Doctor Who Wrote ‘Goldwater Rule’ Says He Would Recommend Dementia Tests For Trump

WASHINGTON ― A psychiatrist who helped craft the 1973 “Goldwater rule” that has kept many mental health professionals from opining on Donald Trump for nearly a decade said that it was not intended as a hard-and-fast prohibition, and that if he were Trump’s doctor, he would order a full battery of tests to determine the cause of what he believes could be the former president’s dementia.

“He seems to be progressively cognitively impaired,” said Allen Dyer, a retired George Washington University psychiatry professor.

Dyer said Trump’s recent behavior warrants medical evaluation, like his apparent inability to remain focused on a single topic or string together complete sentences, for example, or his confusing of people, as he has repeatedly done with former House Speaker Nancy Pelosi and former U.N. Ambassador Nikki Haley. And more recently, his loss of interest in taking questions at his own campaign event, followed by a demand that his staff play some of his favorite songs while he stood onstage and swayed to the music.

“I find it concerning that he doesn’t complete his sentences, seems to lose track of the question he is trying to answer, or avoid, and that one thought doesn’t lead to another, but appears to veer tangentially off track,” Dyer said.

Trump’s campaign did not respond to HuffPost queries about whether Trump has had a recent cognitive examination, beyond the one he continues to boast about having “aced” that he said he took while he was president.

Trump has refused to release any medical records heading into next month’s election, even though he would be, were he to win, the oldest president to take the oath of office. On Sunday, at a campaign event in Pennsylvania, he denied being close to 80 years old or having any cognitive issues.

“I’m not 80, and I’m not that close to 80,” said Trump, who is 20 months away from turning 80. “I’ve done cognitive tests. I’ve done them twice, and I aced both of them, and the doctor in one case said, ‘I’ve never seen anybody ace them.’”

Dyer and other psychiatrists, though, said that test, often used as an initial screening tool which Trump took nearly seven years ago, is not helpful in assessing his current condition.

“That assessment is given to potential nursing home patients to decide which wing to assign them to, not to someone you want to hire, let alone be president,” said Andrew Smolar, a Pennsylvania psychiatrist who has had numerous patients of Trump’s age and apparent condition.

Smolar is among the 440 and counting health care professionals supporting Democratic Vice President Kamala Harris who warn that Trump’s current condition is worrisome and call on him to release his medical records.

“Trump is falling concerningly short of any standard of fitness for office and displaying alarming characteristics of declining acuity,” they wrote in an Oct. 13 open letter. “As we saw in the first presidential debate, Trump is displaying irrationality and irritability. Notably, he ranted about migrants eating people’s cats and dogs. This was widely debunked as untrue. In the limited opportunities we can examine his behavior, he’s providing a deeply concerning snapshot.”

As a young doctor, Dyer was among the six members of the American Psychiatric Association’s ethics committee charged in 1973 with developing guidance for psychiatrists regarding their opinions when it came to political figures. The question resulted from the presidential campaign of 1964, when the magazine “Fact” sent out questionnaires to 12,356 psychiatrists all over the country asking if they thought Arizona Republican Sen. Barry Goldwater was mentally competent to be president. The magazine wrote an article using the 2,417 responses. Among the views they shared from respondents was that Goldwater was a “latent homosexual,” that he “hated and feared his wife,” and that he was conflicted because his father was Jewish and his mother a Protestant.

Goldwater sued Fact for libel, and in 1968 won the lawsuit and an award of $75,000 against the magazine, which had already gone out of business by then.

The APA believed the episode tarnished the reputation of psychiatrists generally and worked to make sure it wouldn’t happen again. They tasked the ethics committee to craft language to add to its “Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.” The result was a ban against offering diagnoses and “professional opinions” about people whom they had not personally examined.

In the coming decades, the new language did not really matter as both major parties nominated candidates who spoke and acted within the mainstream of American political discourse. The only time a presidential candidate’s mental health was questioned was by supporters of George W. Bush in the 2000 primary, when they spread rumors that rival John McCain’s nearly six years as a prisoner of war in Vietnam had scarred him psychologically.

That respite ended in 2016, when Republicans nominated a conspiracy theorist and habitual liar who, even at age 70, displayed symptoms of narcissistic personality disorder as laid out in the Diagnostic and Statistical Manual of Mental Disorders.

After he was elected, some psychiatrists and psychologists began warning about Trump’s behavior, predicting that it would get even worse, and called for his removal under the Constitution’s 25th Amendment. And those doctors and therapists, in turn, were often criticized for violating the Goldwater Rule.

Bandy Lee, a professor of psychiatry at Yale University, was fired after editing and contributing to the book “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Professionals Assess a President.”

In a 2018 article in the British Journal of Psychiatry, John Gartner, a Maryland psychologist and contributor to Lee’s book, wrote that gagging mental health professionals made it impossible for those who best understand Trump’s behavior to speak out about it.

“Blindly following Goldwater legalistically paints us into a logical corner ― a reductio ad absurdum. Since it appears unlikely that Trump will ever voluntarily consent to a psychiatric interview, the truth about his psychiatric state becomes an unknowable mystery, or simply a matter of opinion, like the existence of God,” Gartner wrote. “No matter how grossly impaired Trump may be, or becomes, no matter how overwhelming the evidence, reality will always be unknowable, even if the emperor clearly has no sanity.”

Both Gartner and Lee criticized the APA’s 2017 guidance that appears to ban psychiatrists from offering any opinion at all about someone whom they have not personally evaluated and whose permission they have not received to speak publicly.

“I never objected to the original Goldwater rule, and kept with it,” Lee said. “It was its perversion in March 2017 I objected to, and what we see today is the result.”

In a written statement to HuffPost, the APA said it “did not expand” the scope of the Goldwater standard.

Dyer, who believes he is the last member of the original 1973 ethics committee who is still alive, wondered in a 2020 article in the Journal of the American Psychoanalytic Association whether the APA had gone too far in its revision.

“With regard to Goldwater and Trump, way down deep there is general agreement that public statements should be made carefully and cautiously, but also way down deep there is concern and alarm about Trump’s instincts, desires, behavior, and mental status,” Dyer wrote. “Professionals for good reason try to remain above politics, to hold principle above expediency. I hope at the end of the day, in the face of a president who respects none of that, we will not regret saying too little.”

Ironically, for the entirety of Democrat Joe Biden’s presidency, it was Trump who was accusing the man who had beaten him in the 2020 election of being cognitively impaired.

“He must be insane, or suffering from late-stage dementia!” Trump wrote in a social media post on Sept. 2, 2022.

“I think he should take a cognitive test like I did,” he said on June 15 this year, just before mixing up the name of his White House doctor, Ronny Jackson, and the Republican senator from Wisconsin, Ron Johnson.

But with top Democrats echoing concerns about Biden and his ability to run an exhausting campaign at 81 years of age, Biden abandoned his reelection and endorsed his vice president, Kamala Harris, more than two decades his junior.

And now it is Trump’s words and behavior that is drawing questions about his cognitive ability, particularly after a rash of incidents and decisions in recent months that he and his campaign are left trying to explain.

He has frequently claimed that he defeated former President Barack Obama in the 2016 election, rather than his actual Democratic opponent, Hillary Clinton. Likewise he has confused Obama with Biden. During his testimony in a civil fraud trial against him last year, he claimed that he was conducting important foreign policy work regarding China and Russia in 2021 ― when in reality he was president in 2021 for just three weeks, spanning his coup attempt and its aftermath. Trump acknowledged during further questioning that he was not president during the time period under discussion.

During his rallies and interviews he goes on long tangents unconnected to the topic at hand, most famously, perhaps, in a response to a question about child care costs at the Economic Club of New York, where instead he went on and on about tariffs and oil drilling. Frequently he talks about the fictional serial killer Hannibal Lecter or his preference for being eaten by a shark rather than getting electrocuted by a boat battery.

Trump, in response to news accounts that describe his hour-and-a-half speeches as “rambling,” has said that his stories are a sign of “genius” and has come to call what he does ― going from one topic to another and eventually returning to the original one ― “the weave.”

Trump has started spreading completely fictional conspiracy theories to boost his campaign, from the idea that Haitian migrants were eating pets to a claim that Biden and Harris were intentionally mismanaging the response to Hurricane Helene. Last week, Trump even claimed in an interview that neither Biden nor Harris was running the government.

“It’s a committee of people, and they might not even know who the committee is,” Trump said. “They may not even know themselves — does that make sense? It’s a group of people that are in different levels of D.C.”

Harris has started to make Trump’s mental miscues a part of her own campaign remarks, questioning whether Trump has the mental capacity for the job, leaving aside his felony conviction and multiple outstanding felony charges based on his coup attempt.

“He’s becoming increasingly unstable and unhinged,” she told reporters in Detroit on Saturday. “The American people are seeing it, witnessing it in real time.”

She added a few hours later at a rally in Atlanta: “Now, he’s ducking debates and canceling interviews because of exhaustion. And when he does answer a question or speak at a rally, have you noticed he tends to go off script and ramble? And generally for the life of him cannot finish a thought. And he has called it ‘the weave.’ But I think we here would call it nonsense.”

To Dyer, Smolar and others, Trump’s behavior in his public remarks are ticking off the boxes on the list of symptoms warning of dementia.

Even his tendency to drop obscenities into his public remarks of late ― he used the phrase “I don’t give a shit” speaking at a Catholic Church fundraising event last week and called Harris a “shit vice president” in a Saturday rally in Pennsylvania, where he also spoke of the size of the late golf legend Arnold Palmer’s penis ― suggests “disinhibition,” another sign that his condition is worsening, Dyer said.

He added that if Trump has not yet gotten professional help for whatever is causing these and other behaviors, he should, for his own sake, so that an appropriate treatment could be started.

“I would want to do lab studies, imaging studies, and a battery of psychological tests,” Dyer said. “One would want to know if this is dementia and decreased cognitive function.”

Smoler said it would be important to figure out if Trump’s problems are organic, based in brain chemistry or other physical factors, or psychological, such as anxiety and stress. “The first thing to do is to understand the problem,” he said. “Then you try to figure out if there’s a treatment.”