When People Call Trump “Crazy” Here’s What They Really Mean

These 4 psychological ideas will help you decode a Trump speech

Here’s my takeaway from last week’s presidential debate: While Biden is certainly showing his age, he represents and is supported by a competent safety net of rational and well-meaning elected and appointed officials that ensure the country expresses Biden’s deep and abiding compassion and morality…even if he sometimes struggles to put these ideas into words. On the other hand, while Trump admittedly spoke more clearly at the debate, there is absolutely no systemic check or balance to his ideas – the Republican party cowers at his feet and he is free to express whatever xenophobic, misogynistic, bigoted or simply false idea that pops into his unhinged mind.

In other words, with Biden you get a system and with Trump you get a dictator.

People have been warning that somebody who is this inconsistent in how they view reality cannot be trusted to be Commander in Chief – especially when he has obvious autocratic tendencies. They have even used the word “crazy.” As a clinical psychologist versed in diagnosing mental illness and declines in cognitive functioning – especially comparing baseline functioning to later functioning to determine if there have been any significant changes – I am in a position to put more descriptive language to words like crazy, bizarre, idiosyncratic, or off-script. Some say psychologist observers are not in a position to diagnose Donald Trump because they have not worked with him personally. To that I say we can certainly see enough information – visual, auditory, in print, from the testimonies of people who have worked directly with him – that while I will not officially give him a diagnosis, I will say what I believe is going on here.

We all hear Trump’s “crazy” digressions whenever he looks away from the teleprompter. So let’s a closer look at exactly what “crazy” means.

Here are terms from the world of neuropsychological diagnosis that may help you understand what may be going on in Trump’s brain during these moments.

Impulsivity: For Trump, impulsivity is the gateway that allows other cognitive abnormalities to manifest. It’s how we see a shark entering his diatribe about the pitfalls of electric boats. We’ve seen this for years, for example in impulsive Tweets (before he was banned from the platform), such as the infamous COVFEFE. Likewise, many former advisors have stated that Trump routinely fired officials on a whim or reversed policy decisions without considering the implications. Impulsivity is one component of the brain’s executive function that also include emotional control, attention and adaptable thinking, all of which Trump blatantly lacks.

Loose Association: In many of Trump’s speeches, you can literally see the moment when a scripted remark elicits a non-scripted idea and he cannot help but follow this loose association wherever it leads – for example, his “never fight uphill” digression when riffing on the Battle of Gettysburg. His scripted speech sparked a loose association of a quote he thought he had once heard – and this peripheral idea immediately becomes his focus.

Confabulation: Lying is deliberate and as we know, Trump chooses to lie almost as a first language. Confabulation is in some ways less insidious but more worrisome – it is making something up without knowing you’re making it up. Confabulation fills voids where there is no memory, or according to the National Institutes of Health, “a neuropsychiatric disorder wherein a patient generates a false memory without the intention of deceit.” It can be difficult to determine where lying stops and confabulation begins. Often the distinction can be seen in whether the untruth coming from Trump’s lips at any given moment has a purpose: If he gets something from it, it’s often lying; if it’s just fabrication to fill a void, that’s confabulation.  

Phonemic Paraphasia: Pundits have often accused Trump of “word salad,” which in many cases is a lay term for phonemic paraphasia. In this condition, a person substitutes a word for a non-word that shares phonetic characteristics. As Cornell Senior Lecturer, Harry Segal points out, phonemic paraphasia, or, “swapping parts of words for others that sound similar; these are signs of early dementia, even though they are intermittent.” Many examples of Trump garbling his speech in this specific, telling way can be seen in this 12-minute compilation.

Taken separately, these concepts may help you understand what you’re seeing and hearing next time you tune into a Trump speech. Taken together, they are strong indicators of cognitive decline and often Alzheimer’s, a disease from which Trump’s father suffered.

So, did Joe Biden win the debate? No. Not by a long shot. But when given the choice between an aging gentleman who struggles to express his ideas and a despot whose declining brain leads him into dark corners of impulsive and unhinged conspiracy, I’ll take Grandpa Joe.