Donald Trump: Mental Health

mental status
It is worthwhile to remember that a mental or physical characteristic rises to the level of disease only if it is maladaptive in some way. So, for example, being 7 feet tall may or may not be a disease: Yes, it is maladaptive in lots of situations (head bumps in doorways), but it is surely advantageous on a basketball court.

Whatever Donald Trump's psychological make-up is SEE BELOW, it has not been maladaptive in his professional life: he has achieved fame and fortune and won an electoral majority using an unscripted communication style of remarkable effectiveness (whatever one might think of his politics). Whether his psychology is maladaptive in his personal life, or in the life of American democracy, is more contentious... although few care about his personal life.

Thus, Dr. Zebra agrees with the following summarized viewpoint, inserting a few extra words to remove political bias:

[Dr.] Allen Frances wrote the criteria for narcissistic personality disorder used in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and he doesn't think Trump qualifies. In Twilight of American Sanity 1 Frances says the diagnosis requires the patient to experience significant distress because of his condition. But throughout his life, Trump "has been generously rewarded for his Trumpism, not impaired by it," Frances writes. "[If] Trump is a threat to the United States, and to the world, [it would be] not because he is clinically mad, but because he is very bad." 2 (Also 3)

Though aware of the high-profile book that collects essays from three dozen psychiatrists who analyze Trump's psyche 4 (and prior edition 5), after reading the introduction to both editions, Dr. Zebra has not been motivated to read further. It seemed that (a) new diagnostic entities were being invented just for this patient ("malignant normality"), and that (b) based on the hyperbolic "warnings" about Trump from the authors of the essays, their objectivity and detachment seemed irretrievably tainted. The latter point has been noted by others, too 2.

Some observers have posited organic disease as a driver of Trump's mental state, including:

  • Neurosyphilis 6: Aside from any analysis of signs and symptoms, the disease can be confidently ruled out for other reasons. First and foremost, as of early 2017 Trump had been on a tetracycline long-term ("refilled prescriptions" 7) for rosacea. This would have the side effect of curing any latent syphilis, given that just a 14-day course of tetracyclines are a standard treatment in persons allergic to penicillin 8. Second, at the time of Trump's first marriage New York state still required pre-marital syphilis tests 9. This does not rule out a later infection, but it does clear his teens and twenties. Third, as a germaphobe, Trump would be expected to seek treatment immediately for any of the symptoms of primary or secondary syphilis (the precursor states to neurosyphilis, which is a form of tertiary syphilis).
  • Dementia (1): In January 2018 seventy-five health professionals and para-professionals (including 8 physicians) signed a letter to Trump's physician, Dr. Ronny Jackson, stating their concern that the president had dementia and urging Jackson to administer the "Montreal Cognitive Assessment" test to Trump 10. The White House had earlier declared that a cognitive assessment would not be part of Trump's upcoming medical examination that month 11, but Jackson apparently heeded the letter (kudos to him) and administered precisely the test urged to him. Trump got a perfect score 12, after which the leaders behind the original letter declared that was insufficient to rule out pre-dementia 13. (Which raises the question, why did they urge so inadequate a tool as the Montreal test?) Jackson answered extensive press queries about the test and about Trump's mental abilities 14.
  • Dementia (2): The clear change in Trump's speaking pattern over the last 30+ years 15 -- simpler words, simpler sentences -- has also been taken as a sign of brain degeneration. However, it is not possible to ascribe the change to brain disease without first ruling out the more likely reason that the simpler words and cadences are politically effective 3. Indeed, linguistic analysis of 21,739 of his tweets over 10 years supports this, showing that, in that medium, Trump has 4 language styles that shift systematically depending on his communication goals 16 17.
        Trump's language is also remarkable -- at a level of broken genius, even -- for its slipperiness. Sentences, or more often, sentence fragments, are hedged, qualified, blurred, or ascribed to nameless third parties. His interview with Dr. Oz is an excellent example 19, and he was able to deliver it off the cuff. That's why it's genius, or at least very practiced, because the rest of us would have had to labor hard to draft answers sounding as natural, helpful, and easily digested as his, but so lacking in certainties.
  • Dementia (3): For Trump in 2019 Dr. Zebra does not entertain the diagnosis of dementia of the Alzheimer type, the hallmark of which is declining memory for recent events. Whatever one may say about Trump's mental state, it is quite clear from even his brief interactions with the press that his memory for events of the day is excellent. Continuing the outside scrutiny of Trump's mental faculties is completely valid 20, as is urging his physicians' attentiveness to it, but such scrutiny must consider both the denominator and the numerator, i.e. what the President does well, not just his flubs.

Dr. Zebra does, however, have two areas of concern about Trump's mentation. The first is his sleeplessness, as discussed above, which would seem to be the leading suspect in causing the signs that others have interpreted as dementia.

The second area is mania, in the psychiatric sense of the word. Trump has always been grandiose, but some tweets of his are harrowing:

  • Shortly after a damning book on Trump and his presidency was published and received immense press attention 21, Trump tweeted 22 that he was elected...

    He spoke of himself as an "extremely stable genius" on May 23, 2019 (after a contentious meeting with Democrats 23) and twice more tweeted the "stable genius" phrase 22: on July 11, 2019 (during general bashing of Democrats 24) and on Sep. 14, 2019 (for unclear reasons).
  • Pummeled by bipartisan criticism about concessions on Syria that he made to the President of Turkey after a single phone call, Trump tweeted, in absolute seriousness 25:
The "wisdom and obliterate" tweet was the more gut-punching. Dr. Zebra has long experience in aerospace medicine, assessing whether pilots and other aviators are medically fit to fly. If a pilot, even the boldest and most skilled, sat in my exam room and uttered a serious statement about his or her "great and unmatched wisdom," I would not hesitate to ground the pilot pending a full psychiatric examination. A "stable genius" claim would earn the same response. Readers may wish to consider a situation 26 where they are sitting in a passenger airliner, piloted by a person who on the overhead intercom before take-off announces that in his great and unmatched wisdom he is going to obliterate any barriers to passenger comfort during the upcoming flight, using his skills as a stable genius. You would get off the plane.

It is not easy to assess the mental state of Donald Trump. Dr. Zebra reminds himself of the singular nature of Mr. Trump by keeping in mind some of the more memorable characterizations of him he's encountered, e.g.:
  • [1950s] He "as a boy threw cake at kids at parties and erasers at his teachers at his private elementary school, [so he was sent] first to Sunday morning Bible classes, like his siblings -- and then, unlike his siblings, to a stringent military academy an hour and a half upstate shortly after he turned 13." 27
  • [1997] "An existence unmolested by the rumbling of a soul." 28
  • [2006+] "Being around Mr. Trump was intoxicating. When you were in his presence, you felt like you were involved in something greater than yourself -- that you were somehow changing the world." 18
  • [2011] His "loud, over-the-top, ... Ronco Veg-o-Matic, everyone's-a-mark, carny-barker, hard-sell" 29
  • [2017] "As President Donald Trump began his inaugural address, a cold rain began to fall. A few hours later, Trump claimed the rain had not begun to fall." 30
  • [2017] His "bellow and banter cycles" 31.
  • [2017] He "could not handle watching the news without seeing himself on it" 31.
  • [2017] His repeated claims, for example, that he actually won the popular vote -- is immutable and has had a "numbing effect" on people who work with him, said Tony Schwartz, his ghostwriter on The Art of the Deal 32. "He wears you down," Mr. Schwartz said. 31
It is, however, inaccurate to speak of him as completely soulless. He speaks of his dead brother with emotion, and when meeting with families of American military casualties, those with small children strike him particularly hard -- to the point that he would make up things, soothing things, in talking to the families 33a.

Among the psychological and psychiatric labels applied by his allies are:

  • Narcissism -- Staff Secretary Rob Porter 33b
  • "... his erratic nature, relative ignorance, his inability to learn..." -- notes of a senior White House official, summarizing views of other senior officials, July 2017 33c
  • "He's just a moron." -- Rex Tillerson, Secretary of State, in July 2017 33d
  • "Zero psychological ability to recognize empathy or pity in any way." -- Reince Priebus, the President's Chief of Staff, July 2017 33e
  • "We have a leader who has a personality disorder." -- former Senator Tom Coburn, MD (Republican-Oklahoma), October 2017 34
  • Acted like, and had the geopolitical understanding of, "a fifth or sixth grader." -- James Mattis, Secretary of Defense, January 2018 33f
  • "He's a professional liar." -- Gary Cohn, ex-President of Goldman Sachs and Chief Economic Advisor to the President, in March 2018 33g
  • "A f*cking liar." -- John Dowd, personal attorney to Trump during Mueller investigation, March 2018 33h
  • "A conman." -- Michael Cohen, longtime personal attorney, February 2019 18
  • Although wonderful to play golf with, is a shameless cheater 35. (There is an entire book about this 36!)
Comment: The remarkable vituperativeness of these statements is pertinent. Even a man like Warren Harding, who freely admitted that the presidency was beyond his mental abilities, provoked only half-piercing put downs from sharp-tongued critics like Alice Roosevelt Longworth, who wrote: "Harding was not a bad man. He was just a slob." 37a
Cited Sources
  1. Frances, Allen. Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump. New York: William Morrow, 2017.
  2. Lozada, Carlos. Is Trump mentally ill? Or is America? Psychiatrists weigh in. (Published 22 Sept. 2017. Downloaded on 2017-09-23.) Available on the web:
  3. Frances, Allen. I helped write the manual for diagnosing mental illness. Donald Trump doesn't meet the criteria. (Published Sept. 6, 2017. Downloaded on 2019-12-25.) Available on the web:
  4. Lee, Bandy X. (ed.). The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President -- Updated and Expanded with New Essays. New York: Thomas Dunne / St. Martin's Press, 2019.
  5. Lee, Bandy X. (ed.). The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. New York: St. Martin's Press, 2017.
  6. Beutler, Steven. A Medical Theory for Donald Trump's Bizarre Behavior. (Published 17 Feb. 2017. Downloaded on 2019-10-04.) Available on the web:
  7. Altman, Lawrence K. Donald Trump's Longtime Doctor Says President Takes Hair-Growth Drug. (Published 1 Feb. 2017. Downloaded on 2019-12-24.) Available on the web:
  8. Centers for Disease Control. 2015 Sexually Transmitted Diseases Treatment Guidelines: Syphilis. (Published 2015. Downloaded on 2016-12-25.) Available on the web:
  9. Felman YM. Repeal of Mandated Premarital Tests for Syphilis: A Survey of State Health Officers. American Journal of Public Health. 1981; 71: 155-159. Pubmed: 6779649. DOI: 10.2105/ajph.71.2.155   Also available on the web at:
  10. Buser, Steven. [Letter to RDML Ronny L. Jackson]. (Published 11 Jan. 2018. Downloaded on 2019-12-25.) Available on the web:[1].pdf
  11. Diamond, Dan; Cancryn, Adam. Is Trump mentally fit? Don't count on his physical to tell you. (Published 8 Jan. 2018. Downloaded on 2019-12-25.) Available on the web:
  12. Wilson, Chris. What Donald Trump's Mental Health Exam Doesn't Tell Us. (Published Jan. 17, 2018. Downloaded on 2019-12-25.) Available on the web:
  13. Gartner, John. Trump's troubling behavior raises questions his medical exam didn't answer. (Published Jan. 22, 2018. Downloaded on 2019-12-25.) Available on the web:
  14. Sanders, Sarah; Jackson Ronny. Press Briefing by Press Secretary Sarah Sanders and Dr. Ronny Jackson. (Published 16 Jan. 2018. Downloaded on 2019-12-28.) Available on the web:

    Comment: A transcript of the press briefing is archived here --> MORE

  15. Begley, Sharon. Trump wasn't always so linguistically challenged. What could explain the change?. (Published May 23, 2017. Downloaded on 2019-12-25.) Available on the web:
  16. University of Birmingham. "Very Stable Genius" -- Science Says Trump Tweets Were Systematic Plan of Attack in Presidential Campaign. (Published 5 Oct. 2019. Downloaded on 2019-12-25.) Available on the web:
  17. Clarke I, Grieve J. Stylistic variation on the Donald Trump Twitter account: A linguistic analysis of tweets posted between 2009 and 2018. PLoS ONE. September 25, 2019.   Available on the web at:
  18. Cohen, Michael. Testimony of Michael D. Cohen. U.S. House Of Representatives. Committee On Oversight And Reform. February 27, 2019.
  19. Cillizza, Chris; Blake, Aaron. Donald Trump's interview with Dr. Oz was just as amazingly strange as we thought it would be. (Published 15 September, 2016. Downloaded on 2019-12-01.) Available on the web:

    Comment: Also includes annotations by Cillizza and Blake. Their interview transcript is archived here: MORE

  20. Gartner, John. Trump's cognitive deficits seem worse. We need to know if he has dementia: Psychologist. (Published Apr. 9, 2019. Downloaded on 2019-12-25.) Available on the web:
  21. Wolff, Michael. Fire and Fury: Inside the Trump White House. New York: Henry Holt, 2018.
  22. Trump, Donald J.. [Tweet: President of the United States (on my first try). I think that would qualify as not smart, but genius....and a very stable genius at that!]. (Published January 6, 2018. Downloaded on 2019-12-03.) Available on the web:

    Comment: Other "stable genius" tweets include:

  23. Fritze, John; Collins, Michael. Trump calls himself an "extremely stable genius," while responding to Pelosi criticism. (Published September 15, 2016. Downloaded on 2019-12-26.) Available on the web:
  24. Cummings, William. Trump says he's "so great looking and smart, a true Stable Genius" in tweet bashing 2020 Dems. (Published July 11, 2019. Downloaded on 2019-12-26.) Available on the web:
  25. Trump, Donald J.. [Tweet: great and unmatched wisdom]. (Published Oct. 7, 2018. Downloaded on 2019-12-25.) Available on the web:
  26. Fallows, James. If Trump Were an Airline Pilot. (Published 22 Aug. 2019. Downloaded on 2019-12-25.) Available on the web:
  27. Kruse, Michael. The Mystery of Mary Trump. (Published November/December 2017. Downloaded on 2019-12-06.) Available on the web:
  28. Singer, Mark. Trump Solo. New Yorker. 12 May 1997.

    Comment: This remark is especially notable for pre-dating Trump's involvement in partisan politics. Available on the web at:

  29. Hedegaard, Erik. Donald Trump Lets His Hair Down. (Published 13 May 2011. Downloaded on 2019-12-24.) Available on the web:
  30. Grunwald, Michael. Donald Trump Is a Consequential President. Just Not in the Ways You Think. (Published Dec. 30, 2017. Downloaded on 2019-12-26.) Available on the web:
  31. Haberman, Maggie; Thrush, Glenn; Baker, Peter. The President's Periodic Physical Exam. (Published Dec. 9, 2017. Downloaded on 2018.) Available on the web:
  32. Trump, Donald J.; Schwartz, Tony. Trump: The Art of the Deal. New York: Random House, 1987.
  33. Woodward, Bob. Fear: Trump in the White House. New York: Simon & Schuster, 2018.
    a  p.75  b  p.166  c  p.226  d  p.227. Date is extrapolated from the book's report that this statement occurred near the time Tillerson attended a Boy Scout Jamboree in West Virginia. A similar comment (on page 225) is less delicately phrased.  e  p.235  f  p.308. This was after a contentious principals-only meeting of the National Security Council.  g  p.338  h  pp. 353, 357. Woodward does not characterize this as a spoken comment but as something Dowd "knew to be true." Presumably Dowd had told Woodward this -- it is the final sentence of Woodward's book.
  34. Martin, Jonathan; Peters, Jeremy W. As G.O.P. Bends Toward Trump, Critics Either Give In or Give Up. (Published Oct. 25, 2017. Downloaded on 2019-12-03.) Available on the web:
  35. Terris, Ben. Does Donald Trump cheat at golf? A Washington Post investigation. (Published 4 September 2015. Downloaded on 2019-12-01.) Available on the web:
  36. Bonesteel, Matt. Rick Reilly wrote a book about Trump cheating at golf. Now he's challenging him to a match. (Published 2 April 2019. Downloaded on 2019-12-01.) Available on the web:
  37. Longworth, Alice Roosevelt. Crowded Hours. New York: Charles Scribner's Sons, 1933.
    a  p.325

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