Donald Trump, Joe Biden and dementia: Why not to diagnose from a distance

In recent years, there has been a lot of speculation that Donald Trump and Joe Biden may have dementia or some form of mental health condition. While it’s right that voters should be able to discuss a candidate’s perceived mental and physical fitness for such an important role, it’s not right to speculate that someone specifically has dementia or a mental health condition.

This year will most likely see two older politicians campaigning in the US Presidential elections – one who will be 78 by election day in November 2024 and the other 81.  

During their times in office both Trump and Biden have experienced huge speculation about their mental and cognitive health. This has cast doubt on their fitness to hold office.  

In 2020, Donald Trump took a dementia screening test to prove that he didn’t have dementia. President Biden’s office has had to defend him not taking a cognitive test during his routine physical exam.  

In the meantime, social media platforms have constant streams of posts claiming that at least one of the candidates is unfit for office because they have Alzheimer’s disease, or some other form of dementia or mental health condition.  

On 27 June, this debate intensified further after an apparently faltering performance by President Biden during a TV debate. 
Whatever your political beliefs or opinions, there are several good reasons why it’s unhelpful to say that a candidate has ‘dementia’ without a qualified professional first carrying out a clinical assessment in person.  

4 reasons NOT to diagnose dementia from afar

1. The diagnosis often wrong

There are lots of reasons why a person may appear momentarily confused or forgetful, show poor judgement, or behave strangely.  

Sometimes there may be a medical reason, but often there is a straightforward explanation that doesn’t require them to have a neurological condition. They may be tired or jet-lagged, they may have had a glass of wine, they may have an infection, or they may just not have a very good grasp of the topic being discussed. These are all perfectly possible without the need to raise dementia.

Dementia is a very specific form of cognitive impairment – just one of many possible reasons why someone might not be able to think or remember things clearly. 

A diagnosis of dementia can only be made after a thorough assessment by a health professional. This involves taking a detailed medical history, carrying out a range of tests, and most often arranging a brain scan.  

It’s not possible to diagnose a person just by watching them on TV. It’s fine to say that a candidate appears to be struggling, or that they seem forgetful or confused. However, it’s not possible to reliably state the underlying cause of these problems without a proper clinical assessment.

2. It stigmatises people living with dementia

When an older politician is accused of having dementia, it’s often done to smear their character, question their policies, or seek to disqualify them from holding office. The tone tends to be negative, demeaning and often hateful – particularly on social media platforms.  

This reinforces outdated stereotypes of dementia being a condition that, of itself, disqualifies a person from participating in their community or having a voice that’s worth listening to.

Hearing dementia being weaponised in this way is both hurtful and unhelpful to people with dementia and their families, who live with the condition every day and often struggle to have their voices heard.  

We want a society in which people living with dementia feel understood, valued, and able to play an active role in their community. This is not helped when people use unsubstantiated allegations of dementia or mental health conditions to belittle or humiliate politicians they don’t like or agree with. 

3. It normalises unhelpful language

As with any sensitive medical condition, the language we use around dementia is important. Language affects the way that people living with dementia are treated by others.  

Allegations of dementia in the media often contain lazy or outdated medical terms like ‘demented’, ‘senile’, or ‘addled’.  These terms are no longer used by dementia professionals because our understanding of the condition has now advanced well beyond these crude terms.  

Unfortunately, they continue to be used in the media, which makes it harder for people to have a proper understanding of what dementia is. This can have a real impact when it comes to getting a diagnosis and then discussing it with family and friends.  

People don’t want to be thought of as ‘senile’ or ‘losing their marbles’. They want to be supported to live well with a devastating brain disease. 

If someone does have a diagnosis of dementia, we need to still see them as a person worthy of inclusion, dignity and respect. We should never use their dementia as a label to define or devalue who they are. 

4. Diagnosing without a proper medical assessment is unethical  

The current likely presidential candidates, Joe Biden and Donald Trump, are by no means the first politicians to be challenged about dementia or their mental health.

In 1964, a magazine article was written about presidential candidate Barry Goldwater that carried the headline “1,189 Psychiatrists say Goldwater is Psychologically Unfit to be President!” The article quoted an informal poll of US psychiatrists, none of whom had actually met the candidate.

Goldwater lost the election and successfully sued the magazine for making untrue allegations. Out of this case came the ‘Goldwater Rule’, which to this day strongly discourages psychiatrists from trying to diagnose a person without ever meeting them or doing a proper assessment.

The rule states: “ is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

Although the Goldwater Rule is often broken, it remains an essential piece of ethical guidance for any health professional or expert who might be tempted to diagnose a person without ever meeting them.

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