Brief Synopsis. We need multiple types of assessment and evaluation to determine trump’s cognitive status/decline. We cannot make a determination based on TV appearances and hearsay.
My answer to his decline is I don’t know! I can’t make choice about him or anyone based upon hearing stuff from people around him who are not mental health individuals and TV information. This is not a defense of trump (anyone who knows me knows I absolutely hate him), it is an attack on how people reason about any judgment or decision.
The issue here is people are making a decision based upon the above two factors alone, TV and hearsay. Any clinician knows you can’t do that. At best you can come up with a clinical hypothesis that you would go into an interview with, and further assessment with, that’s all. The codes in various professions state that you have to give the caveat on a judgement or diagnosis that is made with limited or specific types of information.
What amazes me is people are so confident with these two limited types of information. I remember as a grad student (final year) myself and a forensic-neuropsychologist interviewed a mere 22 year for four hours… then I gave him eight hours of psychological testing regarding. With all of this, plus medical, and other special types of information… Our position was still contested in court!
I don’t doubt that trump has some psychological personality issue/s and potential other mental issues. However I would want to interview him privately, talk to; friends, co-workers, family, full medical examinations etc. Then I would to give sophisticated neuropsychological tests to him. Then come to a conclusion.
Remember he was given the Montreal Cognitive Assessment of which he “passed” according to a medical doctor. First this is a mere screening device that takes less than 15 minutes to give! Second it was a medical doctor who gave it and is NOT qualified to give sophisticated tests that psychologists and others specially trained. That “assessment” which is a mere screening device like the Mini-Mental State Exam again takes less than 15 minutes to give. The Wechsler Memory Scale ALONE takes 60 to 90 Minutes. That is not even looking directly at dementia. The infamous IQ test takes 2.5 to 3 hours to give. We have specific cognitive decline tests, ADHD tests, anxiety test, depression tests, learning disability tests, autism spectrum disorder tests, alcohol/drug tests, the list goes on. I mentioned all this in the post, Comment on Trump’s Cognitive Status. So note this, it is a screening device, not a pre-test that gives us a full baseline level of trump’s cognitive functioning.
Also realize you should take the following into consideration…
You must talk to neurologists who can look MRI’s, and other neurological measures and bio-measures that can contribute to, mask or look like a mental disorder. I am not a neurologist to be even able to comment on number of things they can find!
Psychiatrists can look at drug interactions, drug use history, medical issues, currents medications that all can mask or look like a mental disorder.
Medical doctors of ALL different specialties can then assess every different imaginable medical issue/s. Heart, lung, digestive, liver, kidney, pancreas etc. those are just tip of the iceberg. There are numerous issues of the medical nature that can influence how a person comes across cognitively, socially and so on. Just think of your own experience of feeling very ill, with something as an example. You may appear depressed to me as a psychologist upon initial impressions. Yet if I found out that you have had the flu for 10 full days, pneumonia or some other ailment I can’t diagnose, I may completely change my stance. We need the whole picture medical, psychological, and otherwise.
All of the professions can and should contribute to a diagnosis. This is not for a mere arm-chair psychiatrist/psychologist/neurologist to make up their mind based on TV and hearsay by people.
Furthermore the above mentioned examples in the medical domains I mentioned, are simple examples of where someone educated in each could area/field could write a chapter in a book on. I have no idea how an immunologist could go on for pages!
I am just trying get you to realize there is so much more out there to take into consideration than what you see on TV and hearsay.
Finally, something to think about are situational factors. The President by definition I think we agree is under more stress than the average person. This President is under potential indictment, impeachment, prison and losing the upcoming election. Furthermore, we have no idea what his relationship has become with family, friends, his wife, business partners and others. Who even knows what his medical status is right now. All of these situational factors may play a huge part in how he comes across as seen in the past several years. All of which could of evolved in an unexpected way!
Think of it this way, and research bares this out. You take anyone and put them under severe stress, or unusual situation and they will act differently. As an example I am petrified of the dark, and scared of the woods each individually. If you combine and put me in the woods at night and observe me I have no doubt I will appear as if I have some severe mental issue (friends and family know this).
As a simple example look up on Youtube, the Asch line study regarding conformity. People will conform to something that is not real. Look up The Stanford Prison Experiment. Again, people behave in ways that are not representative of themselves “normally.” Look up the Milgram Obedience Study, again abnormal behavior in this situation occurs. Where people shock others even those with medical issues. These all are relatively simple compared to the myriad of factors that this president is facing which may have an additive or synergistic negative effect.
Again, I am NOT defending him or his actions. I hate him, but we have to be even handed in an evaluation of him, otherwise we are basing decisions on terrible information.
This for people paying close attention, you should extrapolate this mindset to other areas of your life. Your spouse may be aggressive at work and docile at home. Your child may be timid at school and rambunctious at home. You are complacent at your religious institution and vocal in public. Add your on examples here.
My thoughts are that all future Presidents need to be measured on all of the above, and more! This needs to happen at the start the presidency, so we have a baseline… Also known in fields as pre-tests. Again the Montreal Cognitive Assessment is a SIMPLE SCREENING DEVICE, not a baseline or pre-test. Then if we see something that appears to be cognitive, social, physical, etc. out of place we can then re-test to see if there is a clinically significant difference. Then we can make informed scientific decisions and not arm-chair ones.
Final note… I am very frustrated and disappointed that psychologists, neurologists, psychiatrists and others have not come out publicly saying this, at least very publicly. The American Psychological Association. Shame on you.
Psychology & Philosophy 