Am I the only anti-Trump shrink who thinks Trump may not have dementia? He may. But he may not. By Hal M. Brown, MSW I was a psychotherapist for 40 years but didn't learn about dementia until I moved to a senior community and saw it in dozens of residents.

 

Sometimes Occam’s razor can have two sides. When it comes to Trump’a increasingly bizarre behavior there are two, not necessarily mutually exclusive, simple explanations. His behavior is certainly consistent with his psychodamics, but how much of it is influenced by dementia? There are those who have jumped on a bandwagon of looking for evidence that he has dementia. They certainly have found it. However, there are other simple explanations for his unhinged behavior. 

This morning Sabrina Haake wrote this in her Substack “Trade chaos wuth a side of dementia”:

Last year we had articles with titles like 'Without any doubt': Experts say Trump shows 'staggering' signs of 'cognitive diminishment' . They didn’t leave any room for doubt. I had my doubts then and despite a chorus of people, some self-described experts and lay people, saying Trump has dementia I am have my doubts.

I am posting this as counterpoint to Sabrina Haake’s Substack and to the argument of Dr. John D. Gartner, founder of Duty to Warn, who she uses an expert source. Gartner, Wiki tells us, specialized in the treatment of borderline personality disorder, bipolar disorder and depression. Haake’s other expert source is psychologist Suzanne Lachmann who wrote in Newsweek “Donald Trump Dementia Evidence 'Overwhelming.” Dr. Lachmann, per her website, works with adults and late adolescent patients with conflicts including relationship issues, trauma, struggles with self-esteem, body image, trust, depression and anxiety.

In my practice I worked with adults with a variety of common psychiatric disorders, but have had experience working with those with complex dissociative disorder (multiple personality disorder) and Vietnam combat vets with PTSD. I never treated anyone with dementia, though (as noted below) I did correctly diagnose two patients with temporal lobe epilepsy.

I wrote the following on Jan. 3rd, 2025. I have not significantly changed my opinion. 

Most mental health professionals who are saying this are not neurologists, let alone neurologists who specialize in dementia. 
Many mental health professionals are absolutely, positively convinced Trump has dementia. I seem like a lone voice among them saying we need more evidence.

I am not an expert, but because I live in a continuing care retirement community I have seen a lot of people with dementia in all stages.

In my training there was no mention of considering dementia in making a differential diagnosis. In my 40 years of practice I never treated anyone with dementia. I did, however, have three clients who I thought had temporal lobe epilepsy which I knew about having read the book “Seized” by Eve LaPlante. I referred them to a behavioral neurologist who did sleep deprived EEGs with them and it turned out two of the three did have this disorder. When I began practice nobody was conversant about another brain disorder, the autism spectrum. My point is that mental health professionals must be aware that there are sometimes physiological and neurological explanations for behavior. This certainly applies to trying to discern explanations for what seems to be aberrant behavior in Trump. The unanswered question is whether is this behavior psychological, physiological, or a combinaiton of the two.

I have seen the photos and illustrations of Trump’s leaning forward posture countless times as if this was absolute proof of dementia. Lots of people his age stand that way at times.

His word salad could be an indication of mania, not dementia, or it could be, as he claims, a kind of improv which he calls the weave.

Many mental health professionals are digging in on the Trump dementia position. I think this is, in a way, wishful thinking couched in science.

We, meaning shrinks, have all the evidence we need to say Trump is a malignant narcissist, but then perhaps desperate to find more to justify saying Trump is unfit, they added dementia to bolster the argument that he was dangerous. I think mental health professionals need to be more self-critical and open minded in our judgments and not succumb to confirmation bias. It is easy to cherry pick from all the evidence when there’s so much Trump, Trump, Trump just about every hour of the day.

Is anybody keeping track of every bit of Trump’s behavior to find indications that he doesn’t have dementia?

We have ample examples of Trump going on for one or two hours without exhibiting any unambiguous signs of dementia. Much of his extemporaneous sidetracking can just as easily be considered a manifestation of his malignant narcissism as of dementia.

There’s currently a Change.org petition online “Our Diagnostic Impression of Trump is Probable Dementia: For Licensed Professionals Only.”

The petition begins:

We, the undersigned licensed medical and mental health professionals (INCLUDE YOUR ADVANCED DEGREE IN YOUR LAST NAME WITH NO PUNCTUATION) concur: From our years of training and experience, we are convinced that, while a definitive diagnosis would require further testing, Donald Trump is showing unmistakable signs strongly suggesting dementia, based on his public behavior and informant reports that show progressive deterioration in memory, thinking, ability to use language, behavior, and both gross and fine motor skills.

I highlighted the part that jumps out at me. First, the “years of training and experience” should apply to those who were in fields like neurology, particularly behavioral neurology, and neurosciense. It is true that a definitive diagnosis would require testing, however the use of the word “unmistakable” along with “strongly suggesting” shows a bias. Leave that word out and I can accept this sentence.

The petition then goes on to list diagnostic indices in these categories:

1) Decline from baseline

2) Memory:

3) Language

4) Motor:

5) Behavior:

The list reads like someone went over a text on dementia and then found things in Trump’s behavior and managed to make a case that he had this disorder. It wasn’t that long ago that splotches seen on Trump’s hands during the E. Jean Carroll led to rampant speculation that he had syphillis. Even before that the syphillis theory was in the news and no social media. This was from 2017: Trump’s ‘Unhinged’ Behavior Could Be Due To ‘Untreated Syphilis,’ Expert Claims. There is a reasonably good case to be made that Trump might be suffering from some stage of dementia. However, reasonably good isn’t good enough as far as I am concerned.

 

I think the list lacks the scientific rigor necessary to reach a foregone conclusion. This being said, I agree with the conclusion whether or not he has dementia:

This represents a unique danger because of Trump’s pre-existing Malignant Narcissistic Personality Disorder. As he continues to deteriorate he will become even more erratic, impulsive, paranoid, and aggressive than he already is. A demented malignant narcissist as president of the United States would have unimaginably catastrophic consequences.

Not only is Trump unfit, but he cognitively incapable of carrying out the duties of president. Under normal circumstances, relatives of such a patient would be seeking consultation with experts, and considering long term care, as he continues to deteriorate.

We feel an ethical obligation to warn the public, and urge the media to cover this national emergency.

The media must report objectively on anything that suggests Trump may have a cognitive impairment and bring in true experts from the appropriate fields. We can’t allow another Goldwater Rule fiasco to occur. When there were obvious examples of his being a malignant narcissist and mental health professionals spoke up about this they were debunked by many and accused of breaking some sacrosanct professional rule. 
Anti-Trumpers who make the news warning about the dangers of Trump wielding the power of the presidency have been accused of having a psychiatric disorder the name of which has been used to discredit them. You know what it is: Trump derangement syndrome. We must not feed into this narrative.
When mental health professionals go public about the possiblity that Trump has dementia they must do this by emphasizing that this is a possiblity not a certainty. They must write or speak with gravitas and always allow for the chance that they are wrong. 
Time will be the ultimate decider regarding this since dementia always gets worse. There may come a time during his presidency that his symptoms are so obvious you don’t need to be an expert in dementia to reach this conclusion.
This is when the 25th Amendment becomes a real possibility. Then we will be dealing with J.D. Vance. Nobody has suggested he has dementia.
More of my thoughts on this subject:

If Trump has dementia it might be a kind doctors have never seen. Call it weaveheimers. If not, the weave may be as brilliant as he says it is.

This was in Salon (I’m the clinical social worker in the title): Clinical social worker: “With the Trump Bible, one must consider dementia”

I also wrote I’m not the only mental health professional who says that Trump needs a rigorous neuropsychiatric evaluation to rule out a cognitive illness.

—————————————————

Note:

I was one of the first members of Dr. John Gartner’s Duty to Warn group and an early signatory to his petition to remove Trump (Version One) under the 25th Amendment. This was because Trump clearly met the criteria for being a dangerous malignant narcissist, or as the titles of the books edited by psychiatrist Bandy Lee, indicate, that he was a dangerous case.

Trump, newly empowered, has emerged as an even more dangerous case. He is dangerous to democracy and the established social and legal norms which are the bedrock of our society. He has gone from being an exemplar of the Dark Triad to being one of the Dark Tetrad. This has sadism added to psychopathy, narcissism, and Machiavellianism of the Dark Triad. I wrote about this here:

When I look at Trump and try to understand him I do so through the lens of psychoanalytic theory. For example “Trump's tweets are a royal road to his unconscious. As usual Trump was up tweeting last night. Psychoanalysts gain insight into someone's unconscious, and the way their mind works by analyzing their dreams. We look at his tweets.”

Can Trump be showing signs of dementia. Of course this is possible. Can we be sure? I don’t think so. Since dementia always gets worse, if he has it, in time we will see it. 

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This Amanda Marcotte brilliant take is too bad (good) not to share, By Hal M. Brown This is the best description of the month, maybe so far in 2025, of a Trump action: "Last day of Waco decline"

I read this on RawStory before looking as Salon this morning. (I would have eventually seen Amanda Marcotte’s column because I always check out Salon) The RawStory article “Trump's latest 'meltdown' has hints of 'last day of Waco' decline” jumped out at me. It summarizes Marcotte’s Salon column Trump blinks on tariffs in face of GOP resistance — but he hasn't given up on his cult leader dreams "BE COOL": Trump is still giving "last days of Waco" vibes despite a 90-day "pause" on tariffs

RawStory did all the work for me summarzing two crucial points which she makes:

• "We're getting a compelling illustration on the national stage of how a cult leader can induce his followers to stick by him, even as he loses his mind and his behavior becomes too erratic and dangerous to defend. Almost every Republican on Capitol Hill knows that Donald Trump's tariff plan is political suicide, but few are willing to admit that Dear Leader fully intends to see this idiocy to the very end."

• "Trump has a messiah complex, which has only grown since that missed assassin's bullet from July was hyped by his followers into 'proof' that he's the Chosen One," she wrote before suggesting, "Even as he blinks momentarily on his tariff mania, his behavior is getting even more erratic in a way that's got 'last days of Waco' vibes from a president who has already unsubtly compared himself to David Koresh. His Truth Social meltdown when announcing the 'pause' indicates a decline in Trump's already-fragile mental state."

• With Trump writing, "They are dying to make a deal. 'Please, please sir, make a deal. I’ll do anything sir,'” Marcotte called it "...a moment quite reminiscent of how late-stage cult leaders experience a total collapse between reality and their grandiose fantasies," before pointing to Trump also boasting, "Everything is going to work out well. The USA will be bigger and better than ever before!"

• "It all feels like the final stage of a cult, when the leader's frantic efforts to retain control result in escalating dictates and prophecies that become increasingly hard for followers to make sense of," she wrote before adding, "Republicans would be foolish to treat this 90-day pause as a victory big enough to justify scurrying back to their holes, to hide from the wrath of Dear Leader. He is spiraling and sees these tariffs as the final proving ground of his total conquest of the GOP. He will keep going back to that well — which means economic tumult, more stock market crashes, and more panicked constituents — unless this tariff nonsense is put to bed entirely.

From the RawStory comment section:

This is from:

Know how people often use "drinking the Kool Aid" as a metephor for undying loyalty? Referencing the Jonestown incident? That is, in fact, incredibly inaccurate. What happened at Jonestown was not mass-suicide, it was mass-murder.

Most of the cultists did not kill themselves willingly, survivors of the event claim that most were forced to drink the stuff at gunpoint, and those who refused were shot.

As far as this story goes, Jones' health had indeed degenerated by then, was informed of a possible lung infection, upon which he announced to his followers that he had lung cancer – a ploy to foster sympathy and strengthen support within the community. He was said to be abusing injectable Valium, Quaaludes, stimulants and barbiturates.Audio tapes showed he was complaining of high blood pressure, small strokes, losing forty pounds within the span of two weeks, temporary blindness, convulsions, impotence, and, in his final month, grotesque swelling of the extremities.

Yeah, he was a sick, crippled, pathetic lunatic, and if he hadn't whacked himself he'd have been dead anyway within a few month, tops. And I'd put money on the end of Trump's "reign' being even less dignified.

Below is an animation:

I won’t go into how and why Trump has deveoled a following that is often be called and analyzed by experts as a cult. Cult expert Steve Haasan appeared on TV and has writen at book, “The Cult of Trump” (review) about this. A web search of “Trump cult” will come up with numerous articles.

Above is from this DuckDuckGo search.

I appologize to my Substack readers who count on me to try to come up with an original slant on an issue. Amanda Marcotte did all the heavy lifting for me today.

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My previous Substacks hopefully have a semblance of originality.

Trump's Hitlerian Henchwomen: Pam Bondi and Karoline Leavitt offer the feminine tone as their Führer sets the stage for sending people to the modern day version of concentration camps,

Attorney General Pam Bondi and Karoline Leavitt, Trump’s press secretary, put a pretty face on his cruel policies. They might as well be twins. Even my AI can’t seem to tell them apart. 1

Now we have news about Trump exploring ways to “deport” U.S. citizens to a prison hellhole in El Salvador.

The Trump administration can now be called nothing less than downright Hitlerian in its aspirations and soon, if they can get away with it, in their actions. 

This is from the HUPPPOST article subtitled “The administration could try removing American citizens if it identifies a pathway it can claim to be legal.”

The article begins:

White House press secretary Karoline Leavitt said Tuesday that President Donald Trump is exploring legal pathways to “deport” U.S. citizens to El Salvador, where the administration has already arranged to house deported immigrants in a prison known for its human rights abuses.

Leavitt suggested the effort would be limited to people who have committed major crimes, but Trump has also mentioned the possibility of sending people who commit lesser offenses abroad.

Any such move on the part of the Trump administration is certain to be challenged in court. It is also not clear what legal authority could be used to justify expelling U.S. citizens from their homeland.

“These would be heinous, violent criminals who have broken our nation’s laws repeatedly. These are violent, repeat offenders on American streets,” Leavitt told reporters at a press briefing.

“The president has said if it’s legal, right, if there is a legal pathway to do that. He’s not sure, [and] we are not sure if there is,” Leavitt continued. “It’s an idea that he has simply floated and has discussed very publicly in the effort of transparency.”

Many people mistakenly think all of Hitler’s concentration and death camps were in Germany. They weren’t.

From 1933 to 1945, more than 40,000 concentration camps or other types of detainment facilities were established by the Nazi regime. Only the major ones are noted on the map (shown here) Among them are Auschwitz in Poland, Westerbork in the Netherlands, Mauthausen in Austria, and Janowska in Ukraine. By 1941, the Nazis began building Chelmno, the first extermination camp (also called a death camp), to "exterminate" both Jews and Gypsies. In 1942, three more death camps were built (Treblinka, Sobibor, and Belzec) and used solely for mass murder. Around this time, killing centers were also added at the concentration camps of Auschwitz and Majdanek.

It is estimated that the Nazis used these camps to kill approximately 11 million people. Reference.

You could say that Trump and his Gestapo think along the lines of “out of sight, out of mind.” To a large extent this is true. Once someone from America, a citizen or non-citizen, is swallowed up into the bowls of the notorious Salvadorian prison, they are indeed out of sight.

They should not be out of mind. Even the worst or the worst criminals deserve to be afforded their rights under the American judicial system. 

If they are non-citizens and found guilty of whatever crime they were charged with I do not think it can remotely be called the American way to send them to serve time in a Salvadorian prison under Salvadorian law. 

The gang members deported aren’t even from El Salvadore. There are allegedly members of the Venezuelan gang Tren de Aragua. While this gang has members who have committed violent acts and broken laws it is wrong to assume that mere membership means they all are the same. Here’s a good article about the gang.

If they are Venezuelan citizens and they are going to be deported anywhere it should be back to where they came from.

So here we have happy Pam Bondi wearing her $50,000 watch doing a photo op in front of a group of prisoners in the Salavdorian prison where, behind the bars, you can see sleeping bunks reminscent of those in Nazi concentration camps. And then we have happy Karoline Leavitt talking about the idea that it’s just fine and dandy to send American citizens to the same prison.

Trump has put these women forward because he thinks they are photogenic and they are as American as Mom with her apple pie.

In fact, these two henchwomen may look the part to Trump and MAGA men and women, but I see them as far darker personalities.

They don’t look the part of a sadistic psychopath like Tom Homan (in the news today):

I see them as being just as cruel and sadistic. They are out front in the bright lights, but the malevolent parts of their personalities are visible to anyone whose eyes are wide open. They can see them for who they really are. 2

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1

Images of Bondi and Leavitt are AI created.

2

Image created by AI and darkened by Apple Photo