We Already Know What’s Important About Donald Trump’s Health
ADHD Awareness Starts at the Top
Americans should attend to what we already know about Donald Trump’s health instead of focusing on unanswered COVID-19 questions. The White House perpetuates mistrust and confusion by not revealing when Mr. Trump first tested positive for COVID-19, what his symptoms have been, and if he has fully recovered. Obsessed with whether coronavirus treatment has rendered him “unstable and confused”, we overlook the president’s Attention Deficit Hyperactivity Disorder (ADHD), which has mightily contributed to chaos over the past four years. We ignore, at our peril, the certain and salient fact that he meets full criteria for ADHD.
A strange confluence of factors allows this definitive diagnosis. The official description of ADHD consists entirely of observable behaviors, and we possess a treasure trove of publicly available, behavioral data on Mr. Trump to establish the diagnosis. In contrast, to diagnose Narcissistic Personality Disorder, we must presume knowledge of his motivations and feelings if we deem that he acts with arrogance, or doesn’t care about others’ feelings. Only ADHD is defined by simple, objective, actions.
Mr. Trump displayed at least a dozen ADHD traits in the first presidential debate:
Can’t stand still.
Wanders off topic.
Fidgets. Interrupts.
Doesn’t listen when spoken to directly.
Trouble organizing.
Distracted by extraneous stimuli.
Forgetful.
Talks excessively.
Unable to play quietly.
Blurts out answers before a question is completed.
Doesn’t listen to instructions and fails to complete tasks.
An adult needs to fulfill just five of these criteria for an ADHD diagnosis.
We need to evaluate more than an evening’s performance to determine the presence of ADHD. Mr. Trump manifests his ADHD with a persistent and pervasive pattern of dysfunctional and distressing behavior, beginning before age twelve, unexplained by other conditions. His handling of the current pandemic constitutes a prime example of this dysfunction: his ADHD-driven behavior consisted of minimal preparation, poor organization, impulsive commentary, and a focus on what interested him, rather than on what was important. While we might surmise that the president is a narcissist, that condition can’t explain his incessant physical restlessness, impulsive blurting, or why he utters so many comments that directly undermine the image of strength, intelligence, or competence that he apparently yearns to project.
Beyond a simple check-list of behavioral symptoms, we currently conceive of ADHD as a problem of executive functions — how the brain directs, sustains and switches attention; organizes, prioritizes and plans activities; monitors and curbs impulses; manages time; employs short term memory; and regulates emotions. ADHD pervasively affects everything that enters, or doesn’t enter, the president’s mind, and everything that exits it. When national security experts of both parties publicly deem Mr. Trump “not temperamentally fit” for the presidency, they are referring primarily to his severe ADHD. Narcissistic presidents have handled the codes to nuclear annihilation without leaving us terrorized.
We diagnose in order to understand, predict, and treat conditions. If sociopathy and narcissism captured everything important about Mr. Trump, authors wouldn’t keep writing hundreds of books trying to explain his chaotic, mercurial, and self-sabotaging behavior. Awareness of his ADHD four years ago could have refuted the claim that he would govern differently than he campaigned and “become presidential” once in office. His ADHD explains his need for external structure and guidance in order to stay on track, and why he becomes less hyperactive and more verbally coherent on the occasions he does take stimulant medications (as evidenced by hours of pupillary dilation).
Tens of thousands of studies expand our knowledge about ADHD, yet we continue to trivialize and ignore the condition. ADHD shortens lifespan by about ten years — as large an impact as depression or diabetes. Over ten million Americans have ADHD, and millions of adults remain unaware of their condition, or dismiss it as simple distractedness. We can’t let Mr. Trump stigmatize ADHD just because his case is severe and complicated by narcissism and other personal attributes. We can’t remain oblivious to ADHD just because the president won’t discuss his condition. With respect to health issues, ADHD has shaped this presidency at least as much as COVID-19 has. We can honor October as ADHD Awareness Month by educating ourselves about this serious, treatable, condition that afflicts so many people, and is altering our whole society.
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