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.

How to Cover "Lost Trump" and the Limo

There's a video of President Trump heading off his plane to his limo, and just wandering off down the runway, until someone turns him around to head back to the car ... which was right in front of him.

What's Going On Here? pic.twitter.com/xC8ORMrblz

— Yashar Ali (@yashar) July 4, 2017

How do we report on such incidents ethically? A few thoughts, as an opening salvo. It's tricky.

1. We can, I think, reasonably ask what happened when the president didn't see his limo. We can describe what we see. We can report on assurances from spokespeople with skepticism, as we should report on all statements from all spokespeople in all contexts. 
2. We can distinguish this observable behavior from the pathologizing of his disgusting behavior. He's been disgusting, in fairly consistent ways, since the 1970s. His use of twitter is consistent with his whole life. My biggest objection to the pathologizing Trump stuff is when people see him behave in a foul way (i.e. constantly) and then characterize it as a mental disability. 
3. We can remember that Twitter RTs will not lead to the 25th Amendment being invoked. 
4. But your friends who have psychological disabilities do hear you link Trump's behavior to your presumption of psychological disabilities. So be thoughtful, please.

Lesley Stahl has talked about her anguish about whether to report on Reagan's "tuning out" and a moment in which he forgot he wasn't still a Hollywood actor. These incidents with Trump, should, likewise, be reported.

#4 is where my concerns lie. How do we report reportable things without hurting the vulnerable? I don't pretend it's easy.

[From last August: My response to the question, "What if Trump really is crazy?"]

Trump and Mental Health Discourse, Part 4392

So Comey said Trump is "crazy," but before that George Will said Trump is "disabled" by Hubris. Will, of course, is the famous father of a man with Down syndrome, so this is particularly disappointing.

One of my critiques of the mental health discourse is that by all accounts Trump has spent his life acting in perfectly consistent ways and has been incredibly rewarded for it. He's always been a liar. He's always been an abuser. He's still a liar. He's still an abuser. This is not a narrative of progressive mental health transformation.

Evan Osnos, with the New Yorker, has more on hubris as disability.

First "Hubris syndrome:"

In February, 2009, the British medical journal Brain published an article on the intersection of health and politics titled “Hubris Syndrome: An Acquired Personality Disorder?” The authors were David Owen, the former British Foreign Secretary, who is also a physician and neuroscientist, and Jonathan Davidson, a professor of psychiatry and behavioral sciences at Duke University, who has studied the mental health of politicians. They proposed the creation of a psychiatric disorder for leaders who exhibited, among other qualities, “impetuosity, a refusal to listen to or take advice and a particular form of incompetence when impulsivity, recklessness and frequent inattention to detail predominate."

Although they say that the Greeks warned as about this, I think the lesson of the Greeks is that hubris is a core aspect of human neurology, not a pathological abnormality.

Second, does it apply to Trump? The creators aren't so sure:

When I asked Owen if Trump meets the threshold of hubris syndrome, he replied that Trump was a hard case, because he reigned over a family business for so long before entering politics. “He has obviously got hubris, but did he acquire it in his business? What was he like when he was twenty? I refuse to put a label on him because I don’t know enough.” Owen added, “Watch him very carefully. It’s a phenomenon that needs to be analyzed, but it will not be very revealing to put labels on it that are inappropriate just because you desperately want to say, ‘He’s crazy.’ ”

This I like, of course. Regardless of the truth of Trump's mental health, it will not be useful to label Trump crazy. It will, however, spread stigma.

Trump Goes (More) Ableist

It strikes me that when Trump needs to criticize white people, he likes to quickly resort on ableism (as opposed to racism, and plus sexism when useful). Here's his comment on Robert Gates, former Secretary of Defense and recent critic of Trump:

Donald Trump launched a series of fierce attacks against former Defense Secretary Robert Gates on Saturday.
"He's a nasty guy. Probably has a problem that we don't know about," Trump said at a rally in an airplane hangar here.

I see that "problem we don't know about" as suggesting that his "nastiness" is related to some kind of mental condition.

This isn't, in the grand scheme of Trump insultapalooza, a big deal. I just like to track this stuff. And as a friend pointed out, Gates' "beyond repair" could also be read as an ableist attack. Follow the "pathologizing Trump" tag for more on that.

Kit Mead: Ableism On the Left

Kit Mead wrote a new post late last week on ableism on the Left. 

The Left isn't especially prone to ableism; rather, ableism is a society-wide phenomenon still in its early days of being discussed, understood, and countered through speech, action, and policy. We're still having to prove ableism exists, that (in the words of Lydia Brown), it's not just bad words, but a hierarchal framework that leads directly to violence and other forms of marginalization.

Mead writes, in the aftermath of Salman Rushdie tweeting about Trump being insane and being dismissive of disabled individuals who questioned his word choice.

I am a mentally ill, twice-institutionalized in a psych ward person. I read your posts. I read your comments. Many of us do. We all notice. We notice how much you want to blame mental illness for bigotry and believe it’s because people are sick in the head that people could say and do such things. For distance – it’s easier to not acknowledge society’s shortcomings when you can point fingers at mental illness. We notice how much you are willing to throw us under the bus to try and defeat Trump. Defeating Trump is a good cause. Using ableism to do it is unnecessary and increases stigma. It hurts people, including me. We know what you think.

Language has power. The power of ableism can be leveraged to wound Trump, but not without consequences for the broader disability community. I believe we can do better.

"What if Trump really is crazy?"

I'm on vacation.

Last week I wrote blog posts and a CNN essay arguing that the urge to characterize Donald Trump as "crazy" relies on stigma around mental illness. I was extremely shocked by the venom in the responses. I never expect to persuade everyone, but if I move the needle a bit and push people to think about the consequences of their language, I'm generally happy.

Instead, I experienced the most surprisingly aggressive set of attacks in email and on Twitter of my writing career. I was repeatedly called a "retard" by people who, in theory, are on my side in many issues. I'm now pretty gunshy about discussing this further and trust my would-be interlocutors, even people who want to engage in polite conversation understand and respect that.

I expect to be yelled at when I write about guns or abortion rights, but in an essay essentially calling for people to think hard about the stigmatizing effect of the language they use, I never expected so much aggression. Score one for the horribleness of online discourse.

There are lots of people who want to argue with me in good faith. Here, for example, is a thread from Patrick Nielsen Hayden, outlining an argument that we need a way to talk about Trump that doesn't stigmatize others, but still expresses his failings in appropriate terms.

@Lollardfish Been thinking a lot about this. Much cultural confusion over axes of "sane/crazy" and "mentally ill/not mentally ill." 1/10

— P Nielsen Hayden (@pnh) August 5, 2016

I have to say I am not convinced. I don't believe we need new words or to apply words like "insane" to argue that the candidate has no self-control, is a liar, is violent, etc. I think we can just say - has no self-control, is a liar, is violent. What does it matter if the conduct comes from neurochemistry versus life-long learned inclination? As writer Arthur Chu noted to me - Trump's behaved like this his whole life. He's been rewarded handsomely for it. In Trump's world, his behavior is entirely rational.

But if I haven't convinced you, then so be it. Thank you for reading. I appreciate any time you've spent thinking about these language issues, even if you've rejected my conclusion.

Hopefully you feel the same way about my disagreement with your counter argument.
Meanwhile, the APA has reminded its professionals of the Goldwater Rule.

Please stop yelling at me. I'm on vacation.

Medicalizing Presidential Candidates, past and present.

Erik Loomis over at Lawyers, Guns, and Money recently emailed me this pdf of a 1975 article in which Garry Wills, the famous author, argued that George Wallace should be disqualified from running for president due to his "infirmity." [Update: The great Rick Perlstein gave me the link to the Google News archive of the column, which is more readable].

Wallace, the [former, he had renounced segregation by 75, in theory] segregationist Governor of Alabama, was running against Jimmy Carter and Jerry Brown (among others) for the Democratic nomination. He had actually been doing very well in the 72 primary before he had been shot, and apparently his opponents and the press turned to criticizing him in 75 for his physical disabilities. In response, Wallace's people complained that he was not being treated with deference for his disabilities, making the comparison to FDR. Enter Wills:

Wills goes into a lot of detail about FDRs last years, arguing that respect for the president's physical disabilities was leveraged by the White House to conceal his rapidly declining mental facility. Wallace, having been "seen struggling with his braces," might similarly use his physical disability to conceal mental unfitness, argues Wills.

No candidate could get away with this now, and no candidate should. Roosevelt placed extraordinary limits on the press, and one serious illness overcame and there was no way for the public to know it. Wallace has been seen struggling with his braces, and has been watched getting out of cars. But there is a natural inhumane restraint in covering these events. It would be wrong for Wallace to trade on such inhibitions and try for the presidency. We his one kind of weakness and Roosevelt (his paralysis) and/or ultimately, therefore, blinded to a far worse condition (his encroaching senility). No man who asked us to hide his weakness can any longer be given the power of life and death that American presidents wield.

Even another Roosevelt should not be elected to office in our time; and heaven knows George Wallace is no second Roosevelt.

I'm no George Wallace fan, and of course 1975 was a long time ago, but this article was written only three years after Thomas Eagleton was denied the VP pick because it was revealed he sought treatment for depression.

Image: Photo of a newspaper article. Sadly, I do not have an accessible version.

The context for this is the drive to medicalize Trump's behavior. The other day I wrote some opening thoughts, along with a storify, on the casual pathologization of Trump's objectionable behavior. It's had an afterlife to which I'll link below. My general thought - we do not need to armchair diagnose Trump to beat him. Leveraging disability stigma to defeat Trump is, at the least, a morally complex choice. I'd like people to think hard before doing it. I won't be doing it myself. 

Here's three pieces by people with disabilities, including mental illness. These are the voices that ought to lead our way:

• Finn Gardiner: Wrong Does Not Mean Crazy

I don’t support the Republicans or Trump’s campaign, but that doesn’t make it acceptable for Clinton or Sanders to use mental illness stigma as a means to criticise them. Trump deserves all the criticism he can get for his bigotry against Muslims, his misogyny, his racism, his endorsement of violence against protesters, his eagerness to use nuclear weapons in Syria and in Europe, his pie-in-the-sky plans to build a ‘great, great wall’ at the US/Mexico border that Mexico will pay for, and every other noxious proposal he’s mentioned during this campaign.

Trump’s disgusting plans are not the result of a mental illness; they’re the result of deep-set, unbridled bigotry that he’s exploiting to worm his way into the White House.

• Kit Mead: On Trump and Mental Health Language:

So, sure, being erratic and lying a lot could be a sign of mental health needs, but that doesn’t mean it’s the reason for things like Trump being a bigot. I’d like to make the point that people with mental health needs are people with many varying viewpoints on the world – so if a person with mental health needs is a bigot, I would argue that the mental health needs are most often a coincidence. I know people with mental health needs who have done less than pleasant things – even, perhaps, said hurtful things about groups of people – in the middle of any sort of episode. I have had episodes where I’ve said less than stellar things, though I don’t think I’ve ever said bigoted things because of an episode – but I think it’s too easy to write Trump off as being a delusional, pathologically lying narcissist.

• Kim Sauder - On Medicalization:

Keith Olbermann made a 20 minute video applying a psychopathy test to Donald Trump. Olbermann did pay lip service to whether doing so was ok but rationalized it thusly “Trump started it” which is true. Trump has applied stigmatizing mental health language to many of his political opponents.
The problem with this justification beyond it’s childishness is that it forgets that pathologizing Trump doesn’t just impact Donald Trump. It also has implications on a broader level to how discourse around mental health stigmatizes people with mental illness. People who haven’t been armchair diagnosed by a public just seeking to discredit a candidate that they dislike.

The conversation is having an impact. James Fallows, with whom I talked on Twitter, has a new piece on recent lies by Donald Trump. He closes with this:

I want to steer clear of “medicalizing” discussion of Trump’s fantasies, his microscopically thin skin, his seemingly uncontrollable outbursts. I have no idea whether we’re seeing his basic personality and temperament, or something else. And from a civic perspective, it doesn’t matter. Either he doesn’t know the difference between truth and falsehood, or he knows it and does not care. Either is a big problem in a president.

He's linking to a piece by Daniel Dale in the Toronto Star. I'm quoted in it saying this:

The armchair pathologizing, and breezy use of the C-word, has upset disabled people and their advocates. David Perry, a disability rights journalist, said that “the casual association of behaviour we find objectionable or erratic with mental illness spreads stigma.”

“He’s a liar, he’s a bigot, he makes bad decisions, he’s erratic and unpredictable. That’s what we need to know. Do we need to then extend a diagnosis to go along with that, to make it really objectionable?” Perry said.

“It hasn’t really worked in eroding Trump’s popularity, but it certainly makes people who actually have these conditions feel very uncomfortable — feel that the message is: ‘If you have a mental health condition, you are not fit to be president.’ And frankly, I suspect we’ve had lots of presidents with mental health conditions, and we’ll probably have lots more.”

Dale adds:

Abraham Lincoln lived with depression. Each of Richard Nixon and John F. Kennedy took a cocktail of anxiety medication. Aides to Lyndon B. Johnson, who experienced severe mood swings, were so concerned about his mental state that they consulted psychiatrists.

Meanwhile, Emily Willingham pulls together some recent reaction and concludes:

Discussions about Trump’s traits are necessary but should be subject to limitations. We should openly talk about the gaps, behaviors and issues like projection and traits associated with narcissism, without diagnosing.

The Big Five personality trait/five-factor model framework that McAdams used in his Atlantic piece is one way to engage in this conversation without stigmatizing. It facilitates speculation about how a Trump presidency might look based on his apparent openness to experience, conscientiousness, extraversion, agreeableness and neuroticism without slapping a mental health label on him.

We can use specific terms about his personality (disagreeable) and temperament (toddler-ish) but not make attributions to a clinical disorder. All of this is doable even as we still dig into why anyoneaccepts this kind of behavior from a grown man, much less a man who is the GOP’s candidate for president.

If we don’t turn inward and examine ourselves for the social factors that feed the bloated ego of someone like Trump, we aren’t doing much better than Trump. If we default to an easy, unexamined “he’s crazy,” we exemplify precisely some of the factors that fuel his popularity.

Linking mental illness and an inability to govern is unnecessary, and history clearly shows that one does not inevitably lead to the other. Such speculation represents a facile refusal to grapple with our own social responsibility.

For me, I'm listening to Kit, Finn, and Kim. I believe we can defeat Trump without leveraging ableism to our cause. I am as loath to use ableism as I would be to use sexism (vs, say, Palin) or racism (vs, say, Carson). We can do better. We must do better.