Take Away His Keys
Donald Trump suffers from two diagnosed disorders that should be of deep concern to the American voters.
One of the disorders -Mild Neurocognitive Disorder (early dementia) — is disturbing because it is a deteriorating condition that calls into question his ability to handle any job, much less the presidency of the United States.
Before spelling out the ramifications of this disorder, we need to demonstrate that Trump warrants such a diagnosis.
Trump no doubt believes he has avoided scrutiny on his brain health by refusing to release his medical records or collaborate in a comprehensive neuropsychological exam. (We should note that Trump boasts that he has successfully handled “cognitive tests.” This assertion is misleading. In 2018, he took and passed a 5-minute screening exam for full-scale dementia, not early dementia, which requires more comprehensive and rigorous testing).
It turns out Donald Trump has, unwittingly, already participated in a cognitive exam, and the results reveal he suffers from neurodegenerative brain disease.
Thanks to reams of videotape on Trump, we have access to many behavioral observations to evaluate for possible cognitive decline. Direct behavioral observation is particularly relevant for the language domain, primarily consisting of verbal expressive behavior. Fortunately, this domain does not require collaboration with Trump since you can directly execute a detailed, clinically meaningful appraisal from many speech samples readily available on YouTube. Furthermore, by comparing speech samples from the past to the present, you can zero in on possible decline — the key shift that reveals neurodegenerative disease — in the language domain.
Thus, we have abundant data in the language domain to evaluate possible neurological dysfunction. The data reveals that Trump is displaying an accelerating decline. Detailed findings from one study that shows Trump’s struggles with language that are indicative of brain illness can be found here and here. A review of other studies documenting his decline with language can be found here. There is accumulating data that Trump meets diagnostic criteria for neurodegenerative disease.
What are the reasons to be deeply concerned about Trump because of this diagnosis?
Once you cross the diagnostic threshold into Mild Neurocognitive Disorder, which Trump did at least a year ago, you are no longer in the category of gradual and often circumscribed decline associated with normal aging. Instead, once you get the diagnosis, your rate of cognitive decline accelerates. The risk of progressing to full-scale dementia, with its accompanying loss of functioning in basic activities of living such as traveling, feeding, and toileting, increases by 15% each year after diagnosis of early dementia. If not earlier, Trump appears to have checked the box for that diagnosis in 2023
.You also start to see the decline, not just in language but also with memory, attention, executive skills, emotional intelligence, and perceptual-motor skills. The result? Typically, the patient begins to have difficulty recalling recent events, struggles to understand complex material or concepts, displays decreased empathy and inhibition, may exhibit pronounced mind-wandering, and shows less capacity to understand others’ speech.
Donald Trump’s cognitive decline is accelerating. Suppose you take a checklist of empirically-derived markers of language indicative of early dementia and apply them to any recent rally, any recent interview, or his debate with Vice-President Harris (which I did). In that case, he checks the box for neurodegenerative disease. At this point, we can simply note that he has passed the duck test (“If it looks like a duck, walks like a duck, and quacks like a duck, then it probably is a duck”). Here are a few of the many instances of the duck quacking, of the ex-president struggling to communicate coherently.
Donald Trump’s second disorder — Psychopathic Personality Disorder — is even more alarming.
The essence of clinical psychopathy, also referred to as malignant narcissism, is captured by its three governing traits, as follows:
(1) Impulsivity — characterized by the inability to inhibit impulses or grapple with any issue that doesn’t serve the psychopath’s immediate, egocentric needs.
(2) Remorselessness — characterized by an utter lack of conscience, linked to an inability to experience states of guilt, shame, and fear that might curb immoral, cruel, or norm-shattering behavior.
(3) Drive to dominate — characterized by a one-dimensional focus on “winning” in all relationships, fueled by arrogant, manipulative, and deceitful behavior.
Proof of this disorder? This condition is evaluated using a rigorous and empirically validated assessment process. It requires some advanced training on how to conduct the evaluation and, most critically, a great deal of life history information to confirm the diagnosis. Interestingly, it does not require an interview. Indeed, there is some evidence that an interview with a psychopath detracts from the evaluation because of their facility for lying.
This wealth of behavioral observations and biographical information on Trump has enabled us to conduct that gold standard evaluation to assess this relatively rare (less than 1% of the population) and severe personality disorder. Donald Trump meets the rigorous diagnostic criteria for that disorder: he is a clinical psychopath. You can find the results of that evaluation here and here.
Why is this diagnosis more alarming? Here, we have to acknowledge the political skill sets that accompany the psychopath’s set of destructive traits. These traits may help the psychopath win elections, even if they are a disaster for the welfare of our republic.
Political power exists in a psychopath’s (Trump’s) drive to dominate trait. Polarization and domination are preternatural skill sets for Trump. “Love to have enemies,” he told an interviewer from Time magazine in 1989. “I fight my enemies. I like beating my enemies to the ground.”
Psychopaths are also adept at stoking grievances in others. Since they often feel aggrieved, they know how to tap into that feeling in others. They know the language of victimization. They are skilled in the art of trolling. They have exceptional skills in whipping up people’s resentments. He has effectively exploited grievances in others to make it easy to ignore his falsehoods.
The man could teach a master class on the dark political arts.
Trump’s remorselessness enables him to lie, cheat, scapegoat immigrants, swallow the dog whistle of racism, and treat others with breathtaking callousness. There is no ember of shame or guilt to constrain him. A man with no capacity for guilt or shame is an alarming opponent. He will do anything to win, whatever the risk or collateral damage.
These traits were displayed during the campaign, where there was a relentless assault on the truth and not a hint of substance. It was all red meat theatre: the world painted as a desolate and dangerous place; America in a state of rampant crime careening toward catastrophe; immigrants invading our towns and cities: political opponents demonized and threatened. Trump spewed out fear and anger, jacking up tribal feelings to the rafters. His traits have infected the body politic. To a shocking degree, cruelty, nihilism, and deceit have become normalized in our civil society and political class.
What kind of threat does a clinical psychopath in the Oval Office pose? Their impulsivity, lack of empathy, and arrogance result in their inability to act predictably, react calmly and without aggression, examine their own behavior and accept responsibility, respect boundaries and limits, and place others’ interests or the common good above their own.
All of these tendencies have the gravitational pull of a black hole. Over time, the social network over which the psychopath has influence slides toward disruption and deterioration. This storm of ruinous traits is not going to dissipate. No repair is possible. The best we can do is recognize its presence and try to protect ourselves.
To protect our now fragile democracy, an informed citizenry with more profound insight into the nature of this clear and present danger is needed. Get yourself and ten friends to the polls.
