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I'm Dr. John Gartner.


I'm Dr. Harry Siegel.


And this is Shrinking Trump, a weekly show dedicated to analyzing Trump from a psychological point of view. Just to give a little bit of background, some of you may know me as the person who started Duty to Warn in 2017. I sometimes explain that as my being a little bit like the nerdy Dr. Randall Mindy in Don't Look Up, who was I'm one of the first to see an Earth-killing asteroid heading towards the planet because of his nerdy area of expertise. I just happened to have an expertise in malignant narcissism because of who I trained with. And it's a historically obscure diagnosis that It's not in the DSM that most people don't know about, but it was introduced by Eric Frome to explain the psychology of Hitler, from whom he fled. And so realizing that Trump was the American Hitler, I felt a duty to warn the population that he was unfit and dangerous. And when I did, hundreds and even thousands of mental health professionals joined us, including Dr. Harry Siegel, who I should be introducing. He is going to be the co-host of this show. Dr. Siegel is a senior lecturer in psychology at Cornell University, as well as in the Department of Psychiatry at Cornell University Medical School.


Harry, I'm really excited to be doing this show with you.


Same here, John. And your viewers should know that John single-handedly started duty to warn And it did amass amazing numbers of mental health professionals who were truly alarmed of what they saw. In fact, beginning on inauguration day, when Trump had a meltdown over reporters not describing the crowd as sufficiently large enough. We saw it right at the first. And then we also saw his press secretary having been berated by Trump to go out and to berate the news media for lying. It was the beginning of the notion of fake news. It began on the first day of his term.


And One of the things, and Harry was also very involved in the New York chapter of Dutti to Warn, but one of the things that we warned about is that the conventional wisdom was that Trump was going to pivot and become more normal once he was in power. And we explained that the psychology of malignant narcissism was the opposite, that they actually get dramatically worse as they gain power and they become more grandiose. But all of this background is a way of saying that this is how the movement began, but it ended with the election, that we thought it was mission accomplished. We took off our uniforms. We went back to our lives. I started writing a book about psilocybin therapy that I'm very excited about. But what brought me back into the public fold is that I saw the public as being gaslit, that they were being told that Biden was cognitively infirmed, and somehow twice as many people believe that Trump was cognitively intact as believe Biden was, and that it seemed like the media was gaslighting people, that it was pathologizing Biden's normal signs of aging and normalizing Trump's blatant signs of dementia.


Now, I had written a couple of a few op-eds and co-authored some op-eds about Trump's signs of dementia back in 2018 and 2019, so I was already aware of this. And so what I saw was that the public was being gaslit. It was the opposite of the truth was what the public was understanding. And that's why I felt the need to get back involved with the public in terms of, again, informing them about what's really going on with Trump's mental health. So this show, Shrinking Trump, is a little bit of a double entendre in that we are shrinks, and we're going to be analyzing Trump. But Trump is also shrinking. That part of what I am predicting will happen over these next months, and you can hold me to it, I'm saying it publicly, is we are going to be documenting his cognitive deterioration, because I always say to people, look at Donald Trump right now, because that's the best Donald Trump you're ever going to see, because dementia is a deteriorating illness, and his rate of deterioration is accelerating. We saw deterioration from the '80s when we were analyzing him in 2017. Now people who were in his administration say he's not the same man he was four years ago.


So the rate of deterioration is accelerating. And so I don't know what will take for the mainstream press to actually ask the question, Is something wrong with Trump's brain? I think even if he was caught wandering down Fifth Avenue in his pajamas disoriented, they wouldn't ask the question, but we'll ask the question, and we will be analyzing that and its effect on his personality disorder, right, Harry?


Yes. And in fact, just to step back for a moment, when John talked about his malevolent narcissistic preside disorder with antisocial or criminal features. John was absolutely right that that character does not spontaneously get better. In fact, it's very hard to treat them in psychotherapy. And what happens is, as someone with this disorder has more and more freedom, they act out more and more destructively and aggressively. This was going on in Trump's so-called business for many years, including making terrible decisions like investing in casinos for which he went bankrupt. So there was no board of trustees. There was no one observing what he was doing. He had a very tight knit group. Any interactions he had, he had people sign nondisclosure agreements, and then he became President. He didn't intend to win in 2016. In fact, he promised Melania that he would lose. She was crying the night that he And so he began the Trump administration with guardrails, with cabinet members that his advisors from the RNC told him to hire, generals who he admired, but of course, needed to undermine because people with his disorder have to feel that they're superior to everyone around them and stronger.


So ultimately, he got rid of all his generals until at the end of the administration inauguration, he was unfettered. And we saw what happened in the way that he cast out on the election, the way in which he refused to concede, the first President never to show up at the inauguration of his successor. And we know that this is what's going to happen if he's elected again. So it's a disorder that doesn't get better. It gets worse when there's less structure. Now he's got a second disorder, which is this.




There's no medication that will cure it. There's no surgery that can fix it. You can slow it down if it's actually acknowledged as a problem. But Trump can't acknowledge any problems because of his personality disorder. So we're going to be seeing and watching over the next few weeks and months the interaction between the cognitive decline and the personality disorder, both of which are severe diagnosis for anybody. And this is for somebody who should never have been in power in the first place and is even less qualified now. That's our concern.


So one of the things we're going to be doing is having a weekly roundup, I think it was the Dementia Weekly Roundup, because I believe Donald Trump has dementia, he can't not show signs of dementia. He can't stop being demented, and he can't not show No signs of it. And so, again, this is a prediction. You guys can hold me to it. But I believe that every week we will have new manifestations. So with your permission, we're going to go over some videotape and look at some of the latest in Trump's demented ramblings. The first is Infrastructure Week.


This is from his greatest hertz, we could call it. Worked out too well. $1.2 trillion for their fake infrastructure Okay, so what we're seeing here is something that I've been talking about, which is Phenemium paraphages, which is this is a sign of dementia where people can't complete a word.


They have a stem of the word, and And usually what they do and what he's done, and you've probably seen this in a lot of these supercut reels that they show on Comedy Central and Twitter, where he says, Miches instead of missles, and Chrisus instead of Christmas. So these are all examples of Phenemicophages. What What I think is interesting about this example is he's deteriorating to an even lower level where he can't even finish the word sometimes. There, he couldn't fake an ending to the word. He just gave up in the middle of the word. It's like what he did with, if you remember when he was talking about Russia, Saudi Arabia and Russia, he said, we'll never do. Even a fake word. He just degenerates into speechlessness. So anyway, that's all I wanted for that example. Was there anything you wanted to say about it?


No, that says it all. Okay.


All right. Well, now, let's listen to what I call Master Lock, wow.


Master Lock closed down. I used to use Master Lock all the time. When I was a little child, I'd take Master Lock, I'd go and ping nice lots of nice little puzzles you put them- All right, keeping an eye on this campaign event in Walker's-by By the way, Fox cut away at that point because he's sounding insane.


So Master Lock, okay? I think what's happening at these moments, okay, is he literally is drawing a blank, right? I don't think he knows what Masterlok is. It's a padlock with the blue emblem on it. I used to lock up my bike with it when I was a kid. First of all, nobody has fond memories of Masterlok. But what he knows is that there are angry working class white people because a fact MasterLog factory closed down. So he wants to identify with Masterlok. Masterlok, how I remember MasterLog. Yeah, as a kid. Nobody has sentimental memories of Masterlok. Because the reason I'm mentioning this is a lot of people say, well, how can you make the differential diagnosis between when he's just lying and when I'm going to introduce this confabulating, where he basically this happens to people who have dementia, that when their memory is blank, nature abhors a vacuum. So they They fill it in. Sometimes they fill it in just with sounds and superlatives like, wow, great, wonderful. We'll get to that with Gettysburg. Wow. But the other thing they do is just make up a story. They make up a memory of something.


Okay, so one way you can tell the difference between when Trump is lying, and actually the fact that he's such a pathological liar is great camouflage for his confabulation. But the difference is number one, when you tell a lie, it has to be comprehensible to work, right? And there's a purpose to it. I want to convince you that I'm great. I want to take your money. I want to attack somebody. Okay, if it makes no sense, then it's not going to serve any purpose for me. It's not going to convince you of anything. And that's what happens when people are demented They make up a story that's bizarre, that couldn't have happened, that everyone knows, but that's how they're manufacturing a memory. So he doesn't know what a master lock is. So he's saying, I remember, bim, boom. He's starting to use Bam, bam. And he's using it. And I used to do puzzles with the puzzles. There's no puzzles on master lock, right? He's making something up. He doesn't know what it is. But I think maybe the way his demented thought process is working is like you unlock something, like you unlock a puzzle or a clue.


So maybe he's thinking like it's a lock, you unlock. That's like a puzzle. So I remember I did puzzles on the master lock. But you see, we're talking about a breakdown in thinking here, right? That's so fundamental.


And one thing our audience should know, at least about the way that the brain works, is the brain never spews out random thoughts. All thoughts have some source or connection to previous thoughts. So for example, I wouldn't be surprised if he was having problems with the word infrastructure because it's been made fun of that in his administration, they had Infrastructure Week every week for for a year and never passed it. And the one thing he knows is that Biden has tremendous credit for having passed it with a bipartisan Congress. So the fact that he was struggling over that word makes sense to me because part of what happens with dementia is when things are loaded emotionally, it can sometimes overwhelm articulation. It's a little bit too loaded. So he has a hard time getting that word out. It's not like he randomly had some other word he could It was infrastructure. And Master Lock, that whole notion of locking something down, of solving a puzzle, it almost expresses his difficulty trying to unlock his own thinking. That's how I look at it.


It's harder than man, woman, person, camera. It's harder than identifying a lion. Okay. Well, look, I feel this is a historic moment for us starting our first podcast. And I feel really that we should, in that spirit, have a few words of Trump's Gettysburg address. Absolutely. Could we hear that?


Where our Union was saved by the immortal heroes at Gettysburg. Gettysburg, what an unbelievable battle that was. The Battle of Gettysburg, what an unbelievable... I mean, it was so much and so interesting and so vicious and horrible and so beautiful in so many different ways. It He represented such a big portion of the success of this country. Gettysburg, wow. I go to Gettysburg, Pennsylvania, to look and to watch. The statement of Robert Lee, who's no longer in favor. Did you ever notice that? No longer in favor. Never fight uphill, me boys. Never fight uphill. They were fighting uphill. He said, Wow, that was a big mistake. He lost his great general. They were fighting, Never fight uphill, me boys. But it was too late.


I'm sorry, the look on your face. I couldn't launch into what I was going to say because I started laughing, looking at the look on your face. And that's an appropriate look.


Oh, He's so disorganized. It's extraordinary. He's grasping different associations, but not able to put them together, except to say that Robert E. Lee is not as respected as he once was. Robert E. Lee, who fought against the Union.


He got the racism right. That was the one thing he knew. That was his North Star. He wanted to throw some red meat to the racist. So you notice they don't like Robert E. Lee. That's the one part where I think he was lucid. But the things I want to point out- What was with the Irish accent? Yeah, a lot of people comment on that. I don't know is the answer, but I don't think he does either because he's making it up, right? He's making it up. Some of the things that I want to point out are, number one, we talk about how people who have dementia use superlatives as filler words, right? Again, I would suggest to you that Donald Trump is completely disoriented at this moment. He doesn't know what Gettysburg is. I don't mean he doesn't know the true spirit of Gettysburg, or he's historically ignorant. He doesn't know a lot of... I mean, you could have dropped him in a cornfield. He is disoriented at that moment. He knows it's something with a civil war and a battle. You know what I mean? But he's saying, Wow, Gettysburg. Wow. Amazing. It was beautiful and horrible.


See, these are all these superlatives because he doesn't know. Actually, he's struggling to form a thought about it. Then he pivots to a loose association. That's part of what made this country great. It has nothing to do with Gettysburg. And then I love this part. He goes, I come to Gettysburg, Pennsylvania to stand and to watch. To Well, first of all, we know he's never come to Gettysburg, Pennsylvania, to have some solemn moment of reflection. But I think what he's doing, and it's the same thing I think he did with Man, Woman, Camera. Man, Woman, Camera were not the words on that test. I think he was literally naming the things that he saw in front of him. He saw a man, he saw a woman, he saw a camera. I think that he's saying, I come to Gettysburg and I stand and I watch. And that's what he's doing right now. He's standing and he's watching, but he's not comprehending. He doesn't know what's happening. He doesn't understand the context. He doesn't know what Gettysburg is. And now, of course, now he has to confabulate. Because if he's drawing a blank, he has to make One of my colleagues suggested maybe he was looking at a hill.


He's standing in the battle, but maybe he's looking at a hill and made up a story about the hill.


It's extraordinary. And I know if you notice, but the people people behind him were registering that what he was saying wasn't making sense. They weren't wrapped listening to him. They were like, distracted because when someone loses that thread of organization, most people get uncomfortable because they can't follow it. You can see Trump getting uncomfortable and trying to get back on track, trying to get to place where he can make it work. And one thing I said in a recent interview, and I want to make sure we say it here, Trump's moments of dementia are intermittent. That is, it's not as though one day he's going to wake up and speak word salad for the rest of his life. We're going to see it when he's tired. We're going to see it when he's stressed out. We're going to see it when he's emotionally activated, because what also What happens with dementia is when people's emotions are running high, it interferes with their ability to organize their thoughts. That's one of the things that happens with it. That's why we're starting to see on Saturday at a fundraiser, he began talking about the Democrats as Gestapo and Nazis, and he started talking about how ugly Jack Smith was and swearing.


And people in the room were reportedly quite uncomfortable with it because there was something dysregulated. So dementia doesn't just mean you can't follow your thoughts or you lose words. It also means you get disorganized if your emotions are running too high.


Yeah, that's a very good point. And again, it's this hiding in plain sight because he's already so erratic and outrageous and breaking every boundary so that when he starts to deteriorate and become more erratic and more impulsive, he said, Well, that's just Trump being Yes, but I keep saying, the Trump you see today is the best one you'll ever see because he's going to get more like Trump in a more infantile and pure id-like way with even less ego controls as his brain begins to shrink. The last thing I want to talk about in terms of our Trump roundup, and then I really want to bring on our guest. I'm very excited about our guest, Dr. Mitz. Totally. Is I want to talk about Trump falling asleep in court. A lot of people have been laughing about it, and now he's sleepy on. But as doctors, we know that things can be signs of the symptoms of an illness. And if somebody already has an illness and they start to show a new symptom that is consistent with that illness, we don't go looking for a new explanation. If they already have five of the six symptoms, and then they do up the six symptoms, it's probably the original disease.


That's Occam's razor. You don't look for a second diagnosis. If the diagnosis we have explains the symptoms. Well, I tweeted a lot about his falling asleep in court being consistent with his having dementia. And of course, I got a lot of pushback. He was like, no, he's on benzodiazepines because his lawyers don't want him to have an outburst. Or no, he can't get his stimulants, so he's falling asleep. Or no, he's under stress and he's sleep deprived. Or no, he's showing his contempt for the judge. I just want to point something out here. This is a statistical argument But follow me here. Defendants never, ever fall asleep in court. When I say never, ever, I mean that I've spoken to dozens of lawyers and there's lots of... Look at legal Twitter, people saying, I've been a lawyer 50 years. It's never happened to me. It's never happened to one of my colleagues. I've never heard of it happening. Lots of defendants on any given day. There are thousands of defendants who are on drugs, who are not on the drugs they want to be on, who haven't had enough sleep or under stress and who have contempt for the judge.


They're not falling asleep. None of them. None of them are falling asleep. So it means something when he's falling asleep, and he's doing it compulsively and involuntarily. He's done it like five out of seven days or five out of eight days. So he knows he's being ridiculed for it. So it's not a strategy. He knows he's being made to look weak, but he can't stop. And his lawyers have adopted strategies to keep him awake. They've given him papers to go through, like little coloring books or something like you give to your kids, I guess, when you go to the restaurant to keep them occupied.


Without the crayon.


You have a child's menu. But anyway, they have a lawyer sitting next to him who is just there to jostle him, awake. That's her only job. When someone goes to the sidebar, they stay with him to make sure he doesn't pass out in between. So he's really fighting an involuntary falling asleep. It's not just a one time thing. And the other thing is, it's very common for people with dementia to fall asleep involuntarily during the day. So maybe one explanation for why you've never seen a defendant fall asleep in court, because there, usually your adrenaline is going, you're totally focused, you're in the dark, because you've never seen a demented person on trial before. When was the last time you saw a demented defendant? Never. And that's why the Venn diagram is basically one defendant. There's one defendant who's falling asleep. It's Donald Trump. And by the way, he's not just falling asleep. He's also farting. So he's losing control of his basic biological functions. I need to get that in.


I'm with you on that. I think also, if we keep thinking about the personality disorder and the dementia, right? One thing it's very clear that's been true about Donald Trump for a long time is he needs to be stimulated constantly. In the White House, people said he would get bored after two minutes if you didn't keep him engaged. And so the fact that he needs stimulation in order to feel, I don't know, alive or powerful and then add to it. Or conscious. But then add to it cognitive mind. And remember, he was falling asleep when they were interviewing witnesses in the early days days of the trial when they were looking at a paperwork. But supposedly when Stormy Daniels was testifying or Hope Hicks, he was not falling asleep during their testimony.


No, he was actually cursing- In fact, the judge had- Judge actually chastised him because he was cursing audibly to fit your point about his disinhibition coming to a new level to actually be cursing at the witness, right? Is a whole new level of disinhibition.


Exactly. Exactly. Dysregulation, disinhibition. And again, the mainstream press is not putting these things together.


I know. I know. I mean, it's really amazing. It's right in front of their eyes. I mean, the man is passed out, passing gas, literally a few feet away from them. I mean, They're reporting it, but they're not putting it into context. Well, they're not putting it into context. And that's why we need medical voices. And that's what really a great intro, Harry, to our guest, Dr. Vince Green So Dr. Vince Greenwood is a director of the Washington Center for Cognitive Therapy. He specializes in treatment of anxiety, disorder, and depression. He's also the founder of duty to inform, a website dedicated to disseminating information at the intersection of psychology and politics. He's also very active on Twitter. Hi, Vince.


Hey, hi.


Now, one of the reasons I'm so excited to have Vince on is, so one of the statements that I've been quoted as making is that this is a tale of two brains, that Biden's brain is aging and Trump's brain is demented. So I've been asserting that statement over and over again. But because Vince was trained as a scientist practitioner, as a cognitive behavioral psychologist, unlike us, analytically trained, he takes his commitment to empiricism seriously. And so he actually did an empirical study. I do, too. I know. We all do. But we've just been so beaten down by the cognitive behavioral psychologist to believe that we're better in science than we are. That we just internalized it.


Well, that's not good.


But I think that what Vince has done is an ingenious study. I don't know how much to say and how much to let you describe it, but I'll just say this much. He He took a checklist of symptoms of dementia and a checklist of symptoms of aging, and he compared Donald Trump and Biden's speeches when they were in middle age to their speeches now. And if I can summarize, what he found is that Trump has gone up dramatically in symptoms of dementia. Biden is flat, none. But Biden has gone up more than Trump in aging, which may explain some of the misunderstandings because, yeah, he looks old. He talks more slowly, he talks more quietly, but he's not showing these more serious thought disorders that you and I have been talking about. So anyway, I didn't mean to steal your thunder, but I want to hear, Vince, more about the methodology of your study and the variables that you looked at when you were analyzing the tapes.


Yeah. Well, first of all, thank you for having me on this inaugural episode of Shrinking Trump. I appreciate that a lot. Well, yeah, let me give a little background to the effort or my attempts to add to the conversation. Of course, I've been following the conversation about Trump and Biden and claims that they suffer from dementia with a certain amount of dismay, really, over the last year, particularly the attacks on Biden showing his verbal gaps and just equating that with dementia or Fox regard him as, use the term senile, which is even more disparaging. But fortunately, that conversation, to me, took a more substantive and clinical meaningful turn in the winter and early spring, when you started not just underscoring some of Trump's verbal struggles, but describing them precisely and particularly showing that These were not just verbal hiccups, but these were actual signs that were linked to a possible neurodegenerative disease. So that was a big step forward. And my background is not in clinical neurology. It is in differential diagnosis and forensic assessment. And I saw an opening where I thought I might be able to add to the conversation. Which was to entertain the possibility of taking particularly your material, other material colleagues have put out, and running it through the ringer of our Bible, the Diagnostic and Statistical manual.


That's the main diagnostic instrument that was put together, of course. Each chapter represents a different disorder group. The dementia chapter is actually called neurocognitive disorder, and that's put together by the leading experts in the world, where they really worked out carefully the definitions, worked out carefully the criteria is not only someone showing some signs of possible underlying neurocognitive degeneration, but do they actually meet a diagnostic criteria?


I'd like to show your first table. I'd I'd like to show your first table. Could we show a Vincent's table? So this is a table of their past behavior. So this is when they were middle-aged, and you'll notice that neither of them seemed demented in middle-aged. But I'd like to just look at these variables because I think the people at home may or may not be familiar with some of these, as you say, that these are DSM signs and symptoms of dementia that we use as doctors in the field when we're making this diagnosis. So maybe you could run down this list and explain to the audience what these things are. I guess we could take it off the screen, but so people have seen it. Can you maybe just give us a little summary of those different markers that you looked at in the speeches?


Take us through each one, if you don't mind.


Yeah, exactly. Could we look at each one?


Sure. Do you have that up on the screen there?


Oh, we can put it back on the screen. Go ahead.


Okay, yes. Yes. So these, honestly, John, I got a lot of these from your writing. These are some specific behaviors in the language domain that have been linked to the possibility of degenerative disease. Phonemic paraphasia, actually, you described that earlier. That's an unintended utterance of a word in which the speaker substitutes an inappropriate sound for part of the word. That was in your first clip there. Semantic paraphrasia is when they substitute an entirely inappropriate word for an appropriate word. One of the examples from Trump is substituting the word oranges for origins. Vocular use, that reflects, that's in the DSM 5, because if someone is in the throes of a possible disease, there's really a drop off in their vocabulary use. Vocabulary is not one of the things that drops off with age, even people into their 70s and 80s. So if you're seeing a real drop off in vocabulary, that's a real meaningful marker. The disordered syntax, Harry was referencing this earlier. This is the speaking in fragmented sentences. We all do that occasionally, and Trump did a little bit of that as a middle-aged man. But as we've seen, it's just off the charts now.


It's really hard to follow him and his ability to stream them together.


Let's just go to the next table, which is the current... Go ahead. It's still the same variables. I just want people to see. So these are the scores that Trump got currently, and these are the scores that Biden got currently, and you see they're very discreet. But sorry, go ahead, Vince. Tell us more about the variables.


Yeah. Word finding difficulty. You talked about that earlier. That's where people just can't find the right word. They use filler words, as you noted. Trump's go-to filler words are often these superlatives. So if you see that, particularly if you see a shift in that over time, that's That's a very meaningful clinical marker. Palalelia is when someone repeats the end of a sentence a number of times. They seem unaware that they're doing that. So that's a very clear cut and also a meaningful marker. Tangential speech is where you're just all over the place. You can't complete your thought. You start in one direction, go in another, and then mixing up people, not just names. You've noted that in some of your articles, John, where you mixed up Nancy and Nikki Haley. So these are not just gaps, not just glitches. They are those, but they're also verbal markers of possible dementia.


And And just to summarize, that comparison in the current functioning was extraordinary. Can we just look at it one more time?


Let's look at the graph. Can we go ahead to the graph of dementia? It should be. There you go. Vince Graftet. A picture is worth a thousand words. Red is Trump, blue is Biden. They both start in middle age at basically zero. They show zero, basically demented signs in middle age. That would make sense. But then Trump goes up like a hockey stick and Biden is flat.


That's exactly right. In all of those markers, you can see it in his current and recent speech. Biden, you can see some of the video mashups on Fox, and it can look halting and hesitant, but not the particular markers that are associated with dementia. Very good point. So Biden's line is more flat. Trump goes way up. And a picture creates a thousand words is true. And let me make one more very critical point, which is in DSM 5, to get an actual diagnosis of neurocognitive disorder. There are only two syndromes, major neurocognitive disorder, which is full-blown dementia, where the person has really lost their capacity for independent functioning and mild neurocognitive disorder, which is quite different from aging. I mean, you're really crossing a significant threshold. That's honestly the diagnosis that's in play here. And to get that diagnosis, you need to show this decline in DSM 5 in one of six areas, and they spell out the six areas. And one of the the areas is exactly what these markers refer to. It's the area of language and expressive languages. You only need to show decline in one area. The people that develop that category and all the research suggests that if you really have that decline in one of those six areas, then something significant is very likely going on, and you do warrant the diagnosis.


Well, I'm really glad to hear you say that. In part of your paper, you talked about this whole gold Goldwater kerfuffle that has been dogging me for years. I always say there's two separate issues about Goldwater. One is you can call me unethical for sharing with the public the signs of Trump's dementia, but I It may be unethical, but that doesn't mean I'm inaccurate. And PS, I think if we learned anything from the Holocaust, it's that being silent is never the more ethical option. So take that. But I think One of the thing is you've defined these behaviors so objectively. These are the behaviors that are in the DSM. We can behaviorally define them. You've systematically observed them in a scientific way. Yes, I realize it's an N of one and one experimenter and two subjects. I realize it's not a very large N here. But the way that you've done this study, and I know you said it was grandiose to call it a study, but I'm going to call it a study. The way you did this systematic observation really does give us observable information that we can point to, as you say, that he meets these diagnostic criteria.


These are the criteria. These are the examples of his behaving in those ways that meet the criteria. According to the big book, that's all we need.


Yes. And it's a lot because all the research and the leading experts have found that that is associated with one of these serious syndromes. If I could say one thing on the ethical- Yeah, please. Just to defend you a moment. Yeah. Some people would call what we're doing, offering informed opinions at a distance and even possibly suggesting diagnosis as unethical. But we do have competing ethical principles, and one of them is the name of your group, that our ethical training does give us or encourage us to warn people when someone might be a danger to others. And so if we have findings that suggests that, that is a competing ethical obligation. My website is called duty to inform. That's a slightly different angle. But many people would say if someone running for any public office, much less the presidency, has some significant health issues that the public has a right to know and people that have have access to that information have a duty to inform. So there are competing principles.


For those of you, the audience, who don't know what the Goldwater issue was, Goldwater ran for President in 1964, and there were psychiatrists who at that time, all psychoanalysts, who were referring to him as disturbed. And it's true that Goldwater held extreme positions, but the fact was he and John F. Kennedy were quite good friends because Goldwater was an engaging, charming, not disturbed, not cognitively impaired person. And his reputation was really sullied by a few clinicians and it put into place for psychiatrists. We're psychologists, as they say in Ghostbusters, we're psychologists. But psychiatrists then had this rule imposed on them that you could never make a diagnosis without actually speaking to someone in person. And I think John really took a lot of heat for that. But he was right to challenge the notion that particularly in this age of incredible numbers of video and data that we can't, as psychologists, pass judgment. And this is not subtle stuff. I mean, who has a tantrum? Because Because you're not reporting crowds of people at your inauguration that didn't exist. I mean, it was really pretty stark. So I hope that cautiously we are trying to talk about observable phenomena that's quite concerning.


Yeah. I really like- And by the way, historically...


Go ahead, Vince. What were you going to say?


I was just saying I like the word cautious, and there are two elements to the gold water rule, as I understand it. One of them, just talked about, should you diagnose at a distance? And we've talked about there might be competing ethical principles that would lead someone to do that. The other element is, can you? Can you diagnose if it's not your client? Do you have the information available? And that's a real issue with this dementia thing, because we don't have the luxury of giving him neuropsychological testing. In DSM 5, they spell out what's required to give an assessment. And I said there were six domains, language being one of them. The other five, these are very basic, broad areas of human functioning, like learning and memory is one of them, attention, social cognition, executive functioning. They basically cover the whole landscape. They break them down into six areas. And language, and since we don't have the ability to do the gold standard for diagnosing this condition would be neuropsychological testing. Sure. Densive, comprehensive, fine-grained that zeros in on those areas. And since we don't have that, we're in a weak position to diagnose in many of those areas.


We can offer our observations and so on. But there is one area where we're not in a weak position because it doesn't require neuropsychological testing. And that is the area that the study involved.


That's a very good point. That's a very good point. Because we can observe it with our own eyes. We are observing the behavior with our own eyes. And the DSM, the The revolution of DSM was that all diagnosis were broken down into observable criteria. So if you can observe it, you can meet a criteria. And by the way, I just want to say a little more about the history, which is really interesting. When I was writing an article for the British Journal of Psychiatry about the Goldwater Rule, I had the chance to interview the last living member of the first American Psychiatric Association Ethics Committee that wrote the Goldwater Rule. His name is Alan Dier. He teaches at GW. And I interviewed him and he said, You know what? If I were on the committee today, I wouldn't write the Goldwater Rule. And I said, Well, why not? He said, Because of DSM. Because when we made the Goldwater Rule, People were making these wildly irresponsible statements. They were saying he was a latent homosexual, that he had been... His oedipus complex was something, or he was scarred by his toilet training. So it was irresponsible speculation, and so it embarrassed the field.


But he said, once we adopted the DSM, all I wanted was not for psychiatrists not to make statements that were not supported by evidence that would then make us look like we weren't a science. But Now we can make statements supported by evidence that are based on science. And so we don't need the gold water. He says, I never intended it to be a gag order on my entire profession. He's like, so sorry he ever wrote the gold water rule. Okay.


Now, modern diagnostics really makes the goldwater rule antiquated. I mean, in many disorders, you got to be with the patient and go through the things. But for many others, we have the means to make the diagnosis. And again, I was just going to say with the dementia. Fortunately, the language domain, we could go in there and really assess that without having the face-to-face contact. And there were two other advantages. In addition addition to the direct behavioral observation, which is there's just an enormous amount of data. Technically, we call it archival data, but it's the videotape. So there's just no shortage We can have enormous amount of data from just go to YouTube for Trump and Biden, get many clips of their behavior when they were middle-aged men, obviously get many clips. So we have enormous that. And then the key thing for the diagnosis is you got to show decline, not just poor performance. And so we can compare the middle age versus the current. And that is the essential diagnostic marker to make the diagnosis. If you show decline in one of those areas, you've gone through the diagnostic portal. And once you go through the diagnostic portal, you can not only say, he's showing troubling signs, you can then refer to all of the research associated with that disorder.


It opens the door to speak with a good deal of authority about what else is going on with him cognitively, what the course is to be based on the research, what the chances are for remediation. It opens the door to so much more information. So that was my hope to add to the conversation, to open that door, not only to confirming the important observations you made, but to talk about it in terms of it really looks like we can talk about it in terms of technically the syndrome is neurocognitive disorder mild, which again is qualitatively and significantly different from aging.


And has a tendency to become less mild over time.


Well, that's a perfect example because you open the door to the research not only has a chance, you can almost take it to the bank. There are very few... There's a small subset of people that gets to the research that have mild neurocognitive that do return to normal. They tend to be younger, and it's when you can identify a very specific remedial cause, and that's just not the case with. How How likely is it? In the research literature, they call it the conversion rate. Once you go through that diagnostic court hole into mild neurocognitive disorder, some Other studies show a 20% conversion rate, most of them around 10 to 15%, meaning that the chances that the person will progress to major, which is the full-blown dementia where the person really has lost their capacity for everyday living or is really jeopardized and not even in question whether they could handle the duties of the presidency. And that's cumulative. So after two Two years once someone's gone through that, once someone's in that diagnostic group, sadly and unfortunately, there's about, roughly speaking, 20, 25, 30 % chance that they might progress to the- So as time goes on, the conversion rate goes up.


So it's a question of, when will we find him wandering around in his pajamas? Will it be next year? Could it be two years from now? But it's... Harry, you look like you were trying to say something.


Well, I love this discussion. I'm always mindful of how most people are not educated in thinking clinically, and they either grab onto something that a psychologist or psychiatrist says and take it concretely, like Trump is this, or they dismiss anything any clinician says, saying, what do they know? And to me, the way that I was trained and the way that I think about clinical things is a diagnosis Gnosis is always a work in progress. It's a series of hypotheses. I'm observing these things. This is suggesting this. And then you gather more observations over time. So it wasn't just that I saw Trump interviewed and said, oh, he has a malignant narcissistic personality disorder. It was reading and watching him over time the way he would become enraged if he was contradicted, the way that news was always if it pointed out something that didn't make him look good, the fact that every moment was important as any other moment for his internal well-being. Those are the things that made me start to think about a personality disorder. Similarly, with these strange lapses in language, articulation in association, it's making me think that we're seeing a disease process in front of us.


But I can't say, yes, I've looked into his his cerebral cortex, and I can see the damage because we can't.


But we can observe- No, I mean, if this were a clinical case, we'd be referring him for a brain scan. We'd be referring him for neuropsychological assessment. And you're right, we often use the term diagnostic impression. Actually, if you look at our petition for clinicians, I say our diagnostic impression is probable dementia. So I have two little qualifiers, impression and probable, because of exactly what you're saying. In other words, look, we've got enough evidence that we're pretty damn sure. Okay. But as you say, the way we work is it's a a work in progress. Right now it would be an impression. And we would say, I'm pretty darn sure this is dementia. I've been seeing it a hundred times, but let's refer them to Dr. Smith just to get a confirmation.


Yes. But also everyone, if they do have mild dementia, expresses it differently. It's affected by whatever he's talking about, what happened that day, what time of day it is. So over time, you and I are going to start to gather a sense of how Trump is having mild dementia, not just dementia, period, but how he has it. Every dementia is like a snowflake.


Actually, can we show one more slide? Every dementia is like a snowflake. Can we show the last slide and table and graph from Vince? So this is verbal markers of normal aging. And so what's interesting here, and let's look at these variables, speech rate decreased, so speaking more slowly, reduced volume and intensity, tremor in speech, harshness in speech, alterations in vocal pitch, Occasional disfluencies, harder to think of the word when needs. If you look here, actually, Trump has gone up a little bit, but Biden's actually gone up more. And so I think, and maybe we could see the graph. You see the aging graph? So this is actually signs of aging. And you'll see, actually, Trump is relatively flat, and Biden has gone up. So I think it's important to acknowledge this. I think it was really smart of Vince to do the study this way, not just to look at the signs of dementia, but also to look at the signs of aging. And I think this, not to brag, but it does support my hypothesis that I said it's a tale of two brains. One is aging and one is dementing. And Vince has really provided us evidence of both statements.


And So the question is, in a forced choice election, which do you want? I'm aging. I forget appointments. I forget the. I call my younger daughter by my older daughter's name. But am I over the hill? I'm still cognitively intact. If you don't believe me, go on our show and debate me.


Yeah. Those are mostly voice quality, which is many of the things that Fox News and other outlets have really zeroed in on and equated with dementia, and they're not in any way related to underlying neurological difficulties. And for some of the key skills that are typically associated with being the chief executive is executive functioning. And executive functioning is actually in contrast to those verbal markers of aging. Executive functioning is not something that really tails off as someone is holding.


And Every report from every expert in foreign policy says that Biden is totally on top of the issues. He remembers everything. He's active. He doesn't fall asleep in meetings. He doesn't need a lot of stimulation to stay focused. That he has a real experience, a certain wisdom that he can rely on. And he is aging. He's in his early '80s.


I think actually there's a lot of ages in this devaluing of Biden. In other words, the markers you talked about, talking more slowly, talking more softly, moving more slowly. These are not signs of somebody being unable or disabled or less able. And by the way, I've talked to a lot of reporters who I had talked to when we had the original duty to warn movement, who had done three or four articles with me. We developed a relationship over the years. And I contacted them when I got back into the fray and said about this cognitive issue. And a lot of them didn't answer me. And a lot of them answered me back and said, yeah, but I think Biden is decrepit, too. In other words, they made a superficial judgment based on the fact that he looks old. But looking old isn't the same as not knowing who the President is. You're running against. Can we get some proportionality here? This is not a nuanced discussion.


Yeah. And in that graph we saw, and then particularly in the table, actually, of the verbal markers of aging. Yeah, I It's just my one person's impression, but I did give Trump some higher marks, Biden, obviously much higher. But I think I would say the fundamental impression of Trump is very vigorous. I mean, he's really got the dominant verbal style down, and he just harrows ahead.


That's a very important point. That's a very important point because our colleague, Drew Weston, wrote a book called The Political Brain, in which he argues that people make their choices for President based on a gut feeling of who's the alpha, who's the strongest, who's going to keep us safe. And so the fact that Trump, first of all, I believe he's hypomanic. I believe he's always been hypomanic. That's why he hate tweeting at 3:00 in the morning, 40 tweets every night. But also, you're right, he has this robust animalistic energy that gives people the impression. Listen, half of Haley voters have said they're going to vote for Biden. The other half said they're going to vote for Trump. They've already voted against Trump. And the main reason they give is, well, at least Trump's a strong leader. So he gives the impression of strength. But my goal in life is to be Toto, the little dog Toto, who pulled back the curtain. When everybody was looking at the big Wizard of Oz, he's so scary, he's Hitler, he's going to take over. And then Toto pulls back the curtain and we are, here's a demented fat old man behind the curtain pulling these levers.


That he looks strong, but he is weak. You can't be strong if you don't know what Gettysburg, Pennsylvania is and you think that there are puzzles on a master Yeah.


Yeah. Yeah. Toto.


Toto, there's no place like home.


That's what you're doing. There was an excellent article just in the last three or four days. I forget his first name, Fish, you may know it was in the New York Times. It was an op-ed, and I think it's based on some of his research it sounded like about this dominant style of politics and how it's- Yes, I read that.


Yes, that was actually a very good piece.


A little dismaying because it testifies to it. It does have an impact on people, but it's the thing we can pull the curtain back a little bit.


And that's why this is so important. That's why this message is so important, because it's not just one more anti-Trump message. It's important because, first of all, doctors, we're the only ones who can really deliver it. But also it totally flips the thing on its head. It undermines the whole premise of Trump's attraction, aside from the racism and all the other evil things about him. What people like is his strength, right? And you can't be strong if you're demented. It's a mutual contradiction. So as long as it's being covered up, as long as it's being normalized, you see what I mean? He's got that advantage. Once the truth is exposed, it takes that advantage away with people who are still persuadable. I understand there's probably only about seven % of the electorate who made a final decision. But these are the people that would make a gut decision based on this. And the Haley voters, the Undecided, the Independence. They're just low information voters. They're going to go with a gut feeling. And so we've got between now and election day to break through with the truth. And for your scientific data. No, for your empirical.


I really appreciate the work that you did to do this study and the work to think of it and to provide what we can do in our field. We know how to do science. We know how to do studies, and we know how to present data. And thank you so much for doing that study.


Oh, you're quite much for having me.


You're welcome. Great to have you. We're going to say goodbye to, Vince. Thank you for being on our inaugural show. Well, Harry, this is the last section we're calling this Shrinkrap, where we're going to wrap up what we've learned. So what have we learned today, do you think? Or how would you summarize our the week in Trump?


That we have a big job. We need to educate and to help people to think in psychological ways that in our culture, we're not really encouraged to do. We like to have vigorous parents and grandparents until they're not and they're in a home. We really worship youthfulness. We have a culture that is critical of Biden because he looks old, whereas in a Asian culture, he'd be revered as a wise, older person. We're a very young, adolescent culture, very impulsive. Very good point. I'm very reluctant to look at ourselves in the mirror. And I think our job is not, although I'm afraid politically and what would happen to our country and the world if Trump is elected, we're not here to bring down Trump. We're here to educate the public as to what is happening to him psychologically, which to our eyes is very concerning and which will be hidden in plain view to most people if they listen to what we and other psychologists and clinicians have to say.


It's as plain as the cofefe on your face. Well, that's our wrap. This is our first episode of Shrinking Trump. We hope you'll subscribe or whatever people do and tune in next week.