Medical Mysteries: Diagnose Trump and Santos

 Medical Mysteries: Diagnose Trump and Santos

By Hal Brown, MSW, Retired psychotherapist and mental health center director

I subscribe to a medical newsletter which regularly has a "medical mystery" article which has a quiz of sorts where a patient is described with a list of presenting problems and symptoms. Then the reader goes through a number of pages which asks questions as to what the reader thinks the diagnosis is. The New Yorker may not be publishing these anymore, but they used to have articles about medical mysteries where a  patient presented with unusual symptoms and the quest to determine the rare disorder was described.

Now we have two politicians who present a psychiatric diagnostic conundrum. 

Trump was the easiest until recently. Numerous mental health professionals went public explaining how he fit the (unofficial) diagnostic criteria for being a malignant narcissist. By now I should have the link to this Wikipedia entry memorized having posted it so often in my articles.

Today we have two Raw Story articles related to Trump's mental health:

Click above to read

George Conway isn't a mental health professional and may or may not be using the reference to losing touch with reality colloquially or clinically. Perhaps he means them both way since he has demonstrated that he's psychologically very well informed. Not being in touch with reality, that is being able to differentiate what is real from what isn't real (called "reality testing") is a hallmark of someone who is on the verge of having a psychotic episode or already being psychotic. 

This summarized an article in the conservative National Review:

Click above to read

Consider this excerpt:

National Review columnist Charles C.W. Cooke believes that former President Donald Trump has been more unhinged than usual, and his latest essay examines what he describes as Trump's "deterioration" as observed through his Truth Social posts.

Cooke describes Trump as "ranting like a deranged hobo in a dilapidated public park" and he notes that his Truth Social posts are loaded with esoteric references that only his diehard fans can even begin to understand.

Note the words unhinged and deranged both of which are slang for someone who is be psychotic. The message being conveyed here is that his behavior has worsened to the point he may be veering into psychosis.

HUFFPOST had this article about the Cooke piece in The Wall Street Journal and offered this excerpt:

“There was a point in time at which Trump’s unusual verbal affect and singular nose for underutilized wedge issues gave him a competitive edge. Now? Now, he’s morphing into one of the three witches from Macbeth. To peruse Trump’s account on Truth Social is to meet a cast of characters about whom nobody who lives beyond the Trump Extended Universe could possibly care one whit.”

I used up my last free Wall Street Journal click to read the article and noted the first sentence: "The former president’s deterioration is on full display in the Truth Social asylum he built for himself." The word deterioration is often used in psychiatry and in the same sentence with asylum it seems the writer is making the case that Trump is ready for the rubber room.

Here's how the WSJ article ends:

Throughout his public career, Trump has resembled nothing so much as a drunken talk-radio caller from Queens, and, on Truth Social, readers get the treat of watching him at the zenith of his rhetorical powers. Nobody — and I mean nobody — can shift gears as fast as Donald J. Trump. One moment he’s proposing that the solution to the Supreme Court leak is to “arrest the reporter, publisher, editor—you’ll get your answer fast,” or, if that fails, “put whoever in jail.” The next, he’s describing the prosecution of his business associate, Allen Weisselberg, as “the greatest Witch Hunt of all time.” His repertoire is unmatched — and unmatchable. He can do edgy insult comedy for the people listening in at the bar: “The reporter was a shaky & unattractive wack job, known as ‘tough’ but dumb as a rock.” He can make numbers up off the top of his head: “The change in the Election was Complete & Total, with Millions of votes switched, at least 17%.” He can use hyperbolic analogies: “Our Country is SICK inside, very much like a person dying of Cancer.” He can even do angry: “May he Rot In Hell!” He can do anything.

Anything, that is, except focus on the world outside — where the problems that Donald Trump once used to propel himself into the White House remain real and pressing, whether or not he chooses to engage with them.

Several times a week it seems there are news reports of Trump lying with no regard for, or not caring about, the bad publicity it will generate. For example: 

Click above for MSNBC story.

We know Trump is impulsive. We don't know if he has an impulse control disorder, or whether his impulsivity is part of another disorder.

In this age of QAnon and election denial there are so many people who believe things that are both irrational and false that researchers have looked into and discovered that the rates of people suffering from mental illness are much higher. than previously thought. Consider this article in The Conversation: 

Many QAnon followers report having mental health diagnoses

Back in 2020 I wrote 

What psychotherapists can't tell us about Donald Trump. Why does he lie? Will be become psychotic?

Hardly a day goes by that one or more Trump Truth Social posts make the news. Many of them are rants that come close to or cross the border between rationality and irrationality. 

As far as George Santos goes, just this morning there are the following articles on Raw Story:

Clockwise from left by first words in title: Bizarre, Complete Chaos, Man Listed, Critics rip.

Since putting together this story collage another Santos story went up on Raw Story:

Click above to read

Updates: 

George Santos made 'offensive' past joke about Hitler and 'The Jews': report

View - Screenshots from over a decade reviewed by Patch show Rep. George Santos has what the ADL called a "deeply offensive" social media history.

George Santos was 'sweet and caring' — until he started stealing from everyone: ex-boyfriend

Posted Fri. Jan. 27:

George Santos appears to admit drag queen past in Wiki post

A user with the name Anthony Devolder wrote in 2011 that they won several drag pageants. Anthony Devolder is a Santos alias.

All of these articles paint a somewhat different picture of Santos but what they have in common is that they describe someone who, to be trite, just isn't normal.

Over my 40 years as a psychotherapist diagnosing uncountable patients I find Santos to be presenting a medical, or psychiatric if you prefer, mystery. Diagnostically the question about Trump and his diagnosis is easier because he has, probably since early adulthood, been a malignant narcissist. 

Currently the question, the mystery, is whether or not he is either becoming irrational because he is having narcissistic rage episodes (read article) or is becoming psychotic.

Santos may just be a stupid sociopath (now called anti-social personality):

Antisocial personality disorder, sometimes called sociopathy, is a mental disorder in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to antagonize, manipulate or treat others harshly or with callous indifference. They show no guilt or remorse for their behavior. Reference

Most addressing this in the general media seem to believe this is the case and don't go deeper by delving into other possible explanations for his behavior.

There are other possibilities. 

The first that comes to mind may be the least plausible but I think of it because of Hershel Walker. Walker wrote a book (probably ghost written) about how he overcame having a dissociative identity disorder, commonly called multiple personality disorder. I am skeptical about the truth of this but it does explain some of Walker's behavior. It also could explain some of Santos's behavior. While most common in women who were sexually abused as children, it conceivable that Santos actually has different personalities (called alters) some of who have amnesia for that the others do.

We do know that Santos, on the surface at least, is a serial liar since it isn't telling a lie if you don't remember doing something you really did. There's no official psychiatric diagnosis for being a serial liar. Like Trump, Santos has lied many times and paid no heed to the fact that his lies could easily be exposed as such. Of course if it was a horse race Trump would cross the finish line while Santos was just leaving the starting gate.

Santos could have a borderline personality disorder, also known as emotionally unstable personality disorder. This is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong emotional reactions.Wikipedia

My sense is that there is evidence he has histrionic personality disorder. It is defined as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval.Wikipedia

No matter what one might deign to diagnose either of these individuals as having Trump is exponentially more dangerous since his cult doesn't care whether he's batshit crazy or not.  Santos is a gift to Democrats. Read  Santos leads the GOP in eliciting Schadenfreude, no doubt more to come.

 Watch satire of supporters of George Santos from his home district explain why they support him:

Anybody think Marjorie Taylor Greene doesn't want to be president?

 Anybody think Marjorie Taylor Greene doesn't want to be president?

By Hal Brown

Two days ago I also wrote about Marjorie Taylor Greene: 

Kevin and Marjorie, sitting in a tree, K I S S I N G

Newsweek article shown above 

Donald Trump and Kevin McCarthy Share Love-In After 'Crazy' Speaker Race

NBC News article shown above

Marjorie Taylor Greene aims to be Trump's VP pick in 2024 -- "She sees herself on the short list for Trump's VP," said former Trump aide Steve Bannon, who has spoken with Greene.

What a no-brainer question my title is. 

I have no doubt that MT Greene aspires to higher office. In her dreams I think she sees herself;f as the first woman president.

She has only three options for higher office unless you count being appointed to be a Supreme Court Justice (one doesn't have to be a lawyer). 

She could run for governor. 

She could run for the Senate. 

She could be Trump's choice as his VP running mate, no inference meant by using the term "mate" intended. This would be her most likely ladder to the presidency since  Trump might not live to complete a term should he be elected. 

Considering her narcissism and need to be the center of attention I think if she had a choice she'd want to run with Trump. If Trump won or lost the primary  she would be thrust into the spotlight in ways that only ever happened when she was featured at a Trump rally.

If horror upon horror Trump won I have little doubt she would be even less in the news than Kamala Harris. Trump doesn't want anybody upstaging him.

Unless Greene has some plans to hasten his demise - not to say she'd take active steps - but stress can be a big factor in life expectancy, she would be advised to consider the fact that he, like Biden, may be what is called a super-ager. Research suggests that both of them are very likely to life our another term if they are elected.

The key findings of the study:

• Biden and Trump are likely to be "super-agers," a subgroup of people that maintain their mental and physical functioning and tend to live longer than the average person their age.
• Both candidates have a higher than average probability of surviving a four-year term in office, relative to other men their age. For Biden, the probability of surviving the next four years is 95.2% (vs. 82.2%). For Trump, this is 90.3% (vs. 86.2%).
• Biden is expected to outlive Trump, even though he is three years older. In the paper, the researchers note Biden's "nearly perfect health profile for a man his age," compared with Trump's "significant but modifiable" negative risk factors.
• While Trump is noted to have an elevated familial risk of late-onset Alzheimer's disease, neither candidate is expected to have major cognitive functioning challenges now or during the next four years.

What she has to be careful of if she wants to be Trump's VP selection is that for the present she serves two masters, Kevin McCarthy and Donald Trump. If these two have a falling out she will have to chose sides. 

That might not be easy. McCarthy has the power to derail her ambitions to be the unofficial Speaker of the House calling the shots whenever she thinks it will accrue to her benefit. On the other hand if she crossed Trump he would never select her to run with him.

If Trump won and became president then Greene, like Harris, wouldn't be a particularly viable national presidential candidate, although I think Harris would be a much better candidate since, well, she's both very smart and sane.

Comment below:

Will Manhattan DA's case against Trump have deadly tentacles

 Will Manhattan DA's case against Trump have deadly tentacles

By Hal Brown

I read this article in RAWSTORY and the phrase shown above leaped off the page and sent me to DuckDuckGo Images to find man-of-war jellyfish.

The article begins:

Manhattan district attorney Alvin Bragg may finally have changed his mind about indicting former president Donald Trump.

The recent conviction of the Trump Organization and its chief financial officer Allen Weisselberg gave a glimpse of evidence that could tie the ex-president directly to the tax fraud scheme, such as a memo he signed approving chief operating officer Matthew Calamari’s illegal request to reduce his taxed salary to cover the cost of his untaxed corporate apartment, reported The Daily Beast.

Here's the portion about the tentacles:

“This case has tentacles,” said Duncan Levin, a former prosecutor who now represents Jennifer Weisselberg and has been communicating with investigators.

The district attorney's office declined to comment on what Bragg meant about another chapter, but former prosecutors from that office say their experience leads them to believe prosecutors will go after Trump.

“For people who want a certain outcome — to go after Trump — it gives hope," said Catherine A. Christian, a former assistant district attorney who investigated financial fraud. "They’re going to be thorough. I’m doubtful he would have said ‘next chapter’ if they weren’t looking."

To tell the unvarnished truth I don't have anything particularly original to say about this. I just wanted an excuse to make a couple of illustrations. I leave it to readers to indulge in fantasies about the Teflon don Don falling into a jellyfish swarm.

I think he might a need a full immersion wetsuit rather than a coating of Teflon to protect him from the jellyfish swarming around him not only in New York (cue music video) but also in Georgia (cue video two).

Update:

Irrelevant to today's story, items to share:

Funniest puniest of the week:

More seriously, everyone should share this image.

This hopefully will be the final straw to break for Santos and humiliate McCarthy. It would be truly great if McCarthy has to take steps to remove him from the House, and at least to immediately kick him off his committee assignments. There are a number of Republicans who shoot their dogs because they can't hunt anymore, but far more are dog lovers. I just wish more articles shared this photo:

More people should see the video in this article. It is of a former Santos roommate describing how he used the Jewish sounding name Zebrosky on his GoFundMe pages because Jews give more money. 

"He would say, 'oh well, that Jew will give more if you're a Jew," Morey-Parker quoted his former roommate.

I wouldn't say that you can make a firm judgement of how smart someone is by how they look, but then again.... (article)

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When it came to surviving Covid, Trump was really Teflon Don

When it came to surviving Covid, Trump was really Teflon Don 

By Hal Brown

Click images below to enlarge.

The original photoshop was tweeted by Trump himself:

Below: The original Teflon don

About the photo of Trump:

I wanted to find a photo of Trump looking as bad as possible and an image search of "Trump looking bad" turned up this one taken by an official White House photographer. Here's an article about it.

This word leaped off the screen when I read this article in Medscape.

Excerpt:

Which Treatments Improve Long-term Outcomes of Critical COVID Illness?

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Treatment with interleukin 6 (IL-6) receptor antagonists or antiplatelet agents improves survival and outcomes at 6 months for critically ill patients with COVID-19, according to new data.

However, survival wasn't improved with therapeutic anticoagulation, convalescent plasma, or lopinavir-ritonavir, and survival was worsened with hydroxychloroquine.

"After critically ill patients leave the hospital, there's a high risk of readmission, death after discharge, or exacerbations of chronic illness," study author Patrick Lawler, MD, a clinician-scientist at the Peter Munk Cardiac Centre at University Health Network and an assistant professor of medicine at the University of Toronto, told Medscape Medical News.

"When looking at the impact of treatment, we don't want to improve short-term outcomes yet worsen long-term disability," he said. "That long-term, 6-month horizon is what matters most to patients."

Remember this?

Of course anyone who isn't a brainwashed and brain dead Trump cultist can't forget this:

https://www.bbc.com/news/world-us-canada-52399464

And then there's hapless Dr. Birx who has to forever live with these moments:

Then we had the publicity stunt which was meant to show both how invulnerable he was and how Covid was no big deal:

This is an excerpt:

In the midst of an aggressive course of treatment for coronavirus, President Donald Trump left the hospital with his security detail Sunday so he could ride in an SUV past supporters cheering him on outside Walter Reed National Military Medical Center. 

The short trip, where Trump waved to his supporters through the window while wearing a mask in the back of his SUV, was an attempted show of strength that displayed the President’s questionable judgment, his willingness to endanger his staff and the fact that he still does not seem to comprehend the seriousness of a highly contagious and deadly disease.

Trump’s doctors on Sunday provided concerning details about his condition to reporters – including two alarming drops in his oxygen levels. But the late Sunday photo op underscored that the chief concern for the President, who was furious at his chief of staff for telling reporters about his troubling vital signs, is projecting a commanding image to the public.

An attending physician at Walter Reed harshly criticized Trump’s Sunday drive-by as a risk to the lives of Secret Service agents who accompanied him in his SUV. 

“Every single person in the vehicle during that completely unnecessary Presidential ‘drive-by’ just now has to be quarantined for 14 days. They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity,” Dr. James Phillips tweeted.

The original Teflon don was Mafia boss John Gotti. He was given this nickname because of the way he avoided legal consequences for his crimes for so many years. He eventually was sentenced to life in prison. He spent the majority of his sentence in effective solitary confinement, allowed out of his cell for only one hour a day. This is how he spent the final years of his life at the US Penitentiary in Marion, ILL

It is a fortuitous coincidence that when referring to Trump with this moniker the word "don" has two meanings, don as the head of a crime family and "Don" as in Donald.

Not only has Trump followed in Gotti's footsteps when it comes to staying out of prison he managed to get elected president despite years of breaking the law. He proved to be Teflon in another way by avoiding dying when he contracted Covid prior to the development of vaccines.

It remains to be seen whether some of his off the rails behavior is a form of long Covid. There's no way to determine this now but one thing we can say for sure is that he's alive and kicking.

If Trump has an autopsy made public after he dies it is possible we will know whether Covid had invaded his brain. Consider, also from Medscape that 

Autopsies Show COVID Virus Invades Entire Body

The researchers said their work shows the virus "is capable of infecting and replicating within the human brain." They also said their results indicate the virus spreads via the blood early during infection, which "seeds the virus throughout the body following infection of the respiratory tract."

Can you imagine what would happen if Trump cultists learn that Covid has invaded Trump's brain, Trump who claimed he had the biggest brain, or as he put it a very, very large brain, also had, literally not figuratively, a very sick brain. 

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Gen. Kelley called Trump dumb, immoral, ignorant, and lazy. Add this to the Dark Tetrad.

Gen. Kelley called Trump dumb, immoral, ignorant, and lazy. Add this to the Dark Tetrad.

By Hal Brown

DonkeyHotey has created uncountable caricatures of Trump, politicians, and others in the news, many of which are used on Crooks and Liars and other well known websites. I often find they capture the essence of Trump and use them in my blog, for example today. I spent a lot of time finding the right emojis for dumb, immoral, ignorant, and lazy and needed an image to put them on.

Click above to read article that prompted this blog

I am weary of writing variations of the same thing from my perspective as having been a psychotherapist for 40 years and analyzing Trump's psychopathology. Use DuckDuckGo to search my name and Trump delusional and the first three links are stories I wrote. Oh well, here's yet another.

Gen. John Kelley gives us another tetrad to add to an assessment of Trump in addition to the Dark Tedrad which is as follows:

The anti-social personality traits of narcissism, Machiavellianism, psychopathy, and sadism. Narcissism involves the tendency to be overly concerned with one’s self-image, Machiavellianism involves the tendency to be deceitful and manipulative, psychopathy includes callousness and lack of remorse, and sadism involves pleasure from inflicting pain on others.

This is an excerpt from RAWSTORY:

Michael Schmidt told MSNBC's "Morning Joe" about what Kelly learned about the former president and his abilities. Schmidt appeared Thursday on MSNBC's "Morning Joe" to discuss the upcoming paperback edition of his book, Donald Trump V. The United States: Inside the Struggle to Stop a President, which includes new revelations from John Kelly.

"So when Kelly came in as chief of staff, he thought that the problem around Trump was that he was not staffed properly and they needed to create a process around him, and that's what the chaos of the first six months of the administration was about," Schmidt said. "But when Kelly comes in as chief of staff, what he realizes is that the problem is not just the fact that there's not a process and that he's not being staffed as well as he could, but that Trump himself was the problem, that Trump was far dumber and immoral and ignorant and lazy than he ever thought he was."

 "Within a few days, he becomes terrified because here he is, the top staffer to the president of the United States, and he's realizing that the president of the United States is far more limited and potentially dangerous than he ever thought, and at that point, there was no one else to call," Schmidt added. "He was -- it was just him and Trump, and he basically spends the next 18 months trying to manage Trump as much as he could.

I don't know what to call being dumb, immoral, ignorant, and lazy. 

Add these personality traits to being an extreme narcissist prone to outbursts of rage when he feels attacked, a psychopath who has engaged repeatedly in criminal and antisocial behavior without remorse or empathy for those victimized, a sadist who takes pleasure in causing and observing the suffering of other, and believing that any means however unscrupulous can justifiably be used in achieving political power, i.e. Machiavellianism. 

While looking at Trump through the lens of my being a retired psychotherapist I have to add that if Trump believes some of the things he says he believes he is also showing signs of having a delusional psychosis. Read my blog from a a few days ago:

I characterize Trump as being a witches brew of toxicity emanating a deadly miasma which is intoxicating to members of his cult who unfortunately represent a base of voters that GOP politicians must pander to lest they risk not being elected. 

Those who should know better, who should realize that he, to reference another psychological concept, is a malignant narcissist. This includes the same traits of the Dark Tetrad. It is defined an extreme mix of narcissism, antisocial behavior, aggression, and sadism. Grandiose, and always ready to raise hostility levels, the malignant narcissist undermines families and organizations in which they are involved, and dehumanizes the people with whom they associate. 

A person with malignant narcissism exhibits paranoia in addition to the symptoms of a Narcissistic Personality Disorder. Because a malignant narcissist's personality cannot tolerate any criticism, being mocked typically causes paranoia.

The social psychologist Erich Fromm first coined the term "malignant narcissism" in 1964, describing it as a "severe mental sickness" representing "the quintessence of evil". He characterized the condition as "the most severe pathology and the root of the most vicious destructiveness and inhumanity"

Wikipedia

If one objectively adds up all that we know about Donald Trump we see that there as only a few aspects of personality that makes him different than despotic genocidal leaders like Hitler and Putin responsible is three of the four characteristics described by Gen. Kelley: his being dumb, ignorant, and lazy. Of the four what he has in common is being totally immoral.

Almost irrelevant to governing is the observation made by NY Times columnist Jennifer Senior that Trump is a preening narcissist (I wrote about this here). Historic despots haven't always been as narcissistic as Trump. Idi Amin and his garb comes to mind and Putin liked to be photographed bare chested or practicing martial arts.

Recall that Trump missed the anniversary of the end of World War I because he was afraid of the rain messing up his hair.

Below from Schmidt's book: It was raining and Trump told Kelley he didn't want to go.He didn't want his hair to be ruined, and he didn't understand why he should go to a memorial site for troops who had been killed. "They lost" he told Kelley.... and then he went on to call them losers and suckers.

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