Am I the only anti-Trump shrink who thinks Trump may not have dementia? He may. But he may not. By Hal M. Brown, MSW I was a psychotherapist for 40 years but didn't learn about dementia until I moved to a senior community and saw it in dozens of residents.

 

Sometimes Occam’s razor can have two sides. When it comes to Trump’a increasingly bizarre behavior there are two, not necessarily mutually exclusive, simple explanations. His behavior is certainly consistent with his psychodamics, but how much of it is influenced by dementia? There are those who have jumped on a bandwagon of looking for evidence that he has dementia. They certainly have found it. However, there are other simple explanations for his unhinged behavior. 

This morning Sabrina Haake wrote this in her Substack “Trade chaos wuth a side of dementia”:

Last year we had articles with titles like 'Without any doubt': Experts say Trump shows 'staggering' signs of 'cognitive diminishment' . They didn’t leave any room for doubt. I had my doubts then and despite a chorus of people, some self-described experts and lay people, saying Trump has dementia I am have my doubts.

I am posting this as counterpoint to Sabrina Haake’s Substack and to the argument of Dr. John D. Gartner, founder of Duty to Warn, who she uses an expert source. Gartner, Wiki tells us, specialized in the treatment of borderline personality disorder, bipolar disorder and depression. Haake’s other expert source is psychologist Suzanne Lachmann who wrote in Newsweek “Donald Trump Dementia Evidence 'Overwhelming.” Dr. Lachmann, per her website, works with adults and late adolescent patients with conflicts including relationship issues, trauma, struggles with self-esteem, body image, trust, depression and anxiety.

In my practice I worked with adults with a variety of common psychiatric disorders, but have had experience working with those with complex dissociative disorder (multiple personality disorder) and Vietnam combat vets with PTSD. I never treated anyone with dementia, though (as noted below) I did correctly diagnose two patients with temporal lobe epilepsy.

I wrote the following on Jan. 3rd, 2025. I have not significantly changed my opinion. 

Most mental health professionals who are saying this are not neurologists, let alone neurologists who specialize in dementia. 
Many mental health professionals are absolutely, positively convinced Trump has dementia. I seem like a lone voice among them saying we need more evidence.

I am not an expert, but because I live in a continuing care retirement community I have seen a lot of people with dementia in all stages.

In my training there was no mention of considering dementia in making a differential diagnosis. In my 40 years of practice I never treated anyone with dementia. I did, however, have three clients who I thought had temporal lobe epilepsy which I knew about having read the book “Seized” by Eve LaPlante. I referred them to a behavioral neurologist who did sleep deprived EEGs with them and it turned out two of the three did have this disorder. When I began practice nobody was conversant about another brain disorder, the autism spectrum. My point is that mental health professionals must be aware that there are sometimes physiological and neurological explanations for behavior. This certainly applies to trying to discern explanations for what seems to be aberrant behavior in Trump. The unanswered question is whether is this behavior psychological, physiological, or a combinaiton of the two.

I have seen the photos and illustrations of Trump’s leaning forward posture countless times as if this was absolute proof of dementia. Lots of people his age stand that way at times.

His word salad could be an indication of mania, not dementia, or it could be, as he claims, a kind of improv which he calls the weave.

Many mental health professionals are digging in on the Trump dementia position. I think this is, in a way, wishful thinking couched in science.

We, meaning shrinks, have all the evidence we need to say Trump is a malignant narcissist, but then perhaps desperate to find more to justify saying Trump is unfit, they added dementia to bolster the argument that he was dangerous. I think mental health professionals need to be more self-critical and open minded in our judgments and not succumb to confirmation bias. It is easy to cherry pick from all the evidence when there’s so much Trump, Trump, Trump just about every hour of the day.

Is anybody keeping track of every bit of Trump’s behavior to find indications that he doesn’t have dementia?

We have ample examples of Trump going on for one or two hours without exhibiting any unambiguous signs of dementia. Much of his extemporaneous sidetracking can just as easily be considered a manifestation of his malignant narcissism as of dementia.

There’s currently a Change.org petition online “Our Diagnostic Impression of Trump is Probable Dementia: For Licensed Professionals Only.”

The petition begins:

We, the undersigned licensed medical and mental health professionals (INCLUDE YOUR ADVANCED DEGREE IN YOUR LAST NAME WITH NO PUNCTUATION) concur: From our years of training and experience, we are convinced that, while a definitive diagnosis would require further testing, Donald Trump is showing unmistakable signs strongly suggesting dementia, based on his public behavior and informant reports that show progressive deterioration in memory, thinking, ability to use language, behavior, and both gross and fine motor skills.

I highlighted the part that jumps out at me. First, the “years of training and experience” should apply to those who were in fields like neurology, particularly behavioral neurology, and neurosciense. It is true that a definitive diagnosis would require testing, however the use of the word “unmistakable” along with “strongly suggesting” shows a bias. Leave that word out and I can accept this sentence.

The petition then goes on to list diagnostic indices in these categories:

1) Decline from baseline

2) Memory:

3) Language

4) Motor:

5) Behavior:

The list reads like someone went over a text on dementia and then found things in Trump’s behavior and managed to make a case that he had this disorder. It wasn’t that long ago that splotches seen on Trump’s hands during the E. Jean Carroll led to rampant speculation that he had syphillis. Even before that the syphillis theory was in the news and no social media. This was from 2017: Trump’s ‘Unhinged’ Behavior Could Be Due To ‘Untreated Syphilis,’ Expert Claims. There is a reasonably good case to be made that Trump might be suffering from some stage of dementia. However, reasonably good isn’t good enough as far as I am concerned.

 

I think the list lacks the scientific rigor necessary to reach a foregone conclusion. This being said, I agree with the conclusion whether or not he has dementia:

This represents a unique danger because of Trump’s pre-existing Malignant Narcissistic Personality Disorder. As he continues to deteriorate he will become even more erratic, impulsive, paranoid, and aggressive than he already is. A demented malignant narcissist as president of the United States would have unimaginably catastrophic consequences.

Not only is Trump unfit, but he cognitively incapable of carrying out the duties of president. Under normal circumstances, relatives of such a patient would be seeking consultation with experts, and considering long term care, as he continues to deteriorate.

We feel an ethical obligation to warn the public, and urge the media to cover this national emergency.

The media must report objectively on anything that suggests Trump may have a cognitive impairment and bring in true experts from the appropriate fields. We can’t allow another Goldwater Rule fiasco to occur. When there were obvious examples of his being a malignant narcissist and mental health professionals spoke up about this they were debunked by many and accused of breaking some sacrosanct professional rule. 
Anti-Trumpers who make the news warning about the dangers of Trump wielding the power of the presidency have been accused of having a psychiatric disorder the name of which has been used to discredit them. You know what it is: Trump derangement syndrome. We must not feed into this narrative.
When mental health professionals go public about the possiblity that Trump has dementia they must do this by emphasizing that this is a possiblity not a certainty. They must write or speak with gravitas and always allow for the chance that they are wrong. 
Time will be the ultimate decider regarding this since dementia always gets worse. There may come a time during his presidency that his symptoms are so obvious you don’t need to be an expert in dementia to reach this conclusion.
This is when the 25th Amendment becomes a real possibility. Then we will be dealing with J.D. Vance. Nobody has suggested he has dementia.
More of my thoughts on this subject:

If Trump has dementia it might be a kind doctors have never seen. Call it weaveheimers. If not, the weave may be as brilliant as he says it is.

This was in Salon (I’m the clinical social worker in the title): Clinical social worker: “With the Trump Bible, one must consider dementia”

I also wrote I’m not the only mental health professional who says that Trump needs a rigorous neuropsychiatric evaluation to rule out a cognitive illness.

—————————————————

Note:

I was one of the first members of Dr. John Gartner’s Duty to Warn group and an early signatory to his petition to remove Trump (Version One) under the 25th Amendment. This was because Trump clearly met the criteria for being a dangerous malignant narcissist, or as the titles of the books edited by psychiatrist Bandy Lee, indicate, that he was a dangerous case.

Trump, newly empowered, has emerged as an even more dangerous case. He is dangerous to democracy and the established social and legal norms which are the bedrock of our society. He has gone from being an exemplar of the Dark Triad to being one of the Dark Tetrad. This has sadism added to psychopathy, narcissism, and Machiavellianism of the Dark Triad. I wrote about this here:

When I look at Trump and try to understand him I do so through the lens of psychoanalytic theory. For example “Trump's tweets are a royal road to his unconscious. As usual Trump was up tweeting last night. Psychoanalysts gain insight into someone's unconscious, and the way their mind works by analyzing their dreams. We look at his tweets.”

Can Trump be showing signs of dementia. Of course this is possible. Can we be sure? I don’t think so. Since dementia always gets worse, if he has it, in time we will see it. 

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Trump's tweets are a royal road to his unconscious, by Hal M. Brown

As usual Trump was up tweeting last night. Psychoanalysts gain insight into someone's unconscious, and the way their mind works by analyzing their dreams. Trump doesn't tell us his actual dreams, but he does tell us what is going on in his mind when we're asleep and he's awake.

You can see above what was on his mind last night. His tweet about Elon Musk was featured in this MSNBC article.

What this tweet tells me, a retired psychoanalyically oriented therapist, is that all the publicity Musk is getting and his being called "President Musk" is getting to Trump. Instead of tweeting about himself being in charge of Musk, he is building Musk up. I suppose he sees this as brilliant reverse psychology.

We know Trump is an avid poll watcher and takes them very seriously. Since the polls are showing that he is tanking, instead of attacking them as inaccurate he used the primitive defense of simply lying and saying that they are the highest ever when the opposite is true.

The tweet that struck me as interesting enough to make the above illustration was about MSNBC. There has been a lot of reporting about Trump's percipitious drop in approval as shown in all major polls on the station. If Trump was smart he'd never mention MSNBC but he can't restrain himself. I am sure that our friends over there take satisfacton in knowing he is watching their shows. I am waiting to see one of them say directly "President Trump, if you're watching this, I want you to answer this question." I wonder which MSNBC host's show is must-see TV for him. This would give bragging rights to the evening host who he called out by name. My bet would be on Rachel. The other night she went over every poll Trump was in free fall on.

The next to the last tweet he throws out is "the southern border is closed." This is a piece of unprovable and inaccurate braggadocio. Obviously saying that the border is closed doesn't mean that people have stopped making it across the border between the points of entry.

His final tweet is about the sixth hostage being released. Of course he wants to take credit for this. Any past president would have written something that showed compassion for the hostages and have sent them his best wishes.

Trump may not realize, or want to admit that this is a victory for Hamas because they are getting 600 Palestinian prisoners back, including one serviing a life sentence for killing an Israeli solder. I doubt Israel wants the public to see it this way.

It was 2017 but it seems to be an eternity ago that my friend Dr. John D. Gartner, the founder of the Duty to Warn movement and the first mental health professional to publish an article saying Trump was a “toxic malignant narcissist” (USA Today, 2017), published the book

All I Ever Wanted to Know about Donald Trump I Learned From His Tweets: A Psychological Exploration of the President via Twitter.

From Amazon:

We had to figure that by electing a decidedly non-career-politician, that things would be… different. But is this any way to run a country? Many opinions have been shared about Donald Trump, but we can learn so much more about the man via what he himself says – in 140 characters or less. Trump has tweeted nearly 35,000 times since launching @realDonaldTrump in March 2009, commenting on everything from immigration to policy climate change to even pop culture. As President, Trump tweets without ceasing, sometimes a dozen times a day, seemingly during important events and meetings. Apparently he believes that twitter is an effective tool for him to drive his agenda. But it’s one thing to be a brash, bold, and outspoken, maverick businessman, it’s quite another when the leader of the most powerful country in the world is talking politics as stream of consciousness.

Here you see something else from psychoanalysis. In addtion to dream interpretation, which Freud called the royal road to the unconscious, analysts encourage there patients to say whatever comes into their mind in a stream of consciousness.

By tweeting in the wee hours of the morning Trump has put himself on the psychoanalyst’s couch. In fact, this is the name of another book;

You can read excepts here.

Gartner introduced me to the concept of malignant narcissim. Understanding it is the best way to grasp what motivates Trump’s behavior, as well as the behavior of many of his cadre. I have written about the subject for years. If you Google search my name and Trump malignant narcissm this is what comes up.

This is the best site to read my essays on.

Trumps "Truth" posts add up to the only psychological test you need to diagnose Donald Trump as a dangerous maniac. All the leaders of our allies need to do to be terrifed that he'll be the next president is to read them, by Hal Brown, MSW

In 2017 Dr. John Gartner, the founder of Duty to Warn, wrote 

All I Ever Wanted to Know about Donald Trump I Learned From His Tweets: A Psychological Exploration of the President 

Currently his tweets on what was then called Twitter have been replaced by what he wants to call "truths" (thankfully not in the dictionary like "tweet" is) on Truth Social. Therefore, if one was to write an updated book the title would have to be changed. 

In 2019 The New York Times (subscription) published 

How Trump Reshaped the Presidency in Over 11,000 Tweets

This article was co-authored by Trump's on again off again pal Maggie Haberman and five other Times writers. It begins:

When Mr. Trump entered office, Twitter was a political tool that had helped get him elected and a digital howitzer that he relished firing. In the years since, he has fully integrated Twitter into the very fabric of his administration, reshaping the nature of the presidency and presidential power.

After Turkey invaded northern Syria this past month, he crafted his response not only in White House meetings but also in a series of contradictory tweets. This summer, he announced increased tariffs on $300 billion worth of Chinese goods, using a tweet to deepen tensions between the two countries. And in March, Mr. Trump cast aside more than 50 years of American policy, tweeting his recognition of Israel’s sovereignty in the Golan Heights. He openly delighted in the reaction he provoked.

“Boom. I press it,” Mr. Trump recalled months later at a White House conference attended by conservative social media personalities, “and, within two seconds, ‘We have breaking news.’”

Flash forward to when Trump lost the election. Trump's tweets, and then his truths, gave us a deeper insight into how his mind functioned. It hasn't been pretty.

He used these to send personal vicious messages to individuals but also to the country since he knew the more inflamatory ones would be shared in the media. This is from the Times article:

“Boom. I press it,” Mr. Trump recalled months later at a White House conference attended by conservative social media personalities, “and, within two seconds, ‘We have breaking news.’”

Whether or not the leaders of our allies or our enemies (some of whom may very well have secret channels to communicate with him) are following what Trump says at his rallies, it's reasonable to assume that they are people with subscriptions to Truth Social. A message to us is also a message to them.

I don't know if Trump cares that leaders and residents in other countries would be reading these too and would be wondering what would happen if this unhinged revenge fueled lunatic became president again. Perhaps, given that he's a malignant narcissist, he wants them to be terrified of him. He wants to be feared. It makes him feel powerful. This is the nature of the beast.

Our allies may see Trump as a clown, but they also see him as a dangerous clown:

Above: AI Generated image

Can you imagine what leaders of NATO thought when they heard that told a rally crowd that he “didn’t even know” much about NATO before he became president — but claimed he figured it out fast. (More from the rally speech on bottom of page). Trump was bragging about what a fast learner he was when he said this when if fact he was revealing what an ignorant dolt he was.

Obviously Trump thinks that video clips of his swinging a golf club are impressive or he wouldn't post them (someone shares the Truth Social posts on X):

Between what comes through Trump's brain and out of his mouth and what pops into his mind and onto Truth Social via his stubby fingers leaders of the world's democracies are no doubt dreading the possiblity he'll become president again.

From the rally speech:

Today he’s (Biden) with the people from NATO and these people show up. I know very well every one of them. They’re very smart. They’re at the top of their game, and then they’re saying, “What the hell is with this guy? We know we can’t figure out –”

You know I saved NADDO [sic] because when I went down — hey, Barack Hussein Obama, has anyone ever heard of him?

He would go, he would go and, you know, go to wherever the holding had a meeting and he’d make a nice speech and Bush would go and make a nice speech and he would leave, in all fairness. Bush, Bush!

But he makes a nice speech and they’re all going to make speeches, and then they wouldn’t even stay there a day.

I went and didn’t make a nice speech. I said, what the hell are you doing? Nobody’s paying, nobody was paying.

And I didn’t want to be obnoxious because I felt it was the first time I’d ever done this. And what? I didn’t even know what the hell NATO was too much before, but it didn’t take me long to figure it out. Like about two minutes.

And the first thing I figured out was they weren’t paying. We were paying. We were paying almost fully for, you know, and and I said, that’s unfair, but I didn’t want to make a big mess.

And I was president in — for about 15 minutes. And I didn’t want you to know go after NATO as my first —

But, but six months later, I went back to the second meeting and I said, you know what? You’re not paying your bills. You got to pay your bills. So somebody stood up from from one of the countries, 28 countries, and only seven were paying what they should be paying. 28 countries, think of that. And these countries now we added a couple but 28 countries. And they said, sir, could I ask you? I said, “you have to pay your bills.”

They said, “Sir, may I ask you a question. If we don’t pay your bills, will you protect us from Russia?”

I said, “You mean you’re delinquent?”

They said, “Yes, we’re delinquent. Let’s say we’re delinquent, will you protect us?”

I said, “No, I will not protect you from Russia.”

The money came in by the billions!

You can read this and previous blogs on two websites and on Substack. One may look better than the other because of how the platforms present the page.

Read on the WordPress Stressline.org (you can subscrbe to this on the upper left)

or….

Read on the Google Blogger platform HalBrown.org This version has a Disquis comment section which makes it easy to post links and images.

or… Hal’s Substack where you can sing up to get an email when I post a new blog.

Changing a lie believing brain with psychology, logic, and attempts at rational persuasion may be futile: psychopathology, neuroscience, ingrained cultural metaphors

 

By Hal Brown, MSW, psychotherapist and mental health center director retired after 40 years of clinical practice.

Yesterday I praised Chauncey DeVaga for his Salon column which featured the opinions of two esteemed psychoanalysts, Justin Frank and Lance Dodes, both of whom have warned of the dangers of Trump's psychopathology for years.

If you missed the blog you can read it here: Dr. Justin Frank, author of "Trump on the Couch" gives us understatement of the decade about Trump's behavior.

I am on the email list for NeuroscienceNew.com and by coincidence was sent the article The Language of Lies: How Hate Speech Engages Our Neural Wiring to Foster Division which I found presented another perspective on what I wrote about yesterday.

The article describes the research described In the book "Politics, Lies and Conspiracy Theories, just released, by Marcel Danesi Ph.D., a professor of semiotics and linguistic anthropology at the University of Toronto, Canada. He analyzes the speeches of dictators including Mussolini, Stalin, Putin and Hitler, as well as prominent hate groups.

Here's the summary:

Researchers analyze the language of dictators and hate groups, uncovering a common use of dehumanizing metaphors to fuel hatred. Such metaphors ‘switch on’ neural pathways in the brain, bypassing higher cognitive reasoning centers and steering focus towards certain ideas.

These mental patterns can become entrenched over time, making it challenging for individuals to revise their views even in the face of contradicting evidence.

The research underscores the potential dangers posed by such language, including the escalation of violence and political instability.

Danesi's research shows that such dehumanizing metaphors are powerful "because they tap into and ‘switch on’ existing circuits in the brain that link together important and salient images and ideas. In effect, metaphors bypass higher cognitive reasoning centers, directing our thoughts to focus on certain things whilst ignoring others."

He observes that the more these brain circuits are activated the more hardwired they become. Eventually they.becomes almost impossible to turn off. This can be see with those who believe conspiracy theories. The more the therapies are reinforced the more difficult it becomes to lead these people to rethink their basis of their beliefs and realize they are wrong. 

The conclusion is far from optimistic:

What can be done?

Is there anything we can do to protect ourselves from the power of lies? According to Danesi, the best thing we can do is to understand the metaphors of the other party, and to examine one’s own metaphors.

However, history and science tells us that it is unlikely to work – research shows that once a lie is accepted as believable, the brain becomes more susceptible to subsequent lying.

Those mental health professionals who are attempting to understand the entrenched and erroneous  belief systems of Trump and his hard-core supporters tend to lean toward those who employ an understanding of the way the mind functions based of Freudian, or psychoanalytic theory (the reason for my photo of Freud's couch above).

I count myself among these mental health practitioners who have been trained in psychoanalytical personality theory and either psychoanalysis for them and psychodynamic psychotherapy for me. 

A highly regarded expert explaining the behavior and beliefs of Trump and his cult  is Bobby Azarian, PhD.  He comes from the world of cognitive neuroscience. Unlike Justin Frank, Lance Dodes, John Gartner, Bandy Lee, and far less prominent mental health professionals like me, who have written about Trump's psychology from a psychodynamic perspective, Azarian writes from what I might call simplistically a brain perspective. Another way to put colloquially it is that he writes about the hard wiring of the brain.

Chauncey DeVega interviewed Bobby Azarian in 2019 here:

Racism on the brain: a neuroscientist explains how the world moved right

"The effects of fear and anger [on the brain]" may make us even more polarized, says neuroscientist Bobby Azarian

His "Psychology Today" articles related to Trump and his followers have titles and subtitles like these: 

There's a glitch on the link to his articles, here, so it is temporarily unavailable. Hopefully this will be repaired before long. You can get an idea of what he writes about from the titles and subtitles of his most recent articles related to Trump and his cult.

How Trump and Media Allies Target the Mentally Vulnerable

Bogus conspiracy theories will undoubtedly play a major role in the upcoming presidential election. The question is whether anything can be done about it.

Study: Trump Tuned in to America’s Collective Narcissism

Is the nation's collective narcissism the reason for Trump's popularity and political invincibility? A study suggests a causal link between the phenomena.

Why Evangelicals May Be Hardwired to Believe Trump's Falsehoods

This brain quirk makes gaslighting particularly easy.

Why Is Trump So Popular?

Research suggests that the president is more intuitive than analytical.

The Belief That Trump Is a Messiah Is Rampant and Dangerous

Was Donald Trump sent by God to save America? Some believe so, and that should have us worried.

How Political Rhetoric Inspires White Nationalist Terror

President Trump’s divisive rhetoric can warp a person’s mind into believing that domestic terrorism is justifiable.

A Complete Psychological Analysis of Trump's Support

Baffled by Donald Trump's political invincibility? Here are 14 reasons why people continue to support the president despite behavior that would have sunk any other politician.

Trump Is Gaslighting America Again — Here’s How to Fight It Gaslighting refers to a type of psychological manipulation used to get people to question their direct experience of reality. It's also one of the president's favorite techniques.

An Analysis of Trump Supporters Has Identified 5 Key Traits

The president's backers share some consistent and troubling characteristics.

My point is sharing the Neuroscience News article and referencing Bobby Azarian's insights is to emphasize how complex addressing the underlying problem of how, if not insurmountable a task it is, how massive an endeavor it is to alter these deeply held beliefs.

Addendum: There's yet a third aspect to understanding Trump and those in power like him, and the hold they have on their supporters. George Lahoff, retired Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley and now Director of the Center for the Neural Mind & Society has written frequently about this subject and Trump in particular. He was writing about his take on "Understanding Trump" (read essay here) as early as 2016.  His focus in on the often incredible power cultural metaphors have on people. 

It is vitally important to grasp how psychodynamics, the wiring of the brain, and ingrained cultural metaphors among certain groups not only influence but shape belief systems and resulting behaviors. These phenomena are interrelated but also must be understood in their own right to gain a complete grasp of why people think and act the way they do for the betterment of society and their own selfish needs to the detriment of society as a whole.