Diagnosing Trump

Yesterday, as news about the Wolff book rolled through the net, I had an accidentally well-timed piece on the complexities of talking about Trump's age and his brain. I acknowledge that in fact age-related cognitive change might be an issue in a president (or other forms of cognitive change), but continue to believe that outside of very judicious high-quality reporting, we've got to stop this wild gossiping. I open with Reagan and write:

I've been thinking a lot about Stahl lately, thanks to the latest round of speculation about President Donald Trump's mental health. For 18 months, I've joined many other disability justice activists in decrying such speculation as based in ableist ideas that associate Trump's cruelty, incompetence, and deception with some kind of easily diagnosable pathology. These armchair diagnoses have provoked tense and angry discussions, driving wedges between diverse segments of the progressive community. I’ve taken a hard line against this speculation. I don’t think it will unseat Trump. I do think it will make people with mental-health needs more likely to stay closeted. With the alleged deception and silence surrounding Reagan's Alzheimer's on my mind, though, I’ve had to admit that there might be some occasions where reporting on presidential mental fitness could be appropriate. Still, we can distinguish between ableist gossip and good, reliable, journalism. Let's set the bar high.

I also tweeted:

When Trump is taken down, the GOP will lean on "mental health" as their rationale, never address the racism and bigotry, and then use that as leverage against any openly neurodiverse candidates.

I don't really see a way around it. But feel it's important to keep saying this.

— David M. Perry (@Lollardfish) January 5, 2018

So it's not that I don't agree that it's possible that there's an issue, as any of us at any time could experience change that might make being president impossible even with reasonable accommodations, but that our cultural ability to talk about mental health is so limited by deeply embedded cultural ableism that it's not going to hurt Trump and it is going to hurt lots of other people. It will emerge when Trump falls anyway (when/if), but it won't be causal. It'll just be a tool of the GOP pretending it's not their fault.


Yesterday The Atlantic published James Hamblin's long and very thoughtful commentary on Trump's mental state. He write, in the key paragraph:

After more than a year of considering Trump’s behavior through the lens of the cognitive sciences, I don’t think that labeling him with a mental illness from afar is wise. A diagnosis like narcissistic personality disorder is too easily played off as a value judgment by an administration that is pushing the narrative that scientists are enemies of the state. Labeling is also counterproductive to the field in that it presents risks to all the people who deal with the stigma of psychiatric diagnoses. To attribute Trump’s behavior to mental illness risks devaluing mental illness.

This is good. A thoughtful paragraph. Glad to see it in such high stakes writing. He goes from there to suggest:

The idea that the president should not be diagnosed from afar only underscores the point that the president needs to be evaluated up close.

A presidential-fitness committee—of the sort that Carter and others propose, consisting of nonpartisan medical and psychological experts—could exist in a capacity similar to the Congressional Budget Office. It could regularly assess the president’s neurologic status and give a battery of cognitive tests to assess judgment, recall, decision-making, attention—the sorts of tests that might help a school system assess whether a child is suited to a particular grade level or classroom—and make the results available.

I, of course, find the idea of a presidential-fitness committee frightening. I know how intelligence assessments are used to reinforce ableist concepts, institutionalization, segregration, and stigmatization of intellectually disabled folks.

I have no solutions, only reactions. It's a tough moment. The problem is ableism and the way it infuses our society, making non-ableist reactions to situations like Trump's brain that nevertheless assess his ability to do his job impossible.