Trump's 'pattern of cognitive decline' alarms psychiatrists

Jerry Adler
Senior Editor
Donald Trump with a map marking New York City and Germany. Background: Fred Trump. (Photo illustration: Yahoo News; photos: AP (3), Getty Images)

Call him “Patient 1”: An individual in Washington, D.C., who presents with symptoms of mental decline, including a bizarre inability to remember where his own father was born.

Bandy Lee, a psychiatrist on the faculty at the Yale School of Medicine, has some insights to share, which we will get to in a moment.

On Tuesday, at a meeting with the secretary-general of NATO, President Trump launched into an impromptu riff on one of his favorite topics, the reluctance of America’s wealthy European allies to pay more toward their own defense. Then, in what might have been a clumsy effort to show no hard feelings, he expressed his love for Germany, the ancestral home of the Trump (or, originally, Drumpf) family:

“My father is German, right? Was German. And born in a very wonderful place in Germany, so I have a great feeling for Germany.”

Trump’s father, Frederick, was born in 1905 in the Bronx, approximately 4,000 miles from Germany, as the accompanying map shows. Trump’s grandfather was born in Germany, but was living in the United States with his wife when Frederick was born.

Frederick Trump's birth certificate from the state of New York, borough of the Bronx.

Of all Trump’s many misstatements, exaggerations, empty boasts and slips of the tongue, this one — which Trump has made at least twice before — stands out for its sheer inexplicability. Ordinarily, when Trump says something ridiculous, it’s for an obvious purpose. He has been on an unhinged rant recently about windmills, whose function in the electrical grid he misunderstands and whose sound he says causes cancer. That is an assertion for which the White House was unable to provide any support, because he unquestionably made it up. But at least it’s consistent with his general disdain for environmentalism, and explainable by his self-interest in fighting to stop an offshore wind farm that he believes will ruin the views from one of his golf resorts in Scotland. And it is, strictly speaking, unfalsifiable; the carcinogenic effect of windmill noise, like a lot of other nonsensical beliefs, hasn’t been scientifically studied, so all you can say is that there’s no evidence for it.

But there’s a New York birth certificate that contradicts Trump’s claim about his father, and no obvious advantage for him to make up a story about it. To the contrary, Trump early in his career disguised his German ancestry, claiming his family was actually from Sweden, a lie that apparently was intended to make it easier to do business in a city with the largest Jewish population in the world. And in his first memoir, “The Art of the Deal,” he wrote that his father’s “classic Horatio Alger” story began with his birth “in New Jersey in 1905.” The Bronx is only just across the Hudson River from New Jersey, but it is in a whole different state.

Trump is disdainful of psychiatry, but one can imagine Freudian explanations for this peculiar assertion, or at least I can. Mistakes, Sigmund Freud theorized, are often the key to hidden feelings and memories. Is it just a coincidence that Trump, who got his start in national politics by peddling a conspiracy theory about his predecessor’s family and birthplace, and who constantly measures himself against him, repeatedly makes the same bizarre gaffe about where his own father was born? Is it resentment toward his overbearing father, who made a fortune building apartment houses in the outer boroughs, and reportedly never quite trusted his son’s foray into glamorous Manhattan real estate? Someone I know who worked closely with Trump in the early 1990s, when his casino empire was teetering on the edge of bankruptcy, recalls him saying dolefully at the time, “I should have listened to my father and stuck with Brooklyn. My father is going to say, ‘I told you so.’”

Of course, I’m no psychiatrist. But that holds the advantage that I am not bound by the American Psychiatric Association’s “Goldwater Rule,” which forbids members to offer opinions at a distance on the mental health of public figures. The provision was added to the profession’s code of ethics after a number of psychiatrists publicly speculated on the fitness and stability of 1964 Republican presidential nominee Barry Goldwater. He, of course, never became president, but Trump’s ascendance has prompted a number of prominent psychiatrists to declare an overriding emergency. Organized as the World Mental Health Coalition, they held a conference in Washington last month on “The Dangerous State of the World and the Need for Fit Leadership.”

“We are talking about the profound danger of the mentally unstable individual who holds the highest office in this country, and most powerful single office in the entire world,” said one of the speakers, Jeffrey Sachs, a Columbia University economist.

“He is rapidly declining,” Lee, the group’s president, said of Trump in an interview. “His rallies have been increasingly less coherent, with greater signs of paranoid responses, increasing attraction to violence, increasing espousal of conspiracy theories. A few weeks ago, there was the ‘Tim Apple’ episode, and the other day he referred to Venezuela as a company, while recently he confused his father’s birthplace with his grandfather’s.

“His mistakes are growing more and more bizarre,” Lee said. “If we match the pattern of his deterioration against pathology, what disease states look like, we can say he is not well.

“Continually we have been seeing that his erratic thoughts and behavior are more consistent with mental pathology than strategy. Now we are seeing a pattern of cognitive decline.”

Shortly after Trump took office, Lee edited a book called “The Dangerous Case of Donald Trump,” a collection of essays by mental health professionals, which recently appeared in a second edition. “What we said then was that he was worse than he appeared in public and would grow more dangerous over time. That his mental pathology would spread into his administration and the population.” She referenced a phenomenon called “shared psychosis,” in which delusions spread from one family member to his or her relatives.

“In terms of the presidency,” she said, “the nation is the family. That is what we’re seeing now. One of the first things you lose is the ability to recognize that something is not right and to get help. An increasing proportion of the population is unable to recognize that something is not right. What you do in such a situation is contain the person, remove them from access to weapons and do an urgent evaluation. Then you manage the person in the least restrictive manner according to the results of the evaluation.”

Lee said her organization was “in the process of forming an expert panel that can test fitness for duty” by presidential candidates, pointing out that military officers in control of nuclear weapons undergo regular psychological evaluations. The exam she has in mind tests for such things as the ability to consider the consequences of decisions, to follow a logical train of thought, and to understand and explain back a story or scenario.

I think that would be a good thing to do for Trump, and for any of his would-be successors.

But if I were administering the test, I’d start with one simple question:

“Do you know where your father was born?”

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