Let’s Talk About You Know Who’s Deteriorating Mental Health

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Perhaps unsurprisingly, the White House doctor said of Donald Trump’s recent, sudden visit to Walter Reed Hospital: “Despite some speculation, the President … did not undergo any specialized cardiac or neurologic evaluations.”

You don’t have to be a medical professional to recognize that the patterns of the unscheduled visit, interrupting the weekend on a Saturday evening, conform more closely to a medical emergency than a routine check-up. Just as the reality of Trump’s corruption and criminality is catching up with him through the impeachment hearings, the reality of his mental and physical condition cannot help but catch up with him.

Some of this was on full display in his highly concerning, 53-minute breathless outpouring of grievances that his interview with Fox and Friends on Friday morning became. He reverted to unsubstantiated or debunked conspiracy theories—as he often does under stress—of Barack Obama’s wire surveillance of him, a coup in the works from the beginning and the claim that Ukraine, not Russia, interfered in the 2016 election and had a secret DNC server.

All of this came just a day after his former Russia expert warned that the Ukraine theory would bolster Russian, not American, interests. Finally, he added that he fired former FBI Director James Comey to stave off an investigation into him and that he was glad to have done so.

These are the very self-defeating, blatantly abnormal signs that have raised alarms for psychiatrists and neurologists for years. No “specialized … evaluations” on the White House physician’s part seems especially inappropriate in this context.

Declining Cognition

The president’s cognitive functioning alone, in terms of his ability to process information and thoughts, has deteriorated to the point where he has difficulty stringing together a single coherent sentence. His word-finding difficulties, repetitions and loose connections are only superficial indicators of a more serious, deeper process. He has additionally shown multiple neurological signs, including slurred speech, movement abnormalities and confabulations (filling in gaps of memory with fabricated stories).

The psychiatric signs of impulsivity, recklessness and erratic decision-making have been even more consequential. Earlier this year, preoccupied with his former fixer’s testimony to the special counsel, he walked away from a high-stakes nuclear talk with North Korea. The impeachment inquiry began because of a phone call he made over the summer to solicit Ukraine for election interference, the day after the special counsel’s testimony on Russia’s interference in the 2016 election. More recently, as the impeachment proceedings unfolded, he gave permission, without consulting any of his advisers, for Turkey to massacre our Kurdish allies and together with Russia seize control of the region.

Irrational Behavior

These are not actions that are explainable as rational or political strategy, as much as a typical manifestation of the mental impairments we have been observing for a long time.

In January 2018, then-White House Physician Ronny Jackson, now discredited, administered to the president a screening test. An Alzheimer’s researcher consortium had specifically recommended against the test for ruling out serious conditions, given that full-blown Alzheimer patients and hospitalized schizophrenia patients were found to score in the normal range. It did not stop the rear admiral from using the results to declare his employer and commander-in-chief “fit for duty.”

Earlier this year, newly appointed White House doctor Sean Conley involved “11 different board-certified specialists” in evaluating the president as “very healthy,” without the mention of a psychiatrist or neurologist. Conley failed to give reasons for the unusual number of specialists for a healthy individual with allegedly no concerning signs, since excessive testing carries its own risks, such as false-positive findings. He also did not explain departing from his own prior practices to split a so-called routine check-up many months apart.

Physician Constrained

Neuropsychiatric matters may be beyond a White House-employed emergency physician’s repertoire. As a subordinate under the commander-in-chief, he may also feel constrained in issuing an accurate assessment, as did his predecessor.

Then he should delegate. A group of us has, for this very reason, devised over a year and a half a process for forming an independent, nongovernmental panel of specialists and have offered ourselves in the interim. This is even more appropriate when a president’s symptoms become more than just matters of his personal health but of national and international security.

White House physicians, historically, have not served the public’s interests when it comes to presidential debility. This is one of the reasons for our acting on our societal responsibility since the start of this presidency, as our medical code of ethics dictates.

Further, the American Psychiatric Association’s code states, “Psychiatrists are encouraged to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.”

Since Congress members who asked to meet with us ceded that there was not much they could do without public awareness, we embarked on educating the public, following the APA guideline that we contribute to activities that improve the community and better public health.

We agree on the importance of public awareness: Subtle signs for the untrained person can be blazing red lights to a specialist. Misconceptions surrounding psychiatric issues are particularly common, even though within medicine they are considered to be no different than physical ones: They are just as science-based, objectively observable and debilitating, with predictable courses and standardized protocols for management. Mental health is just as important, if not more so, when it comes to the office of the presidency. It should not be relegated to the realm of insults or partisan attacks. Healthy discussions are therefore necessary if we are to dispel secrecy and stigma, so that we might take the necessary precautions to keep ourselves safe, since, with the president’s diminishing political power, greater mental health challenges are sure to come.

Bandy X. Lee is a forensic psychiatrist at the Yale School of Medicine, president of the World Mental Health Coalition and editor of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.

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