"Like someone pulled the metaphorical plug": Dr. John Gartner on Trump's "accelerating dementia"

Since at least 2016, some of the world’s leading mental health professionals have been sounding the alarm that Donald Trump appears to be emotionally and psychologically unwell – and perhaps even a sociopath or a psychopath. Unfortunately, throughout Trump’s presidency, the COVID pandemic and his willfully negligent response to mass death and suffering, the Jan. 6 coup attempt and the attack on the Capitol by his MAGA forces, and now several years beyond, their warnings have repeatedly proven to be correct. Donald Trump only appears to be getting worse, not better, as he ages, and the pressures of his multiple criminal and civil trials and the 2024 presidential campaign grow heavier.

In a recent conversation with Dr. John Gartner, a prominent psychologist and contributor to the bestselling book "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President," the former faculty member at Johns Hopkins University told me that based on Trump's speech, memory, recall, and other behavior, he appears to be “hypomanic” and cognitively deteriorating at a rapid rate:

Almost as if on cue, in a series of speeches and interviews at the Conservative Political Action Conference (CPAC) and elsewhere last week — which took place after my conversation with Dr. Gartner — Donald Trump again manifested these symptoms. So I spoke with Dr. Gartner again on Tuesday about Donald Trump’s recent behavior, what comes next if his apparent cognitive challenges and related maladies continue to worsen, the dilemma of having human sympathy and concern for a vile person like Donald Trump, and why so many medical professionals (and members of the news media, political class, and others with a public platform) are continuing to be silent about the corrupt ex-president’s very troubling and dangerous behavior.

This interview has been lightly edited for clarity and length:

We spoke last week about how Donald Trump's apparent mental and emotional challenges and pathologies appear to be getting much worse. That conversation was widely read and circulated — including by the British and other foreign news media. Why do you think your warnings gained so much traction?

Most of us have known someone, possibly in our own families, who’s had Alzheimer’s or some other form of dementia. The diagnostic signs are not subtle. My warnings and conclusions about Trump simply confirmed what many people had already observed and concluded for themselves but didn’t have the authority to assert. I was giving voice to what ordinary people see with their own eyes, and they were grateful for validation from a mental health professional.

Why do you think so many of your peers who also have expertise in psychology, the brain, aging, and related topics and subjects are remaining silent? 

I've been reaching out to several colleagues who are real experts in this area. They were happy to share observations and diagnostic conclusions about Trump’s severe organic mental decline, privately, but even among colleagues who were once outspoken, there's a new high level of fear, not to mention exhaustion, that we didn’t see before. Each of these experts convinced me they weren’t being paranoid when they believed there was a good chance, they would lose their jobs if they went on the record, not to mention other forms of retaliation, especially for those who live in red states.

How are you processing the reality that if Trump wins, there is going to be retaliation against his critics and anyone else who has dared to oppose him and the MAGA movement and American fascists more broadly? Trump has repeatedly said this. Revenge and punishing “the enemies” of the regime are central to Project 2025 and Agenda 47, for example. They're going to get even; there's going to be score settling for the truth tellers.

Wow. That is a powerful way of putting it — yes, there is going to be score settling for the truth-tellers. We're really seeing in real time how a people can be beaten down. People who were enthusiastic members of "the resistance" against Trump and the MAGA movement are now saying, "I can't do it. I'm intimidated." The reality and potential for retaliation by Trump and his followers is extremely real. In 2016, what were my peers afraid of? The American Psychiatric Association? What was the worst that could have happened to us? We could have been expelled from the American Psychiatric Association. So what?! With Trump trying to come back to power, people are looking over their shoulders out of a reasonable fear of professional, social economic, and even criminal retaliation, as well as the threat of political violence from the right wing. We weren't making those risk assessments before.

Trump, who is a pathocrat, and what he symbolizes and has channeled and summoned, is impacting all of us. 

It's taken a psychological toll on the population, both clinically and non-clinically. Exhaustion. Depression. Fear. Being detached and disengaged mentally and intellectually. The collective trauma of Trumpism has put many Americans in survival mode. 

In our last conversation, you warned that Trump is suffering serious cognitive decline as shown by his speech, memory, and other behavior. Almost on cue, Trump manifests these symptoms at CPAC and at other events over the course of several days. Once you see this pattern of aberrant behavior you can't unsee or otherwise ignore it. 

This weekend, Trump showed more evidence of his accelerating dementia. Trump named the wrong month for the primary, said that Putin would rather see Biden as president and he agreed with him, and that he made Israel the capital of Israel. But most important are the fundamental breakdowns in his ability to use language. Once you become aware of a symptom, you start to notice it, whereas before you might have overlooked it.

Trump manifested a number of phonemic paraphasias. He was trying to say evangelist, for example, but haltingly said "evangelish.” He was trying to say “three years later," but said, “three years, lady, lady, lady.” Trying to spit out the word “lately,” he sounded like a car with a bad battery struggling to turn over. When Trump can't find a word his whole demeanor changes. It’s almost like someone pulled the metaphorical plug. Trump looks blank, stops in mid-sentence (or mid-word), his jaw goes a little slack, and when he starts to talk again, he slurs, speaks haltingly, and often looks confused. Trying to get the word out, he shifts to a non-word that is easier to pronounce. When people are losing their ability to use language they use non-words. They start with the stem of the real word, and then they improvise from there.

In my family we call sandwiches “slamichs” because that’s what my stepson called them when he was three. It was cute then. It’s not cute watching and adult man regress to the mental age of a three-year-old. It can make you even feel sorry for Trump in those moments when he appears so vulnerable, confused, and disoriented. I asked several highly specialized experts about Trump's use of language, and they told me that what Trump is doing in total, but especially the phonemic paraphasias, were almost certain evidence of brain damage. This is not minor, or within normal limits, like forgetting who the president of Germany is, for example, as Biden has been pilloried for. Trump is evidencing formal thought disorder, where his basic ability to use language is breaking down.

Trump is also showing signs of "semantic aphasia" where he is using words in the wrong way. For example, when Trump talked about "the oranges of the investigation." We saw an example of that this weekend, as well. Trump said, “We’re going to protect pro-God….” In mid-sentence, he goes blank and looks at the ceiling. The words he uses to complete the sentence don’t really make sense: “…context and content.”

Trump is bragging about passing the MOCA, a screening test for dementia, as if it made him MENSA, when it’s a test any kindergartener should pass. Specialists tell me a patient can be in steep diagnosable organic decline for an extended period before they fail the MOCA. Someone with an advanced degree from an Ivy League school, for example, has a lot of IQ points to give before they hit kindergarten level. If you pass the MOCA it certainly does not mean you’re cognitively equipped to be President of the United States. Trump can’t even name the current president of the United States. Seven times he’s said he’s running against Obama. That’s not a gaffe or joke. That’s hard clinical evidence of serious organic brain damage.

When this is happening to Trump, how is he feeling? Does he know what's happening?

One of the things that's most notable is Trump's lack of awareness when he makes these mistakes. He very rarely corrects himself or goes back, typical for someone with this kind of organic decline. Ironically, Trump boasted that “If I were cognitively impaired, I’d know it,” but actually he wouldn’t, and he doesn’t. Sometimes a patient with organic brain damage will have what we call a "catastrophic reaction," where they suddenly realize "Oh, my God, I can't think!" They'll then have an anxiety attack or begin weeping because their denial has been broken through and suddenly, they realize just how serious their condition is.

As for Trump's MAGA people and other supporters, in a healthy relationship, they would become concerned for Trump and realize that what appears to be his worsening cognition and other behavior actually makes him not qualified for the presidency and that he should seek help. Instead, the worse Trump's behavior becomes the more they seem to adore him. This is textbook collective pathology. 

Trump’s hypomanic energy gives him power and makes him charismatic to his followers. Trump's behavior has a type of primal appeal to his followers. As I warned in our conversation last week, whatever personality disorder someone has, it gets dramatically worse as their cognitive functions decline. All of Trump's viciousness, hostility, and unpredictable and other pathological behavior is only going to get worse. In the end, Trump and the MAGA movement are a cult, and he is the leader.

Does Donald Trump deserve pity if he is indeed struggling with these types of challenges?

In psychology, we often try to use our reactions to understand the patient and to develop a diagnostic workup. Trump is someone who many people despise because he is evil. Yet, when Trump acts in what appears to be a demented way, our reflexive reaction is actually sympathy. He seems vulnerable. He seems confused. He reminds you of your relatives. In a way, such a reaction to Trump is a type of confirmation that something may be seriously wrong with him. You're reacting to him in such a protective way, you feel sorry for Trump, and you want to help him because he's a doddering old man. Trump is confused. Seeing Trump or anyone else in such a state brings forth our normal human empathy.

Is there a social taboo, especially among the news media, that is limiting our much-needed discussions of these types of health issues as seen with politicians and other leaders?

I don’t want to say the mainstream media is covering up Trump’s cognitive disability, but they certainly aren’t covering it like the 5-alarm fire it is. The media will show Trump being combative and saying something outrageous and his audience reacting to it — but they are consistently not showing the parts of Trump’s speeches and interviews where his eyes go blank, his jaw goes slack, he looks confused, and slurs words, uses non-words, can't finish a sentence, rambles, perseverates, confabulates and babbles incoherently. That’s what should make the 6 o’clock news. Doesn’t the media have a duty to warn the public that the man who wants the nuclear codes back (not including the ones he probably stole) is publicly displaying unimpeachable evidence of a broken and deteriorating brain?

The obvious comparison here is Ronald Reagan. I am no fan of Reagan and do not understand the worship of that man. We now have confirmation that towards the end of his presidency that he was basically senile. The United States and the world were very lucky that Reagan was surrounded, mostly, by very serious people who were institutionalists. By comparison, Donald Trump is surrounded by fascists, white supremacists, Christian nationalists, plutocrats, corporatists, and other malign actors who are going to take advantage of the situation to get what they want. That possibility — if not outright certainty — should terrify any reasonable thinking person. 

There will be no guardrails to Trump's absolute most primitive, impulsive, destructive, and insane actions. There will be no pushback from within his inner circle and regime. It is certainly very possible that a person in a state of cognitive decline is in a state where they are highly vulnerable to suggestions and being manipulated by others. I can easily imagine a scenario where Trump is a figurehead and there is a real power behind the throne pulling the strings.

What is the difference between someone being older and getting older, and someone being mentally and emotionally ill? Given how Biden is being unfairly maligned because of his age while Trump's obvious deficits, which are far more serious and dangerous, are being mostly ignored, that distinction needs to be emphasized — repeatedly.

They're not the same thing. I feel like older people should take offense to Trump's behavior being explained away by aging. There are natural things that happen with aging such as occasionally using the wrong word or calling someone the wrong name because they remind you of someone you worked with. President Biden is confusing names, not people. The Dementia Care Society says “mixing up people and generations” is a sign of dementia. Recently Trump confused Nikki Haley and Nancey Pelosi, for example. He also mixed up the generations in his own family when he said his father was born in Germany, when it was his grandfather. Michael Wolff said Trump frequently didn’t recognize old friends. And most importantly Biden isn’t showing a fundamental breakdown in his ability to use language. The whataboutism narrative is that this is a race between two old men. True but one has an aging brain, and the other a dementing brain. If Trump were your relative, you would be reaching out to doctors in a state of alarm. If Joe Biden were you’re relative, you might have to remind him of things from time to time.

How do you think Trump is going to respond to the experts and other such voices who are publicly sharing their concerns about his apparent worsening cognitive and other intellectual and emotional challenges?

As I said earlier, Donald Trump is going to make theater and spectacle out of it. But Trump will keep betraying his denials through his behavior. He has other symptoms as well. These physical symptoms include a wide base to his gait, his leaning posture, and his loss of fine motor control. A dementia diagnosis is not limited to an interview. To reach a firm conclusion one needs observations, reports from informants and other people around the person in question, and an MRI for example to see exactly what is going on with Trump's brain. In my opinion, Trump is showing a level of symptoms where no real expert would think that there is not something seriously wrong with his mind and brain.