Are Biden or Trump Well Into Their Dotage?

We can't definitively say they're senile, but we can have a pretty good sense of the probabilities.

With the 2024 season in full swing, attention has focused on the potential that one or both of the presumed nominees for president is well into their dotage.  Most attention has focused on President Biden, both due to his relatively frail performance and the sense his administration is shielding him from public scrutiny.  However, former President Trump has also had his cognitive gaffes.  Is it possible the person we elect to be the most powerful human being in the world in November may have the decision-making power of turnip soup?

Let’s acknowledge two elephants (or donkeys as the case may be) in the room.  First, clinicians’ hands are tied when it comes to diagnosing public figures.  To give an accurate diagnosis requires a full mental health exam, which most of us psychologists can’t do with either Trump or Biden.  But if we did then confidentiality would prohibit us from speaking publicly.  Anyone who seriously thinks a psychologist would assess a presidential candidate on Tuesday, then publicly declare them unfit for the presidency on Wednesday simply doesn’t understand how this works.  Technically, psychiatrists are bound by the Goldwater Rule, calling for restraint when commenting on political figures’ mental health (psychologists are not so constrained).  This didn’t stop 27 psychiatrists and psychologists from declaring (correctly to my mind) Donald Trump to be mentally unfit for the presidency. 

As I discuss in my book How Madness Shaped History at least two presidents (Wilson and Reagan) experienced significant cognitive decline in the latter presidencies.  There are various ways to assess politicians’ behavior either through clinical observation of their public behavior (and that of their administrations such as the apparent shielding of Biden from public scrutiny), or via statistical analyses of their speech.  The public good of speaking out probably outweighs the costs, so long as done both prudently as well as in recognition of the political biases of the mental health profession itself (most practitioners are liberals or progressives).

Second elephant: concerns about presidential fitness are not ageism.  To be sure, cognitive decline becomes more common with aging, and acknowledging this hard reality that comes for us all is not ageism.  Someone who has managed to avoid that decline should be free to serve, whatever their age.

As I discussed in 2020, the first time Biden and Trump ran against each other, I estimate the probability of at least one of them having some degree of cognitive impairment at about 51%.  Tacking on four more years certainly hasn’t improved that statistical math.  Both Trump and Biden have demonstrated verbal gaffes on the campaign trail.  Even normal aging brings cognitive decline with it, sorry, so this may simply reflect their age, or may reflect something more. 

Biden is at the disadvantage, in part because his own administration has shielded him from doing many difficult public engagements.  This can’t help but raise the concern that his own aides are dubious about his mental faculties.  This is furthered by the perception that “Everyman Joe” Biden has had difficulty reigning in the far-left impulses of his younger staffers, a problem of administrative control he shares with Reagan during Reagan’s Iran-Contra scandal.

By contrast, Trump appears far more energetic, despite his cognitive errors.  As such, he maintains the optical advantage on this score.  The only way for Biden to shake this would be get out in front of the public and perform in difficult exchanges…of course he can’t do that if he really is impaired.

My best clinical guess…offered tentatively…is that Biden’s cognition, whether due to simple aging or early dementia, has probably declined past that which is optimal for leader of the free world.  Trump’s mental limitations may be less cognitive and more personological.  Of course, there’s always the argument that presidents are figureheads, and the government can run without them (as admittedly occurred at the end of Wilson’s presidency, more or less).  If so, perhaps we should just elect San Antonio Zoo’s Timothy the Hippopotamus, who just launched his presidential bid.  “Naps for everyone” is his campaign slogan.  For once, perhaps that’s a platform we can all get behind.