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Hillary Clinton is “medically unfit to serve” as President and Donald Trump has narcissistic personality disorder: Stop this uninformed medical speculation about the candidates!

I’ve been debating whether to write about this for a while now, given that the first article that I noticed about it was first published a week and a half ago. Part of the reason for my reluctance is that it would be too easy for politics to be dragged into this more than I generally like. Of course, I don’t make a secret of my political leanings, but I usually don’t go out of my way to be an explicitly political blogger. I do, however, frequently write about areas where science and medicine intersect, and when I do I always come down on the side of science and rationality.

This brings us to a trope that has popped up in the media that Hillary Clinton is somehow “medically unfit” to be President. I first learned of this smear on August 10, when I found the latest e-mail release from the American Association of Physicians and Surgeons (AAPS), written by its executive director Dr. Jane Orient and entitled Is Hillary Clinton Medically Unfit to Serve? I thought about writing about it at the time, but unfortunately this Dug the Dog saw a squirrel. Next, I was made aware of an article by Martin Shkreli (yes, that Martin Shkreli) using his “expertise” as a pharmaceutical executive to claim that Hillary Clinton has Parkinson’s disease. Even though I was honored to appear as a guest rogue on The Skeptics’ Guide to the Universe and the topic came up, with Steve Novella delivering a forceful denunciation of such speculation, featuring Shkreli’s speculation as the “dumbest thing of the week,” still I didn’t write about it. Then, three days ago, the AAPS dumped another e-mail into my in box, this time in the form of a post by Dr. Gerard J. Gianoli entitled Is Clinton’s Health Less Important than Trump’s? That was the last straw. I made up my mind that I had to address the issue of the armchair diagnosing of the health of Presidential candidates, particularly since my good blog bud and fellow “Walking Dead” fan, Skeptical Raptor, took on the issue just the other day.

It’s not as though I haven’t done this before, of course, although it’s been a long time. The last time I discussed speculations about the health of a Presidential candidate was in 2008, when the issue of John McCain’s history of melanoma came up. I basically said that it was unlikely that his melanoma would recur, and time has proven me correct, as McCain is running for another term as senator this year and doing fine—physically, that is; politically is another question—as he approaches 80.

Finally, I decided that all this idiotic and uninformed speculation about Hillary Clinton’s health was getting on my nerves, as the speculation about Donald Trump’s mental health had done before. As I told Steve Novella on SGU, few people despise Donald Trump or as alarmed at the prospect of a Donald Trump Presidency as I have been, but even so I was profoundly uncomfortable with all the psychological diagnoses being thrown around about him, seemingly without much care. At first, I even thought that it had been a lot of this speculation about Donald Trump’s mental health that had lead Trump supporters to fight fire with fire with even more ignorant speculation about Hillary Clinton’s health, but I soon learned that the “Hillary Clinton is medically unfit to serve” meme had been appearing on Breitbart.com at least as far back as January 6, when a story entitled Law Enforcement Officials, Medical Professionals: There’s Something Seriously Wrong With Hillary Clinton’s Health was published.

Let’s take a look at some of these claims. First, Dr. Orient laid down an op-ed clearly designed to be picked up by as many newspapers as she could get it picked up in (given that it’s only around 700 words long) that consists mainly of a whole lot of JAQing off. After praising Trump for his bluntness and noting that some liberals are throwing around psychiatric diagnoses about Trump, noting, “…keep in mind that a lot of them think conservatives, Christians, and pro-life advocates are crazy too,” Orient lets loose the JAQing off:

There’s the photograph of Secretary Clinton’s difficulty walking up some steps. Now inability to climb stairs does not necessarily disqualify a person for public office. However, neither she nor people with her apparently anticipated a problem. The people helping her seem to be preventing a fall. Did she simply trip? Or was it a seizure or a stroke?

Videos widely circulated on the internet are, if authentic, very concerning. One shows prolonged, inappropriate laughter; another, strange head movements. In a third, she appeared momentarily dazed and confused, and lost her train of thought. Reportedly, she has a volcanic temper. (This is probably not new.)

A man who stays close to her, who is reportedly not a Secret Service officer, was photographed carrying something in his hand that purportedly might have been an autoinjector of Valium.

While we don’t have Mrs. Clinton’s medical records, it is widely stated that she experienced a fall that caused a concussion. Since then, she is sometimes seen wearing eyeglasses with prisms, as are used to correct double vision.

Evidence for these speculations? Almost none. Just a photo and some videos claiming “strange head movements,” a moment of looking “dazed and confused” (Orient’s age may be showing, given the obvious Led Zeppelin reference), and “inappropriate laughter.” There are, of course, also second and third hand reports where the primary witness is never identified, several of which can be found in this Breitbart.com piece and one of which Orient was cited by Orient in the passage above.

Meanwhile, another “brave maverick” doctor of AAPS, Dr. Gerard Gianoli, tries to provide Dr. Orient with tactical air support but only embarrasses himself spectacularly with some really stupid JAQing off:

What are the symptoms of increased intracranial pressure? The most common are headaches, visual problems, and dizziness/balance problems. We know that Ms. Clinton has had all three of these. Less commonly known are “brain fog,” problems with concentration, and short-term memory problems. Sounds familiar?

Asking:

Why has the media not been inquiring about Mrs. Clinton’s health records as aggressively as they did when GOP candidate John McCain had skin cancer? What do her visits to ophthalmologists and neurologists show? Has she had any neuropsychological testing, as is routinely done in traumatic brain injury cases?

Actually, the media didn’t really inquire that aggressively about John McCain’s skin cancer. Rather, it was a couple of really far out left-wingers who gained notoriety for using McCain’s history of successfully treated melanoma to drive a narrative that McCain was a “dead man walking” (which, obviously, he wasn’t, given that he’s alive and well eight years later), much the same way that it has been Martin Shkreli and Jane Orient who have been driving the false narrative that somehow Hillary Clinton is “medically unfit to serve.”

This is all incredibly thin gruel that leads Orient to wildly speculate further:

Concussions often cause traumatic brain injury, which might not be visualized on standard CT or MRI. Many of our veterans who experienced blast injury from improvised explosive devices suffer from it. These are some symptoms: difficulty thinking, attention deficits, confusion, memory problems, frustration, mood swings, emotional outbursts, agitation, headaches, difficulties with balance and coordination, and seizures. Many veterans with such an injury cannot hold a job or interact normally with their families.

Obviously, it would be very dangerous for a person subject to symptoms like this to be dealing with foreign leaders or making critical decisions. The President of the United States may have to make world-changing decisions on a moment’s notice. For example, should we launch nuclear-armed missiles? And if the Commander in Chief is confused, who will make the call?

To be honest, I’d be much more worried about a perfectly healthy Donald Trump having access to the nuclear missile codes than even a Hillary Clinton with post-concussive syndrome. (Sorry, I couldn’t resist interjecting a little of my own politics there.) I’d also point out that when the President is incapacitated, the Vice President assumes the powers of the Presidency. Be that as it may, what do we have here? Again, nothing other than speculation.

Here’s some of what we do know about what happened. In December 2012 while she was still Secretary of State, Hillary Clinton, ill with a gastrointestinal virus and dehydrated, fainted and hit her head, suffering a mild concussion. After Christmas, she underwent an MRI for unclear reasons (there was a quote about this possibly being “follow-up MRI, that probably would not have happened for regular people” and the routine for a concussion in a patient who recovered rapidly after a few days and hadn’t suffered a skull fracture doesn’t generally include followup imaging). This found a blood clot known as a cerebral venous thrombosis. She was treated with anticoagulation and recovered. Neurosurgeons interviewed for the story agreed that this sort of clot was uncommon after a concussion with no associated skull fracture and was a potentially life-threatening condition for which treatment was indicated. Clinton was treated, and, by all accounts, made a complete recovery.

At this point it’s not inappropriate to note that Dr. Orient’s organization, the AAPS, is a an embarrassingly quacky physician organization that I first discussed ten years ago. (Has it really been that long?) Over the years, I’ve documented how the AAPS, through its house organ the Journal of American Physicians and Surgeons (commonly abbreveated JPANDS), has abused science with hilariously bad studies purporting to demonstrate that abortion causes breast cancer (it doesn’t); that administering multiple vaccines at one visit is not safe (it is) that with respect to DDT and the Zika virus the best strategy is to spray, baby, spray (it isn’t); that shaken baby syndrome is a “misdiagnosis” for vaccine injury (it isn’t); and that President Obama uses neurolinguistic programming to get Americans to do his bidding (he doesn’t). The AAPS is also all-in for a large number of antivaccine tropes.

It’s not too surprising that Jane Orient would like Donald Trump. After all the AAPS is explicitly opposed to any form of government regulation of health care; considers the FDA and Health Care Financing Administration to be unconstitutional; is utterly opposed to Medicare, viewing it as immoral; urges physicians not to participate in Medicare; describes public health programs as “tyranny“; and liberally quotes Ayn Rand. Basically, the AAPS believes that the free market will fix everything that’s wrong with health care. Well, not exactly. Rather, the AAPS believes that the free market, coupled with removing pretty much any restrictions on how doctors practice medicine, be it evidence-based guidelines, board certification, maintenance of certification, peer review, or even state licensure will return medicine to a golden age in which doctor knows best and can do whatever he thinks best for his patient. Of course, it doesn’t matter to the AAPS that such a golden age of medicine never existed.

The leadership of the AAPS, including Orient, and apparently many who publish in JPANDS seem to be a bit too enamored of their self-proclaimed “maverick” status and give the appearance of thinking that, like Ayn Rand’s hero, they’re “supermen” whose egoism and genius will inevitably prevail over timid traditionalism and social conformism. Reining them in with evidence only interferes with their autonomy and prevents them from exercising their genius for the good of their patients. If only the “herd” could appreciate that! No wonder JPANDS has published several articles with titles such as Evidence-based Guidelines: Not Recommended, The Effect of Peer Review on Progress: Looking Back on 50 Years in Science (featuring another scornful dismissal of the “herd instinct” and “conformity” and a fair amount of exaggeration of how much scientific progress is due to “violent confrontation” of old paradigms and how much is due to the slow accumulation of knowledge), and editorials attacking evidence-based medicine. To the AAPS, scientific consensus is evil, and evidence-based guidelines are unacceptable limits on the autonomy of physicians, as are any government regulations or third party payer systems.

But what about the claim that Hillary Clinton has Parkinson’s disease? As Steve Novella points out, first of all, Shkreli is not a neurologist. He isn’t even a physician. Yet he thinks that because he’s been involved in drug development and clinical trials he can diagnose Parkinson’s on the basis of a video in which Clinton shows an exaggerated startle response that looks kind of goofy, which he calls dystonia. He also claims the video in which she trips is a “Parkinsonian freeze.” Dr. Novella, of course, is a real neurologist, and he tells us that none of these were dystonia, a seizure, or anything consistent with Parkinson’s. As he points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize. He also notes that it’s impossible to hide for very long and that Clinton has been in the public eye constantly for thousands of hours over the course of the campaign.

This brings us to Donald Trump. Four days ago, the New York Times published an article by Benedict Carey entitled The Psychiatric Question: Is It Fair to Analyze Donald Trump From Afar? The story starts noting an incident from history:

In the midst of a deeply divisive presidential campaign, more than 1,000 psychiatrists declared the Republican candidate unfit for the office, citing severe personality defects, including paranoia, a grandiose manner and a Godlike self-image. One doctor called him “a dangerous lunatic.”

The year was 1964, and after losing in a landslide, the candidate, Senator Barry Goldwater of Arizona, sued the publisher of Fact magazine, which had published the survey, winning $75,000 in damages.

But doctors attacked the survey, too, for its unsupported clinical language and obvious partisanship. In 1973, the American Psychiatric Association adopted what became known as the Goldwater Rule, declaring it unethical for any psychiatrist to diagnose a public figure’s condition “unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

Supporters of the rule make the arguments that (1) most diagnoses made from a distance turn out to be wrong; (2) the labels themselves can cause real harm to the person and family members; and (3) the practice undermines the field’s credibility. All of these are very good arguments, every bit as good as arguments why physicians shouldn’t be “diagnosing” Hillary Clinton with a neurological disorder. The Goldwater rule is still a good rule, but unfortunately during the campaign there have been psychiatrists openly flouting the rule when it comes to Donald Trump.

What I find particularly troublesome is the disingenuous and downright slippery rationalizations made by some psychiatrists and psychologists making these “diagnoses.” For example:

Dr. Steven Buser, a psychiatrist who with his colleague, Dr. Leonard Cruz, coedited a new book, “A Clear and Present Danger: Narcissism in the Era of Donald Trump,” stressed, “We are careful not to make a clinical diagnosis here, to say that Donald Trump has narcissistic personality disorder.” The contributing writers include psychiatrists and psychologists, but Dr. Buser said, “We are focused on the image he projects, on TV, in tweets, in quotes.”

This is, to put it kindly, self-serving bullshit, and highly unethical bullshit at that. Dr. Buser should be ashamed of himself, but obviously isn’t. He should also take a goo, hard look at himself and ask himself how much of his “diagnosis” is due to his political dislike of Donald Trump, and I say this as someone who quite literally despises Donald Trump and opposes him more than any Presidential candidate who’s run in my lifetime.

In the end, as is often the case, my views tend to align with Steve Novella’s view. First, using psychiatric diagnoses as a form of political attack further stigmatizes mental illness. Arguably, this is going on both in the attacks on Hillary Clinton and Donald Trump. While the attacks on Donald Trump explicitly invoke mental illness, the attacks on Hillary Clinton imply that she is unfit due to “brain fog” or mental or psychological consequences of a concussion. I also agree that, if you’re a professional, you should be really, really cautious and circumspect about attributing diagnoses to people whom you have not personally examined and whose medical records and tests you have not personally reviewed. And, certainly, if you are not a professional, you should just stop with the armchair diagnoses altogether. That’s nothing more than embracing the Dunning-Kruger effect wholeheartedly.

The retort one will hear, of course, is that the President is the most powerful person in the world. He or she will have access to the nuclear codes and will command the most powerful military in the world. Surely, the voters have a right to know if a Presidential candidate has a medical condition that might seriously compromise his or her judgment. While this is a good argument, armchair diagnoses, be they from actual physicians with no clinical contact with the candidate or amateurs with no clinical expertise, do not actually address that argument, nor do they serve to prevent compromised candidates from acquiring power. That’s because diagnoses aren’t made that way. They’re still made through direct, hands on diagnosis by physicians who have the appropriate expertise. In the hands of amateurs like Shkreli, quacks like Dr. Orient, and disingenuous, self-justifying docs like Dr. Buser, they are political weapons, not diagnoses.

Hijacking medicine for political purposes serves neither medicine nor politics. It just becomes a tool for partisans to bring down their opponents. Skeptics should not succumb to the temptation to use medicine that way.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

209 replies on “Hillary Clinton is “medically unfit to serve” as President and Donald Trump has narcissistic personality disorder: Stop this uninformed medical speculation about the candidates!”

I hate armchair/internet/whatever diagnoses with a passion.

It isn’t just in politics: the other day I was reading a piece about UK cyclist Mark Cavendish (for those who don’t follow cycling, he’d just won an Olympic silver, shortly after winning another 4 stages of the Tour de France, making him the most successful sprinter in Tour history, he’s a bit good on a bike)), who can be very blunt in interviews, not suffering fools at all, and can give very detailed tactical analyses of a race…

Some berk took this as signs of Asperger’s…

Immmm, no. Cavendish comes from a part of the UK which does have a reputation for plain speaking, he’s been asked more than his share of stupid questions by journos over the years, and he lives and breathes cycling and, especially, tactics in races, which is why he’s so good at it…

People trying to see MH diagnoses annoys me especially, given my clinical background.

Golly gosh!

This is now twice this week I’ve been the first responder: this must be sign of a conspiracy or that I am under the control of Orac or something…

Excellent post. May I add something else? Not only does this kind of pseudo diagnosis of politicians add to the stigma around mental illness, but it drives further the trope that being old is being unfit. What would the modern armchair arbiters of presidential health make of JFK? Or F.D. Roosevelt?

“Inappropriate” laughter? Show me someone who only laughs when it’s “appropriate”, and I’ll see someone with a stick up his or her ass. Not someone I would wish to get to know further. I imagine HRC’s personal and political history has provided many causes for “inappropriate” laughter. Look who she’s married to, for starters. Add in all the muppets (foreign and domestic) she would have met as Sec of State: if you didn’t laugh about it, you would go mad.

And now that Breitbart guy is atop Trump’s campaign, it’s only going to get worse from all angles.

I’m not a professional psychologist, although I have read quite a bit of the subject. However, I am not offering a diagnosis of Trump. I will however say that he shows signs in public of being grandiose, self-centered, greedy, vain and short tempered. Yes, there is a DSM or ICD diagnosis that contains all of those. No, I’m not going to “go there” and claim Trump has that disorder. Yes, I am going to say that based on those characteristics I would not want Donald Trump to be president. I would have said the same of Barry Goldwater and of Joe McCarthy. Put bluntly, Trump may or may not meet the medico-legal definition of “insane” but he certainly isn’t the stable, rational, intelligent man whom I want at the helm of the ship of state. (not to mention the nuclear release codes.)

Just wanted to add that Dr Drew Pinsky has joined the fray, claiming that he is “Gravely Concerned for Mrs Clinton’s health.” (methinks Dr Drew is Gravely Concerned for Dr Drew’s Ratings. )

After talking this over with friends, I’ve decided to write to all of these people and ask for their help. I’m pretty much a shut-in these days, and the thought of being able to just send off a video of myself and receive a diagnosis (and possible prescriptions, because Dr. Drew whatisname, who knows Clinton isn’t taking the correct medication, is all about the right prescriptions) without ever having to leave my house or having any of them examine me is intriguing! I’d never have to worry about transportation to a medical appointment again!

(3) the practice undermines the field’s credibility.
I am not convinced that “undermining the credibility of psychiatry” is any reason to abandon a practice. If anything, it’s a reason for more of it.

Slightly OT, but every remaining irony meter I had blew a few days ago blew when I read that AV kook Robert De Niro called AV kook Donald Trump “totally nuts” ( http://www.usatoday.com/story/life/people/2016/08/13/robert-de-niro-trump/88676126/ ).

I like what Douglas Adams has to say about those who wish to rule, er, I mean lead us:

The major problem—one of the major problems, for there are several—one of the many major problems with governing people is that of whom you get to do it; or rather of who manages to get people to let them do it to them.
To summarize: it is a well-known fact that those people who must want to rule people are, ipso facto, those least suited to do it.
To summarize the summary: anyone who is capable of getting themselves made President should on no account be allowed to do the job.

What I find interesting is comparing the 2 attending physician letters for the candidates.

Dr Jen Gunter looks at the letter that is supposedly from Donald Trump’s doctor, and rips it apart as unprofessional. (And, as a medical professional, I agree. It’s very badly written. Sadly, I can also say that working in health insurance, I’ve seen letters just as badly written.)

Contrast that letter to the one Skeptical Raptor links to from Hillary Clinton’s doctor. It’s very professionally written, discusses her concussion and treatment, and states she is in very good health.

Just on the basis of the MD letters, I’d prefer Hillary over Donald.

@Mephistopheles O’Brien

*I* think he looks unhinged (not a psychiatric diagnosis, mind), but I like where you’re going with this.

“What are the symptoms of increased intracranial pressure? The most common are headaches, visual problems, and dizziness/balance problems. We know that Ms. Clinton has had all three of these.”

I have all three of these from time to time also. Maybe I am not fit to do my job! May I go on disability?

As for Trump and narcissistic personality disorder, I came up with that one on my own without hearing any of this nonsense first. I just did not go running to the press with it.

This idea that elections are won by dissing your opponent is beyond disgusting. I fear that this time we have reached the point of no return.

Personally, I think Trump has a totally non-clinical case of foot-in-mouth disease just from the huge number of ill considered, poorly thought out, and potentially dangerous remarks he has tossed out in his speeches and interviews.

My father and grandfather both had Parkinson’s disease, but they were both very clear headed until they died in their 80’s and 90’s respectively.

My grandfather was a rather dour Baptist dairy farmer from Ohio and I barely remember him laughing, much less laughing inappropriately, but he did have a very dry sense of humor.

I also remember Gerald Ford got a lot of heckling for a couple of falling incidents, but I don’t remember it being considered a disqualification.

I don’t think you can blame people for trying to come up with something to describe the bizzare behavior and odd speech patterns that emanate from Trump. I also think the Goldwater Rule is a good thing. So…just what is appropriate when a public figure actually displays weird symptoms? Candidates usually release a letter from their medical doctor, but is it too much to expect the same for mental health?

Frankly, I’d rather have a Prez with a manageable medical issue that an undiagnosed and untreated mental illness.

@squirrelelite: I remember Gerald Ford very well, also. And his stumbles/falls were laughed off as “chronic clumsiness”. No one questioned his fitness for the presidency based on those. But then, he was a WASP.

No one questioned RR’s fitness, even though there were signs of dementia when running for his second term.

Strange how it’s dangerous for a woman to (theoretically) show signs of problems, but never in a man.

@MI Dawn,

I agree about the double standard. I’ve seen a couple well written discussions of the narrow path Hillary has to tread .

Using my pediatric acumen, I will state both candidates are well outside my age range of comfort. They are are breathing, have a pulse and are perfused. Medically I will say nothing further.

@Chris Hickie: as a CNM, I’d go a little further and say that HRC is a well-developed, well-nourished woman who looks to be her stated age. Beyond that, I will say nothing without a physical exam or at least being in the same room with her and speaking to her (then I could asses some other things).

I would have nothing to say about DT as men were out of my field of practice completely.

“I remember Gerald Ford very well, also. And his stumbles/falls were laughed off as “chronic clumsiness”. No one questioned his fitness for the presidency based on those. But then, he was a WASP.”

Ford was also an ex-athlete in good physical shape. But he was mocked unmercifully for alleged clumsiness.

“…both candidates…are breathing, have a pulse and are perfused.”

Ha, what independent physicians have certified any of these “facts”? Can we confidently state the two major candidates are not alien robots simulating human physiology and feelings? Some observers have spotted false notes, especially regarding expression of human emotions.

Just raising some possibilities here.

@Dangerous Bacon: Isaac Asimov wrote about this in the short story “Evidence”. Perhaps both candidates are from alien robotic cultures fighting for control of Earth.

Bornstein is a gastroenterologist. I regard such a specialty as being far to up-tract for a physician to Trump.
I would have thought it customary, when a physician intends to release actual details of someone’s medical data, to address the letter to the person in question and allow that person to release the letter.

I suspect part of what is going on is diversion from the refusal of Trump to release his tax filings.

From the RationalWiki article on AAPS: “While purporting to have high regard for the Hippocratic Oath, “the sanctity of the patient-physician relationship, and the “practice of private medicine”,[1] …” Yet Orient is quite content to malpractice very publicly when it comes to HRC.

As he points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize.

This was how Billy Connolly was first diagnosed.

” As he points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize.

This was how Billy Connolly was first diagnosed.”

My dad was diagnosed after his GP happened to see him walking down the street.

There is a big difference between the lay person saying eg Trump is a narcisistict, power hungry, looney and a doctor saying it.

Listening to political experts/ news folk delve into the morass that surrounds the Orange One is like deja vu for me because of my experiences trudging through the various swamps of unreason I frequent.

It’s as though Null logic and the Adamsian thought [process/ libel factory have gone mainstream.

I look upon the entire circus as just that, a circus. Three rings worth.
There is no Constitutional health requirement, otherwise, Grover Cleveland would’ve never saw the inside of the oval office, as well as 1/3 of other past POTUS’. Period. Some, so unhealthy as to shock one and all today. Indeed, FDR was so ill, he had a stroke so severe, his aides first thought he was shot in the head.
No, just severe hypertension and a CVA from hell, which leaked from his ears.
Indeed, it’s dubious if Congress could impeach a mentally ill POTUS, as mental illness is neither a high crime nor misdemeanor and a mentally ill person may well be capable of acquitting the office of POTUS without a problem (hell, these days, it actually might help).
In the fiction of things, it comes down to the popular vote. In reality, it comes down to convincing the electors (most states don’t have a statute to force an elector to abide by the popular vote).

As for stumbling on stairs, glazed looks, I’ve had more than a few of those on my part. I injured my back when catching my wife after her abdominal surgery, preventing a fall, but ending up with severe spasms in both legs, especially calves. So, doctor prescribed an opioid for pain and it did well as a “muscle relaxer” enough that the “muscle relaxer” he did prescribe was only taken at bedtime.
But, I sure had glazed eyes and the neurological issues with my legs made stairways problematic.
Fortunately, I retained dad’s cane after he died, as it came in really handy in preventing more falls than I had after the initial injury.

In other personal news, I saw the orthopedist today, it was found that my shoulder wasn’t separated, but the ligaments were stretched. PT should help with that.
Maybe that would be considered disqualifying me for POTUS in some eyes or something.
Personally, I think my career inclination and preferences, plus my disposition disqualifies me from the office. Maybe that’s why I won’t run. 😉
Or more accurately, I’m not interested in that aggravation. 😛

re comments above- various

Clumsiness ?
Yours truly played much tennis, dancing, martial arts, etc over many years.
In April, I had an incident with stairs near an underground train and have been dealing with it since and have improved until I tripped over a cat ( please don’t laugh, Narad) 3 weeks ago and have had trouble driving, because of the clutch but am somewhat better. The cat survived without obvious damage.

I doubt that ethnicity has anything to do with it.

Don’t get me started on cats tripping me!
Ours did his usual antics as I returned from home earlier this week. I was using the cane to walk, leaning rather heavily upon it, lest one leg collapse unannounced.
He tore around me, clipping the cane *just* as I was leaning down onto it and placing it on the ground, tearing it from my grasp and spilling me straight down onto one knee on the nice, soft ceramic floor.
Once recovered and inventory showed nothing broken, but fairly bruised, I picked up the cane and shook the crook at him, “Stay the F out of my sight until I calm down!”.
He sat in the window watching me for the next half hour, then came over for his attentions.
He did end up waiting another hour for food to be set down for him – I was in no way ready to bend to put that bowl down after that twisting impact with the floor!

Thankfully, he’s been more careful since.

I swear I have never tripped over a cat before.

Even wearing 90 or100 mm heels or after having ingested various libations/ potions.

I did slip on a wet floor once to avoid stepping on a cat.

Cats are wonderful magical creatures, no?

Medicine, politics, and social media.. a living venn diagram of dysfunction. If politicians ran medicine, we’d have the best iron lung in the world right now, but nary a polio vaccine. If social media and popularity bandwidth wagon ran medicine, the CDC mmwr would be off the chart.

Cats have an evil side…I had a few that LOVED to seek attention just as I tried to go down the stairs, usually with my hands full. They would wind around my ankles purring. One, however, preferred to try to jump into my arms. The first time he tried, however, when I had both arms full of baby, was the first time I didn’t catch him. The look of betrayal on his face…

Claiming your opponent is incapable is a great way of trying to re-level the playing field when your own candidate is a abject failure and startlingly weak. But why the vehemence?

Answer: http://www.nytimes.com/2016/08/12/opinion/pieces-of-silver.html?_r=0

It all comes down to rich people, like quack doctors and financial speculators, not wanting to pay more taxes. After all the high-minded language about what is best for the nation it all comes down to what is best for their bank accounts. Both craven and simple.

Ugh, Shkreli. He needs to go jump down an obuliette.

MOB @ 12: Well played. He does look tired, don’t you agree?

I am not convinced that “undermining the credibility of psychiatry” is any reason to abandon a practice. If anything, it’s a reason for more of it.

I could once be counted on to defend psychiatry, but I must say I am not at all a fan of this business of locking people up who haven’t committed a crime (attempted suicide is not a crime the last time I checked), something which I narrowly avoided. (Thanks, lone sane shrink!)

^ One might note that “It’s my life and my business,” in so many words, is not the best line to take when asked about one’s feelings regarding suicide by the DMHP.

@JP – after a suicide attempt that failed in my twenties I was asked by my assigned physician if I might try again. The actual words, “That was stupid. Going to do it again?” My response was, “Duh. It didn’t work.” Close enough. They released me.

Off topic (but about woo. Isn’t woo always a topic here?): we went to the state fair this week and Mr Woo got talked into a fifty dollar rubber bracelet that “blocks radiation to allow detoxification and reduced inflammation.” I couldn’t hide my disdain, but he still offered to get me one, too, anyhow.

I am opposed to any third-party speculation about the health of Ms. Clinton or Mr. Trump. However, they are both 70. We have seen what time in the White House did to Mr GW Bush and Mr Obama. I think it is fair to ask all presidential candidates for an independent health screening and a list of their medications–regardless of age.

You really don’t need to diagnose Trump with a mental illness or disorder to call him what he is: a colossal asshat.

I don’t know why people need to justify labeling him with the former when the latter language will do quite nicely.

We have seen what time in the White House did to Mr GW Bush and Mr Obama.

TINW. Was it the same thing to both? What about everybody else? I mean, Obama wasn’t 70. This really seems to need some more comprehensive data, no matter how primitive.

Honestly though, who hasn’t shown the strain of being POTUS, even if they only had four years in office?

Seriously, does anyone here think that having that job wouldn’t be a tremendous strain, the late night awakenings due to a crisis, having to learn of, then speak to a nation after a mass shooting or other tragedy, heaven help those leading the nation in time of war!
Between that and the politics involved in all parts of the job, I wouldn’t dream of wanting that job. It doesn’t pay enough for the stresses involved and the BS inherent in the politics of the job.

As a Canadian, with no medical training whatsoever, I have become convinced from watching the news that your whole country is insane!

@Narad, while amusing sounding, one can get stuck in a bathtub without being wedged in it.
Both my wife and I have (individually) been “stuck” in the tub, unable to rise from it, in one case, an injury that was being soaked prevented self-extraction from the tub.
In another, the kids had an excess of bubblebath residue in the tub, preventing regaining my feet and necessitating assistance from my wife, a small hoist and a skid jack.
OK, not really all of that, it just seemed that way as my feet slid like they were on oiled glass.
Funny now, but I very nearly broke my neck when I tried to stand up to exit the tub the first attempt. Even today, decades later and the kids long gone from the house, with homes of their own, I still ensure that the bottom of the tub isn’t slicked down with bubblebath or conditioner (just about as bad).

As for Taft, well, he did break the bathtub ring, a porcelain price fixing ring. It’s interesting that he’d break up such a criminal price fixing cartel, to suddenly find himself allegedly stuck in a bathtub… 🙂

Oh, for a bit more TMI, to this very day, I still take baths. It relaxes back muscles that are in spasm when I get out of bed quite effectively. A shower entirely fails to do that.
But, I do watch out for conditioner spilled in the tub. That crap’s lethal!
For more amusing home accident anecdotes, get my wife on and ask her about my superman imitation on satin sheets, while making an amorous dive toward her. While it more resembled the landing of “The Greatest American Hero”, my wife tells it humorously and accurately enough to bring the house down every time.
With a fair amount of effort, I did manage to repair the wall six feet away from the bed.

I have to agree – long distance diagnosis sucks, with some few exceptions One that I can think of is the profile a Dr. Brussel made at police request of George Metesky, the “Mad Bomber”, who planted bombs all over NYC for too many years. It turned out to be stunningly accurate. The War Department also commissioned a psychological profile of Adolph Hitler.
With the major exception of exigent circumstance and no direct access to the subject, it is thoroughly unacceptable, unethical, and dangerous. I also believe that a professional publicly offering an unsolicited attempt at diagnosis is somewhere way out in the ethical stratosphere, where the air is mighty thin. It might pass in cases of “across the room” or augenblick (German for “blink of an eye”) diagnoses, cases where the diagnosis jumps out at a knowledgeable practitioner. None of what’s passing for diagnoses in this election rises to that level.

I too have “headaches, visual problems, and dizziness/balance problems” when I have migraines (not so much actual pain – acephalgic migraine). Or did three neurologists, a neuro-ophthalmologist, and a neuro-otologist who worked me up for a concurrent issue miss my elevated intracranial pressure and doom me to disability and death?

Much as I want to stay out of politics here, I do think that Trump’s criticism of other people’s appearances is prime chutzpah coming from someone who looks like a jack o’ lantern left on the porch all winter.

@Wzrd1: A similar thing happened to my ex-husband (while we were still married.) His hip occasionally would go into spasm, due to a flag football injury where he was tackled *just* the wrong way. (And yes, I know you aren’t supposed to tackle in FF – tell teenage boys that.)

Anyway, he’d taken a bath to relax some sore muscles, tried to stand up and realized he couldn’t. He yelled for help, which I went to give him. Mind, I was 8 months pregnant at the time. Trying to life someone twice my (unpregnant) weight, with a very pregnant belly shifting my balance, was not an experience I want to ever repeat. However, we did finally manage to get him out.

FYI: if the footing is too bad, a number of towels thrown in underneath the feet and hips eventually will help.

@MI Dawn, my wife had gallbladder surgery and had a umbilical hernia repaired (c-section scar that is 30+ years old started to fail at the umbilicus) last month.
It was endoscopic surgery and hence, she returned home a few hours after surgery.
A few hours after that, she started to fall and I managed to catch her, injuring my back in the process and ended up with severe sciatica pain and spasms in both calves that literally pointed my toes downward and spasms across the arch of my feet, literally collapsing my arches. I’m on hydrocodone for the pain and it’s effective against the spasms, so I’m only taking the “muscle relaxer” at bedtime.

The next morning, while I was at work, her legs gave out on her (she has a severe herniation of L5-S1 pressing upon the cauda equina (in the lumbar region, it isn’t spinal cord, but the cauda equina (horse’s tail of nerves bundled in a sheath).
I drove home from work after receiving an e-mail that she was on the floor, unable to rise. Not too bad, as the house is only four miles from my office.
It took a few tries to get her up off of the floor, as she lacks the leg strength to plant her feet firmly and she kept sliding on the tile floor. I finally placed her toes against my shoes and that gave enough purchase to lift her onto her feet.
Fortunately, she’s not fallen since.
She also had an MRI of her cervical spine, viewing the dicom imagery, I couldn’t find a single disc in her neck that wasn’t impinging upon the spinal cord. Worse, the radiologist report later confirmed that.
Even worse, she has advanced osteoporosis. Something our former primary, back in PA, concealed and claimed had somehow cleared up. So, she’s currently inoperable, lest the vertebrae collapse during surgery.
We’re awaiting special dispensation from the insurance company to begin her injections to correct the osteoporosis.
She apparently had several vertebrae suffer fractures and heal and she currently has two fractures that are fresh.

Yeah, I’m getting accustomed to picking her up, either from a chair or from the floor. :/
Fortunately, I learned how to lift patients in a wide variety of situations, ranging from battlefield emergency moves through using bed lifts.
Laughably, once, I was working with a man who lifted weights on a regular basis and was quite muscular. He had trouble moving our weighted medical mannequins. Oddly, he entirely forgot all of his training in lifting an unresponsive patient and tried to manhandle the dead weight.
I used standard means to lift the mannequins, utilizing their articulating knees and hips, lifting them to chairs and medical litters with minimal effort.
Of course, moving an infantryman is easy – offer him a drink. 😉

@JP – after a suicide attempt that failed in my twenties I was asked by my assigned physician if I might try again. The actual words, “That was stupid. Going to do it again?” My response was, “Duh. It didn’t work.” Close enough. They released me.

I was actually trying to work out if this meant that you were or weren’t going to try it again, then decided that you are probably a lot smarter than I am.

@Narad, while amusing sounding, one can get stuck in a bathtub without being wedged in it.

I know; I’ve actually slipped backward and clothed into a dry tub while sitting on the edge and been stuck for several minutes while trying to figure my way out of the transverse-on-back-situation (as well as slipping during a regular shower, narrowly avoiding cracking my head, and having to resecure an upright stance).

This does not ameliorate my disappointment that the Taft story is bogus, though.

@JP – after a suicide attempt that failed in my twenties I was asked by my assigned physician if I might try again. The actual words, “That was stupid. Going to do it again?” My response was, “Duh. It didn’t work.” Close enough. They released me.

I was actually trying to work out if this meant that you were or weren’t going to try it again, then decided that you are probably a lot smarter than I am.

I wasn’t quite sure about that anecdote myself.

Not quite the same, but I am periodically interrogated on the matter. “Not today, not tomorrow, but…” has worked. The question is what comes after the suspension dots. I’m down with Ken White here.

Dr. Gerard Gianoli is asking for medical record release, I am not a doctor but one thing I know for sure that no concussion will affect a person’s integrity and we need someone to lead this nation in good faith. You however, Dr. Gianoli, did you act in good faith when you performed an unnecessary surgery and left me in a state of disability?

Long distance diagnosis is crap. It should only be done when there is no access to the subject. I can only think of two kinds of case where it belongs. One is when the patient is at a remote location where there is no one qualified to examine or treat, and the person at the other end accepts responsiblity. The other is behavioral profiling (Good riddance, Mr. Gibson.) of criminals and such. A brilliant profile helped in catching NYC’s Mad Bomber of the ’40s and ’50s. The OSS had a psychiatrist profile Adolf Hitler and I’m sure it’s been done on many others since.
Even if it’s an across-the-room or an augenblick diagnosis, it’s reckless and unethical to disclose it in public rather than privately to the subject. Not a lawyer, don’t play one on TV, but I could posit circumstances in which there could be civil liability. Once you undertake to diagnose someone, anyone, to my mind it imposes confidentiality restraints if you’re a practitioner, and imposes moral restraints on amateurs.
I was impressed by this quote cited on Dr. David Ramey’s blog – “Before you speak, ask yourself: Is it kind, is it necessary, is it true, does it improve upon the silence?” – Sai Baba

“Not today, not tomorrow, but…” has worked.

I have decided to give myself a year or so and then I’ll reassess. I don’t plan on letting the shrinks in on this plan, though.

(This is no fun, though section 7 is better than the alternative.)

In happier news, my department wants me to take a year long leave of absence for “medical” reasons, so I am. The only thing left is to get the final form to the doctor and have him send it to Rackham.

(I gotta say that after recent experiences I miss my shrink back in Michigan.)

I respectfully disagree. Not being a physician, much less a neurologist or psychiatrist, I would be missing an observation about Trump that apparently is known to those in the field. It would now be appearing as a whispering campaign at the very least. The important point is that Trump’s behavior — both as political candidate and in the rest of his life — is far off the charts for normality. Moreover, it’s characteristics are known to the experts, and future behavior is predictable.

This description makes it easy for me to pigeon hole Trump as a potential catastrophe to America.

I can understand how reasonable people (i.e. readers of this blog) are annoyed with the phony attacks on Clinton’s health, but they were already occurring and were going to occur in any case. It’s the same political movement that continues to question the president’s birthplace and commits so many other outrages. I would suspect that the only way to combat the attacks on Hillary is to refute them as has been done here.

This is not to suggest that the way to combat lies about Clinton is to make up lies about Trump, but the stories suggesting that Trump is highly narcissistic ring true, and we all have a large amount of data from his public pronouncements. Providing the public with the clinical term NPD may be a bit of a stretch, but it gives us a framework on which to hang Trump’s bizarre reactions.

From my more lay point of view, the question is less about whether medicine is being hijacked, and more about which side is telling outrageous lies vs which side is telling the truth. In that regard, I suspect that the hostility to Barry Goldwater was taken beyond what was psychiatrically logical, whereas the concern over Trump’s mind is legitimate.

Sai Baba

I take it that this is Sathya Sai Baba. A friend once brought over a giant haul from the (original) Powell’s free-book box, to which all but one returned (The Holy Man … And The Psychiatrist, just to remind me of the event).

In happier news, my department wants me to take a year long leave of absence for “medical” reasons, so I am.

Good. I remain dumbfounded by the atavism of the State of Washington’s laws here.

Sorry for borked link; the last two fingers on my hand are not working, due to ulnar palsy I didn’t know I had and thus never got checked out. Unable to use my left hand much at the moment.

Let’s try this. (PDF)

The whole experience did give me the occasion to ominously use the word “asylum” when a friend of mine suggested that maybe I needed to go to the state hospital and that I would get better soon there.

Let’s try this. (PDF)

Or this (the link still had ‘.pddf’). I can’t read the whole thing right at the moment, but I’ll note that having a basis for doing something is different from doing it automatically.

I’m sorry but there’s not a rational person that would look at Hillary and think she’s healthy. Even Dr. Phil expressed his concerns.

Funny how all the radical Democrats talk about Trump as if he’s a narcissist; as If he’s run for president in the past; As if he’s a career politician who’s made his fortune of the taxpayers.

@ Panacea:

I feel that psychologists shouldn’t diagnose anyone in this fashion…
HOWEVER every single person has ( some) ability to evaluate how others act, speak and perform and it is on this basis- social perception- that I think anyone can speak up.

I don’t think that he has the skills for the job. He doesn’t have the social skills for negotiation. He carries grudges to obscene lengths. * Y mucho mas*

There was that old test: would you like to have a drink with the candidate? ( Even if s/he doesn’t drink ).
No way. Unless if I were writing something and needed material.

@ JP;

Hey, I’m glad to hear that you are out and about ( which might be a triple entendre). At any rate, I hope so.

Besides tripping over large, Indolent furry creatures, I am rather well.

Following political news recently resembles my usual activities surveying woo in all of its rancid glory.

As a case in point:

today good old Mikey ( Natural News) rails against the *elites* whom he places as a class separate from regular folks like wage earners, the unemployed and HIMSELF.

Yes, Mike is just a regular guy. Just like the other woo-meisters. They are on the side of the working/ average person, they understand all of the problems poor people and minorities have and what is more
They are your friends.

In this alternate reality, what they say IS.

Narad, the quote is verbatim from Dr. Ramey’s page so I don’t know whether his Sai Baba is your Sai Baba. Whoever said it, it’s an ideal that I wish I could live up to.
Ramey himself is horse veterinarian in California, and while I’m not a horse person, his blog is entertaining, informative, and woo-free.
Here’s the URL: http://www.doctorramey.com

Hey, I’m glad to hear that you are out and about ( which might be a triple entendre). At any rate, I hope so.

Yes, don’t worry, the places I have been in and the place I was on the docket for don’t have Internet access (at least I assume so of the Eastern State Hospital) so it’s a sure bet I’m not there. I have to live in “residential housing,” though, for 90 days (halfway through) and am on something called an LRA for the same length of time, which says I’m not (ever) allowed to own firearms, that I can’t drink or use drugs, that I have to follow a court-ordered course of treatment, etc.

I can come and go as I please, though. I did get in trouble once recently for being out late walking around, but I had been told when I got there that there was no curfew, and I had signed out saying I would be out late. Oh well. (They even called the police and the DMHP to go looking for me, but called them off.)

I can use the Internet at the public library (the technology at the house goes as far as radios, VHS, and a landline telephone) which is where I am right now.

One way to put this into perspective is to change the scale. Think of a local school board election. During the run-up to the vote, a local psychiatrist steps up at meet-the-candidates night and declares, “I’ve been watching Ms Smithjones for some time now, and it’s my professional judgment that she’s a borderline schizophrenic.” I think you can imagine the consequences. If not a psychiatrist but a pediatrician, general surgeon, or a school nurse did it, it would be just as unethical, immoral, and possibly slanderous. Among other things, it is assuming a cloak of false authority, if done by a professional of any sort. To do it on a national scale is just as wrong as to do it in a village councilor election.
To my mind, if done to influence an election, it might reach the threshold of actual malice,the standard for proof of slander of a public person.
Besides all that, long distance diagnosis is nearly always just plain wrong.

(Sorry for the replicated posts upstream. Lately many things I have tried to post online seem to get lost in cyberspace.)

@JP, @ Narad

I was honestly saying I wouldn’t try that method again. I was still very suicidal. Luckily, I guess, the inclination wore off before I found access to an adequate method that I was willing to use. I have dealt with periodic dark periods since childhood.

My theory has always been that it took them the 72 hours one would normally be on psych hold to get my kidney function where it should be. There were a lot of blood gas tests and high perfusion IV that kept setting off alarms (I think – this was the late 80s and I got pretty out of it for part of the stay there). I suspected my terrible health insurance didn’t offer coverage for psych admissions and it further played a part in letting me go.

I’m sorry but there’s not a rational person that would look at Hillary and think she’s healthy. Even Dr. Phil expressed his concerns.

Dr. Phil? Ha. Haha. Hahaha. Hahahahahahahahahahahahaha!

Dr. Phil is not a doctor. So who cares what he thinks?

I suspected my terrible health insurance didn’t offer coverage for psych admissions and it further played a part in letting me go.

When I was recently involuntarily detained (for one thing, I didn’t say that I regretted doing it because I have so much to live for, but rather I regretted that it didn’t work) it was under the involuntary treatment act (ITA), so the state paid for it. Probably they decided that you weren’t “dangerous” enough to detain; I’m guessing you used pills.

It’s kind of a morbid discussion, but the attempt I made was considered “violent” (I think most things besides pills are), which probably factored into it, too. And the method in the back of my mind is pretty violent, too, especially if done correctly.

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