A worrisome tell in Trump interview

“Have you heard that expression [prime the pump] used before? Because I haven’t heard it. I mean, I just … I came up with it a couple of days ago and I thought it was good. It’s what you have to do.”

In his Washington Post column on May 11, Philip Bump asks “Is he riffing? Is he joking? Is he serious? Is he exaggerating? Is he lying?” Sadly, I think the answer is more worrisome and tragic.

I am not a fan of the president. Personally I think he’s a narcissist, but I’m no psychiatrist. However, I do know a bit about dementia, having been around it my whole life. Growing up, my grandmother lived with us while she sank into dementia. As an adult I witnessed my father’s decline into dementia from Alzheimer’s disease until his death 10-years ago. Now, I am helping my mother as her descent into dementia takes hold. I’ve spent countless hours engaged with these loved ones and, after they moved into assisted living, interacted with dozens of others similarly afflicted. So, when I read the president’s ‘prime the pump’ quote above from The Economist and learned he had used the phrase multiple times in his campaign speeches, my ‘dementia detection radar’ lit up. It reminded me of a story related by a friend who worked in a dementia care facility; her patient wanted to sing her a new song he had written — he called it Amazing Grace. This is very different than riffing, joking or even narcissism: it is more significant than that indicates there may be dementia.

As individuals lose their short-term memory, their linear experience of daily life becomes disjointed. Because they can’t link the present situation with a sequential series of events, they fill in the blanks with their own narrative, essentially creating their own history so their mind can make sense of the current moment. And then they work hard to cover gaps from others by telling the stories. It is done unconsciously, and continuously. Being disoriented like this is very frightening, like the ground is not stable under your feet. This can lead people to go to the dark side of their imagination, blaming others and creating conspiracies for disconnected events. Recently my mother has started to believe that people are taking her money, when in reality, she doesn’t remember hiding it to keep it safe (though there is no explanation about her cupboards being filled with cookies and Diet Coke).

Dementia would explain the president’s other off kilter actions recently including his tempestuous firing of Director Comey, and his releasing secrets to the Russian Foreign Minister and Ambassador. The Comey firing was obviously not executed with calm rationality, but makes sense from a problem/response viewpoint, but the leak really only makes sense if a person is non compis mentis. He’d have not know that Russia is an adversary, not a friend, and the information he was releasing was secret and vitally important. That’s more simple than forgetfulness.

Dementia is a bumpy one way ride. While there can be periods of stability and seemingly increased lucidity, sudden declines in capacity occur. My father’s decline was much darker than my mom’s, with angry outbursts and borderline behavior. Unfortunately for the president, increased stress tends to hasten its progression. Over time, his grasp of reality will continue to fade, and with it the personality his family and public knows. In my family, that is when we work hard to keep the vibrant person we knew close to our hearts, while taking care of the person who has taken their place.