Sunday, December 30, 2018

Is Something Neurologically Wrong With Donald Trump?

Trump and Wilson: mentally incapacitated occupants of the White House?
Many mental health professionals believe Donald Trump suffers from mental illness - e.g., malignant narcissism disorder - including Virginia's governor who is a neurologist by profession.  A recent post , in fact, set out the attributes of this mental disorder all of which appear to apply to Trump in every detail.  But a very lengthy piece in The Atlantic suggests that Trump may have other mental health impairments and looks at the USA's shocking lack of any mandatory system to evaluate the mental health of a sitting occupant of the White House, something that is important in any would be application of the 25th Amendment as a means to protect the nation.  The issue is one of long standing and goes back 100 years to the presidency of Woodrow Wilson, who suffered a serious stroke which left he largely incapacitated and caused many to believe that his wife Edith came to function as almost de facto president.  A century later, we still have no method to determine a president's mental competence and Trump has brought the need for such a system back front and center.  Here are lengthy higligts from the article (read the entire piece): 

Donald Trump’s decision to brag in a tweet about the size of his “nuclear button” compared with North Korea’s was widely condemned as bellicose and reckless. The comments are also part of a larger pattern of odd and often alarming behavior for a person in the nation’s highest office.
Trump’s grandiosity and impulsivity have made him a constant subject of speculation among those concerned with his mental health. But after more than a year of talking to doctors and researchers about whether and how the cognitive sciences could offer a lens to explain Trump’s behavior, I’ve come to believe there should be a role for professional evaluation beyond speculating from afar.
I’m not alone. Viewers of Trump’s recent speeches have begun noticing minor abnormalities in his movements. In November, he used his free hand to steady a small Fiji bottle as he brought it to his mouth. Onlookers described the movement as “awkward” and made jokes about hand size.
Then, in December, speaking about his national-security plan in Washington, D.C., Trump reached under his podium and grabbed a glass with both hands. This time he kept them on the glass the entire time he drank, and as he put down the glass. This drew even more attention. The gesture was like that of an extremely cold person cradling a mug of cocoa. Some viewers likened Trump to a child just learning to handle a cup.
Then there was an incident of slurred speech. Announcing the relocation of the American embassy in Israel from Tel Aviv to Jerusalem—a dramatic foreign-policy move—Trump became difficult to understand at a phonetic level, which did little to reassure many observers of the soundness of his decision.
The neurosurgeon Sanjay Gupta described it as “clearly some abnormalities of his speech.” This sort of slurring could result from anything from a dry mouth to a displaced denture to an acute stroke.
Though these moments could be inconsequential, they call attention to the alarming absence of a system to evaluate elected officials’ fitness for officeto 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. The Constitution sets finite lower limits on age but gives no hint of an upper limit.
After age 40, the brain decreases in volume by about 5 percent every decade. 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. 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.
Even if they were voluntarily undertaken, there would be no requirement to disclose the results. 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.
With declining support for fact-based discourse and trust in expert assessments, would there be any way of convincing Americans that these doctors weren’t simply lying, treasonous “liberals”—globalist snowflakes who got triggered?
The downplaying of a president’s compromised neurological status would not be without precedent. Franklin Delano Roosevelt famously disguised his paralysis from polio to avoid appearing “weak or helpless.” He staged public appearances to give the impression that he could walk . . . .
Unfortunately, the public medical record available to assuage global concerns about the current president’s neurological status is the attestation of Harold Bornstein, America’s most famous Upper Manhattan gastroenterologist, whose initial doctor’s note described the 71-year-old Trump as “the healthiest individual ever elected to the presidency.”  The phrasing was so peculiar for a medical record that some suggested that Trump had written or dictated the letter himself.
The frontal lobes also control speech, and over the years, Donald Trump’s fluency has regressed, and his vocabulary contracted. In May of last year, the journalist Sharon Begley at Stat analyzed changes in his speech patterns during interviews over the years. . . . He also more frequently finished sentences and thoughts.
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.”
[T]hough it is not possible to diagnose a person with dementia based on speech patterns alone, these are the sorts of changes that appear in early stages of Alzheimer’s. Trump has likened himself to Ronald Reagan, and the changes in Trump’s speech evoke those seen in the late president. 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.
[A]fter 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.” 
[I]t generally assumed that the president would be willing to undergo diagnostic testing and be forthcoming about any limitations.  This might not happen with a person who has come to be known for denying any hint of weakness or inability. Nor would it happen if a president had a psychiatric disorder that impaired judgmentespecially if it was one defined by grandiosity, obsession with status, and intense aversion to being perceived as weak.
It was for these reasons that in 1994, Carter called for a system that could independently evaluate a president’s health and capacity to serve. At many companies, even where no missiles are involved, entry-level jobs require a physical exam. A president, it would follow, should be more rigorously cleared. 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.”
[Q]uestions 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.” Last April, Representative Jamie Raskin introduced a bill that would create an 11-member “presidential capacity” commission.
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. In a hospital or doctor’s office, a neurologist may describe a patient with Parkinson’s disease as having “impaired impulse control.” The National Institute on Aging lists among the symptoms of Alzheimer’s “poor judgment leading to bad decisions.”
[T]housands 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.”
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.
That math and polling can be ignored or disputed, or the CBO can be attacked as a secretly subversive entity, but at least some attempt at a transparent analysis is made. The same cannot be said of the president’s cognitive processes. We are left only with the shouts of experts from the sidelines, demeaning the profession and the presidency.

No comments: