I'm not the only mental health professional who says that Trump needs a rigorous neuropsychiatric evaluation to rule out a cognitive illness, by Hal Brown, MSW

 The article, above, Trump's Repetitive Speech Is a Bad Sign has been summarized in RawStory with the title Psychiatrist flags 'alarming' debate tic — and urges Trump to seek a neurologist, the EconoTimes with the title Psychiatrist Urges Donald Trump to Seek Neurological Exam After 'Alarming' Debate Behavior Raises Cognitive Concerns, and elsewhere.

They save me from the task of summarizing it. Still, I recommend that you read the entire article here.

I have been writing about this issue ever since the debate firmed up my own diagnostic assessment that Trump had a cognitive disorder, either early dementia, mania, or a combination of the two. But then again I am not an eminent mental health professional. I was what could be called a country psychotherapist for 40 years because I practiced in rural areas and graduated from what was once called a cow college, originally Michigan Agricultural College, now Michigan State University. 

The author of this article is what can be called eminent. He's  Richard A. Friedman, who  also has a Wikipedia page.

Two days ago I wrote BEDLAM IN HIS BRAIN: Call it insanity, mental illness, or cognitive impairment, Trump gave us ample evidence he needs professional help. 

My conclusion was the same as psychiatrist and professor Friedman's. This is that this debate showed is that if Trump was anybody else his family would be seeking professional help for him.

The number one reason Trump should never set foot in the Oval Office is that he will destroy democracy. The related reason is that dementia never gets better and as I wrote yesterday there will be a point where his symptoms will be so severe he'd be removed through the 25th Amendment and J.D. Vance would become president.

The country would go from having a sociopathic president who was mentally impaired, irrational, and unstable like Idi Amin who didn't have nuclear weapons, to having a sociopathic one who is as sane, rational, and calculating as Vladimir Putin, Kim Jong Un who do have nukes, and dare I say, as Adolph Hitler was. 

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Consider sane malignant narcissist J.D. Vance as president. By Hal Brown, MSW

Trump is a narcissistic sociopath (aka malignant narcissist), but also after the debate he has given us conclusive proof that he has an organic brain disease - dementia, mania, or a combination of the two. Of course this makes him even more dangerous. But there is another element to consider. 

This means that if elected there's a good chance his condition will deteriorate to the point that he will be removed through the 25th Amendment and then we will have J.D. Vance as president. He too is a malignant narcissist, but he doen't have an organic brain disease. 

Remember, Hitler was a sociopath but there has been controversy among experts over whether or not he suffered from organic psychopatholgy (see Wikipedia). I am not an expert on Hitler but my own impression is that no matter whether or not he might have had any of the disorders listed in the following chart none of them significantly impaired his ability to think rationally.

Click to enlarge image

I don't see any indications that J.D. Vance suffers from any organic, or brain, psychopatholgy. Narcissistic sociopathy is psychopathogy, but it is a personalty disorder. He fits into the category of people without severe organic mental disorders that led to the coining of the term "the banality of evil" by Hannah Arendt. Below from Wikipedia:

Famed is Hannah Arendt's invention of the phrase the "banality of evil"; in 1963, she stated that for a Nazi perpetrator as Adolf Eichmann, mental normality and the ability to commit mass murder were not mutually exclusive. Harald Welzer came to a similar conclusion in his book Täter. Wie aus ganz normalen Menschen Massenmörder werden (Perpetrators: How ordinary people become mass murderers).

We all know the kind of country J.D. Vance wants to turn the United States into.

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BEDLAM IN HIS BRAIN: Call it insanity, mental illness, or cogntive impairment, Trump gave us ample evidence he needs professional help, by Hal Brown, MSW

Bethlem Royal Hospital, also known as Bedlam, was England’s first asylum for the treatment of mental illness. 
Bedlam has become a word meaning a scene of uproar and confusion.

What Trump did last night in the debate may not offer a precise psychiatric or medical diagnosis though it does demonstrate that his mind is not working properly. I don't like to use the dated and coloquial term "insanity" in place of mental illness, but I do so because it gets the point across. In fact Trump also used the word "insane" in the debate.  He was trying to make his point when he repeated his unsupported claim that "millions of people" are "pouring into our country from prisons, jails, from mental institutions and insane asylums."

Trump is lumping  people who, through no fault of their own, have a mental illness with people who have commited crimes. This is interesting because he has both committed crimes and, after this, I have to say he also has a mental illness. 

I wrote yesterday (here) that the debate could provide evidence that he has early dementia, mania, or a combination of the two. What I am left with is the fall-back diagnosis clinicians use when someone has elements of several diagnoses but not enough of them to fulfill the requirment for making a firm diagnosis. This is to say they have an atypical condition with symptoms of two or more disorders. Trump may be showing us what happens when someone with a narcisstic personality disorder gets dementia or mania. Trump meets the diagnostic criteria for this disorder.

The fact is that old insane asylums like Bedlam actually had many patients who manifest behavior very much like what Trump expressed during the debate. Before the first medications, Thorazine and lithium for example, were able to control psychosis and mania these hosptials were filled with raving and ranting patients whose words made no logical sense. Patients with dementia were among those who ended up in these hospitals in addition to people with those with scizophrenia and bi-polar disorder (previously called manic-depressive disorder).

In my 40 years as a psychotherapist I saw just a few patients whose symptoms were as blatant as Trump's. This is because my program was outpatient and by the time they came to us they'd already been stabilized on medication. I only saw them when they stopped coming for a period of time, went off their medication, and then came back.

(Aside: As I have this on, just this second, Joe Scarborough said "any sane Republican" in reference to what Trump should have done differently and then used the word "addled" to decribe his performance.)

The word "sane" has now become the prefix to the newest word in the media, sanewashing. I have seen it hyphenated and as two words. I expect it will end up being on the top of lists of words added to the dictionary in 2024.

Even Fox News, much to the rage of Donald Trump in the spin room afer the debate, didn't try to sanewash his debate performance.

You can call it mental illness, insanity,or cognitive impairment, but what this debate showed is that if Trump was anybody else his family would be seeking professional help for him.

Updates: Later shows following Morning Joe on MSNBC are not focusing on the cognitive impairment Trump demonstrated in the debate.  They are talking about the policies he tried to expound on. They are sanewashing.

This is another indication of cognitive disorderL

'What’s wrong with Trump?' Onlookers stunned as ex-president smiles at 9/11 memorial event

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The debate may help determine if Trump has dementia and it may also demonstrate whether or not he has mania. By Hal Brown, MSW

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Peter Baker's OpEd in The NY Times, As Debate Looms, Trump Is Now the One Facing Questions About Age and Capacity (subscription) addresses the what he calls "the rambling sometimes incoherent statements" Trump makes. What struck me in his column was the following (my italics):

Stephanie Grisham, who served as Mr. Trump’s White House press secretary but broke with him after the Jan. 6, 2021, attack on the Capitol and spoke at last month’s Democratic National Convention, said that Mr. Trump “can be disciplined when he wants to be” and that she expects him to get through Tuesday’s debate without looking diminished, given the rules and time limits.

For me this is a crucial test for clinically assessing Trump's mental acuity and may give others in the medical or mental health profession who, like me, have speculated about the possiblity, in some cases, the likelihood, that Trump has early dementia.

Mary Trump, a clincial psychologist and Trump's niece, wrote about this the other day 

Excerpt:

It’s deeply disturbing that somebody as unhinged and incoherent as Donald is allowed to run for the presidency in the first place (and that leaves aside all of the other disqualifying things about him), but the disturbance is compounded when you consider that corporate media can’t seem to muster any urgency in the face of Donald’s increasingly bizarre behavior. On any given day, he is demonstrably untethered from reality—and it often seems that the reason the warning lights aren’t constantly flashing red is because nobody covering him expects otherwise.

Surely a political press corps that spent months arguing that President Biden’s age rendered him mentally unfit, wouldn’t look the other way when the Republican candidate, the oldest person to run for president in American history, is not only old but decompensating before our very eyes. The difference of course is that Biden is aging while Donald is dementing.

So did Dr Jeffrey Kuhlman, a former White House medical director who worked with former Presidents George W Bush, Bill Clinton and Barack Obama. Here's an excerpt from this article:

Speaking from his office in Florida, Dr Kuhlman said: “Watching Trump on TV during rallies, he doesn’t exhibit critical decision-making capability.

“When I hear his words, his thought patterns – he changes course.” 

He added: “If someone is going to be president until age 82, medically we would want to make sure they are not exhibiting accelerated cognitive decline or progressive dementia, which one in six Americans in their 80s have.”

In his opinion, Dr Kuhlman was confident that Trump “has cognitive decline”, which he said is very common with ageing and can reduce someone’s “executive function” to organise, plan, and problem-solve. 

Back to Stephanie Grisham saying that Trump "can be disciplined when he wants to be” and that she expects him to get through Tuesday’s debate without looking diminished, given the rules and time limits."

If Trump has dementia it is doubtful that he will be able to get through the debate, no matter what the rules and time limits are, without demonstrating symptoms. In fact, the rules and times limits may frustrate him and exacerbate the symptoms.

Someone with dementia can't turn off their symptoms. One can't tell someone with dementia to turn off their symptoms for 90 minutes. Can you imagine one of his advisors telling him that he has to be disciplined during the debate? 

I will keep an open mind as I watch the debate. If Trump does manage a coherent performance I will reassess my opinion that he most likely has dementia. 

I will also be watching for signs that Trump is suffering from mania. Like with dementia, someone with this disorder can't control the symtpoms.

If he has mania there's a good chance he will have a manic episode during the debate.  This hasn't been a focus of experts or of the media.

Here's a definition of mania from Wikipedia. Note that a symptom is a flight of ideas. This is excessive speech at a rapid rate that involves causal association between ideas. We often see this with Trump although he calls it "the weave" as if it is a brilliant oratory device.

Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived of as a "mirror image" to depression, the heightened mood can be dysphoricas well as euphoric. As the mania intensifies, irritability can be more pronounced and result in anxiety or anger.

The symptoms of mania include elevated mood (either euphoric or irritable), flight of ideas and pressure of speech, increased energy, decreased "need" and desire for sleep, and hyperactivity. They are most plainly evident in fully developed hypomanic states, however, in full-blown mania, these symptoms become progressively exacerbated. In severe manic episodes, these symptoms may even be obscured by other signs and symptoms. 

If Trump doesn't have dementia and does have mania this can often be successfully treated with medication. 

Trump will have about 45 minutes, five minutes short of the typical 50 minute hour most therapists devote to their patients, to provide me with enough information to do what I had to do in my 40 years as a psychotherapist. This was to determine at least a tentative diagnosis to submit to insurance companies. 

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Prestigious Coumbia Journalism Review asks "is the press sanewashing Donald Trump?" By Hal Brown, MSW

 

Above: My photo, click to enlarge.

Read CJR article here.

Their article begins:

There’s a hot new term doing the rounds among media critics: “sanewashing.” The term itself actually isn’t new, and it wasn’t born in media-criticism circles, per se; according to Urban Dictionary, it was coined in 2020 on a Reddit page for neoliberals (which Linda Kinstler wrote about recently for CJR), and meant “attempting to downplay a person or idea’s radicality to make it more palatable to the general public.” (It was deployed in discussions around, for example, “defunding the police.”) Recently, though, various observers have applied the term to media coverage of Donald Trump. Aaron Rupar, a journalist who is very active on X, has been credited with coining “sanewashing” in this specific context, but the term appeared to really blow up last week, after Parker Molloy wrote a column about it in The New Republic. (She expanded on the idea as a guest on the podcast Some More News.) The word has since been picked up by media bigwigs including Paul Krugman and Rachel Maddow, and appeared in outlets from Ireland to India.

As applied to Trump, the idea is that major mainstream news outlets are routinely taking his incoherent, highly abnormal rants—be they on social media or at in-person events—and selectively quoting from them to emphasize lines that, in isolation, might sound coherent or normal, thus giving a misleading impression of the whole for people who didn’t read or watch the entire thing.  

Excerpts:

As I see it, newsroom policies discouraging remote diagnoses of mental health are generally to be followed, even if they shouldn’t curb any and all discussion in this area; also, Trump does have (or at least is associated with) policies that merit scrutiny, however incoherently he articulates them, and—as even some critics acknowledge—there has been at least somesharp recent coverage centering the incoherence. The idea that “the media” as a whole has ignored Trump’s fitness for office is very hard to sustain. Nonetheless, I find the sanewashing criticism persuasive, on the whole. Too often, major outlets clean up Trump’s language—especially in shorter formats, like headlines and ledes—to the point where it barely resembles what he actually said. 

The article asks "if journalists are sometimes sanewashing Trump, why are they doing it?" Here's part of the answer:

Could it be that elite journalists think so little of Trump that they effectively condescend to him by cleaning up his speech? Do they think that picking meaning out of his word salads makes them sound clever or original? Is he held to a lower standard than his opponents because the latter are expected to speak in full sentences and he never has been? Is Trump sounding incoherent simply old news at this point, in an industry that prizes novelty?

The article concludes:

Tomorrow night, viewers will get an unadulterated dose of Trump when they tune in for his debate against Harris on ABC. Well, somewhat adulterated; Harris will be there too, of course, and Trump’s mic will be muted when she is talking—to the frustration of Harris’s team, which wanted her to be able to grill Trump in real time and also reportedly saw benefit in letting viewers hear Trump acting out. Ironically, it was Biden—who agreed to the terms for the debate before dropping out—who demanded muted mics; even Trump’s opponents, it seems, can’t agree on whether it’s best to shut him up or let him be heard. Unlike at the Biden-Trump debate in June, a “pool” of journalists will reportedly be close enough to the stage to hear the candidates this time. It might end up being their job to tell us what Trump said off-mic. Unavoidably, it’ll be all our jobs to describe what Trump said with the mics on.

"The Columbia Journalism Review (CJR) is a biannual magazine for professional journalists that has been published by the Columbia University Graduate School of Journalism since 1961. Its original purpose was 'to assess the performance of journalism in all its forms, to call attention to its shortcomings and strengths, and to help define—or redefine—standards of honest, responsible service.' " (Wikipedia) Columbia is ranked as the third best journalism school in the country.

The CJR is asking a rhetorical question in their title. Their article answers the question. They know that reporters with a semblance of journalistic chops know the answer is "damn right it is."

We expect this kind of sanewashing from right-wing media but it is when it comes from what we like to consider objective reporters, some of whom actually have degrees in journalism and were assigned articles in the Columbia Journalism Review to read in college, it is appalling. 

As the CJR points out, the follow-up coverage of tomorrow's debate will be a measure of how responsible journalists are in doing their jobs.

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