An Open Letter to Americans both Democrat and Republican, Generals, Admirals, and Members of both the Senate and the House of Congress:

As a second year resident in Clinical Neuropsychology, more, as an American citizen, and, after careful consideration in conversation, collaboration and consultation with other medical and mental health professionals, the time has come that I can no longer remain silent in relation to the observable state of cognitive decline and behavioral/personality decompensation of Mr. Trump. As this affects public health and safety, there is a medical obligation to warn the public of his evident incompetency and the danger this presents.

Moreover and similar to the behavior of individuals and groups who become enthralled via abuse, to the insane behavior of abusers, I have watched as my fellow Americans have developed an artificial numbness otherwise known as "the acceptance of pathological normalicy." This occurs when folks suffering under such abuses, no longer see and respond to outrageously abusive behavior as insane. The more folks feel trapped and unable to escape, the more likely that abject helplessness sets in leading them to accept and expect such abuses as "just the state of things that happen” (i.e., its the way it is).

This is a natural defense mechanism designed to normalize abuse in order to survive it. However, this defense also KEEPS FOLKS TRAPPED within the insane reality created for them by the abuser. I believe as Americans, we are now in this darker place in the cycle. Quite plainly, this has become our MALIGNANT REALITY. Moreover, no one is coming to rescue us, they cant, we must do this for ourselves.

I want to make clear that while I bring a different point of view to the forefront here, I unequivocably support and agree with the clinical diagnosis and assessment of risk put forth by Yale Psychiatrist Dr. Bandy Lee and Colleagues (broadly representative of a Coalition of concerned Neuroscience/medical professionals) who notably broke with tradition to lay the groundwork for a badly needed public conversation addressing the Dangerous Case (risk) of Donald Trump and his pathological mental/psychiatric state.

However, from the point of view of a Clinical Neuropsychologist, the rapid cognitive decline routinely displayed by Mr. Trump, (e.g., 5 Feb 2019 two plus hour irrational, nonsensical diatribe and 13/14 March 2019, fifty plus barely intelligible paranoid vindictive and hate-filled tweets, recent WH interview clearly exhibiting an inability to learn and/or curtail his commentary to obscure criminal intent; something he was plainly cognizant of and capable of doing previously) has clearly reached an alarming critical mass.

Although repeatedly calling attention to Mr Trumps malignant narcissism and criminal psychopathy, it does not seem A) Dr. Bandy Lee and colleagues observations and recommendations regarding Mr. Trump will amass any real tread beyond professional circles and, B) I firmly believe that an urgent call to activate the 25th amendment should be undertaken AT THIS TIME, based on Mr. Trumps observable symptoms of cognitive decline, consistent with Dementia.

THE PROBLEM

While Mr. Trump clearly exhibits all the symptoms and behaviors of clinically diagnosable personality disorders, delusional disorder and criminal psychopathy, its the decline in his cognitive functioning that so clearly demonstrates progressive symptoms of Dementia to include: his behavioral impulsivity, changes in personality verified over and over by those who know/knew him well, his compromised executive functioning, complete lack of social judgement, constant eating/talking (hyper-orality), verbal trailing off, word loss, disorientation, CLEAR memory loss, confabulation, confounded by compulsive pathological lying and a few even more subtle symptoms that give him away. This is NOT to say he exhibited anything approximating good social judgement before now, its the present decline in function that is of clinical concern. This is also not to say he didnt talk incessantly or eat junk food before now, but it has reached an uncontrollable threshold as has his obviously poor judgement evidenced by an inability to inhibit what he reveals via his constant talking/tweeting (e.g., his recent interview with G. Stephanopoulos and his announcement 6/16/19 that he may need to be president for more than two terms- both evidence of delusional functioning and cognitive decline; and both completely beyond the bounds of reality testing).

And although Mr. Trump has never been very smart, he has always been extremely cunning. Mr. Trump has long made use of his uncanny media savvy via the targeted generation of sensational falsehoods, lies, narratives of vengeance, greed, fear, envy, victimhood, racism and hate pointedly appealing to the worst in folks to garner negative brute loyalty. This approach is all too common among many sociopathic cult and mafia criminals. But, Mr. Trumps ability to gage, monitor and control his baser impulses relative to what passes for acceptable conversation in public at this point, regardless of his more nefarious intentions, let alone presidential discourse, has rapidly declined in such a way as to undermine even his own renowned media savvy.

Above and beyond the psychopathology implied by the above constellation of symptoms, the decline in his ability to contain what is so obviously unacceptable, criminal and untethered to reality, strongly argues for Dementia related cognitive decline, and specifically, Fronto Temporal Lobular Disease-Behavioral Variant (FTD-bv), a type of Dementia. While Dementia related cognitive decline does not take away from or excuse Mr. Trumps sadistic narcissistic criminal sociopathy (all of which both obscures and magnifies his existing symptoms of Dementia), it is equally true that with every additional diagnosis, the clinical picture is confounded, meaning it gets harder and harder to attribute symptoms to this or that disorder. However, in terms of diagnosis, the first and foremost question in my mind as a clinician is always "whats driving this train" or "what and where is/was the first domino drop."

When doctors dont know, we use words like, multifactorial, confounded and idiopathic. In this case, based on the above behavioral symptoms, it would appear dementia most likely, FTD-bv is driving Trump's rapid decline in cognitive function. The evidence for this: Mr. Trump had all the same Personality Disorders and criminal inclinations long before running for office. But he also had the wherewithall to keep them in check and himself together enough to avoid blatant displays of criminality, let alone symptoms of dementia; because they did not yet exist!

However, if you look, over last 10 years you begin to see a slow, at first almost imperceptible, decline in cognition that picks up speed like a snowball. Mr. Trumps history is plainly visibly via a historical cache of video recordings. Go back 15-20 years ago, before he started his presidential run. You can see via video and radio interviews, the slow degeneration and decline in his functioning right there in living Technicolor. Now fast forward the video tape. Thats NOT disintegration based on Personality Disorders, thats Dementia related decline in cognitive functioning IN THE OVAL OFFICE. And that's why its time for 25th amendment.

THE SOLUTION

I propose a solution is available via a non partisan independent Medical Evaluation Board (MEB) that could rapidly be assembled and likely acceptable to both parties in congress. Call for the 25th based on symptoms of DEMENTIA, plainly visible to all, with the demand for a full Neuropsychological Evaluation, followed by a PET scan to confirm diagnosis, as the truth would then be incontrovertible.

Respectfully, the reason you'd need a Neuropsychological Evaluation first is that even if a PET scan found evidence of Dementia, it could easily argued that, "well yes, Mr. Trump does have Dementia, but that doesnt mean he's not functional." Presently, only a Neuropsychological Evaluation can determine lack of functionality or incompetence, and, based on findings, propose a provisional diagnosis which a PET scan could/would then confirm. While I may be off the mark in the type of Dementia the President has, I'm not wrong about the cognitive decline that's progressing and the rapid decompensation that is clearly occuring.

An MEB for Dementia is likely the only legitimate reason the whole country could understand and work with and the only incontrovertible evidence there may be to mount a call to activate the 25th amendment.

Thank you for your time.

Respectfully,

Kate (Kathleen) Shaw, M.A., M.S., Psy.D. 
Clinical Neuropsychology Resident