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.
