Raj Persaud is a psychiatrist and author of The Mental Vaccine for COVID-19.
The wide-spread view across the media appears to be that the assassin’s bullet that narrowly missed Donald Trump, may have, oddly enough, made it easier for Joe Biden to withdraw from the race to be the next President of the USA.
The consensus is that Trump became a ‘shoo-in’ given the tidal wave of emotion that has been generated, a groundswell that threatens to completely sweep aside the faltering Joe Biden.
However, the problem the Democrats appeared to have before the recent incident, was persuading Joe Biden to accept the blindingly obvious, he was not convincing the electorate that his mental state was clear enough to do the job.
That is a different point to whether his mental state was actually defective. Instead, it’s whether he could convince voters on this issue.
We were told the only way for the Democrats to replace their candidate was if the President himself agreed to step aside, and yet he appeared intransigent on this point.
He had previously indicated that only God could persuade him to step down, but now he has suggested that if his doctors indicate there is a relevant medical problem, he will concede.
This is a significant psychological shift in position.
As a psychiatrist used to dealing with people who suffer from various neurological and psychological disorders which rob them of insight into their condition, the problem of convincing the insightless, is a daily one in my clinic.
What may be working for Joe Biden, is precisely what we see work in the clinic.
The Trump close shave has reframed the conundrum for Biden.
It has removed the stigma that Biden is not good enough, a position he would naturally have difficulty accepting, to now, a different problem.
Now it’s the case that no one may be able to stand in the way of the new Trump tsunami, so it’s now more logical to let another person fail, rather than be the one who catches the recrimination following a Trump landslide in November.
The problem of getting Biden to agree was always beset by a predicament psychiatrists face daily with many patients. How to convince someone using reasoning when it is that very reason which has been lost by the condition being treated?
The New Yorker magazine recently asked several neurologists and other doctors what they thought and many privately admitted they were concerned about Joe Biden but could not publicly go on the record with their apprehensions.
Doctors, however, would have been looking at Joe Biden’s performances from a different perspective to the lay public.
As a qualified medical doctor and psychiatrist, I am used to dealing clinically with those suffering from psychological, or even neurological impairment, yet who remain in denial, or lack insight into their true condition.
I am based in the UK and so stayed up late, and eventually saw the whole Joe Biden press conference, which was billed by his staff, and supporters, as potentially slaying the speculation over his mental state.
No doctor would make a diagnosis from a televised appearance, but are the media currently looking in the wrong place when assessing the president’s performance?
Yes, he misspoke, and confused his own running-mate with his adversary, and he also mixed up a national enemy with an ally, but a thorough clinical assessment, amongst other issues, would also focus on how he spoke, not just what he said.
If someone eventually struggles to find the right answer in a clinical interview, that very effort can also become medically significant.
Joe Biden looks to be concentrating very hard with each question, and the furrowed brow, plus intense focus, seem to indicate someone who may haltingly, finally arrive at an acceptable answer, but the journey was tortuous, and somewhat nail-biting, particularly if you cared for the man.
So, the press, and the public, who are not clinicians, may be focusing overmuch on the wrong area – it’s not just that he gets words wrong and makes verbal stumbles, but it’s the tortuous process of arrival at any point he is trying to make, which may also be clinically significant.
In other words, it’s not just the content of what he says, which is much easier to report on, than the nuance and subtlety of how he says it, that’s also possibly significant.
The president appears to have developed a somewhat halting delivery, often pausing unexpectedly, perhaps appearing to be trying to find the right word.
It seems as if he is having to concentrate massively to just make even simple points.
Whenever he looked down to read the names of the next reporter listed to ask a question, he seemed to be labouring, groping to find his correct place.
But in politics, unlike medicine, the issue is not whether he was struggling, but maybe it’s deadly enough that he appeared to be.
The conundrum remains not just that he may ‘pass’ a formal cognitive test – much was made of this point in various exchanges over this issue, but the fact is the baseline for such specialist testing is low. To not be diagnosed with dementia is surely no major achievement, if you are applying for any demanding executive position?
How did we get to the state of affairs?
Instead, the issue is, does the candidate possess the mental capacity to dazzle, or at least impress, the voters, colleagues, adversaries, and even other world leaders, which is surely what is required in this job?
This is not about merely passing a test, but instead acing it.
Another consideration is how enemies of the US could alter their strategy if their assessment, even if erroneous, is the enemy could now be outwitted?
Even Biden’s outburst towards the end of the press conference, when he fulminated about child deaths and guns, could hide another problem, though many would regard these as his best moments. Sometimes those who become aware they are perceived as intellectually weak, seek to overly compensate by ‘thumping the table’, setting up a concern amongst clinicians that the intellectually cornered sometimes ‘come out swinging’ through frustration or compensation.
The electorate may worry not just about if Biden is impaired, but also his possible emotional reaction to this experience.
His response to questions from the press so far about his mental competence is to repeatedly cite past achievements.
But, as with any hypothetical neurodegenerative condition, it’s not the past that matters so much, in a degenerating dynamic disorder, instead the concern is for the future, or even the present.
Yet the psychiatrically impaired often believe it is so self-evident they are completely sane, that they cannot even understand why anyone would question their faculties. Hence their defences are rarely reassuring, and are indeed often counterproductive.
Those who are already convinced that the president no longer has ‘the right stuff’, may also have to ask themselves how is it that his inner circle keeps allowing him to wander into the media spotlight, and appear caught in the headlights? Perhaps one possible answer is that those close to him don’t realise what every psychiatrist does, that when people lose insight, you frequently can’t reason with them – there has to be another mechanism to deliver the body blow that he may just no longer be good enough to win the election, other than through logical and rational debate.
My clinical experience is that key trusted authority figures close to the client become crucial at this juncture.
Unfortunately, in the case of this top job, the confidantes are also then arguing themselves out of affiliated, desirable, high-status positions.
Psychologists have coined the term ‘group think’ to capture the predicament when an inner circle turns into disaster oblivious to the blindingly obvious.
I don’t know if the president is delusional or not, or if he is actually impaired, but I do know delusions can be shared, and it’s not uncommon, indeed it’s even got a clinical name.
Folie à Deux– when a delusion is shared between just two people or folie à trois or folie à quatre…etc.
Raj Persaud is a psychiatrist and author of The Mental Vaccine for COVID-19.
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