[Trump's moments of slurred speech, cognitive and other anomalies] call attention to the alarming absence of a system to evaluate elected officials’ fitness for office—to reassure concerned citizens that the “leader of the free world” is not cognitively impaired, and on a path of continuous decline.
Proposals for such a system have been made in the past, but never implemented. The job of the presidency is not what it used to be. For most of America’s history, it was not possible for the commander in chief to unilaterally destroy a continent, or the entire planet, with one quick decision. Today even the country’s missileers—whose job is to sit in bunkers and await a signal—are tested three times per month on their ability to execute protocols. They are required to score at least 90 percent. Testing is not required for their commander in chief to be able to execute a protocol, much less testing to execute the sort of high-level decision that would set this process in motion.
The lack of a system to evaluate presidential fitness only stands to become more consequential as the average age of leaders increases.
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After age 40, the brain decreases in volume by about 5 percent every decade.
The Atlantic
So, when I say, "I'm losing it," it's not just a figure of speech.
The most noticeable loss is in the frontal lobes. These control motor functioning of the sort that would direct a hand to a cup and a cup to the mouth in one fluid motion—in most cases, without even looking at the cup.
Something we've seen Trump have trouble with at least twice in the past.
These lobes also control much more important processes, from language to judgment to impulsivity. [...] An annual presidential physical exam at Walter Reed National Military Medical Center is customary, and Trump’s is set for January 12. But the utility of a standard physical exam—knowing a president’s blood pressure and weight and the like—is meager compared with the value of comprehensive neurological, psychological, and psychiatric evaluations. These are not part of a standard physical.
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A president could be actively hallucinating, threatening to launch a nuclear attack based on intelligence he had just obtained from David Bowie, and the medical community could be relegated to speculation from afar.
To be fair, though, even if there were such a requirement, could the president's doctor be trusted to evaluate fairly and tell the truth? Certainly not any who have given us a report on his health to date.
Trump was once a more articulate person who sometimes told stories that had beginnings, middles, and ends, whereas he now leaps from thought to thought. He has come to rely on a small stable of adjectives, often involving superlatives. An improbably high proportion of what he describes is either the greatest or the worst he’s ever seen; absolutely terrible or the best; tiny or huge.
The frontal lobes also control speech, and over the years, Donald Trump’s fluency has regressed, and his vocabulary contracted.
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He also more frequently finished sentences and thoughts.
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Ben Michaelis, a psychologist who analyzes speech as part of cognitive assessments in court cases, told Begley that although some decline in cognitive functioning would be expected, Trump has exhibited a “clear reduction in linguistic sophistication over time” with “simpler word choices and sentence structure.”
And a tweety bird's focus:
People want the border wall. My base definitely wants the border wall, my base really wants it—you’ve been to many of the rallies. Okay, the thing they want more than anything is the wall. My base, which is a big base; I think my base is 45 percent. You know, it’s funny. The Democrats, they have a big advantage in the Electoral College. Big, big, big advantage ... The Electoral College is very difficult for a Republican to win, and I will tell you, the people want to see it. They want to see the wall.
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This is evident even off camera, as in last week’s post-golf sit-down with The New York Times at his resort in Florida:
The tax cut will be, the tax bill, prediction, will be far bigger than anyone imagines. Expensing will be perhaps the greatest of all provisions. Where you can do something, you can buy something … Piece of equipment … You can do lots of different things, and you can write it off and expense it in one year. That will be one of the great stimuli in history. You watch. That’ll be one of the big … People don’t even talk about expensing, what’s the word, “expensing.” [Inaudible.] One-year expensing. Watch the money coming back into the country, it’ll be more money than people anticipate. But, Michael, I know the details of taxes better than anybody. Better than the greatest CPA. I know the details of health care better than most, better than most. And if I didn’t, I couldn’t have talked all these people into doing ultimately only to be rejected. Now here’s the good news. We’ve created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. Millions of people. That’s gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that’s a big thing …
The paper said that the transcript was “lightly edited for content and clarity.”
Jesus Christ, it was worse than that?
If Trump’s limited and hyperbolic speech were simply a calculated political move [...] then we would also expect an occasional glimpse behind the curtain. In addition to repeating simplistic phrases to inundate the collective subconscious with narratives like “no collusion,” Trump would give at least a few interviews in which he strung together complex sentences.
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Reagan announced his Alzheimer’s diagnosis in 1994, but there was evidence of linguistic change over the course of his presidency that experts have argued was indicative of early decline. His grammar worsened, and his sentences were more often incomplete. He came to rely ever more on vague and simple words: indefinite nouns and “low imageability” verbs such as have, go, and get.
After Reagan’s diagnosis, former President Jimmy Carter sounded an alarm over the lack of a system to detect this sort of cognitive impairment earlier on. “Many people have called to my attention the continuing danger to our nation from the possibility of a U.S. president becoming disabled, particularly by a neurologic illness,” Carter wrote in 1994 in the Journal of the American Medical Association. “The great weakness of the Twenty-Fifth Amendment is its provision for determining disability in the event that the president is unable or unwilling to certify to impairment or disability.”
Indeed, the 1967 amendment laid out a process for transferring power to the vice president in the event that the president is unable to carry out the duties of the office because of illness. But it generally assumed that the president would be willing to undergo diagnostic testing and be forthcoming about any limitations.
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Carter called on “the medical community” to take leadership in creating an objective, minimally biased process—to “awaken the public and political leaders of our nation to the importance of this problem.”
More than two decades later, that has not happened. But questions and concern around Trump’s psychiatric status have spurred proposals anew. In December, also in the Journal of the American Medical Association, mental-health professionals proposed a seven-member expert panel “to evaluate presidential fitness.”
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The real-world application of one of these systems is complicated by the fact that the frontal lobes also control things like judgment, problem-solving, and impulse control. These metrics, which fall under the purview of psychiatrists and clinical psychologists, can be dismissed as opinion.
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Indeed, thousands of mental-health professionals have mobilized and signed petitions attesting to Trump’s unfitness to hold office. Some believe Trump should carry a label of narcissistic personality disorder, antisocial personality disorder, or both. The largest such petition has more than 68,000 signatures—though there is no vetting of the signatories’ credentials. Its author, the psychologist John Gartner, told me last year that in his 35 years of practicing and teaching, “this is absolutely the worst case of malignant narcissism I’ve ever seen.”
Many other mental-health professionals are insistent that Trump not be diagnosed from afar by anyone, ever. [...] A personality disorder is “only a disorder when it causes extreme distress, suffering, and impairment,” argues Allen Frances, the Duke University psychiatrist who was a leading author of the third edition of the Diagnostic and Statistical Manual, which was the first to include personality disorders.
Fine. Trump's personality disorders cause the rest of us extreme distress, suffering and impairment.
After more than a year of considering Trump’s behavior through the lens of the cognitive sciences, I don’t think that labeling him with a mental illness from afar is wise. A diagnosis like narcissistic personality disorder is too easily played off as a value judgment by an administration that is pushing the narrative that scientists are enemies of the state. Labeling is also counterproductive to the field in that it presents risks to all the people who deal with the stigma of psychiatric diagnoses. To attribute Trump’s behavior to mental illness risks devaluing mental illness.
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The idea that the president should not be diagnosed from afar only underscores the point that the president needs to be evaluated up close.
A presidential-fitness committee—of the sort that Carter and others propose, consisting of nonpartisan medical and psychological experts—could exist in a capacity similar to the Congressional Budget Office. It could regularly assess the president’s neurological status and give a battery of cognitive tests to assess judgment, recall, decision making, attention—the sorts of tests that might help a school system assess whether a child is suited to a particular grade level or classroom—and make the results available.
Good idea. A committee. It'll never happen.
Even if every member deemed a president so impaired as to be unfit to execute the duties of the office, the role of the committee would end with the issuing of that statement. Acting on that information—or ignoring or disparaging it—would be up to the people and their elected officials.
So...it probably wouldn't matter anyway. At least not with a president like Trump and a Republican political party like we have now.
...but hey, do what you want...you will anyway.
