’s business sense, but both parties are self serving and only looking out for themselves rather than the people.

  20. The comments about Trump were Juvenile. Too much of what I hear is divisiveness from ideologues pushing their ideology along with a lot of spin where data is concerned.

  21. Thanks Kip. The president’s inconsistency is indeed a fascinating problem. Related, it’s interesting to see how the media can’t avoid “normalizing” that…since if someone (Trump) is constantly contradicting themselves, it fails to be news after a while. It’s just what he does, part of his persona. Or is it because he really can’t remember? We don’t know. And the WH folks don’t even try to defend it.

  22. I disagree as long as THCB posts blogs that are well reasoned and not just bloviations, especially political. The health care debate has long been a polarized and passionate one, and that’s now really amped up. There’s no avoiding partisanship on it…but at THCB that partisanship should be around policy debate and not just pure politics.

  23. Totally agree with you, Joe, that Rs could suffer major blow back if Senate bill becomes law. That they do not see that is amazing to me.

  24. Thanks Jason. That’s indeed what I was trying to do — raise the issue in context of a bit of health and medial ethics policy. Some people could not see past the politics to understand that. While I am obviously not a Trump supporter, I do not wish a mental illness upon him. It’s a very feasible scenario here that he’s not mentally ill in any way, but just a jerk (there are stronger words) in his behavior and modus operandi. That would not disqualify him from the presidency, nor obviously impede his ability to achieve an amazing amount of success. Which tells us something about our culture perhaps. His election has certainly made millions re-evaluate their assumptions about who can be elected president.

  25. Absolutely! Hillary’s health was an issue in the campaign of course, although I don’t recall anyone suggesting she had dementia. Would have been hard to support. Not clear with Trump either, as my piece says. It’s just one plausible explanation for his behavioral problems and speech issues.

  26. Allan – way too personal. You become part of the divisiveness problem in our culture, and add nothing at all to THCB, with comments like this.

  27. For a bit of fun, Google “Trumpisms” Recall “Bushisms”? Donald’s are Bigly Better.

  28. I think that we should avoid diagnosing people on the basis of some speeches and interviews. For all we know he talks like this since he found it an effective way to communicate when he did his reality show. The correct way to approach this in public discourse is not to medicalize it, but to make fun of it. When in doubt, make fun of politicians.


  29. Some of the juvenile are trying to elevate their stature with witless and non medical commentary on the President’s mental status hoping that if they talk loud and long enough that desire will suddenly convert into fact. Those juveniles might look good to the marchers wearing controversial clothing who are threatening to blow up the White House, but that is precisely the group that is armed to the teeth with real “flame throwers”.

    “write about Hilary clintons supposed dementia…. – would Steve be ok with that being ” Of course not. He is too thin skined and all too infrequently has an unawareness of the facts he is discussing.

    A good summary of what is going on was provided by Margalit, “Original thinking is an act of treason now”.

  30. This is more reflective of the place much of the left is in (not a good one) rather than trumps lunacy 🙂

    Here’s a ?- if someone were to write about Hilary clintons supposed dementia , serious health issues as the lunatic right has done – would Steve be ok with that being published?

  31. “the President is very good at presenting big, simple arguments with inflammatory, divisive language. To engage him or his followers with big, simple accusations in inflammatory, divisive language is to carry a knife to a gun fight. Calling the President stupid, even proving that he is deranged, makes those who voted for him and place their hopes in him feel that you are calling them stupid and deranged. And once they feel insulted by you, they are certainly not going to listen to anything else you have to say.”

    Yeah. That’s the George Lakoff “Don’t Think of an Elephant” argument. i.e., giving negative attention to Trump just reinforces Trump.

  32. I appreciate your definition of flame-throwing, Joe, but I do not share it. Flames can be scorching, but also illuminating. I don’t think anybody suggested indiscriminate lobbing of fire bombs laden with lies and insults. We are not at war. We are being manipulated to believe we are at war and therefore have some sort of moral “duty” to hold the line. Original thinking is an act of treason now. Trying to understand and respect opinions different than our own is tantamount to fraternizing with the enemy. Changing your mind is a sign of moral failure. This is being painted by interested parties as a religious war between good and evil and we are the foot soldiers. I refuse to play this game….

    Flame-throwing in my mind is anything one can say or write or do to break this destructive pattern of engagement.

  33. Appropriateness also comes down to being able to write cogently and sensibly on controversial topics and I have no qualms about Steve’s piece as a framework for raising the serious issue of the President’s mental health.

    While I don’t think THCB is the appropriate forum for clickbait,
    flamethrower headlines, if a sincere analysis leads to a conclusion that
    is incendiary, I have no problem with that.

  34. We do not need more flame-throwers.

    We do not need more flamer-throwers either in THCB or in the world at large.

    By flame-throwing I mean name-calling, personal attacks, shading of the truth or outright lying in order to make political points.

    Why? Because it doesn’t work.

    Work for what? I have to ask (we each of us have to ask ourselves) what are we here for? Why do we bother? What’s our goal, what’s your goal? Are we here just to vent? To prove ourselves smarter, better, more capable than the other? To convince others of a different point of view? To find our own way to something that is true through dialogue? To effect change for the better?

    If your goal is to vent, maybe to feel better for having vented, then name-calling and ridicule work admirably. If your goal is anything else, any of the other possible goals you can think of, name-calling and ridicule don’t work. They don’t convince anyone with a different point of view, they obscure the path toward working out the truth, they make consensus impossible — and they even obscure our own ability to discover more.

    Even if you conceive that we are in a conflict, that the other side in whatever argument you are making is not your partner in searching for truth but is in fact your enemy, and they and their point of view must be wiped out, even then, name-calling, fiery argument, and ridicule display a fundamental ignorance of how conflict actually works. I studied martial arts for many years, have a black belt in Hombun Aikido, and have read in Sun Tzu and military history for a long time, precisely because I want to understand conflict. Perhaps the most fundamental bit of wisdom derived from all that is: Don’t accept your opponent’s definition of the field of battle, the weapons to be used, the time to engage. Pick your battles. Know your opponent and yourself. Find a way to concentrate your strength at the opponent’s place of weakness. Find a way in which your opponent’s strength is their weakness (as when an army’s mighty forts means that its forces are tied down, or when a successful deep invasion means that its supply lines are overstretched and its forces ill-equipped for the oncoming winter).

    A “flame thrower” does their own cause little good.

    In the current situation, for instance, the President is very good at presenting big, simple arguments with inflammatory, divisive language. To engage him or his followers with big, simple accusations in inflammatory, divisive language is to carry a knife to a gun fight. Calling the President stupid, even proving that he is deranged, makes those who voted for him and place their hopes in him feel that you are calling them stupid and deranged. And once they feel insulted by you, they are certainly not going to listen to anything else you have to say. You have engaged the opponent at their strong point, on their chosen field of battle, using their chosen weapons — which they have more of and bigger ones. You have allowed the opponent to distract you from their weak points, their stretched supply lines, their unstable back foot that could be swept from under them, their weak unanchored flank

    In contrast, what is the Republicans’ weak point in the healthcare battle? Clearly, the large gap between their big, simple promises and the ways in which their actual policies will show up in every American’s individual lives and pocket books. Their actual policy-making is way out beyond the limits of their actual political support. The support is for what they have promised, not for what they are actually doing. So the most effective weapon is finding ways to connect those dots in their daily lives for people: How it will actually affect them, their neighbors, their families, people in situations like them. I can only do that if I do not first paint myself as insulting them and questioning their morality or sanity. If I do that, I am a self-casualty.

    This is not the politics of kumbaya. This is smart management of conflict.

    I don’t do this to vent, or to win the argument. I do this to change healthcare, not just because healthcare is a mess and a fraud, but also because fate has given me a career path that has put me in a position where I might actually be heard. If I become a flame-thrower, I toss that platform away.

  35. I too, think THCB should push the envelope or turn the blowtorch setting higher sometimes. I’m glad to know I’m not alone in that perspective. Readers seem to connect and engage better.

  36. I actually disagree with previous objections to Steve’s excellent article.
    As long as presented fairly, with appropriate links to original research and
    analysis, I believe commenting on the issue lies at the intersection between
    politics, mental health and complicated regulatory/ethical issues in

    Furthermore, just as I think discussions of Hillary Clinton’s wellness
    during the campaign wasn’t out of bounds, I don’t think discussions of
    Donald Trump’s mental health is inappropriate given that both issues
    directly impact their ability to perform the tasks demanded of the
    President. As long as we don’t go into diagnosing Trump ourselves, we can
    highlight existing concerns about the President’s wellness, which is
    exacerbated by his reluctance to even release cursory medical records.

    The issue of the President’s health isn’t just academic or mere politics.
    Harry Truman was ushered into the backdoor to be VP when Democrats thought
    that Henry Wallace wasn’t fit to be President. Truman’s stewardship of the
    world after WWII still has direct impacts on Americans today. Donald
    Trump’s actions – particularly regarding our group’s concerns on healthcare
    and social programs – will reverberate for years to come and it is
    appropriate that THCB readers are given the appropriate tools from which to
    make up their own minds on the issue.

  37. You know my political persuasions are to the left of center but I do not think a discussion in THCB about Trump’s cognitive abilities is appropriate. This will succeed in polarizing THCB and ensuring everything else posted on THCB is praised or vilified based not on the merits of the argument but based on one’s political persuasion.

  38. Wow, great article, Steve. I’m going to offer two quick thoughts. I might offer more thoughts in a day or two when I’ve had a chance to think about your article.

    I have also wondered why Trump is so inarticulate. I wasn’t aware that as a younger man he spoke in complete sentences on a regular basis. That’s very important information. Trump’s odd way of talking is different from George Bush’s. Bush’s mistakes were funny, but even when he was making a fool of himself he did so in complete sentences, as in, “I understand how hard it is for you to put food on your family.”

    I’m curious as well about Trump’s inability to stop undercutting his staff and his allies in Congress. I see a headline on CNN now that says he thinks the House health care bill is “mean.” Is that a memory problem? Is it hostility to the whole world including his closest allies? It’s so strange it cries out for analysis.

  39. “ 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?”

    Somehow Steve F. reading what you produce makes me wonder the same things about you. I don’t always find your words properly balanced and that makes me wonder. That wonderment doubles down when you recognize what happened to Goldwater yet you still want to sign onto character assassination. Maybe those that consider themselves journalists should stop and think that maybe there should be a bit more journalistic integrity. Maybe that is just asking too much from those who place their own feelings ahead of their integrity. I have no problems with anyone finding fault with Trump, but when they purvey drivel like this present missive, they deserve to be looked at with scorn.

    I think Dr. S Jha in his blog makes things quite clear from the medical perspective, “There’s something delightfully empowering, and annoyingly juvenile, about diagnosing the famous with medical conditions.” Juvenile is a good word to end on, but with all of this juvenile desire to use character assassination against one they don’t agree with let us remember that Winston Churchill and Abraham Lincoln both probably had serious psychiatric issues.

  40. Dusting off ole’ B.F. from his banishment to the basements of Harvard, Trump is simply our Skinner Rat in Chief. The 50 year period comprising his adult life has been one long random interval / random ratio reward schedule experiment bearing the Durable Learning “fruits” (Bill-ee-ions of dollar-denominated pellets) of the extremely profitable aggregate upshot of his decades of wanton Gresham’s Dynamic behaviors. I don’t think the speculation needs to get any more “clinical” than that. Ya Dance Wit’ The One Whut Brung Ya.

    As to his more recent incoherence, you can’t do much better than his C-SPAN ramble on “the nuclear.” https://www.youtube.com/watch?v=Elhyo-_fR0E Just TRY to diagram that stuff.