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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