Walter Reed physicians ~ assess Donald J. Trump's mental health (please!)

It almost goes without saying that literally zero congressional Democrats have said that there was no collusion between Russia and the Trump campaign during the 2016 election. Zero. ~ by Ezra Klein and echo opinion published in Vox.com

In the New Year, when Donald Trump is finally evaluated for the state of his medical health, the bigger question is about how the physicians will assess his mental health. On a below zero temperature day in Maine, this report about Donald Trump's rambling interview with the New York Times - unprepared and unscripted- is leaving me with cold chills.

Incoherent, authoritarian, uninformed: Trump’s New York Times interview is a scary readThe president of the United States ~ Donald J. Trump ~ is not well.

The president of the United States is not well. That is an uncomfortable thing to say, but it is an even worse thing to ignore.

Consider the interview Trump gave to the New York Times on Thursday. It begins with a string of falsehoods that make it difficult to tell whether the leader of the free world is lying or delusional. Remember, these are President Donald Trump’s words, after being told a recording device is on:

Virtually every Democrat has said there is no collusion. There is no collusion. And even these committees that have been set up. If you look at what’s going on — and in fact, what it’s done is, it’s really angered the base and made the base stronger. My base is stronger than it’s ever been. Great congressmen, in particular, some of the congressmen have been unbelievable in pointing out what a witch hunt the whole thing is. So, I think it’s been proven that there is no collusion.

It almost goes without saying that literally zero congressional Democrats have said that there was no collusion between Russia and the Trump campaign during the 2016 election. Zero.

What key Democrats are actually saying is closer to the opposite. On December 20, for instance, Sen. Mark Warner, the vice chair of the Senate Intelligence Committee and thus the Senate Democrat leading the investigation into collusion, said, “despite the initial denials of any Russian contacts during the election, this Committee’s efforts have helped uncover numerous and troubling high-level engagements between the Trump campaign and Russian affiliates — many of which have only been revealed in recent months.”

Nor is Trump’s base strengthening, or even holding steady. In a detailed analysis of Trump’s poll numbers, FiveThirtyEight’s Harry Enten concluded that the president is losing the most ground in the reddest states:

In states where Trump won by at least 10 points, his net approval rating is down 18 percentage points, on average, compared to his margin last November. In states that were decided by 10 points or less in November, it’s down only 13 points. And it’s down 8 points in states Clinton carried by at least 10 points.

The fact that Trump has lost the greatest number of supporters in red states is perhaps the clearest indication yet that he is losing ground among some form of his base, if you think of his base as those who voted for him in November.

CNN took a different angle on the same question and also found slippage among Trump’s base. It looked at the change in Trump’s approval ratings from February to November among the demographic groups that formed the core of Trump’s electoral coalition — in every group, there’d been substantial declines. Trump’s numbers have fallen by 8 points among Republicans, by 9 points among voters over 50, by 10 points among whites with no college, by 17 points among white evangelicals. “It has become increasingly clear that even his base is not immune,” CNN concluded.CNN

As for Trump’s contention that “it’s been proven that there is no collusion,” it’s hard to even know how to begin responding to that. In recent months, Trump’s former campaign manager and national security adviser have both been charged with crimes by Robert Mueller, and the investigation is not just ongoing but apparently widening in its scope and ferocity. Yet here is Trump’s take:

I saw Dianne Feinstein the other day on television saying there is no collusion. She’s the head of the committee. The Republicans, in terms of the House committees, they come out, they’re so angry because there is no collusion. So, I actually think that it’s turning out — I actually think it’s turning to the Democrats because there was collusion on behalf of the Democrats. There was collusion with the Russians and the Democrats. A lot of collusion.

HELLO???

Sen. Feinstein has not said that she, or any of the ongoing investigations, has concluded that there was no collusion. 

Instead, what she has said is that investigators believe Trump may have obstructed justice in his efforts to derail inquiries into collusion:

The [Senate] Judiciary Committee has an investigation going as well and it involves obstruction of justice and I think what we're beginning to see is the putting together of a case of obstruction of justice.

It speaks to Trump’s habits of mind, to the sycophantic sources from which he prefers to get his news, that he heard something Feinstein said and has come to believe she has absolved him — yet misses the actual thing she said that threatens him.


It would be comforting, on some level, to believe that Trump is simply lying, that he is trying to convince us of what he knows to be untrue. It is scarier to believe that Trump is delusional, that he has persuaded himself that Democrats have said things they’ve never said, that his base has strengthened when it has actually weakened, that it’s really his opponents under investigation for collusion, that his campaign has been cleared of wrongdoing when the circumstantial case for collusion has only grown stronger.

But that is far from the end of the interview.
Trump: “I have absolute right to do what I want to do with the Justice Department”

A few paragraphs later, for instance, Trump offers this chilling comment when asked about Hillary Clinton’s emails (which, amazingly, we are somehow still talking about in December 2017):

NYT: You control the Justice Department. Should they reopen that email investigation?

TRUMP: What I’ve done is, I have absolute right to do what I want to do with the Justice Department. But for purposes of hopefully thinking I’m going to be treated fairly, I’ve stayed uninvolved with this particular matter.

Read Trump’s phrasing carefully: “I have absolute right to do what I want to do with the Justice Department.” It’s a statement that speaks both to Trump’s yearning for authoritarian power and his misunderstanding of the system in which he actually operates.

And it’s followed by something yet scarier. “For purposes of hopefully thinking I’m going to be treated fairly, I’ve stayed uninvolved with this particular matter,” he says.Chris Kleponis-Pool/Getty Images

Here, Trump offers insight into his own thinking. He appears to believe that he is engaged in some explicit or implicit quid pro quo with the Department of Justice: He doesn’t fire Jeff Sessions, demand prosecution of his political enemies, or whatever it is he imagines doing with his “absolute right,” so long as they treat him and his associates “fairly,” which likely means protecting him from Mueller’s investigation.

Imagine reading this comment on transcripts from Richard Nixon’s tapes. It would be the kind of comment that would leave us glad Nixon was forced from office, chilled that such a man ever occupied the presidency at all.

The interview, of course, is not done.

TRUMP: It’s too bad Jeff recused himself. I like Jeff, but it’s too bad he recused himself. I thought. … Many people will tell you that something is [inaudible].

NYT: Do you think Holder was more loyal to …

TRUMP: I don’t want to get into loyalty, but I will tell you that, I will say this: Holder protected President Obama. Totally protected him. When you look at the I.R.S. scandal, when you look at the guns for whatever, when you look at all of the tremendous, ah, real problems they had, not made-up problems like Russian collusion, these were real problems. When you look at the things that they did, and Holder protected the president. And I have great respect for that, I’ll be honest, I have great respect for that.

Read that again. Trump’s premise in this section appears to be that President Obama engaged in a wide array of criminal, undemocratic, and negligent behaviors but his attorney general protected him from justice. And Trump’s conclusion is that Obama’s attorney general did his job well. To Trump, the attorney general doesn’t serve the country, or the Constitution, but the president.

Trump does not know what he doesn’t know, and he overestimates what he does know

At this point, the interview moves towards policy topics, and Trump relaxes into self-flattery:

I know more about the big bills. … Than any president that’s ever been in office. Whether it’s health care and taxes. Especially taxes. And if I didn’t, I couldn’t have persuaded a hundred. … You ask Mark Meadows [inaudible]. … I couldn’t have persuaded a hundred congressmen to go along with the bill. The first bill, you know, that was ultimately, shockingly rejected ... I know the details of taxes better than anybody. Better than the greatest C.P.A. I know the details of health care better than most, better than most. And if I didn’t, I couldn’t have talked all these people into doing ultimately only to be rejected.

In psychology, there’s an idea known as the Dunning-Kruger effect. It refers to research by David Dunning and Justin Kruger that found the least competent people often believe they are the most competent because they “lack the very expertise needed to recognize how badly they’re doing.” This dynamic helps explain comments like the one Trump makes here.

Over the course of reporting on the Trump White House, I have spoken to people who brief Trump and people who have been briefed by him. I’ve talked to policy experts who have sat in the Oval Office explaining their ideas to the president and to members of Congress who have listened to the president sell his ideas to them. I’ve talked to both Democrats and Republicans who have occupied these roles. In all cases, their judgment of Trump is identical: He is not just notably uninformed but also notably difficult to inform — his attention span is thin, he hears what he wants to hear, he wanders off topic, he has trouble following complex arguments. Trump has trouble following his briefings or even correctly repeating what he has heard.

This is all perfectly evident if you listen to Trump discuss policy in public even momentarily. For instance, in this same New York Times interview, he tries to explain how he’s changed Obamacare:

So now I have associations, I have private insurance companies coming and will sell private health care plans to people through associations. That’s gonna be millions and millions of people. People have no idea how big that is. And by the way, and for that, we’ve ended across state lines. So we have competition. You know for that I’m allowed to [inaudible] state lines. So that’s all done.

Now I’ve ended the individual mandate. And the other thing I wish you’d tell people. So when I do this, and we’ve got health care, you know, McCain did his vote.

... We’ve created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. Millions of people. That’s gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that’s a big thing. And the individual mandate. So now you have associations, and people don’t even talk about the associations. That could be half the people are going to be joining up. … With private [inaudible]. So now you have associations and the individual mandate.

I can, with some effort, untangle what Trump might have been trying to say here, but it’s so incoherent, so suffused with half-related ideas and personal obsessions (why did Trump feel the need to bring up McCain’s vote?), that it’s hard to say for sure.

At best, Trump is saying something that is comprehensible but incorrect. He signed an executive order making it easier to form association health plans, which are health plans formed by groups of small businesses, and making it easier for those plans to skirt Obamacare’s insurance regulations and to contain small businesses from multiple states.

As of now, and Trump doesn’t seem to realize this, it’s just an executive order — the rules defining and implementing it have not been written, so it is not yet happening, and we don’t know how it will work in practice, much less how many people may eventually sign up. Nor does the order get rid of the prohibition on selling insurance across state lines for most people — it’s only for this one kind of plan which can include members in multiple states, and which will only serve a tiny minority of the health insurance market.

Whatever Trump is saying, it does not reveal much familiarity with health policy, or even with the status and limits of his own actions. And yet Trump believes himself, on policy, to be the most informed president in American history. As the Dunning-Kruger effect suggests, he doesn’t know how much he doesn’t know, and that, combined with his natural tendency toward narcissism, has left him dangerously overconfident in his own knowledge base.

Speaking of narcissism:
We’re going to win another four years for a lot of reasons, most importantly because our country is starting to do well again and we’re being respected again. But another reason that I’m going to win another four years is because newspapers, television, all forms of media will tank if I’m not there because without me, their ratings are going down the tubes. Without me, The New York Times will indeed be not the failing New York Times, but the failed New York Times. So they basically have to let me win. And eventually, probably six months before the election, they’ll be loving me because they’re saying, “Please, please, don’t lose Donald Trump.”

What is one even to say about this? Is it a joke? If so, why is Trump taking this opportunity to make it? Is it an attack on the media? Is it Trump finding another way to compliment himself, to give himself credit for the media’s success?

Imagine how we would react to literally any other president speaking like this. Trump has bludgeoned us into becoming accustomed to these kinds of comments but that, too, is worrying.

This is the president of the United States speaking to the New York Times. His comments are, by turns, incoherent, incorrect, conspiratorial, delusional, self-aggrandizing, and underinformed. This is not a partisan judgment — indeed, the interview is rarely coherent or specific enough to classify the points Trump makes on a recognizable left-right spectrum. As has been true since he entered American politics, Trump is interested in Trump — over the course of the interview, he mentions his Electoral College strategy seven times, in each case using it to underscore his political savvy and to suggest that he could easily have won the popular vote if he had tried.

I am not a medical professional, and I will not pretend to know what is truly happening here.  (Dear Ezra~ I am a medical professional. A registered professional nurse.  Something is definitely not right in the mind of Donald Trump. My professional opinion is that he makes things up as he goes along. He lives in a narcissistic bubble.) 

It’s become a common conversation topic in Washington to muse on whether the president is suffering from some form of cognitive decline or psychological malady. I don’t think those hypotheses are necessary or meaningful. Whatever the cause, it is plainly obvious from Trump’s words that this is not a man fit to be president, that he is not well or capable in some fundamental way. That is an uncomfortable thing to say, and so many prefer not to say it, but Trump does not occupy a job where such deficiencies can be safely ignored.

Listen: Ezra Klein on the case for impeachment