Donald Trump and the pathology of leadership…

Dame Iris Murdoch, the Dublin born novelist, won the Booker prize for fiction in 1978 for The Sea, The Sea. Her final novel, Jackson’s Dilemma, was published in 1995 and was met with a muted response from the critics. She was subsequently diagnosed with Alzheimer’s Disease which was confirmed on post-mortem after her death in 1999.

Subsequently, a textual examination of The Sea, The SeaJackson’s Dilemma and her first novel, Under The Net, showed that her vocabulary was considerably reduced and ‘commonplace’ in her final novel, but extensive in The Sea, The Sea.

A more complete textual analysis was undertaken in 2011, and studied not only Murdoch, but also Agatha Christie who was suspected of having Alzheimer’s, and PD James who had aged healthily. This was a ‘diachronic’ analysis, that is, studying changes in the use of language over time. This also showed a reduction in vocabulary in Murdoch’s later works, in keeping, the authors thought, with the early onset of dementia during her last novels. Similarly, they found that Agatha Christie was also affected, but that PD James was not.

Ronald Reagan was, at the time of his inauguration in 1981, the oldest man to have become President of the United States. There were doubts about his mental abilities from early in his Presidency; these doubts increased in the last two years of his second term, though no action was taken. Reagan issued a statement in 1994 saying that he had been diagnosed with Alzheimer’s disease; he died a decade later, aged 93.

Using transcripts of Reagan’s press conferences, a similar textual analysis was performed in 2015. Changes in speech patterns were found, including the use of repetitive words and the substitution of ‘thing’ for specific nouns. The use of ‘unique’ words also decreased over time. These features could be consistent with Alzheimer’s disease, though the authors were careful to stress that this did not necessarily mean that the President was mentally incapable when in office; rather they suggested the use of such analysis as part of early diagnosis.

I previously wrote about The Pathology of Leadership in April 2017; there are many, many more examples of people in positions of leadership who became simply unfit for office. We are generally only made aware of problems after the event, often very much later. Professor Ferdinand Sauerbruch, was the head of surgery at the Charité in Berlin during WW2, and for a period afterwards. Sauerbruch breakfasted on a pear which had been preserved in brandy. He quite clearly went senile, botching operations which the underlings had to fix behind his back. He wrote the most peculiar, fantastical autobiography in which the publisher had to enclose a note warning the reader not to believe everything. Because Sauerbruch was such an internationally renowned surgeon, even the East German government, not noted for a kid glove approach, quailed at the idea of sacking him; his protracted but eventual removal was described in The Dismissal.

Senator Barry Goldwater was the Republican candidate in the 1964 Presidential election against the incumbent Lyndon Johnson. During the campaign, Fact magazine reported on a poll of 1189 psychiatrists who said that Goldwater was psychologically unfit to be President. Johnson won the election. Goldwater then sued the magazine for libel and won. The American Psychiatric Association subsequently declared that it was unethical for psychiatrists to give an opinion about public figures whom they had not personally examined. This decision became known, unofficially, as the Goldwater Rule.

The Goldwater Rule inhibited not only discussion of individuals, but also discussion around the general idea that public figures and politicians ought to be of sound mind, not only free from mental illness, but also free from personality defects. Only recently has it become acceptable to publish about this, usually with the caveat that it is a discussion related to ‘safety’ and ‘danger’.

The New Statesman published an article in early 2017 (here) asking whether candidates for the Presidency should be candidates for psychiatric testing. Two major concerns were antisocial personality disorder, in which someone thrives on continuing conflict. Kim Jong-un was suggested as a candidate. The other disorder suggested was narcissistic personality disorder, though no one was named; the article was headed with a picture of Donald Trump smirking.

With the recent publication of Fire and Fury which describes events in a dystopian White House, questions around the mental health of the present incumbent are again being asked. Bandy Lee, in the Guardian, notes that she and other psychiatrists attempted to assess the President in 2017, though keeping within the spirit of the Goldwater Rule. They felt that they could nevertheless make some assessment of a person’s fitness from general observations, and that when they felt that the subject was becoming a public danger, there was a duty to speak out. “But to assess dangerousness, one only needs enough information to raise alarms.” Trump’s aides are said to be concerned as well, suggesting that he may have learning disabilities, dementia — or is simply illiterate. Mr Trump, however, describes himself as a ‘genius’. Mrs May, neither a psychologist or psychiatrist, isn’t concerned about the President’s health; another group of allies defends him here. How much of this is Republican/Democrat politics and how much is real, rather than ‘fake news’ isn’t clear to me: who to believe?

As an aside, the President is said to sleep for only fours a night; Mrs Thatcher likewise. Such sleep deprivation is associated with obesity, diabetes, poor mental health and dementia. Mrs Thatcher indubitably developed Alzheimer’s disease. Note: an association does not mean causation. The President uses the early hours to tweet, an unusual dawn chorus.

The President has a yearly ‘physical’ at Walter Reed Hospital in Washington; it’s unclear if this includes cognition. In the UK, yearly mental health checks for MPs have been suggested. They can have 3-yearly medical screening, though not all MPs attend. Commercial airline pilots seem to be the only group in whom regular and comprehensive tests of physical and medical health are required.

What then might be the (mental) attributes that a candidate for President of the US or Prime Minister of the UK, or indeed any subsidiary office, requires? There have been some suggestions, such as here and here. I’d suggest that any candidate needs to be reasonably intelligent, to be able to pick aides who aren’t simply yes-men, to have a good memory, to permit dissent as a precursor to an agreed position, to have a sensible, achievable set of objectives, to be able to distinguish rigidity from strong leadership, and to be able to relax. I’m sure there are other necessary attributes. As there seems to be no job description for either position, selecting a candidate on the basis of their skill set is rather meaningless.

The Framers of the US Constitution did not make wholly adequate provision in the event that the President became incapacitated: or how to get rid of a President who was incapable of performing the duties of office, either on a temporary basis — such as during a general anaesthetic — or on a permanent one. Eventually, the 25th Amendment provided for a process which involves the vice-President and a majority of the Cabinet. There is no formal mechanism in the UK; one could expect that removal of an incumbent would be a matter of ‘events’ which ‘emerge’.

Telling truth to power isn’t easy; in some countries it might be the preamble to a visit to the firing squad. How do you tell the leader that he’s ‘past it’ and should go? There are far too many examples of leaders who have stayed on well beyond their ‘best before’ date. If you are a fan of French-noir, you might have seen the most recent episode of Engrenages (Spiralon BBC4. In this, the juge d’instruction, François Roban has been suffering from memory loss and assorted other cerebral problems. He has a ‘lesion’ in his brain which requires a biopsy. He attends a neurological surgeon who suggests that he ought not to be at work. Roban insists that he is the best assessor of his mental capacity, only to be firmly, accurately and correctly told that he isn’t and can be ‘supervised’ and removed from his work. A century ago, King Edward VII developed appendicitis, complicated by an appendix abscess. Two days before his coronation, the King and his medical advisors had a furious row; he was advised to have an operation to drain the abscess, and he refused point blank. Eventually, the King played his ace, saying that he would keep faith with his people, he would go to Westminster Abbey. “Then, Sire” responded Sir Frederick Treeves, “you will go in your coffin!” The operation was performed, the coronation postponed.

Where today is a Treeves when we need one?

  • JohnTheOptimist

    If you are looking for a sign that a politician is mad, I’d say walking around with a loaf on his/her head is as good as any.

  • MainlandUlsterman

    Really interesting read, thanks. I read the Bandy Lee article in the New Statesman and must admit I was a bit uncomfortable with its attempts to circumvent the Goldwater Rule. I think people ought to be allowed to say something; I just think psychiatrists giving professional opinions that verge on diagnoses on people they haven’t examined personally isn’t fair on the individuals and does the profession no favours. But I guess some broad commentary is fine. The bigger problem with her piece as a reader was that she spent at least half the piece defending her right to write it. Protesting too much methinks.

    My other observation as regards dementia is that brains change and brains age, without everything being dementia. Few people can learn languages in their 30s or 40s the way they can in their teens; memory does get less good for a lot of people; other skills are developed and refined on a use it or lose it basis. I’m no expert but my point I suppose is that it’s natural leaders in their 60s and 70s will have different mental shapes and modes of thought than they had when they were younger (and not all for the worse). The thing is whether they can do the job

    By the way, one technicality about disgnosing Alzheimer’s – it can only be definitively identified after death. While the person is alive they officially have “suspected” Alzheimer’s.

  • Korhomme

    Bandy Lee’s problem is not a new one; when is a duty of confidentiality to an individual patient outweighed by a public duty to speak out? Medical confidentiality in the UK isn’t absolute; physicians are required to notify certain infectious diseases; here, there is a duty to inform when a patient has been injured in a terrorist incident. If a patient continues to drive despite having epilepsy, what is to be done? If someone in a position of power appears irrational, again where does the duty lie? And, will that person in authority take any notice of what is said — are they even capable of taking notice?

    As you say, the natural, inevitable changes in the aging brain don’t necessarily mean dementia or that someone is incapable. There is a story, only an anecdote, about a man in his 70s who attended his GP with a problem with chess. The man, he said, used to be able to see nine moves ahead in chess, but now could only see five; he found this very upsetting. All clinical tests were entirely normal. The man died of an unrelated cause a couple of years later; at post-mortem, very extensive changes of Alzheimer’s were present. This is in keeping with the idea that those who have used their brain can afford to lose some capacity while remaining functionally intact.

  • Korhomme

    PS Candidates for the Presidency are expected to publish their medical records (and their tax affairs). Donald Trump’s physician apparently wrote this while the limo which was to collect it waited outside:

  • npbinni

    Most people now agree – apart from some die-hard lefties who continue to flog dead horses – that Ronald Reagan was a great president, despite all the ‘concern’ for his mental state.

    Yesterday’s widely reported discussions between Trump, the GOP and the Dems clearly demonstrated a very capable president in full control of all his faculties. It puts a huge hole in the malicious narrative that his detractors are trying to create now that their Russia narrative has imploded.

    Even CNN’s typically-hostile commentators were honest enough to acknowledge how impressed they were with the president.

    It’s worth three minutes of your time. That’s if you want to come out of your echo chamber. 😉

  • Ben De Hellenbacque

    He certainly restored pride in the nation among US citizens. This was after an uncharacteristically gloomy period in US history when the country’s ideals looked questionable both internally & internationally (even though that has continued possibly as a reaction to the ‘certainty’ that he re-established).

    A lot seems attributable to sunny outlook/optimism/belief/faith all predicated on the American Way. However, I don’t think that’s under question here. In addition, Reagan’s administration team, as with President’s administration team, was also a lot less chaotic than Trump’s is which raises the question over The Donald’s weaknesses as the leader of a country and the ‘leader of the free world’.

  • npbinni

    Indeed, and others ‘liking’ and retweeting it as funny. Talk about shooting yourself in the foot.

  • npbinni

    If you have the time you should watch this:

    Undoubtedly, Trump has his weaknesses, but he also has some great strengths, like the amazing cabinet team he has surrounded himself with, and it’s abundantly clear he is not the doofus or, indeed, monster that some want to portray him as.

  • Ben De Hellenbacque

    And Bandy Lee has devoted 20 years of her career to ‘prevention of violence’ which is open to a number or interpretations and has also broad application. Her studies of the ‘immorality of character’ while applicable are simultaneously to be subject to context or environment, e.g. what prevents someone from lashing out in the pub or street can be awareness of the potential opprobrium of those who witness it. Trump’s Oval Office nor the system of ‘checks and balances’ do not seem to have the power or authority to contain him. But then he hasn’t really been tested yet.

  • Ben De Hellenbacque

    If he isn’t the ‘doofus’ it’s interesting why he feels he needs to present himself as such. He is, after all, out of his comfort zone with no history in elected office. The environment of Presidential Office contains restrictions that aren’t necessarily found in the business environment from where he came. How he adapts to those restrictions (along with his entire performance) will only be fully assessable after his term in office ends.

  • npbinni

    Korhomme, are you not able to, or is it just that you are unwilling to talk about substance rather than salacious gossip, innuendo and Trump trivia?

    Even the celebrated New York Times anti-Trumper, David Brooks, realises what’s happening:

    ‘the anti-Trump movement, of which I’m a proud member, seems to be getting dumber. It seems to be settling into a smug, fairy tale version of reality that filters out discordant information.

    More anti-Trumpers seem to be telling themselves a “Madness of King George” narrative: Trump is a semiliterate madman surrounded by sycophants who are morally, intellectually and psychologically inferior to people like us…

    The anti-Trump movement suffers from insularity. Most of the people who detest Trump don’t know anybody who works with him or supports him. And if they do have friends and family members who admire Trump, they’ve learned not to talk about this subject. So they get most of their information about Trumpism from others who also detest Trumpism, which is always a recipe for epistemic closure…

    I’ve noticed a lot of young people look at the monotonous daily hysteria of we anti-Trumpers and they find it silly.’

    Do you understand, Korhomme, that for a lot of people, you and your type are becoming quite the joke?

  • Korhomme

    Alas, the laptop is playing up and I can’t hear the dialogue.

    Sauerbruch quite clearly went senile; there is no doubt of that. In his prime he was one of the top surgeons in Europe, even in the world. Very late in his career he went to a surgical meeting in Bern. An unusual case of thyroid disease was being discussed, and the meeting came to a diagnostic conclusion. All, except Sauerbruch that is; and he was proven to be correct. Strangely, the dementing can have moments of extreme clarity.

  • Ben De Hellenbacque

    Something of the exact type of over-reaction that you are accusing Korhomme of. Echo chambers are indeed very reassuring and comfortable places but the world ain’t a comfort zone even if ‘snowflakes’ merely melt in your hand.

  • Korhomme

    Reagan didn’t think of himself as an intellectual; rather he was the showman, the front man, the great communicator; he was very good in this role. He also had a coherent team and left them to do the heavy lifting while he went horse riding. It’s a very different approach to the micro-management of, say, Gordon Brown, but it worked for him. [I hope to say more about Reagan in the future.]

  • hgreen

    Next you’ll be telling us the pussy grabbing tape was by a voice over artist.

  • Korhomme

    No, I don’t understand or accept that. Your quote seems so much like the ‘fake news’ that we hear about.

    Do you remember Trump’s inauguration, when he claimed that the crowds were much bigger than at Obama’s? Were they? I’m no fan of Bush43, but his quip about the inauguration speech — that’s some weird s*** — struck me
    as accurate.

    What I do find very difficult is separating the reality from ‘fake news’. Who invented ‘fake news’?

  • npbinni

    Having a history of successful elections is no guarantee of ability or competence. Just look at Obama’s dismay record at everything he has ever done.

    Trump has undone in one year what Obama took eight years to try to foist upon America. For the first time in more than 10 years Americans are feeling more confident about the future.

    And this is just the end of the beginning.

  • Ben De Hellenbacque

    So he is undoing a lot. Well, good for him. I and anyone can demolish with one kick something that’s taken years to assemble.
    Is his legacy going to be destruction or will it be construction or production? At least a bit of both will be acceptable.

  • Korhomme

    You think the Affordable Care Act, aka Obamacare, was a bad thing?

  • npbinni

    Please try to keep up, Korhomme!

    Before you accuse others of disseminating fake news, get your facts right first. I’m sure the Slugger editors have noted your rather impetuous and ill-informed comments.

    You clearly do not read the NY Times. Or maybe that’s above your reading level. Or, maybe you just have a propensity to block out anything that might burst your little anti-Trump bubble.

    Whatever the case, waken up and smell the roses.

  • npbinni

    Wow, there’s no hope for you, HR! 😉

  • npbinni

    I’m sure there’s a nugget of wisdom in there somewhere, Ben.

  • Ben De Hellenbacque

    Anyone would feel wise reading your posts. There’s also merit in letting you know that it’s lonely in your echo chamber.

  • npbinni

    hey, y’all have a good life!

  • npbinni

    I’ve no personal experience, and don’t know all the pros and cons of it, but several of my American friends with illnesses have told me their horror stories about huge increases in their premiums and deductibles and less coverage and options for doctors.

    The passage of Obamacare was based on numerous false claims. It seems to have done more harm than good.

    Kind of fits in with the premises of this article…

  • npbinni

    He’s making America great again. And more and more people are starting to realise it. He’s still arrogant and obnoxious, obviously, but, really, he got that from his time among the Democrats and in Hollywood’s cesspool.

  • Fir Bolg

    Really. Haven’t you seen Netflix “rotten” documentary series.
    Wearing processed food is far smarter than EATING it.
    SF are doing a public service.
    The evils of Processed food.

  • npbinni

    Are you on something?

  • Brian O’Neill

    Stop being so arrogant. You can make your points without being rude.

  • Teddy Oberman

    Why no mention of the use of legal prescribed psychotropic drugs? Should politicians not disclose a medication profile? Are we seeing/hearing someone, or just his pharmaceuticals?