My father-in-law Art was extraordinary. He returned to the States after being a front-line radioman in WWII to build a life with the wife he married just before shipping to the South Pacific. He was one of those people whom Tom Brokaw labeled as the “greatest generation.” Art lived humbly and took care of his immediate family and many others. He was always checking in on some elderly relative or another. On weekends, he’d take his kids and any from the neighborhood on excursions. He was the guy who’d give you, as the aphorism goes, the shirt off his back. Except with Art, that wasn’t metaphorical. I had to be careful not to compliment him on something because he’d insist I take it. I have a beautiful Pendleton, wool-lined vest that he bought on a trip to the Pendelton factory and gave to me a few days later when I admired it.
Art was also a brilliant civil engineer. He never finished his degree at UC Berkeley because it became impossible to juggle a job, a growing family, and school. Instead, he went to work for the city where he lived and helped to manage city infrastructure. He had a preternatural skill with math formulas and complex calculations. He used the skills and knowledge he developed to build a side business as a surveyor on weekends as the community surrounding him grew in the post-war building boom.
So when he got to the point where he got lost driving familiar streets, couldn’t remember how to set the initial point of a survey, and started to be obsessive over trivia, we knew something was wrong. With time, his inability to manage simple tasks like going to the grocery store and returning with what he had intended to purchase became major signs of concern. This wasn’t the man we knew. We knew he was experiencing dementia. His physicians confirmed what we could see. If you’ve had this experience with a loved one, you know the feeling of hopeless freefall off of a cliff that comes as a result. You tumble downward with them and look for the soft spots on the way down.
As things progressed, his son had to take his truck away to avoid any more accidents. We discovered that he kept a loaded pistol and had killed a bird in his yard that he was trying to scare away – we took away the gun. He’d awaken in the middle of the night, dress, and walk a mile down the hill to the Catholic church where he’d awaken the priests in the rectory and ask them to hear his confession. In the midst of summer heat, he’d put on three or four jackets, grab some tools to put in a bag, and leave to go “up north,” a vague reference to some unknown destination.
In many ways, he was still the same gentle soul we’d always known. When he had to be in a care facility, he would stand by the door and have conversations with people who came to visit. Because he was friendly and coherent, visitors assumed that he was also there to visit someone and they’d open the security door to let him out. He would teach the others in the facility words in Tagalog, a language he picked up 70 years before when his father was stationed in the Philippines. Eventually, he didn’t remember his wife of 60+ years, and his health failed. But that took a few years. Even as he was in his final days in a hospital bed where kidney failure took his life, he greeted me with a happy, “Hello, Roberto,” an affectionate nickname he used for me over the years.
The prefrontal cortex of a brain manages what’s called “executive functioning.” That brain region regulates emotion and helps with planning and organizing. It provides us with the ability to regulate our impulses and handle complex tasks. In Art’s progression, those parts of his brain functioned less well with each month. Someone who didn’t know him would talk with him, and he’d appear to be in fully cognitive. The speech functions of his brain weren’t affected. But if you knew him and heard him talking about going for a walk to visit his daughter that day, you’d know that wasn’t possible because both daughters lived hundreds of miles away. And you’d have to listen closely to hear how ideas that he discussed weren’t really connected. Instead of being able to manage complex ideas, as he did throughout his life, he became minutely obsessed and unable to manage some emotions – increasingly focusing on his dislike of certain politicians that he heard about as he listened compulsively to AM talk radio.
I wasn’t qualified to diagnose or treat Art’s dementia. But his decline was obvious to anyone who saw him over time. While we had a medical diagnosis to confirm his condition, that was so we could explore treatments with medical professionals. His everyday actions told us what the doctors didn’t need to explain. The family watched and we did our best to keep him safe and comfortable. It’s what we’ve done with multiple relatives who had levels of dementia, and the experiences have left an impression on me of what dementia looks like.
The news reports I’ve seen over the past year have me thinking. I see the president exhibiting the same characteristics that overtook my father-in-law. The list of examples grows with each day’s news about the president: his inability to logically explain ideas; his obsessiveness and hyper-focus on inconsequential details; his shifting positions on critical issues; his incomprehensible and offensive messages to world leaders; his inability to regulate his emotions.
To anyone who’s watched someone slide into dementia, the patterns are familiar. It’s all very different than how dementia gets portrayed in movies and television where it’s commonly shown simply as memory loss. Memory loss is a part, but there are other indicators of declining cognition as the person loses executive functioning. We see the president demonstrate those indicators daily.
Unlike what our family provided my father-in-law, though, no one seems to be looking at these symptoms and offering an intervention that would mitigate the effects of what everyone sees. Instead, because of the position he holds, everyone around him defers to his whims and allows him to careen out of control as he sends troops to invade a foreign country, builds a powerful federal police force to invade cities he doesn’t like, and threatens our allies. The actions get attributed to his radical world view. But what if that ideology is augmented by diminished cognition?
His advisors take advantage of his whims to enact policies that bring the nation closer to their own vision of authoritarianism and oligarchy. These people work behind the scenes. They enact a direction for the nation that’s completely contrary to the “more perfect union” that the nation has striven to create since its founding. The ones closest to him feed the narcissistic needs at the core of his personality. As happened with my father-in-law, his current state stems from the person he has been. The president has always needed to be worshipped, and the team around him worships as they lie, cheat, and steal in his name. In the twisted world he’s created, good ideas don’t win, but sycophantic fealty does. He’s lived his privileged life like that so none of this is surprising. However, his erratic actions suggest that there’s something more than narcissism happening.
When responsible people see a relative behave like the president has acted in the past year, we take away the car keys and make certain that person can cause no harm. Failing to do so puts the person and everyone around that person at risk. When it’s the president of the U.S. with the powers of that office, the dangers are exponentially more significant – to individuals, as we’ve seen in Minneapolis, to communities as different as Chicago and Portland, Maine, to the entire globe. As his national police force becomes more out of control; as his social policies create more damage to the most vulnerable; as his saber-rattling destabilizes the world – it’s time to talk about taking away the keys before this presidency creates more damage.
My observations and experiences aren’t diagnosis. As I noted above, I’m not qualified, and I’m not in the position to offer more than these observations. There are people whose job demands that they do more than observe what we all see. It’s time for the nation’s elected and judicial leaders to do the job that the Constitution demands them to do and judge him for fitness to the office. This isn’t a partisan question. This is a question about the nation’s survival. The Constitution assumes that the nation’s leader is mentally fit for the job’s responsibilities. This president is showing he is most likely not.
