When this piece of criminal sewage stole his way into the presidency, people with an understanding of Psychopathology were able to make some very accurate predictions. It was as close to a sure thing as one can get in a “probabilistic” system that there would be no “pivot” by Trump into more serious and sensible behavior. Nor was he likely to give up his embrace of the political far right, even though he used to be an odd mix of racism and social liberalism. (He was “pro-choice” except in cases involving women of color ? —please excuse the feeble attempts at gallows humor).
Above all, given the man’s extreme narcissism, we could predict that two kinds of situations would whip up his impulses to a state way beyond the strength of his ego-controls: SUCCESS and FAILURE. That is, any kind of perceived “win” on his part would induce grandiose, floating-on-air, manic optimism. Good news makes him giddy. Failure, on the other hand is so intolerable that he must do anything, ANYTHING to nullify the situation. Here we see the use of primitive defenses such as denial of objective reality. If it’s literally raining on his parade he not only says that the sun is shining, he believes it.
What we have not been able to predict is the rate of his decline due to organic factors. Nor Have we been able to estimate in advance how the pressures of the job would tax his resources, even if the job isn’t performed very energetically. When you’re The President every action you take, or don’t take, is critiqued. The evaluating goes on relentlessly. And even if you don’t exert yourself doing the job, if you are hypersensitive to criticism, the wear on you is severe and incessant.
In all likelihood Mr. Trump suffers from cardiovascular disease of the brain. Those of you who are really up on the mechanisms involved can explain a lot better than I can, the types of difficulties Trump is dealing with. I’m thinking of brain blood vessels that are partially occluded. The decrement in oxygenation affects brain function. Worse yet is a condition in which one or more of these vessels suffers either complete blockage or a tear. Those situations are a form of stroke, and we know that even very small strokes can lead to permanent decline of abilities.
If you have had the experience of dealing with someone who is undergoing cognitive decline you know that the patient often feels mortified by such losses. Losing mental abilities is an awful blow to self esteem. If one has a pre-existing problem with self-esteem maintenance, a patient like Trump is apt to go to extremes to deny evidence of organic deterioration.
In sum, I believe we are seeing a confluence of several streams of decompensation. Trump is in a mental “death spiral”. We may therefore anticipate wilder destructive behavior. The man is in a state of barely disguised rage. The question is what can we do to lessen the impact of Trump’s lashing out in what we hope is his final year.