A question I am often asked by those who know me as a psychiatrist, and frequently by friends and family at social gatherings, concerns my clinical opinions about celebrities who appear in the news. This is especially relevant during emotionally charged political seasons, such as the upcoming presidential elections, where our candidates are often scrutinized.
What signs can we detect from afar, by watching a TV interview or a debate, about the mental health of our political figures? Can we determine if they are mentally fit for the role they are running for? It is a challenging task to arrive at a diagnosis based solely on visual observations and media reports. According to the DSM-5 (the diagnostic manual universally used in the US to classify psychiatric disorders), a direct interview with targeted questions and often psycho-neurological testing are essential for a plausible diagnostic conclusion. However, some inferences can be made about individuals we see on screen, just as we might with anyone we meet casually.
A major distinction should be made between what we classify as a “personality disorder” and what we call a “psychiatric illness.” Everyone has a personality—a cluster of long-standing characteristics that define each of us. If these traits are dysfunctional in society, creating problems not only for ourselves but also for those around us, they may be classified as a personality disorder. A psychiatric illness, on the other hand, is a distinct event that interrupts the habitual functioning of an individual. For instance, one may experience depression, bipolar disorder, or dementia at a specific point in life, while personality traits remain a constant definition of who one is throughout life.
During the first presidential debate between Biden and Trump, many observers noted a change in President Biden. He appeared different from before; his expression, speech delivery, and mannerisms seemed to suggest that a pathological event had interfered with his regular way of functioning.
Evaluating former President Trump’s mental status is somewhat more complicated. The distinction between personality traits and potential psychiatric illness may be less clear. An analysis of Trump’s speeches over time, both during his presidency and his current campaign, shows numerous indicators of narcissistic personality disorder. This includes an excessive use of the pronoun “I,” a tendency towards self-aggrandizing statements, embellishments of facts, and a total disregard for the truth when convenient.
Independent fact-checking has repeatedly demonstrated that this behavior is a stable, consistent way of dealing with reality. For instance, Trump recently falsely accused VP Harris of inflating the numbers of attendees at her rallies. As reported by The Guardian, this led to criticism even within the Republican Party: “Kevin McCarthy urges former president not to attack Harris on personality issues after he falsely claimed VP used AI to inflate rally attendance.”
This blatant miscalculation might suggest a deterioration in Trump’s cognitive abilities. In some forms of dementia, a lack of judgment can be an initial sign, often preceding memory loss. However, due to Trump’s longstanding obsession with comparing crowd sizes at inaugurations, this behavior might also be seen as another exaggerated manifestation of his narcissistic personality, or potentially a combination of both.
In the absence of concrete evidence from an expert neuropsychiatric report—one that is unlikely to be made available for any of our candidates—the question remains open.
