Tag Archives: mental illness

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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The Banality Of Crazy

Thomas Edsell recently had a guest essay in the New York Times that addressed a question I’ve had for a long time. Why don’t media figures state the obvious? Donald Trump is mentally ill. Crazy.

Edsell quoted political scientist Brian Klaas, whose Oct. 1 essay was titled, “The Case for Amplifying Trump’s Insanity.”

Klaas argued that the presidential contest now pits a 77-year-old racist, misogynist bigot who has been found liable for rape, who incited a deadly, violent insurrection aimed at overturning a democratic election, who has committed mass fraud for personal enrichment, who is facing 91 separate counts of felony criminal charges against him and who has overtly discussed his authoritarian strategies for governing if he returns to power against “an 80-year-old with mainstream Democratic Party views who sometimes misspeaks or trips.”

“One of those two candidates,” Klaas noted, “faces relentless newspaper columns and TV pundit ‘takes’ arguing that he should drop out of the race. (Spoiler alert: It’s somehow not the racist authoritarian sexual abuse fraudster facing 91 felony charges.)”

Klass points to the multiple pundits telling Biden to drop out, or engaging in “doom and gloom” predictions about Biden’s age. Meanwhile, the response to Trump’s increasingly unhinged behavior is, as he says, “crickets.”

How is it possible that it’s not front page news when a man who soon may return to power calls for law enforcement to kill people for minor crimes? And why do so few people question Trump’s mental acuity rather than Biden’s, when Trump proposes delusional, unhinged plans for forest management and warns his supporters that Biden is going to lead us into World War II (which would require a time machine), or wrongly claims that he defeated Barack Obama in 2016?

Klaas thinks that media outlets have succumbed to what he called the “banality of crazy.” That has led them to ignore

even the most dangerous policy proposals by an authoritarian who is on the cusp of once again becoming the most powerful man in the world — precisely because it happens, like clockwork, almost every day.

Klass argues that the “don’t amplify him” strategy is nothing short of disastrous–and I agree.

Edsell reminds his readers that, three months after Trump took office, the Yale School of Medicine convened a conference called A Duty to Warn. Conference attendees issued a book titled  “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.”

I read that book; it was recommended by a psychiatrist friend. It had chapters with titles like “Our Witness to Malignant Normality,” “Unbridled and Extreme Hedonism: How the Leader of the Free World Has Proven Time and Again That He Is Unfit for Duty,” and “Pathological Narcissism and Politics: a Lethal Combination.”

I understand that a given individual can be deeply mentally ill. What I simply do not understand is how people can look at Donald J. Trump and fail to see a cognitively impaired, unstable and delusional individual who is getting worse as he ages.

Trump has pledged to shoot shoplifters (“We will immediately stop all the pillaging and theft. Very simply, if you rob a store, you can fully expect to be shot as you are leaving that store.”), pledged to “root out” the “communists, Marxist fascists and the radical left thugs that live like vermin within the confines of our country that lie and steal and cheat on elections and will do anything possible — they’ll do anything, whether legally or illegally, to destroy America and to destroy the American dream.”)

On Nov. 6, Isaac Arnsdorf, Josh Dawsey and Devlin Barrett reported in The Washington Post that Trump “wants the Justice Department to investigate onetime officials and allies who have become critical of his time in office, including his former chief of staff John F. Kelly and former attorney general William P. Barr, as well as his ex-attorney Ty Cobb and former Joint Chiefs of Staff chairman Gen. Mark A. Milley.”

Edsell includes quotes from several psychiatrists who attribute the spiraling of his insanity to age (he’s only 4 years younger than Biden) and the stress of his multiplying legal problems.

Most of the specialists I contacted see Trump’s recent behavior and public comments as part of an evolving process.

“Trump is an aging malignant narcissist,” Aaron L. Pincus, a professor of psychology at Penn State, wrote in an email. “As he ages, he appears to be losing impulse control and is slipping cognitively. So we are seeing a more unfiltered version of his pathology. Quite dangerous.”

In addition, Pincus continued, “Trump seems increasingly paranoid, which can also be a reflection of his aging brain and mental decline.”

Edsall and Klass are right: the media needs to call crazy, crazy.

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White Supremacists, Islamic Terrorists, Trumpers

I know that sane Americans are all holding our breath until January 20th, when most of us are anticipating being able to breathe a sigh of relief.  We foresee a return to normal concerns– policy debates based at least partially on logic and evidence, an actual national response to the COVID pandemic, and an end to waking up each day to news of the President’s latest lunacy and/or his administration’s latest, ever-more-blatant corruption.

Apparently, however, we won’t be clear of existential threats when Trump and his mobsters depart.

The Washington Post recently carried a column on the results of a study done by Jigsaw, the research arm of Google.The research looked into violent white-supremacist groups, and found that they had formed a connected global movement even before Trump’s presidency gave them oxygen here in the U.S., and that movement will almost certainly continue long after he leaves office.

These white-supremacist groups have used the Internet to recruit and train followers, much as Islamist extremists did a decade ago, argues a major new study by Jigsaw, a research arm of Google. The study, described here for the first time, is being published Tuesday by Jigsaw’s digital journal, the Current.

The study shatters the image that many analysts have of white supremacist attackers as “lone wolf” extremists. Jared Cohen, the chief executive of Jigsaw, argues that “this myth obscures the vast underlying infrastructure of white supremacist online communities around the world.”

These groups “move fluidly between mainstream and fringe platforms,” Cohen warns. They recruit followers on Facebook or YouTube, among other venues, and then direct them to protected “alt-tech” sites where they can privately share propaganda and boast about operations.

The report describes a movement that is much larger, much more violent and much better organized than most of us have realized. Information from the University of Maryland’s Global Terrorism Database  suggest the existence of a global network that has been steadily growing since 2010.

A chilling factoid: that network has expanded “in tandem with Islamist extremism, its twin in using online media to spread hate.”

Consider these comparisons: In 2009, white supremacists were responsible for six deaths in 19 incidents, while Islamist extremists were responsible for 14 deaths in 12 incidents. Those numbers kept climbing steadily through the decade. By 2019, white supremacists were linked to 165 deaths in 336 incidents, while Islamist extremists were tied to 193 deaths in 82 incidents.

In three “hot spots” for white supremacists — Germany, Britain and the United States — the number of incidents seemed to spike because of special factors: in Germany, the influx of Syrian migrants in 2015; in Britain, the angry debate over Brexit in 2016; in the United States, Trump’s presidency in 2017.

When we look at the evidence all around us–it is hard not to conclude that we live at a time when huge numbers of people are simply crazy. Not just wrong about this or that, not just uninformed or unpleasant (although most also fall into those categories), but off the charts deranged.

It isn’t just the “soldiers” of these horrifying, radicalized terrorist threats.

It’s also the huge numbers of Republicans who believe that Donald Trump was mentally and emotionally fit to occupy the Oval Office. It’s the millions who insist that an election that delivered victories to their party’s down-ballot candidates, was supervised in many states by their own party, and was lost by over seven million votes, was somehow “stolen.” It’s the huge numbers who believe in “QAnon” and its conspiratorial allegations that Democrats are trafficking and  killing children and drinking their blood. It’s the inconceivable numbers who continue to dismiss the pandemic as a “hoax” while their friends and relatives die.

I know rational folks are supposed to “reach out” to those on “the other side”–but how do you reach out to people who are on the other side of sanity?

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Those Trump Supporters

I frequently refer to the recurring discussions among sane Americans–the ones that begin with incomprehension: what do Trump’s supporters see in him that they find attractive? What evidence can they cite to suggest that he is even minimally competent? How do they explain away the copious, constantly-growing evidence of his corruption, his ignorance, his childish and unhinged behaviors?

Clearly, the ability of voters in the age of the internet to rely on sources of “information” that confirm their desired “facts” has played a major part.

A recent post by a friend of mine suggests that the purveyors of cyber-disinformation rely on the civic ignorance of their audience; he posted a copy of a story from a Trump site about four Democratic Senators who have announced they were switching parties in response to impeachment. There were pictures of the Senators, and they were identified by name. One small problem: None of them were real. They don’t exist.

Presumably, those who created the site were confident that visitors wouldn’t know that there are no Senators with those names (or faces).

That’s what my people call chutzpah, and Kellyanne Conway would call “alternate reality.”

I’ve seen a number of articles either penned by or interviews of psychiatrists, and in most of them, like this article from Raw Story, the professionals identify traits common to Trump supporters: authoritarian personality syndrome, social dominance orientation, and a connected group of diagnoses that revolve around bigotry. Studies following the 2016 election found a significant relationship between racial resentment and support for Trump; studies also found that Trump voters have fewer interactions with people of different races or religions, and are more likely to exhibit “relative deprivation.”

Relative deprivation refers to the experience of being deprived of something to which one believes they are entitled. It is the discontent felt when one compares their position in life to others who they feel are equal or inferior but have unfairly had more success than them.

I was intrigued by an article focusing on the opinion of a long-time conservative named Tom Nichols (full disclosure, I have no idea who he is–hadn’t previously come across him). Nichols says that “being nuts” is Trump’s “superpower.”

If Trump were not able to convince his cult that reality isn’t real, we’d be arguing about who’s really doing well and who isn’t – just as we did under Obama and every other president. Farmers would be up in arms,” Nichols said in a Twitter thread. “When Trumpers say they’re better off, there’s no evidence for it other than that they *feel* better off. Factories aren’t reopening. Dead small towns are not being reborn. The cities? Doing fine, thank you. But Trump says: ‘This isn’t true,’ and being *nuts* is what sells it.”

Nichols noted that Trump’s ridiculous behavior was on full display in the bizarre letter he sent to Nancy Pelosi. He pointed out that the tone and absurdist quality of the letter —not just Trump’s usual lies and numerous exclamation points —have led many observers to genuinely question Trump’s mental health.

I don’t question it. I have long been of the opinion that Trump is significantly mentally ill. Others are finally coming to that same conclusion.

“I’m only 2 1/2 paragraphs in to Trump’s letter and it’s clear to me that our President is unwell, unfit and very uninformed about our government & our legal system. And that fills me with a profound sadness that we’re at this point. It’s time to fix this,” wrote legal analyst Joyce Vance.

Lawfare Executive Editor Susan Hennessey wrote: “This is not a letter authored by someone of sound mind or in full command of his mental faculties. The implications of that are obviously immense and quite scary but how long can we really continue to ignore it?”

As Nichols pointed out, Trump’s supporters celebrated that letter. (“He tells it like it is…”)

How much do people have to lie to themselves, and for how long, before we can conclude that they aren’t just uninformed, but mentally unwell? How much do people have to hate and resent various “Others” in order to reject the evidence of their own eyes and ears?

And most important of all, as we approach November of 2020, how many of these people are there?

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The Forty Percent

A recent column by Gary Younge, a Guardian columnist has identified the most dangerous problem illuminated by Donald Trump’s erratic and incompetent Presidency–and it isn’t his obvious mental illness.

It’s the 40% of Americans who still approve of his performance.

As Younge notes, there is no serious debate about Trump’s mental disorders among most observers.

Divining, assessing and adjudicating the mental health of this US president has become more than just a parlour game. Following a 2017 conference, 27 psychiatrists, psychologists and other mental health experts wrote a book, The Dangerous Case of Donald Trump, arguing it was their moral and civic “duty to warn” America that “for psychological reasons”, Trump was “more dangerous than any president in history”. They diagnosed him with everything from “severe character pathology” to “delusional disorder”, which can be added to the more common verdicts of “narcissistic personality disorder” and “antisocial personality disorder” which are regularly offered.

Younge also notes the signs of deterioration, as the pressures of impeachment mount, and polls showing that he is likely to lose his bid for re-election proliferate.  Trump’s bizarre behaviors are more frequent (although somehow that doesn’t seem possible), and his melt-downs more embarrassing and concerning. It is, as Younge writes, “deeply worrying” that the powers of the presidency are in the hands of a man who is “at one and the same time so brittle, aggressive, vindictive, ridiculous and self-obsessed.”

As dangerous as this administration is, however–as much harm as it is doing and may still do–Younge argues that it would be a mistake to think that simply replacing Trump and the cabal he has assembled with rational and honest public servants will solve the problem.

The problem, Younge says, isn’t just Trump. It’s how he got to the Oval Office. It is the nearly 63 million people who voted for him, and the 35-40% who still tell pollsters they approve of his performance.

For along with Trump’s personal frailties is a series of political characteristics that underpins his anomie. He is a misogynist, a racist, a xenophobe and a nationalist. Those are not psychological descriptors but political ones, fortified by systems and ideology.

As such, his behaviour has been irascible but hardly erratic. The rhetorical objects of his disdain are not random. He has not lashed out at the National Rifle Association, the religious right or white people. Politically, his tantrums invariably find their mark in the weak, the poor, the dark, the female, the Muslim, the marginalised and the foreigner. (He will attack powerful people, but not simply for existing. They must cross him first.)

These inclinations were clear when he stood for the presidency. He has been every bit as bigoted, undisciplined, indiscreet, thin-skinned and braggadocious as his campaign promised. And he won.

This was not because people didn’t see those things, but because they either didn’t care, cared about other things more, preferred him to the alternative, or simply didn’t show up. As such, his victory marked a high point for the naked appeal of white supremacy in particular and rightwing populism in general, and a low point for the centre-left, neoliberal agenda.

In other words, Younge tells us, Trump’s bigotries–his particular form of mental illness– enjoy significant, if not majority, support. His hatreds are shared–or at least not considered disqualifying– by millions of people.

That is our problem. And it’s chilling.

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