Although the US and most developed countries are nominally democratic, many of us seem to be again yearning for a man on a white horse, and in the current era, the horse ridden is corporate.
On Health Care Renewal, we having been talking about this pheonomenon for a long time. We have written about it in terms of the messianic (or visionary, or charistmatic) CEO, CEO disease, and the imperial CEO.
These concerns are diffusing into the broader media. For example, from the introduction to a revent Vox article entitled "The Problem with CEO Worship"
Society has always had heroes, be those of war or art or politics. But entrepreneurs are particularly suited for our current moment, in which success in business is our primary marker of achievement. Business acumen doesn’t just get you money anymore; it can make you the most powerful man in the world.
The signs of CEO worship are everywhere: unprecedented venture capital funding for founders, media overemphasis on company leaders, and to use the most extreme and obvious example, the election of Donald Trump.
That article noted that CEO worship may overestimate the importance of leaders; create "secular fundamentalists" out of individuals; perpetuate destructive neoliberal ideologies; encourage CEOs to make worse decisions; and be bad for business
Those are not the only consequences. CEO worship makes it possible for a progressively impaired leader to go unconstrained. Unfortunately, we may be seeing the ultimate example of this in the US.
Incoherent Verbal Utterances
Even before he was elected, we noted that Donald Trump sometimes was completely incoherent when describing his health policy ideas. In early 2016 we raised questions about Donald Trump's cognition. At that time, a conservative columnist labelled as "word salad" Trump's attempts to sketch a position on health care, specifically the "mandate" provision of the Affordable Care Act (ACA). We found other examples of his utterances on health care policy that could be characterized as gibberish. This one was short, if not sweet
I want to keep pre-existing conditions. I think we need it. I think it’s a modern age. And I think we have to have it.
How could anyone understand this while listening in real time? A close reading suggests that maybe this was meant to suggest that some people ought to have insurance coverage for pre-existing conditions. However, Trump seemed to befuddled by that concept. Furthermore, note that pre-existing conditions are not desireable, so that one would not want to "keep" them, nor can one choose not to. To what the word "it" in the second sentence and again in the fourth refers is unclear. The third sentence seems to be a complete non sequitur.
We found additional examples of incoherent verbal responses about health care in 2017, and early 2018. In the last six months, things have only gotten worse. Examples of verbal incoherence have multiplied, although most were not related to health care.
In July, 2018, MediaIte reported Trump's incoherent comments at a political rally,
I have broken more Elton John records, he seems to have a lot of records. And I, by the way, I don’t have a musical instrument. I don’t have a guitar or an organ. No organ. Elton has an organ. And lots of other people helping. No we’ve broken a lot of records. We’ve broken virtually every record. Because you know, look I only need this space. They need much more room. For basketball, for hockey and all of the sports, they need a lot of room. We don’t need it. We have people in that space. So we break all of these records. Really we do it without like, the musical instruments. This is the only musical: the mouth. And hopefully the brain attached to the mouth. Right? The brain, more important than the mouth, is the brain. The brain is much more important.
Perhaps this was meant to suggest that the president drew a larger crowd to an arena than did Elton John. However, note the non-sequiturs: from "Elton has an organ" to "lots of other people helping" to "we've broken a lot of records," "They need much more room, for basketball, for hockey..." Who are the people helping whom are they helping, and to do what? What records were broken by whom, and how is this relevant to Elton John, etc. To whom does they refer, and why do they need a lot of room? Etc, Etc. Again, in real time this would have made no sense at all
In September, 2018, CNBC reported that speaking at a meeting about preparations for Hurricane Florence, Trump said
This is going to be a very large one ... It's tremendously big and tremendously wet. Tremendous amounts of water
Maybe he meant to say this will be a very large hurricane, bringing a tremendous amount of rain. However, he seemed to be unable to convey the concept of rain.
In September, 2017, the Hill had reported that Trump had defended difficulties in providing relief for Puerto Rico after Hurricane Maria thus,
This is an island, surrounded by water. Big water. Ocean water
Again, to be charitable, he seemed to handle the concept of an island in a vast ocean as would a three-year old.
Media articles also suggested that normal people cannot follow or understand what Trump says in real time. For example, on November 8, 2018, a Bloomberg op-ed said this about a recent Trump news conference,
In fact, the president was difficult to follow because he simply doesn’t make any sense half the time.
Trump was asked one specific question about health care, and good luck to anyone who tries to figure out what his answer meant. He pretty clearly has just as little idea what he’s talking about on most major policy issues as he did when he first started running for president. On Jamal Khashoggi, waivers on Iranian sanctions, North Korea and Russia, he either ducked the questions with non sequiturs or just babbled.
On November 11, 2018, an article in Slate noted that Trump confused Baltic states with Balkan states in a way that could have foreign policy repercussions,
When President Donald Trump met with Dalia Grybauskaitė of Lithuania, Kersti Kaljulaid of Estonia and Raimonds Vējonis of Latvia earlier this year, he started with a criticism. At the White House in April, Trump opened by chastising the Baltic leaders for starting the war in the 1990s that ended with the breakup of the former Yugoslavia. The Baltic leaders were apparently very confused and it took them 'a moment' to realize that the commander in chief was confusing Baltic states with the Balkans
this case is particularly notable considering Melania Trump is originally from the Balkans. The first lady was born in Slovenia, which gained independence in 1991 at the start of the Balkan wars. As Le Monde wrote, Trump remained 'apparently uneducated in the matter by his wife, Melania, originally from the former Yugoslavia.'
This suggests at best that at times Trump may be unable to distinguish words that sound vaguely alike but have quite different meanings.
A November 28, 2018, Vox summary article about Trump's recent interview with the Washington Post provided this quote from Trump about economics,
And I’m not blaming anybody, but I’m just telling you I think that the Fed is way off-base with what they’re doing, number one. Number two, a positive note, we’re doing very well on trade, we’re doing very well — our companies are very strong. Don’t forget we’re still up from when I came in 38 percent or something. You know, it’s a tremendous — it’s not like we’re up — and we’re much stronger. And we’re much more liquid. And the banks are now much more liquid during my tenure. And I’m not doing – I’m not playing by the same rules as Obama. Obama had zero interest to worry about; we’re paying interest, a lot of interest. He wasn’t paying down — we’re talking about $50 billion lots of different times, paying down and knocking out liquidity. Well, Obama didn’t do that. And just so you understand, I’m playing a normalization economy whereas he’s playing a free economy. It’s easy to make money when you’re paying no interest. It’s easy to make money when you’re not doing any pay-downs, so you can’t — and despite that, the numbers we have are phenomenal numbers.
The author of the article stated,
I have basically no idea what Trump is talking about here, and I’m pretty sure he doesn’t either.
On repeated close reading, I still do not have any idea what Trump meant. I would add the following questions: 38 percent of what? Who is much more liquid, and how is liquid defined? Who is paying a lot of interest? What does "paying down and knocking out liquidity" mean? What is a "normalization economy?" Note that this was coming from someone who claims to be a brilliant business manager.
Furthermore, consider what Trumps aid about the climate,
And when you’re talking about an atmosphere, oceans are very small. And it blows over and it sails over. I mean, we take thousands of tons of garbage off our beaches all the time that comes over from Asia. It just flows right down the Pacific, it flows, and we say where does this come from. And it takes many people to start off with.
Oceans are "small?" What "blows over and sails over?" Over what? What "flows?" What "takes many people?"
In 2017, StatNews published an article describing how
STAT reviewed decades of Trump’s on-air interviews and compared them to Q&A sessions since his inauguration.
To summarize the conclusions.
The differences are striking and unmistakable.
Research has shown that changes in speaking style can result from cognitive decline. STAT therefore asked experts in neurolinguistics and cognitive assessment, as well as psychologists and psychiatrists, to compare Trump’s speech from decades ago to that in 2017; they all agreed there had been a deterioration, and some said it could reflect changes in the health of Trump’s brain.
In 2018, Trump's verbal communications at times are even more garbled. Parts of the passages above suggest the word salad produced by somebody with fluent aphasia versus the nonsensical responses produced by patients suffering from acute delusional states. That Trump is capable of producing this sort of word salad at times, without realizing he is making no sense, suggests the intermittent symptoms seen early in progressive dementia.
Lack of Insight About Cognition
Furthermore, Trump appears to lack insight about his difficulties commicating.
In July, 2018, after the NATO conference, Politico reported, that Trump seemed to have no insight about why much of what he says appears unbelievable to others. The article noted
leaders who spent the first 18 months of Trump’s presidency thinking there might be a method to his chaos creation — and struggling to discern what it might be — now seem to have concluded that it’s just chaos, and that Trump himself may not understand what he’s doing.
More specifically, European officials commented on what Trump was saying:
A senior NATO official said leaders had concluded that they simply could not rely on anything Trump said.
'You know the way he speaks, you cannot take him literally,' the official said.
Another EU official echoed the point. 'He speaks a language that doesn’t match with diplomacy,' the second official said. 'We were used to the Brits, who speak a more frank diplomatic language, but this is another thing.'
These officials again seemed to be stating that Trump's verbiage can be completely incoherent, albeit they were doing so diplomatically. After the conference, however, when confronted with a question about the inconsistency of his remarks,
When a Croatian journalist confronted Trump about his inconsistencies, the president flatly denied there were any, and he repeated a defense of his own sanity that he had made when previously questioned about his fitness for the presidency.
'We understand your message, but some people ask themselves, will you be tweeting differently once you board the Air Force One?' the reporter said.
Trump, speaking at his news conference before leaving the summit, replied: 'No, that's other people that do that. I don’t. I’m very consistent. I’m a very stable genius.'
Not to belabor the point, but the examples noted above suggest neither consistency nor stability. And true geniuses almost never boast about their intellect.
In September, 2018, The Hill reported an interview with Trump in which he said his personal health and management style were reasons that Republicans might do better than expected in the 2018 elections,
'You know, I took that test when I got my last physical, and the doctor said that’s one of the highest scores we’ve ever seen,' Trump said. 'I did that not because I wanted but I did it, I was always good at testing.'
He continued: 'But if there’s anything great about me it’s stability, and I’m a good manager. Always been a good manager, but you know, I have a vision,'
Note that above Trump was presumably referring to the screening test for dementia he took during his official physical examination. High scores on the test are common, and do not signify great intelligence, just the probable absence of dementia.
In addition, this interpretation assumes that the test was administered in an unbiased way. However, there are reasons to question whether Trump's physical was unbiased. In retrospect, we now know that soon after taking the test, Trump nominated the physician who administered it to be Secretary of Veterans Affairs. Later the physician withdrew his name after allegations of his questionable personal behavior appeared (look here).
At least Trump's boast about having "a vision" does correspond to the language often used by public relations spokespeople to justify their CEOs' lack of accountability and high compensation (look here)
Similarly, in the Vox summary of the November, 2018, Washington Post interview (see above for link), Trump stated
a lot of people like myself - we have very high levels of intelligence
Finally, a November 18, 2018 article in MediaIte described this interchange between Trump and interviewer Chris Wallace on Fox News, starting with his response to a question about how he makes decisions
'I don’t think about them,' Trump replied. 'I don’t think about, you know, how I make them....'
However, he responded to a question about Federal Reserve policy
They're making a mistake because I have a gut, and my gut tells me more sometimes than anybody else's brain can ever tell me
This suggests that Trump has lost insight into his own thinking.
External Observers Suggested Trump Is Cogitively Impaired
In August, Vanity Fair reported:
More than ever, Trump is acting by feeling and instinct. 'Trump is nuts,' said one former West Wing official. 'This time really feels different.' Deputy Chief of Staff Bill Shine has privately expressed concern, a source said, telling a friend that Trump’s emotional state is 'very tender.' Even Jared Kushner and Ivanka Trump are unsettled that Trump is so gleefully acting on his most self-destructive impulses as his legal peril grows.
In September, 2018, Newsweek reported two instances in which apparent Trump insiders sought psychiatric or medical help for Trump's perceived cognitive problems
[Dr] Lee told Salon that two Trump administration officials approached her after the book was published to express their concern about the president’s mental health, saying he was 'scaring' them because he was 'unraveling.'
In comments to Newsweek over email, Lee said 'it appeared that the officials (if they were officials at all) were at least frequently in [Trump’s] presence.
She continued, 'They were definitely calling from within the White House, which I confirmed by calling back their number. However, I did not ask about their rank. There was no reason for me to doubt they were high-ranking enough to have regular access to the president.'
Lee also said that a 'person [who] was a friend of his entire family, since his childhood” had also been in touch with her at the same time in October 2017, as people in the White House were “stating concern about the president (this was an observation from afar).'
Also in September, 2018, a Politico review of the new book by Robert Woodward based on numerous White House interviews suggested that Trump's inner circle called him a "dope," "idiot," or "moron."
Donald Trump is the chief executive officer of arguably the most powerful country in the world. Starting during his campaign for the US presidency, we noted that his utterances about health care were at times so incoherent as to suggest cognitive dysfunction. In the two years since then, especially in the last six months, he has increasingly been noted to be verbally incoherent or confused, has seemed to lack insight about these episodes, and has been observed by close allies and associates to be cognitively impaired.
However, there have ben few, at best, public attempts to link these suggestions of cognitive impairment together, nor to discuss their implications. The most recent of those that I have found was in January, 2018 (look here and here). Yet the problems appear to have been getting worse since then.
While patients with worsening cognitve impairment deserve accurate diagnosis, compassionate care, and access to what few effective, safe treatments may be available for their condition, they obviously should not be in a position to make consequential decisions. They certainly should not be in charge of large organizations, particularly powerful countries with nuclear weapons.
Yet President Trump's apparent cognitive decline remains anechoic.
For this we may blame CEO worship, which we have too often seen in health care. We have seen many health care leaders praised for their brilliance and paid royally despite leadership resulting in financial distress, threats to the organizations' health care missions, poor patient care, unethical behavior, or even crime. Yet health care CEOs, like other corporate CEOs, and like politicians are just people, sometimes smart, but almost never brilliant. Promoting them as messianic to bewitch key constituencies, justify the remuneration of other top managers, and the hiring of more public relations flacks is likely to lead to the sort of organizational disasters and system-wide dysfunction we discuss on Health Care Renewal. The rise of the falsely messianic leader may allow the entry of the most dangerous false messiahs, the psychopathic ones. (We discussed the likelihood that some health care leaders are actually psychopaths here.)
We must get quickly past our worship of CEOs. We may not long survive in a world where leaders of nuclear armed nations have no cognitive clothes.