Sunday, December 15, 2019

Words are the physicians of the mind diseased.

"Words are the physicians of the mind diseased." – Aeschylus


...and Speech-Language Pathologists get to figure it all out.

I've written extensively here about 45's disordered speech and language, and during the past few weeks we've gotten some new data points of the speech and language disorders that the "president" is experiencing. I'm more and more firmly convinced of a diagnosis of mulitinfarct dementia.

This man talks a lot. Speech is a Speech-Language Pathologist's lifeblood. Lots of data here! We see that his language is becoming emptier and emptier, a hallmark of language in dementia. He talks a lot but says very little. There were many more examples of his bizarro language, too. Things that don't make sense; words and concepts mixed up; lies and confabulations. And his intermittent dysarthria – a sign of transient ischemic attacks (TIAs), or mini strokes – gives it (multi-infarct dementia) away.

I think he is experiencing multiple TIAs. The ones that we see, those that cause the intermittent slurring and motor speech programming, are the bigger ones, but TIAs can occur without noticeable symptoms. Add enough of them together, and a dementia can develop.

First let me say that I'm kinda tickled that my political geekiness has intersected with my speech geekiness cuz I get to geek out majorly and teach my readers a little bit about disordered speech, language, and cognition!

You may remember the terms dysarthria, apraxia, paraphasia, confabulation. I've shown you examples before, and we also often see empty speech and disorganized language with DJT. To refresh you:

Dysarthria is (loosely) a motor weakness disorder. The articulation muscles are weak or uncoordinated and the sounds aren't formed precisely. The person with dysarthria sounds slurred. I often hear patients say, "People think I'm drunk."

Apraxia is a motor programming disorder. The sounds come out mixed up. Maybe a later-occurring sound comes early in the word, or syllables are transposed.

Paraphasias are word substitutions. There are semantic paraphasias, where a closely-related word in meaning is substituted, such as chair for table. And there are phonetic paraphasias, where a different phoneme is substituted, such as label for table. Phonetic paraphasias can look like apraxic errors.

Confabulation is a made-up story, believed to be true. It's not a lie per se, as the person believes it to be true. There is no intention to deceive.

All of them are signs of a neurological problem.

We have a lot of new samples since I last wrote about the subject of speech and language disorders in September. Let's look at some recent ones, shall we?

He had a big MAGA rally in Hershey, Pennsylvania last week. His rallies are where he's at his most basic (base) self. He's relaxed, in his element, unfettered .... and unhinged. Here is the whole speech, but thanks to a twitter user, I'll look at some individual clips below. Your stomach will thank Aaron Rupar from Vox.

To be clear, this rally illustrates much of what is wrong with this ugly man. He is at his slimiest here. In thus post, I won't address his lies and his dangerous rhetoric during this speech. But here is Aaron Rupar's article from Vox, who also supplied the tweets with pieces of video to illustrate. There is much to be said about the content, but for our purposes, I'm just looking at the neurological signs.


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Here are some examples of his slurring his words during his speech in Hershey. Dysarthric errors abound.







One that Rupar didn't link to was at this. Listen to it (video starts there). It's so slurred that it is unintelligible.



The transcript reads, "And then they announce there was no bias." I had to go back to the transcript to figure it out.

Back in August at a Florida rally, he gave us this gem.



This one is more of an example of apraxia. In this case, the phrase he wanted was "stock market" but his mouth formed, "sock rocket." The sounds were mixed up a bit. The /t/ of stock was dropped and the /r/ of market came too early.

You notice that he realizes he said the wrong thing, he stopped with an interjection and then said "stock market" again, like he was wrestling a lion to the ground. He often has this pattern when he makes a mistake and he catches it. Watch for it.

Here is another set of examples from August. Dysarthria and apraxia both abound in this speech:



Though his rallies are where we find his most natural speech and language, given that he is relaxed and in his element, we should perhaps be more concerned about his more "presidential" appearances, when he is supposed to be restrained and cogent. Oh, who am I kidding? We should be concerned about it all.

This stuff came out of his mouth just last week.


This is a classic paraphasia. It could be a semantic paraphaia (he meant aborted) or a phonetic paraphasia (he meant torn; though torn for born could also be semantic). In any case, his brain chose the word born. This is disordered language, folks. Just one of many examples.


His ramblings on FAUX News are a treasure trove of non-sensical, empty speech. He had a phone-in on November 22.




During the November 22 phone-in, he said this: "So -- so here's the thing, we have so many -- regardless of what's coming out, OK, the information that we have now is beyond belief already. But what they have coming out, I hear, is historic." Normal people do not talk like this. This is disorganized, empty speech.

He called attorney John Durham "Bull Durham" during the phone-in ramble. What kind of error? Paraphasia.

In talking about Crowdstrike, he caught himself: "Which is a country – which is a company..." Paraphasia.

"I do want always corruption...." Fruedian slip! And disordered syntax.

"And if she [Elizabeth Warren] took down the wall … You need the wall. You know, they want to have drones. They want to have drones flying around, up and down and this and that. It’s all just a waste of money. Other than we have drones flying to see if anybody’s trying to break through the wall, because if you have a bulldozer or if you have heavy blow torches and things, you can break through. We have, the wall is electrified so that if anyone touches it, we know exactly what’s happening and we can get there within minutes. Now we built that-" Language organization problem; confabulation or lies.

"But look, the Republican party has never been more unified, both the Senate and the House. Mitch, Lindsey, I could name 20 names up there. I could name … they have never had … look, we won 196 to nothing. That never happens. I always say, the Democrats are lousy politicians, they have lousy policy, but they stick together and they’re vicious. [crosstalk 00:26:46] They’re more vicious, frankly. But the Republicans, they have a tendency, they break up. They don’t … the Republicans, I have never seen anything like it, they’re sticking together." Language organization problem.


Last month, he claimed the Democrats have a War on Thanksgiving. Just weird.




It's possible that this is an example of a paraphasia. Perhaps he was going to talk about the war on Christmas but accidentally substituted Thanksgiving, and then doubled- and tripled-down after the erroneous word-choice? Or maybe it's just a run-of-the-mill TRUMP lie/disinformation/distraction.

And this shit. Flushing 10 to 15 times?



For this one, I suspect more naiveté of the real world, disdain for science, hatred for regulation, compounded by his wont for aggrandizement and disinformation. I peg this one as a classic, non-impaired Trumpism. Much of that is apparent in all of his ramblings, as well.

But these two examples could also be confabulation, which is, you recall, conflating the truth with the brain's made-up imaginings. Confabulation is different from lies in that there is no intent to deceive, and the matter is usually inconsequential. Of course, nothing that any president of the United States, including this one, says is inconsequential. That's part of our problem.

Or maybe he has run out of regular lies and has to go all out.

Dave Granlund




So what do we make of all of this?

Neurological disease? Mental health issues? Lies? I've been of the opinion that it is a little of all of the above. We know he is a life-long con man. He lies as often as he breathes. And if there is something organic going on, neurological or psychiatric, then it's all jumbled into this bizarre discourse. He is losing his grip on reality in any case. 45 needs medical attention.

And last month, he seemed to seek it. He made an unscheduled Saturday afternoon trip to Walter Reed Hospital. By all accounts, it was far from a routine visit. This hospital visit is suspicious for many reasons. His doctor traveled with him in his limo, for one. This is highly unusual. All the tests that he supposedly underwent could've been done at the Whitewash House. Though 45 claimed the he "began phase one of my yearly physical," physical exams don't work that way. And they aren't done months ahead of schedule; his previous physical was just nine months prior.

I betcha anything that one of his TIAs was a little bigger and longer-lasting than the others and he went to get checked out. I wager the TIA resolved, as they do, and he refused any further workup. He was out within an hour.

The report from the doctor to the media didn't specify what all tests were done, just "specifically, he did not undergo and specialized cardiac or neurologic evaluations." Hmmmmm. Because they weren't warranted or because he refused them? It's all fishy.

The anonymous author of  the book "A Warning" noted that “he stumbles, slurs, gets confused, is easily irritated, and has trouble synthesizing information, not occasionally but with regularity.” The president* “also can’t remember what he’s said or been told" according to the author. “Trump genuinely doesn’t remember important facts.”

The observable behaviors make it crystal clear that something is going on and has been for a long time. It could be multi-infarct dementia, frontotemporal dementia (my top two guesses), syphilitic dementia, or another kind of brain disease. People have speculated about drug use or a serious personality disorder like malignant narcissism. Something else could be going on. Most likely it is a combination of factors. He's a deeply flawed man with something neurological on top of it, and the compounded effect is becoming terrifying.

In the end, it doesn't matter. He needs to step down from the office of the presidency and have a thorough work-up.





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