The normalizing of Trump's mental decline

A group of mental health professionals points to signs of what they see as Trump's dementia, distinguishing it from Biden's normal aging. Dr. John Gartner, a psychologist, spoke with me about it.

John D, Gartner, Ph.D, is a psychologist who has been published in many journals and written several books, and writes for newspapers and magazines as well. He contributed to the bestselling book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.” He began a Change.org petition recently that has now been signed by hundreds of mental health professionals. 

It reads: 

Our diagnostic impression of Trump is probable dementia:

We, the undersigned licensed medical and medical health professionals…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. 

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Gartner joined me on my SiriusXM program last week. You can listen here. A transcript, edited lightly, is below.  

JG: Well, thank you so much for having me. And thank you so much for reading the words of the petition that we now have over 500 licensed professionals have signed the petition.

MS: So it's hundreds of licensed mental health professionals [who’ve signed this petition].

JG: Correct. And I think what's even more significant to me are the comments that they left, which you can read at our pinned tweet at @Duty2Warn, like 1.8 million people have already read it. 

And it's the comments of the actual signers, people saying, look, I'm a gerontologist. I'm a geriatric nurse. You know, I'm a neuropsychologist. I'm a neurologist at an academic medical center. These are the symptoms of dementia. And these are the examples, and these are people who are really taking a risk. Most doctors I know are pretty cautious people. And many were afraid to sign the petition. But these people are signing them under their own name, and they're explaining why.

MS: I remember when the book was published, The Dangerous Case of Donald Trump. There was some controversy over mental health professionals assessing someone's mental health. You know, people were talking about narcissistic personality disorder and other issues, assessing mental health without examining someone. And here there is that issue too. So talk a little bit about how you assess someone with regard to dementia without having examined them and how you can make the suggestion, if you will.

JG: Right, right. So three points with regard to that. 

The first, it's important that we make a distinction that even if you want to say I'm unethical for sharing the signs of dementia that we see in Trump, that doesn't mean I'm inaccurate. They’re two different things. So I at least want to make that distinction. 

But as far as the ethics is concerned, the short answer is if we learned anything from the Holocaust, it's that saying nothing is never the more ethical option. The longer answer is that, actually, the way we do diagnosis in our field has changed. 

After 1980, which was after the Goldwater rule was passed. We now use what we call “observable behavioral criteria” for making all diagnoses. So that means if you can observe someone's behavior, you actually can make a diagnosis. 

Now, of course, normally you do that in person. Although quite often we use informant reports as we have here, of so many people who are telling us about Trump's cognitive decline, people who are in his inner circle, who are saying they can't believe how much he's deteriorated in four years. 

So that's the longer answer, is that since the DSM came in, we're actually able to, make a reliable diagnosis if we have a good sample of behavior. 

And of course, we've all spent more time watching Trump's behavior than all of our patients put together, because he's in our lives, whether we want him to be or not.

MS:. The petition lists various issues:  1) decline from baseline; 2) memory, 3) language, 4) motor [skills]; 5) behavior. So you're looking at a variety of areas. Talk a little bit about the behavior you're seeing Trump engaged in that suggests dementia.

JG: Well just to run through it first of all we see a precipitous decline from his own baseline. So if you look at video of him speaking in the 1980s, he had a rich vocabulary. 

He spoke not only in complete sentences but actually polished paragraphs. So what we see is that, a great decline. 

Now he can barely finish a sentence. Sometimes he can't finish a word, and sometimes he doesn't use words at all. He just waves his hands and says, whoosh, boom. So this is a great regression from his Ivy League, baseline. Then we also see very specific signs of breakdown in language that are very telltale signs of dementia. One is something called a phonemic aphasia. Now, some of you have probably seen, you know, supercut reels of this on Twitter or comedy shows where he garbles a word. 

It's called a phonemic aphasia, where you use a non-word in place of a word, but it has some part of the word in it. So like when he says mishes instead of missiles or Chrishes instead of Christmas, he's not able to complete the word and he shows semantic aphasia where he uses words in ways that they don't mean, like the oranges of the investigation.

And he just goes on tangents where he literally becomes incomprehensible, where thought fragments are combined in a way that nobody could tell you what it was. He said, you know, he starts talking about the USS Gerald Ford, the aircraft carrier, apropos of nothing, and he says, “They stopped using the John Deere hydraulics. They want to use magnets. That's crazy. Magnets dissolve in water.” What does that even mean? 

You know, and there's so many examples of that. And what I feel is happening right now is that we're being gaslit. The press is pathologizing Biden's normal signs of aging, and they're normalizing Trump's blatant signs of of dementia. And so the people are really being told a kind of double lie. Either it’s twice as many people believe Biden is not as cognitively fit as Trump. Or we have the tired old “two old men” narrative, you know, we have a gerontocracy. And the point is that, look, we're talking about a tale of two brains here. Biden's brain is aging, Trump's brain is dementing. We're comparing apples to rotted oranges here. They're not the same.

MS: Wow. I want to come to Biden in a minute. What you described about Trump—we haven't even gone down to the other issues. That was just in the language part. Right? Some of us have attributed this to him misreading the teleprompter, like he can't really read it. So he says the word wrong. But you're you're saying that, no, it's not that. It's something in his brain.

JG: Right. And I'm not an expert in this area, but we have a lot of people on our group who are. And I picked their brains all the time, and I asked them questions like, well, do you see people who aren't brain-damaged do that? And they say, no, you know what I mean? 

It's very sort of pathognomonic of some real regressive brain damage. You know, you may get drunk, but you don't start speaking in nonsense or using non-words, you know, and also then you recover. It doesn't just get worse and worse and worse. Part of what we're seeing here, and this is really important for people to understand, is Trump is right now—you’re seeing the best Donald Trump you're ever going to see because dementia is a progressive illness. 

So he's already progressed an extraordinary amount in the last four years according to the people who know him best. But that rate of decline is going to accelerate. He's going to go downhill faster and faster. And then typically with patients like this, at a certain point, they go over what's called the cognitive cliff and they become completely disabled. I believe that Trump will become, if he were to become president again, I believe that he would become completely disabled while in office. I think it's very, very likely.

MS: So the next section you talk about is motor and behavior. Tell us about that.

JG: Yes. Well, the motor is interesting. There was an article in Salon right now where they've interviewed Dr. Elizabeth Zoffmann, who's a specialist in frontotemporal dementia, and she's pointed out that Trump has what's called a wide-based gait. He kind of swings his right foot like it's sort of a dead weight and kind of a semi-circular motion. It's not something that you would really notice that much or really attribute much to it if you weren't someone like her, a trained neuropsychiatrist. But that's a little bit of a tell. 

Also, his difficulty with fine motor in terms of, you know, being able to drink a bottle of water or a glass of water without using two hands. The other thing I really do want to mention, aside from from behavior, where he's basically becoming more dis-controlled, more irrational, more angry, more impulsive. In some ways it's hard to tell, right? But people are saying he is getting worse, and that's why he can't even stop himself from having outbursts in court. And the judges don't even think he's capable of doing that. But the last area I want to mention is memory, because that's the area that people have been, you know...

MS: Oh, right. Yes…

JG: …criticizing Biden about, you know, Biden called the president of France by the old president of France’s name. You know, I'm 67. I call my younger daughter by my older daughter's name. Like, that's part of normal aging. Okay? It doesn't make me dumb, okay. But that's different than what Trump is doing. The Dementia Care Society says that a sign of advanced dementia is when you start combining people and generations. You literally mash people together into one person. 

Like my uncle, before he had to go to memory care living, you know, said, “Somebody called John. He's a lawyer. He'll know what to do.”  Because my dad was a lawyer, so he made us one person. Trump showed us the combination of people when he made Nancy Pelosi and Nikki Haley one person. It wasn't a slip of the tongue, okay? It wasn't that he meant to say one name and he said the other. He gave a speech about the person I'm running against in this primary who was responsible for security at the Capitol. He actually confused the two people. You see the difference?

MS: Right. You know, I spoke to a neuroscientist about President Biden. And it was right around that time when, of course, The Hur Report came out. And then Biden gave the press conference and he said—he meant the president of Egypt— but he said the president of Mexico and the neuroscientist was saying, of course he knows the difference, right…

JG: Right, right, right. Exactly.

MS: The problem would have been if he didn't remember that he ever met the president of Egypt. Right. He was making the distinction between small f forgetting and big f forgetting.

JG: Yes. And and it's, it's, you know, the press isn't good at nuance, but we're going to have to get better. And this is why we need the voices of professionals, because these are huge distinctions. They're not the same.

MS:. Right. But what you're describing, what you're describing, this issue of basically mashing together people like Nikki Haley and Nancy Pelosi, are two women who, in his mind ,were just these these forces that he—

JG: Exactly—

MS: — is angry at. And he put them together and he's he's doing it with Obama and Biden, too. Yeah, exactly.

JG:  When he keeps saying Obama is president, I think he's mashing Biden and Obama together as well. And like you said, the association, you can see kind of the associative link in his mind. You know, Nikki Haley, Nancy Pelosi, strong women I don't like, you know, and because emotionally he hates both these women. But his brain is turning to mush. So he just mushed them into one big mashed potato woman.

MS: Yeah. Now, he's also said his father was born in Germany when that was his grandfather—

JG: So that's an example of combining generations. So there you have it.

MS: And he's failing to recognize old friends, according to Michael Wolff. Yes.

JG: That's exactly what um, Wolff, who wrote a book about him, said as he was shadowing him to write his book.

MS: So people around him must be seeing this. Certainly, you know, we're getting some reports of people who who say they see this, but the people around him every day must be seeing this in an enormous way.

JG: Well, and the thing is, this story is not going to go away. It's going to get bigger and bigger because he can't get through a rally now without some tell of his dementia and it's only going to get worse and worse. It's going to be harder and harder to hide, harder and harder to control. However, you know, I wouldn't put it past the press to find some way to normalize it. And, you know, I mean, if you read the headlines, you know, Trump “in a rambling speech,” you know, “promises a river of blood.” Okay, well, rambling doesn't really quite cut it if it's actually incomprehensible. You know, I like to say, you know, rambling is when you smoke too much pot and you don't remember, why you're in the middle, of telling a story. This is a breakdown in language and thinking so that you're not capable of communicating thought to another human being.

MS: Talk a little bit about how the press—you just described what the press is doing, and you were saying a little while ago how they have made Biden's normal aging into something abnormal, but they're making Trump's mental decline, dementia-possibility into something normal. How does that happen?

JG: Well, [laughs] you’re in the press. Help me understand.

MS: I mean, it's fascinating that we're seeing these things. I feel like is it because his decline has happened over a period of time and they've just become used to it? I mean, he was showing, some of these signs, say going back to 2020, or going back even during the pandemic, right, while he was president, that it almost has become something they've gotten used to. “Oh, that's just Trump.” They don't see it as anything out of the ordinary.

JG: Right. I think what's happened is, we've become so numbed, right? Because the bar has been lowered so many times, you know, that we've actually become unable to respond to the bar lowering further, you know what I mean? And so I think the reason we need to hear the voices of professionals is really a hard thing to find these days. 

Right? And so we're saying, we know where reality stands because we actually have years and years of training and education and background and experience in this area. And we're trying to tell you there actually are norms, okay? They're not decided by, you know, popular demand or the Fox narrative. Okay. There's actually objective indicators that we would use.  So many of the professionals said, "My God, if Trump was my patient, I'd wheel him in for an emergency neuropsychiatric evaluation and a cat scan. You know, ASAP,  and we'd be evaluating whether he could live independently.”

So there's a way in which we've become numbed to his downward ratcheting, and we've lost the true north. We've lost objective reality. And that's where I'm saying, these professionals can provide objective reality. There are norms, there are symptoms, there are diagnostic criteria. And there are people who've said, look, if I've been working with these patients for 30 years, I think I know it when I see it.

MS: Yeah. And to your point, if he were not someone running for president and were simply somebody in somebody's family, this would be something they'd be concerned about and go to a mental health professional about.

JG: Absolutely. No doubt about it. I mean, with all the things we're hearing, it's just bizarre. Someone is really losing all executive function is running for the the highest executive office in the world.

MS: This is so important and I I'm glad we could give it some attention and I'm glad it's getting more attention and that the Change.org petition is getting a lot of attention as well. I appreciate your coming on and talking about it. And people should also go to @dutytowarn Twitter feed as well.

JG:  Yes, to hear what the doctors have to say. And the nurses. And  the social workers And psychologists. Absolutely. Thank you for having me on.