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Interviewing President Trump: You can't diagnose from TV clips

Interviewing President Trump: You can't diagnose from TV clips
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Americans have come to falsely believe that we can evaluate our leaders based on TV snippets. Some doctors too easily fall into this trap, too, but they should not be diagnosing people they have never met. The American Psychiatric Association’s famed "Goldwater Rule" is more applicable now than ever. The rule emanated from Fact Magazine, in 1964,  publishing a survey of psychiatrists who said Sen. Barry Goldwater (R-Ariz.), then the Republican presidential candidate, was crazy during that year's national election.  

President TrumpDonald John TrumpFox News president, top anchors advised to quarantine after coronavirus exposure: report Six notable moments from Trump and Biden's '60 Minutes' interviews Biden on attacks on mental fitness: Trump thought '9/11 attack was 7/11 attack' MORE has received more than his share of attacks from psychiatrists. Dr. Bandy Lee, a Yale psychiatrist, published a book of essays in late 2017 by numerous mental health experts entitled, “The Dangerous Case of Donald Trump.” In December, during the House impeachment proceedings, she and others presented a petition to Congress signed by 350 mental health professionals claiming that the president’s mental fitness was rapidly declining.

What did these professionals all have in common? They had not met or treated the president.

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On July 22 I was invited to the White House to interview President Trump for Fox News. Despite having not met him before, I spent more than an hour in the interview and in the Oval Office. It was close to 90 degrees outside but Trump appeared quite comfortable and was not sweating or short of breath. I found him to be nothing at all like he’s been described; he was gracious rather than ill-tempered or mean. He was a showman, choosing the places and the camera angles for the interview, standing in the pillared walkway alongside the White House's Rose Garden.

I was not there to evaluate or provoke him but, rather, to ask questions and allow him to answer. This was my brand of journalistic restraint, and it was also how I was brought up — to show respect. The interview was about him, not about me. He was engaged, focused, displayed empathy — not at all what you would expect of someone with a psychiatric diagnosis. When I asked him about masks, he spoke about his feelings during a recent visit to Walter Reed Military Hospital: “I was seeing young people that were hurt very badly in military situations. And I felt for them, not for me, I felt for them. My wearing a mask was a good thing. I felt extremely comfortable. I don’t feel comfortable in other settings when I’m all by myself on a stage and everybody’s way far away.” 

He spoke somberly of the people he’d lost from COVID-19. In that moment, this was not the raging narcissist that Dr. Lee and others have described. “I’ve lost five people,” he said. “Probably six, actually, as of this moment, I think pretty soon. But I’ve lost five friends that went in. One of them tested – great guy, Stanley Chera, one of the top real estate people in New York, a very successful man, good man, who was never into politics until I ran, he became like a political wild man. He loved it, but a great guy with great spirit, he said, 'I tested positive.' And I said, 'Well, that’s too bad, but you’ll be okay.' ... He went to the hospital. Two days later, he’s in a coma. And two days later, he died. And, you know, that’s happened on numerous occasions. Probably happened to you with people, too. I never remember anything like that.” 

This was an interview, not a medical encounter — but, in the time I spent with him, I saw no evidence of a psychiatric problem being manifested.

With the election coming up, I asked him about candidate health. I said that “presidential health or health of a candidate is going to be on the table, of course, as it always is. And I’ve been someone always asking for that. And I’ve seen a lot about you being in good health. What do you think should come out or be the attention regarding Vice President Biden?”

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He did not attack Biden directly, as he might have done in the past. Talking about himself, he said, that "first they’d say he wants to take over the world, he’s going to take over the world. He’s a dictator. The next day they’ll say he’s crazy. The next day they’ll say, oh, he’s incompetent. The next day they’ll say … something.” Trump said he’d had the cognitive test — the Montreal Cognitive Assessment — with Dr. Ronnie Jackson, the former White House physician, in part “to shut these people up.”  

Part of the test was remembering five words, in order; Trump gave as an example “person, woman, man, camera, TV.” Apparently the memory test he’d taken included sequential word memory, and he bragged that he’d had a very high score. Of course, the late-night comedians and pundits made a mockery of his grandiosity, the way they always do.

But there was more. President Trump was serious about the need for an advanced intellect as a qualification to be president, saying that “we have to have somebody that’s sharp. Because I can tell you, President Xi is sharp. President Putin is sharp. (Turkish President) Erdogan is sharp. You don’t have any non-sharp people that you’re dealing with. And we can’t have somebody that’s not 100 percent.” Trump suggested that Biden “should take the test in a way as an obligation to because you have to be able to show this country that the person that we’re picking as a leader is sharp.” 

Since the interview, I have reached out to the Biden camp to try to secure an interview, but have been unsuccessful.

It was a shame that the clip of Trump talking about his cognitive test went viral. True, it was good TV, great social media, but it also obscured the larger reality of the interview. Trump had shown coherent insights and charisma, traits that could help him to unite us,  to overcome our fears in a time of terrible crisis, if only more people were receptive and he could apply these traits consistently. 

Marc Siegel M.D. is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter: @drmarcsiegel.