This month is Mental Health Awareness Month. It’s important because every day, people in this country and around the world have experiences that impact their mental health. It can be situational—maybe it’s just a bad day or week—or chronic and ongoing. When it comes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are so many categories it is difficult to keep up. But one thing remains true: cognitive tests do not test intelligence.
Speaking at an Ohio rally, Donald Trump told the crowd he took the cognitive tests to prove to people that he was smart—and that once he had those positive results in hand, they all had to back off. There are so many things wrong with this analysis, but as someone who had a traumatic brain injury (TBI) and just finished my most recent cognitive exam review last Thursday, I wanted to share what these tests are really about, and why they matter for us to understand mental health awareness and address disabilities.
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I’ve written about the Montreal Cognitive Assessment (MoCA) before and tried to explain my experience. Since I wrote that piece, two years have passed. That doesn’t seem like a lot, but when it comes to checking in on your mental health state and how well you are doing, you try to make sure that you get good support.
MoCA tests are one part of a neuropsychological workup. You take the MoCA, you get bloodwork done, if needed. You complete a series of assessments using flashcards, memory tracking, and even more. You let your doctor get full feedback from your friends and family about their experiences with you—good and bad—to let them know how things are going.
I wish I could say all of my experiences with these tests are positive. As I sat with the doctor reviewing results last Thursday, I found my ego wanting to take over. The test result was several pages long, and on those pages were numerous boxes that read “average,” which meant that I am within the average of my peer group, and two “extremely superior” marks, which meant I was performing in the top 1% of those categories.
What did I focus on? The four areas of the test that listed “below average.”
This is not uncommon. People have a tendency to focus on one item instead of the whole. If I had looked at my test as a whole, I could say, “My test as a whole is pretty average. I’m going to be okay.” I feel sometimes bad because I get these results and think of how my life might have been without TBI, but I have to stop living in the past and move forward, and that average is A-OK.
My struggles with this, as we enter into Mental Health Awareness Month, have been real. As I get older, my mind gets tired more quickly. I end up in meetings in evenings—which works out for me well—but as a result, I sometimes take an hour or forty-five minutes during the day to “quick nap” so I can be prepared for a 6 PM or 7 PM set of phone calls.
What is also presented when we do these tests are the things we struggle with, and our solutions to fix them. Like many with TBI or PTSD, I can experience intermittent explosive disorder (IED). Out of nowhere, I can be overly angry about, well, nothing. It takes me a while to cool down, and in those moments I just don’t feel like me. The bad news is that my brain is just pumping out the wrong mix of neurochemicals. There are several other findings that I go through in every test, and I have to admit that every day can be a struggle to make sure I am doing what I can to manage issues.
This is where Trump’s statements become toxic and dangerous. MoCA and cognitive tests like it are not designed to determine intelligence. They are designed to really look at your psychological state in a particular period of time, can help assess mental deterioration, and help with medication management.
When I see pronouncements like this one from Trump, I know that there are issues I have to work on, and I sit and try to invoke solutions. I fail way too often in them, and I know at times I am not working hard enough to do what I can. But the view Trump falls into is clearly one where he cannot be seen as “average.”
As speculation only, many patients receive a mix of results. The results have several “average,” a few “below average” and maybe one “above average.” Where would Trump focus? In any area, any at all, that lists him as even slightly above average for his age range.
This is not a measure of what your responsibility is as a patient and a human being. I know that I have gremlins that haunt me at times. I could simply say: “Well, I have doctors who tell me that’s how I am, so, tough. If someone gets hurt it is on you.” Is that fair to the other person, or even to myself? Instead, I have to say to myself that I have this knowledge and as a result, I have a responsibility to do everything I can to curtail that reaction in my brain.
Mental health issues can be a stigma. When we use mental health and cognitive testing means as a way to make a case for ourselves, we are going into them with self-serving results. If I went into a test with a doctor and said, “I need this result or I want this result,” then I can likely pull any test apart to get the result that I want, or I can make the result I am given fit into the solution I desire.
That isn’t how things are supposed to work. It took me years—and I’m still not there yet—to say to myself that I am okay with having average scores and that I won’t fixate on what could have been. Due to TBI, I will deal with some issues for the rest of my life. Others I monitor every few years and, as one doctor told me to do, keep working on it and try to improve.
The only person who really knows these experiences, though, are those who have been through it.
This is where Trump and so many others from the outside misunderstand mental health issues. Unless you have been there, unless you have had a disability, or you handle mental health issues, you cannot simply address the issue. If someone were to say to me that they could write at length about the anxiety I feel in some settings, or talk about how a person with a disability manages the world, they would be completely wrong—and, frankly, offensively wrong.
When Donald J. Trump makes his announcements on smarts, he is doing so based on his lived experience only: his desire to see the world through his viewpoint, and bend it to match what he needs.
I would argue that both of these perspectives are dangerous. If you believe you can understand the realities without a lived experience, you are stripping away the needs and realities of large numbers of people. If you acknowledge that your disability can impact others and you work to help be a better community member by understanding your disability, you become a better friend and a better advocate.
Donald J. Trump does not care about understanding his test. He doesn’t care about using medical care that can help him understand what these results mean.
The results don’t mean you are smart. And if you took a MoCA or a mental health examination to determine if you are smart or not, the instant answer is that you are not smart enough to realize that the test isn’t about being smart; it is about finding weaknesses and strengths that you have and trying to give yourself and those around you the best life possible.
When you have questions about someone with a mental health issue, being supportive matters. Helping them find ways to cope matters. If they don’t intend to help themselves, and heaven help me, there have been moments in my life where I want to say, “I don’t want to do this.”
And the person who can’t get help, even when it hurts others and they know it? Well, that is when the test should be telling them all about their responsibility.
Trump, responsibility? I doubt that’s a story we are going to hear anytime soon.