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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Read my previous Substacks.

If Trump was told and forgot about what was reported by The Atlantic this could be solid evidence he has dementia, By Hal M. Brown, MSW, Retired psychotherapist.

 

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Short term memory loss is one of the primary symptoms of early dementia. I’ve been agnostic on what other mental health professionals point to as indications of his having dementia. I see this as possibly being just as plausibly Trump feleing unleashed and more majic than usual when he goes off on a rant.

Read:

Also read this earlier essay:

The June 2016 Article in The Atlantic wasn’t the most alarming early article about how dangerous Trump’s psychopathology was. That would be Dr. John Gartner’s Donald Trump's malignant narcissism is toxic in USA Today published on Mar. 4, 2017. The Atlantic does feature it as their cover story and it doesn’t have a particularly unflattering photo of the preening nacrssist who is so concerned about how he is depicted. See what I wrote about Trump’s obsession with how he looks yesterday.

Here are two other 2017 Atlantic articles, one of them has Trump on it and the other a sinking White House.

The Atlantic has not been kind to Donald Ttump. It is clearly on his shit list.

The the psychologist’s article in the June, 2016 edition wasn’t effusive in praising him. It thought it was rather mild. But it is by a clincial psychologist who did not say he was the most mentally healthy person in the world. I’d be surprised if he didn’t have a copy of the magazine given to him because he was on the cover.

It’s possble this was an early contributor to Trump’s animosity toward the magazine.

(I published a portion of the following yesterday.)

Here’s a summary of the article:

In the 2016 presidential election, Republican nominee Donald Trump has thrown this year’s contest for President of the United States into a tailspin. A conventional presidential candidate, he’s not.

In June 2016, the Atlantic Monthly ran a front page cover story covering the psychology and mind of Donald Trump. For political scientists, fundamental features of human personality—such as extroversion and narcissism—help shape the distinctive leadership styles of our elected officials and the decisions they make. Dan P. McAdams writes about Trump’s dispositions, cognitive styles, motivations and self-conceptions that comprise his unique psychological makeup.

The Department of Political Science at Cal Poly Pomona has assigned the Atlantic Monthly article for summer reading. Freshman and transfer students have been given a copy of June’s Atlantic Monthly to read up on Trump and other current political events. When school resumes in September, professors will discuss McAdams’s article with students in various courses and at department events.

Read the Atlantic Monthly article here. 

Trump may have just revealed the most compelling evidence that he has early dementia. This happened when he was asked about the number one story of the past two days. 

You have to actually watch this video to understand my suggestion that Trump’s reaction to being asked about the security breach could be strongest indication Trump now has dementia.

Excerpt:

Asked about Monday's story by The Atlantic that top cabinet officials and aides used Signal and texted war plans to a reporter, Trump said, "I don't know anything about it. I'm not a big fan of The Atlantic. To me it's a magazine that's going out of business. I think it's not much of a magazine. But I know nothing about it. You're saying that they had what?"

Trump added in his comments that it was the first he was hearing about the alleged sharing of the information.

There aren’t too many plausible explanations why Trump didn’t have a coherent answer. Either none of the officials in on the Signal chat didn’t know that the news had come out that the editor of The Atlantic revealed that he was in on the classified message chain. How could that be possible since it was the main story in the news for two hours? They should know that Trump could have learned about it from watching TV. How could they risk Trump finding out about it not from them but on TV?

Watch that video of Trump. He appears confused. He seems to know nothing about the incident. He launches into an attack against The Atlantic. 

If Trump was told about this or learned about it on TV, or was told about it by an official, and forgot about it, one objectively has to call this short term memory loss. This is a major symptom of dementia.

Even if Trump had no knowledge of the security disaster he was clearly put off balance by the question. Going with this explanation would mean that he jumped to the conclusion that this was fake news because it was reported in The Atlantic. 

If Trump was not the volatile angry person he is and for whatever reason he wasn’t aware of this he would have known that The Atlantic is a credible news source. He would have had the reporter who asked the question carefully explain to him what was reported in the story. 

This would have put Trump in the worse than embarrassing position of having to throw some or all of his national security officials under the bus. He would have to say that they were negligent in not keeping him in the loop and that he would investigate why this top secret information was shared with the editor of The Atlantic.

Everyone so far is talking about other aspects of this story. I suggest we all look at this possibly being this is the strongest evidence to date that he may have dementia.

Read my previous Substacks.

Whether it's demented or not, we're all now at the mercy of Trump's big brain, by Hal M. Brown.

 

How the holy Hell does Hezbo-f*cken-llah being involved in Jan. 6th pop into Trump's brain when he's downplaying what happened on Jan. 6th? 

Here's is the excerpt about this from HuffPost:

Trump took questions from reporters near the end of the roughly hour-long remarks, during which he pledged to make “major pardons” for people convicted of participating in the Jan. 6, 2021, insurrection at the U.S. Capitol.

Asked if he intends to pardon anyone convicted of violent offenses for their actions that day, Trump dodged — instead appearing to blame both the FBI and Hezbollah, an Iran-backed militant group in Lebanon, for the violence.

“We have to find out about Hezbollah, we have to find out about who, exactly, was in that whole thing,” Trump said. “Because people that did some bad things were not prosecuted.”

Hezbollah? Really? These guys?

Trump likes to brag about how intelligent he is. He characterizes this by saying he has a very, very big brain. Consider this from a science website:

Trump's "Very, Very Large Brain" Comment Underscores Myth About Intelligence

Intelligence has a lot more to do with what's inside your brain than its size.

BY SARAH SLOAT

SEP. 27, 2018

Excerpt:

President Donald Trump has repeatedly dedicated moments of his presidency to informing the public about his intelligence. A few weeks before he took office, Trump announced he didn’t need daily intelligence briefings because “I’m, like, a smart person.” In January, he reminded everyone on Twitter that his “two greatest assets have been mental stability and being, like, really smart.” Now, he’s telling reporters about his “very, very large brain.” But contrary to longstanding claims, a bigger brain doesn’t mean a smarter man.

Speaking at a press conference in New York on Wednesday, Trump referenced an interview that Michael Pillsbury, the Hudson Institutes director for Chinese strategy, gave to Fox News last month. Pillsbury said that China respects Trump because he is “so smart.”

“If you look at Mr. Pillsburgy, the leading authority on China, he was on a good show — I won’t mention the name of the show — recently,” Trump said. “And he was saying that China has total respect for Donald Trump and for Donald Trump’s very, very large brain.”

The article explains that the size of a brain has nothing to do with intelligence: "Assuming that absolute brain size is decisive for intelligence, then whales or elephants should be more intelligent than humans, and horses more intelligent than chimpanzees, which definitely is not the case.” 

Perhaps Trump really believes his brain is literally larger than 99.9% of the world's population and that this means his IQ ranks in the upper 1/10 of one percent. Of course this would put him off the top of the IQ test scales at the Einstein level.  

If brain size determined intelligence, Trump would be less intelligent than he was as a young man because brains shrink as people age:

"Your cerebral cortex, the wrinkled outer layer of the brain, gets thinner as you age. It's especially noticeable in the frontal lobe, which processes memory, emotions, impulse control, problem-solving, social interaction, and motor function. Thinning can also be noticeable in parts of the temporal lobe, which is located behind the ears and helps people understand words, speak, read, write, and connect words with their meanings." WebMD

The brain shrinking, or atrophy, that is inevitable when one ages does not affect intelligence. What does happen with some people when they age is that they develop one or another form of dementia. 

Human brains weigh between 2.8 to 3.1 pounds. Brain size can vary slightly among different populations and individuals. Gender also plays a role in brain size variations. On average, male brains are about 10% larger than female brains. However, this difference disappears when accounting for body size, and importantly, there’s no evidence that this size difference translates to any cognitive advantages. (Reference: Human Brain Size: Exploring Dimensions, Comparisons, and Evolutionary Significance)

There's no way of knowing if Trump has dementia at this point. There's no actual diagnostic test for it like an MRI which can find a brain tumor that is affecting behavior. A dementia diagnosis can only be made with a full neurological assessment. Whether you're an expert or a lay person you can only reach a conclusion based on your observations of Trump's behavior.

Without this we are left with looking at Trump's behavior to try to discern whether these recent examples of his throwing out abberant ideas are a manifestion of brain disease or of Trump's psychological condition. It may very well be the latter. Trump may be feeling that, since he has won the election, he can totally let loose and express any thought no matter how weird or unrealistic that pops into his mind. 

A personal note: When group of residents in the senior community where I live started an improv group, I didn't even consider joining even though I thought it would be fun. I think I have a modicum of talent for this. I knew I couldn't do improv without being able to go blue and unleash my inner Lenny Bruce.

Where did Hezbollah come from when he was trying to gaslight about Jan. 6th? You can say it doesn't matter. Maybe it doesn't. It could be that he'd been seeing stories about it on the news or reading about it since. It has been in the news:

We are still left with not knowing what is really going on in Trump's big brain. It could be that he's showing more signs of dementia. It could be that we're seeing the true Trump unleashed in all his unhinged glory.

If this is dementia one thing is certain: it will get worse. If this occurs there will be a point where it will be impossible to hide given Trump's lust to be in the limelight and his being a motor mouth. He won't have the advantage of being given questions in advance like he was 30 minutes before his Fox News Iowa Town Hall (see article). Besides, even being given a heads up about questions wouldn't make a difference since the results of an election won't be in the balance. He won't feel he has to come across as presidential.

There is no way anyone with severe dementia can present as cognitively unimpaired. If this happens we have the 25th Amendment scenario. I have no doubt that once it is obvious to the public, Vance would lose his loyalty to Trump in a New York minute.

 

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Am I the only anti-Trump shrink who thinks Trump may not have dementia? By Hal M. Brown, MSW

Many mental health professionals are absolutely, positively convinced Trump has dementia. I seem like a lone voice among them saying we need more evidence. 

Most mental health professionals who are saying this are not neurologists, let alone neurologists who specialize in dementia. 

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.

---------------------------------------------------

I post my blogs on Stressline.org where you can subscribe (for free everywhere) and on Substack where, if you want to submit your email, you can be notified of all new blog posts. I also post them on Medium because this enables them to be easily found on internet searches.

The halbrown.org platform includes a Disquis comment section. To use it you have to register on Disquis.