Trump is scheduled to give his first State of the Union address soon. The address itself is unlikely to give us more information about the much more pressing question of the state of the president’s cognitive function, because he gives the least evidence of his condition when reading a speech off a teleprompter written by unimpaired people. That said, Trump could surprise us if he decides to ad-lib.
It’s been obvious for the past year that Trump has at least early dementia. But lately both his public behavior and revelations such as the Wolff book are providing evidence that maybe his disease is more advanced than just early dementia. The distinction makes a potentially huge difference, because while even his early dementia makes him unable to carry out the duties of the office, more advanced dementia casts doubt on the status of everything he’s signed while in office, and the legal exposure of the people who got him to sign things they knew he didn’t understand.
Dementia is mostly only diagnosed relatively late in its course, and because of this, most people think of behaviors of late dementia as characteristic of the disease. We usually don’t worry that an elderly relative has Alzheimer’s until and unless they stop remembering how many children they have, or start thinking it’s 1987 — lacunar memory loss and gross disorientation. But if you get a careful history from the relatives when a patient presents with such obvious symptoms, you can build a picture of many years before the lacunar memory loss, of the gradual loss of cognitive function that showed itself in less dramatic ways, manifestations that were written off at the time as the patient just taking it easier, simplifying their lives. People retire anyway in this age range, early dementia or not. The kids grow up and move away, so they don’t have to prepare complicated meals three times a day, or drive anywhere but to the local grocery store, and their finances become dramatically simpler. Dementia is mostly only diagnosed after the progressive inability to process new information finally makes it impossible for the patient to manage even the simpler less demanding lifestyle that old age tends to allow most of us to get away with, demented or not.
Dementia can present relatively early if the patient can’t simplify, or even, as in Trump’s case, moves into an even more demanding and complicated life situation. If judgment — executive function — is preserved, and if the patient has support and assistance of subordinates in his new, more demanding circumstances, patients can compensate successfully for their loss of personal cognitive function. They can’t keep all the balls up in the air, but they have enough staff to keep hundreds of balls up in the air. Reagan later developed clear, late dementia, but even at the time and not just in retrospect, he also clearly had early dementia on assuming office. He had this saving grace compared to Trump, however, that he had enough preserved executive function left to let competent staff handle all the details. The job of being president is so complicated that even a person of obviously greater than average mental acuity, like Obama, has to delegate quite a bit. Someone like Reagan or like Trump, with at least early dementia, just has to delegate a lot more to avoid dysfunction in managing his current role in life.
It has been obvious from day one of his presidency that Trump can’t do that, can’t delegate successfully to competent staff. That, added to the loss of cognitive function evident in so many other ways, might be interpreted as early dementia working on an existing shaky executive function. But even such inability to delegate at least suggested his dementia was more advanced. Now we have all of this at least anecdotal evidence that Trump shows behaviors out of the public eye that really do call into question his orientation and even, perhaps that he has some lacunar memory loss (doesn’t recognize people he’s known for decades).
Early dementia does not, by itself, call in question competence to make decisions. You don’t have to understand every detail of a will you sign to make your signature valid, and if your wealth is extensive and complicated enough, it is not to be expected that even a genius — who didn't also happen to be an expert in the law of successions -- would understand all the details of all the provisions of a will. But if you don’t understand even the broad brush practical effects, who gets approximately how much, if you imagine, and give voice to your imaginings, that it has effects clean contrary to the effects of the document you signed, then your competence in signing comes in question, and your signature on the will might be judged to not represent your assent to contents you do not at all understand.
Somewhere between early and late dementia, you become incapable of understanding matters which a president of the US must understand for his signature to be valid, to represent his will and his assent to what he has signed. And that’s exactly where we are now in our knowledge of Trump’s dementia. It was never clearly only early dementia, but now it becomes ever more clear that it has got beyond early, and into a stage at which it cannot be taken for granted that anything he has signed was not some sort of imposture, people other than the president getting him to sign things he had not the slightest clue about what he was signing. Just from early excerpts of the Wolff book, it sure sounds like the WH the past year has been Fraudland and Imposture City in the way staff has handled their demented patient. And he’s got a lot of it on tape, apparently.
We already know enough to know that Trump’s dementia requires his removal from office, because his performance has demonstrated an inability to execute competently many of its duties. The question now, one that requires a thorough clinical evaluation to resolve, is whether his cognitive dysfunction has progressed to the point that he was ever, while he has held the office, been competent to understand what he has signed sufficiently that his signature was not an imposture, something obtained fraudulently by his handlers.
The people who could have started the 25th Amendment process when it first became obvious, some time in January 2017, that Trump had dementia that resulted in the inability to do his job, failed to do that. That failure has created a trail of executive orders and bills that he has signed since, whose status would enter a legal limbo if these people did their duty today, the 25th was geared up, and Trump was subjected to a clinical evaluation that now seems likely to find that he has dementia advanced enough to call in question how all these things he has signed, got signed. If it was too difficult for the VP and the cabinet and the Congressional leadership to do their duty in February 2017, it has since become much, much harder to do that right thing. Trump is now clearly further advanced into his disease, a clarity that these insiders had available a year ago, and yet these insiders connived at his signing things they knew him to be incompetent to sign. They could have switched out Trump for Pence a year ago, and probably done even better in political terms since, than they have with Trump in the Oval Office. But that window has closed for them. In the past year it now seems that they have engaged in fraud and imposture that would be exposed if Trump were to be examined for dementia. Even if the laws and orders he has signed will survive legal scrutiny because of legal precedent governing how official acts of dubious provenance are handled (but don’t be too confident of that, this is an unprecedented situation), these public officials would have trouble surviving electoral, and perhaps even legal, scrutiny.
The current VP and cabinet and Congressional leadership have lost their chance to remove Trump from office for his dementia. At this point, they simply aren’t going to risk going there. Our side can’t replace the VP or cabinet — at least not in the normal way — until 2020. But the 25th can be implemented by just the Congressional leadership, and we can replace them later this year. And if Trump is ever examined by the relevant clinical specialists for his dementia, that D Congress is likely to thereby gain proof that the VP has committed impeachable offenses, the fraud and imposture involved in conniving at a clearly demented person being allowed to pretend to sign laws and executive orders that Pence knew perfectly well he was clearly incompetent to understand and give the assent required for his signature to be a true expression of his will.