Tag Archives: dementia

Doonesbury Nails It

Stinging humor has been one of the more notable characteristics of what I devoutly hope will NOT be known as “the age of Trump.” Late-night comedians have gone where GOP politicians terrified of their MAGA base (and Democrats persuaded to  “go high” when Republicans “go low”) have failed to go. 

The result has been a situation in which the most biting–and frequently, most accurate–commentary has come from stand-up comedians and the Sunday funnies. Last Sunday, Doonesbury used a fictional psychiatrist to echo observations and conclusions that have been discussed for several months by real mental health professionals: Trump is rapidly slipping into dementia.

Elias–Doonesbury’s fictional “resident psychiatrist”– points to the symptoms: repeatedly mixing people up (not just forgetting names, which happens to all of us, but calling Biden Obama or Haley Pelosi); phonemic paraphasia (“freestyling” off the stem of a word); slurring; semantic aphasia; and tangental speech. The last panel of the cartoon is a warning, showing nonsense words coming out of the White House.

In all fairness, I didn’t find the Sunday strip funny. I did find it educational–and terrifying.

Trump’s “word salads” have been the subject of innumerable Facebook jokes and memes, but mental health professionals and pundits agree that his more recent speeches and outbursts have changed in nature. The Doonesbury labels appear to fit.

Phonemic paraphasia, for example, is defined as a disorder in which incorrect phonemes are substituted. For example, one may say “spot” instead of “pot.” Literal paraphasia could also be switching syllables or creating reverse compound words such as “markbook” instead of “bookmark.” There are differing types; according to Wikipedia,

Wernicke’s aphasia is characterized by fluent language with made up or unnecessary words with little or no meaning to speech. Those who suffer from this type of aphasia have difficulty understanding others speech and are unaware of their own mistakes. When corrected they will repeat their verbal paraphasias and have trouble finding the correct word….

Phonemic paraphasia, also referred to as phonological paraphasia or literal paraphasia, refers to the substitution of a word with a nonword that preserves at least half of the segments and/or number of syllables of the intended word. This can lead to a variety of errors, including formal ones, in which one word is replaced with another phonologically related to the intended word; phonemic ones, in which one word is replaced with a nonword phonologically related to the intended word; and approximations, an attempt to find the word without producing either a word or nonword. These types of errors are associated with Wernicke’s aphasia, among others. Phonemic paraphasias are often caused by lesions to the external capsule, extending to the posterior part of the temporal lobe or internal capsule.

Wikipedia defines “semantic aphasia”as a “progressive neurodegenerative disorder characterized by loss of semantic memory in both the verbal and non-verbal domains. However, the most common presenting symptoms are in the verbal domain (with loss of word meaning). Semantic dementia is a disorder of semantic memory that causes patients to lose the ability to match words or images to their meanings.”

Tangential speech is a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation. (Full disclosure: my kids will tell you I have this one…although usually I do– eventually– return to the initial topic.)

Quite obviously, I am not a doctor, nor do I play one on TV. Neither is Gary Trudeau, the Doonesbury cartoonist. That said, Trudeau hasn’t created this diagnosis out of thin air or political pique–increasing numbers of mental health professionals have raised alarms. It began during his first term, with “The Dangerous Case of Donald Trump” in which 27 psychiatrists evaluated concerning aspects of his personality; and has accelerated with psychologists warning of the dangers posed by  more recent evidence of his mental decline. (One example: Harry Segal, a senior lecturer in psychology at Cornell University who has been critical of the former president’s mental health since he was first elected, said Trump was showing clear signs of onset dementia.)

It doesn’t correlate with age. Some people “lose it” at sixty; others are mentally sharp at 100.

And it isn’t simply the bone-chilling prospect of a single, truly demented head of state. The Trump presidency has illuminated a challenge going forward. It has become standard for candidates to share their medical evaluations with the voting public; is it time to require aspirants for high office to be screened for mental illnesses? 

And given some of our past Chief Executives, where would we set the bar?

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Charles Pierce Identifies It–What Are We Going To Do About It?

My mother used to recite a rhyme that I don’t recall entirely, but the gist of it was that the only difference between men and boys was the size of their toys.

Americans are being “governed”–if you can dignify what is coming from the White House as governing–by a boy with a nuclear toy. (If there were any remaining doubts, Michael Wolff’s new book should dispel them.)

Who among us would ever have anticipated having an occupant of the Oval Office tweeting “mine is bigger than yours” at another, equally demented, world leader? (Do you suppose we could settle this by putting the two of them in an examining room, and measuring their “parts”?)

I used to attribute Trump’s unbelievable lack of self-awareness to privilege. We all know people whose money or power insulates them from contact with people who will tell them the truth; the longer their isolation from ridicule or dissent, the less grounded they become. But I think Charles Pierce has a more accurate evaluation of the problem.

Pierce’s column analyzed Trump’s recent interview with New York Times reporter Michael Schmidt. Schmidt had intercepted Trump on a golf course, where are no aides to constrain the free flow of what Trump apparently regards as sentences, and reaction to that interview has been shock and (terrified) awe.

Pierce dismissed criticisms of Schmidt’s conduct of the interview as irrelevant to what it exposed:

In my view, the interview is a clinical study of a man in severe cognitive decline, if not the early stages of outright dementia.

Over the past 30 years, I’ve seen my father and all of his siblings slide into the shadows and fog of Alzheimer’s Disease. (The president*’s father developed Alzheimer’s in his 80s.) In 1984, Ronald Reagan debated Walter Mondale in Louisville and plainly had no idea where he was. (If someone on the panel had asked him, he’d have been stumped.) Not long afterwards, I was interviewing a prominent Alzheimer’s researcher for a book I was doing, and he said, “I saw the look on his face that I see every day in my clinic.” …

In this interview, the president* is only intermittently coherent. He talks in semi-sentences and is always groping for something that sounds familiar, even if it makes no sense whatsoever and even if it blatantly contradicts something he said two minutes earlier. To my ears, anyway, this is more than the president*’s well-known allergy to the truth. This is a classic coping mechanism employed when language skills are coming apart.

Pierce gives several examples from the transcript of the interview–boasts that embarrass rational people, non-sequiturs that most observers (reasonably enough) attribute to ignorance, and Trump’s trademark, repellant grandiosity, which Pierce sees as the desperation of a man who is losing the ability to understand the world around him.

And as he points out, this lack of capacity is oh-so-useful to Congressional Republicans.

In Ronald Reagan’s second term, we ducked a bullet. I’ve always suspected he was propped up by a lot of people who a) didn’t trust vice-president George H.W. Bush, b) found it convenient to have a forgetful president when the subpoenas began to fly, and c) found it helpful to have a “detached” president when they started running their own agendas—like, say, selling missiles to mullahs. You’re seeing much the same thing with the congressional Republicans. They’re operating an ongoing smash-and-grab on all the policy wishes they’ve fondly cultivated since 1981. Having a president* who may not be all there and, as such, is susceptible to flattery because it reassures him that he actually is makes the heist that much easier.

If we had a Vice-President and Cabinet who actually gave a rat’s ass about America rather than their own prospects and assorted zealotries, we could hope for invocation of the 25th Amendment.

If we had Congressional Republicans who were willing to put country above party, we could hope for impeachment.

If the President is seriously mentally ill–and it’s hard to argue with that diagnosis (a number of psychiatrists have already concurred)–that explains his terrifying behaviors.

What’s everyone else’s excuse?

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This May Explain Some Things….

Not that the explanation is reassuring. Quite the contrary.

Vox recently ran an article about the healthcare perks that members of Congress enjoy while they are working hard to deny poor Americans access to basic health insurance. Here’s the WTF section of that article:

Mike Kim, the reserved pharmacist-turned-owner of the pharmacy, said he has gotten used to knowing the most sensitive details about some of the most famous people in Washington.

“At first it’s cool, and then you realize, I’m filling some drugs that are for some pretty serious health problems as well. And these are the people that are running the country,” Kim said, listing treatments for conditions like diabetes and Alzheimer’s.

“It makes you kind of sit back and say, ‘Wow, they’re making the highest laws of the land and they might not even remember what happened yesterday.’”

The article noted that the current Congress is the oldest in our history. It appears that more than half of the senators who plan to run for reelection in 2018 are over 65. (Dianne Feinstein just announced that she plans to run for another 6 year term; she will be 85 at election time.) The average age in the House of Representatives is a (comparatively) youthful 57, and the average age in the Senate is 61.

We all age at different rates, and thanks to breakthroughs in medicine and nutrition there are growing numbers of people nearing 100 who remain mentally and physically sharp. It is also true that most of us begin to figure life out as we grow older–there is some validity to the adage that wisdom comes with age. So I would oppose a blanket rule requiring lawmakers to retire at an arbitrary age certain.

That said (since today is my own birthday, and at 76 I am by no means a “spring chicken”), I can personally attest to the indignities the years bring. Memory and recall play tricks on the aging mind; the accelerating rate of technological change is especially disorienting to those of us who grew up with typewriters and rotary phones affixed to walls. Cultural changes embraced by our children and grandchildren can be difficult for us old folks to assimilate and accept.

And all of that is what aging does to healthy seniors, those of us who have retained substantial amounts of our physical vigor and intellectual capacities.

One positive consequence of the 2016 election–assuming we live through the disaster that is Donald Trump–is a new appreciation of the importance of a President’s mental health. It is likely–again, if we survive this–that along with a mandatory disclosure of taxes, a clean bill of physical and mental health will become legal requirements of presidential candidacies.

We need to seriously consider imposing a similar requirement on candidacies for the House and Senate. It’s bad enough that we have only cursory background checks for gun purchases; surely, voters are entitled to similarly cursory physical and psychological checks on people seeking positions where they can do considerably more harm than a deranged shooter.

We may not be able to disqualify the wackos like Roy Moore, but surely we can make Alzheimers a disqualification for public office.

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