Last Thursday, we sent a letter signed by more than 70 mental health professionals — psychiatrists, psychologists and others — urging Rear Admiral Ronny Jackson, the White House physician, to include a cognitive examination during his medical evaluation of the President.
Over the past year, we as well as other mental health professionals have grown increasingly concerned over the President’s behavior. On a near daily basis, President Trump publicly displays erratic emotional states, exhibits suspect judgment, and appears to struggle with impulse control, all while he rambles and often has difficulty completing a thought.
The President’s speech patterns are increasingly repetitive, fragmented, devoid of content and restricted in vocabulary, and his overuse of superlatives suggests reduced verbal fluency. This evidences a marked deterioration when compared to his previous level of verbal functioning, suggesting the possibility of an organically based process of cognitive deterioration.
We are not alone in our concern regarding Trump’s cognitive well-being. A majority of Americans see the President’s mental fitness as a legitimate concern. Providing any specific neurological or psychiatric diagnoses “from afar” is an ethical violation of our unique professions. However, it is not a violation of our profession to inform the public of our observations and urge action to evaluate these issues and thereby safeguard the American people. In fact, we believe it is our duty to do so.
For a typical 71-year-old patient that any doctor might see for an outpatient examination covered by Medicare, a cognitive screening is an essential part of the evaluation. Medicare guidelines state the clinician is to make an effort to “detect any cognitive impairment the beneficiary may have.”
The elderly are at increasing risk of organic cognitive decline. One out of 10 American males over 65 is at risk for Alzheimer’s, and that risk increases as patients get older.
Cognitive screening is standard protocol for all older patients, but in a case where the patient evidenced the alarming signs of cognitive deterioration mentioned above, failure to follow up with further testing would simply be impossible to justify medically — even if the fate of the world didn’t depend on this particular patient’s mental acuity.
The fact that almost all Americans 65 and older are subject to cognitive screenings while the person who holds the highest public office in the land might not receive that indicated level of care is worrisome. President George W. Bush’s first physical did not include an examination by a psychiatrist, but it did include a neurologist to screen for cognitive maladies, as well as a gastroenterologist, radiologist, optometrist, orthopedist, audiologist, dermatologist, otolaryngologist, pulmonologist, urologist, cardiologist and podiatrist.
The President’s health is not an unusual issue to discuss. In fact, President Jimmy Carter wrote an article in the Journal of the American Medical Association in 1994 about the “continuing danger” that a sitting president could suffer from neurological illness. Considering Trump is the oldest person ever inaugurated to a first term of the presidency, this issue is legitimate to ponder. Keeping in mind the President’s behavior, this topic becomes a matter of national security and requires action.
Members of Congress are beginning to understand the magnitude of the issue we face. Just as President Carter proposed in his article warning of this unique danger, Rep. Jamie Raskin (D.-Md.) has introduced a bill establishing an “Oversight Commission on Presidential Capacity to determine whether the President is mentally or physically unable to discharge the powers and duties of office.”
Another bill introduced by Rep. Ted Lieu (D.-Ca.) would stop any President from launching a nuclear first strike absent Congressional authorization. These are not bills to take lightly. They are essential checks on any current or future President, whose judgment might become organically impaired. Revelations that President Ronald Reagan might have been suffering from early signs of Alzheimer’s late in his presidency should add concern to our current discourse.
The Office of the President is the most powerful political position in the world, and the health of its inhabitant has implications for every American. As such, we especially hope Jackson included a cognitive examination of the President during his physical last week. During a time of heightened global angst — in large part due to the problematic behaviors and statements of the current inhabitant of the executive office — we must take steps to mitigate the potential harm to the American public. Members of Congress have already started to do so. And it’s our duty to warn that there is increasing reason to do so.
Gartner is a psychologist and former assistant professor at Johns Hopkins University Medical School. Buser is a clinical psychiatrist practicing in Asheville, NC and former U.S. Air Force psychiatrist. Reiss has been a practicing psychiatrist for more than 30 years specializing in “front-line” adult and adolescent psychiatry.
