March 4, 2024

I wanted to share a note I received from TPM Reader JR and my reply. Helps me refine my understanding of what we see in both Biden and Trump and how they are both perceived.

From TPM Reader JR

I’m a practicing psychiatrist who has evaluated many people over the years for dementia.

Based on my experience, Josh M is on to something when he wrote about how Trump’s anger makes him seem less cognitively impaired than Biden.

It’s well known within the mental health field that dementia is often missed in the setting of patients who express anger and are explosive in general. Why this is I’m not sure (maybe having to do with the incorrect assumption that anger shows a level of higher cognitive functioning?) but it happens a lot even with trained professionals in the field.

When you add in something like a stutter (which is more often than not misconstrued as a sign of cognitive impairment), the perception (versus reality) gap between Biden and Trump becomes that much larger.

As such, by showing anger Biden is not only reducing that gap but also showing some “dominance posturing” which I suspect is a crucial, if unfortunate part of how people evaluate candidates at that level.

This was my reply …

I think this is right. I think the common view of dementia is confusion and a kind of passivity. And obviously it can be that. But anger is perceived as action and intention. So sort of the contrary of dementia or cognitive fade. As you say, this isn’t really how it works or not the only way it works. My grandmother shifted very late in life – she lived into her 90s. Must have been in part some undiagnosed stroke or infarct. Because it was fast. But she just became nasty. She wasn’t less present. Her personality just changed.

When you look at Trump now, how he talks, how he communicates on social media, it’s way more untethered and wild than anything we saw in the 2016 era. The difference is palpable when you watch side by side. For a long time I saw this as just he’s more pissed. Losing the election was a massive ego injury and now he could end his life in prison. But at least when I watch him it seems like a major component of it is that sort of cognitive decline disinhibition, whatever the technical term for that is.

When I look at Biden he’s clearer slower than he was 10 or 15 years ago. But when you look past the stutter it’s same old quite intricate explanations of policy issues, etc. He’s fine, as far as I can see. Trump seems much more ragged in cognitive terms. But because he’s angry and wild it doesn’t register somehow.