Not my finest work, but I wanted to be able to post it as quickly as possible after the debate. EDIT: To address a few things that have come up... 1. "Why not do a video on Harris?" Well, it's because Harris doesn't display any of these signs of neurocognitive impairment. You might not agree with her policy positions and that's ok, but disagreeing with her doesn't make her ill. 2. "But Harris avoided answering questions too; doesn't that mean she has a thought disorder?" The issue here is whether avoiding a question is deliberate. If during a debate a politician deliberately avoids answering a question because either it's a hard question or because they want to use their limited time to make an entirely different point, that's not evidence of dysfunctional thought process (though it is frustrating!). For example, when one of the moderators asked Trump about the bipartisan border deal that he worked to kill, he responded with a rant about the size of crowds at his rallies which somehow morphed into his delusion about immigrants eating cats and dogs. The fact that he avoid the question was not pathological; what was pathological is that the ranting he did in place of an answer was a bit disorganized (though not to the extent of the two examples shown in this video). 3. "Don't both of these candidates sometimes exhibit "word salad"?" The short answer is no. Somehow, just in the last few months, the media has latched on to the term "word salad" and have been using it very loosely. In a medical context, "word salad" is the most extreme disorder of thought process in that there is no identifiable ideas within the string of unrelated words that comes out of a person's mouth. Neither Trump, nor Harris, nor Biden have ever said something which I think is accurately labeled "word salad". IMO, t's a relatively modest example, but here's the best attempt of it that I could find in 3 minutes on TH-cam: th-cam.com/users/shortsBYnxADJDGnU Sorry, I should have included a brief mention of the "word salad" misuse within the video. 4. "How can I talk about his health without having personally examined him?" At no point do I give Trump a diagnosis. In fact, I explicitly state in the video that I don't know the underlying etiology of his neurocognitive findings. But it is definitely possible to watch a video of a person saying the wrong word and label what form of paraphasia it is. Just like it's possible to watch a video of a person speaking and identify an abnormality of thought process. This is no different than a cardiologist listening to a heart murmur recording and stating the murmur is a systolic, high-pitched, crescendo-decrescendo murmur; or a dermatologist looking at a picture of a rash and describing its appearance with dermatological terminology. Or a radiologist interpreting a CT scan of a patient for whom they don't have the complete medical history. These doctors couldn't say what specifically is causing the abnormality in that particular person, but they can still identify the presence of the abnormality, describe it using medical terminology, and list a few possible causes of that abnormality in general. That's all I'm doing here.
I don't know if it is your finest work or not. Your channel just appeared in my feed and this video was tempting enough for me to watch and caused me to subscribe. I appreciate your professional analysis.
I'm curious: in the furniture -> future example, though furniture is a real word, if we pretend Trump doesn't know what furniture is (very possible), could this be considered a phonemic paraphasia due to the similarity it has to the word "future"? Edit: holy shit, that linguistic professor's analysis is brutal lmfao.
Is there a linguistic test that assesses the mental fitness? The mental test that Trump touted that he passed right flying colors looked like too basic to judge a person with the status that Trump has.
The test that Trump has bragged about for years, called the Montreal Cognitive Assessment or MoCA, is pathetically easy. Unless you have dementia, of course. Trump took it years ago. Plus, it was administered by Ronny "Dr. Feelgood" Jackson, who is full of shit (pardon my French). While I don't know if Trump literally has dementia, I'd bet the house that he would not "ace" formal neuropsych testing administered by an objective expert.
@@StrongMed Totally agreed. I saw the contents of the MoCA before. He just has so little sense of self awareness that he doesn’t know it is so embarrassing to brag about passing such a test. That Dr. Jackson is a Congressman now, endorsed by Trump. His opinions and talks are so biased, boarding total lies. I guess Ronny must have done a superb job for his boss :d. In terms of linguistics / language testing tools to assess mental health, it seems there are some active researches, such as this one on Nature Digital Medicine 7 (2024): 《Robust language-based mental health assessments in time and space through social media》. One of the authors is from Stanford. Not sure if they counted “TruthSocial” | TruthMedia” as social media, perhaps Trump could be a subject ;) Here is one perhaps more relevant article: Schizophr Bull. 2023 《Language Analytics for Assessment of Mental Health Status and Functional Competency》
@@StrongMed totally agree. I saw the contents of the MoCA test, so basic, like 1+2=3 for a child, but he boasted it like he passed a Mensa :d. He just wouldn’t recognize how embarrassing it is to boast his IQ and mental acuity based on passing such tests :d. That Dr. Johnson was so self serving and unhinged that his opinions and talks are boarding total lies, yet he became a Congressman now, endorsed by the person he loyally served 😂. For linguistic / language tools to detect mental health issues. It looks like it’s an active area of research, with advent of AI and various language models (including some from Stanford HAI).
Before you answered the question in the video, I was thinking that maybe you could classify the two examples you cited as Circumstantial speech? His answers were definitely meandering, disorganized and nearly incoherent, but in both clips he did sort-of get around to answering the original topic ("Iranians are great negotiators...they just killed us" in regards to the Iran Nuclear Deal and basically a rambling answer about how expensive child care is and repeating his usual "make America great again" points in regards to making child care affordable). He's definitely giving non-answers, but that's just typical politician behavior a lot of the time. Just having difficulty with the classifications, I know it's like this for a lot of other conditions, which typically use some kind of scoring system (like the GCS and whatnot), so wondering if anything similar might exist for these kinds of speech classifications? Thanks!
That's a good question. There's no scoring system for these designations. It's just subjective opinion, and equally experienced people can still disagree on them. As far as those 2 examples go, I don't know if "Iranians are great negotiators" was really intended as the punchline to the story. My guess is not, although I haven't seen a more complete excerpt of the speech on line. I'm guessing Trump was intending to use the outcome of the Iran nuclear deal to criticize Obama (it was approved during the Obama administration) because he's done that many times before. Unfortunately, the clip does get cut off. In the second clip though, the question was asking for whether Trump would commit to any specific legislation, and he never discusses any legislation or plan to lower child care costs at all. He mentions the phrase child care many times, but I don't think he ever really came back to the original question. The closest he approached to an actual answer was - in his own, meandering way - implying that economic growth for the country would be so good with him in charge that paying for child care wouldn't be a problem. I think that was the point he was trying to make, maybe?
If ever there was an example of a person unfit for the office of the president, Donald is it. Thank you for your insights and putting science to what all of us are already seeing….. well those of us seeing clearly anyway 😊
I've been a hospitalist for 18 years. For anyone unfamiliar, a hospitalist is an internal medicine physician who specializes in the care of hospitalized patients. During that time, when considering the number of days worked, average patient census, length of stay, and readmissions, I would estimate I've seen 6000-9000 unique patients (another 1000+ if you add in IM residency). Approximately 1/3 of the patients I see (i.e. >2000) present with some form of cognitive impairment. Sometimes a patient arrives with an established diagnosis of dementia, other neurodegenerative disease, drug abuse, or a primary psychiatric diagnosis, but many times they do not. For the many patients who do not, the hospitalist is the primary individual responsible for ultimately making a determination of the reason for cognitive impairment and guiding treatment. We do have neurologists and psychiatrists who are invaluable in assisting in that process, but for the patients who are admitted to the inpatient internal medicine service, the primary responsibility belongs to the internal medicine service. In addition, some of the diseases - particularly dementia - are very challenging to diagnose in the inpatient setting due to confounding factors such as delirium and other acute medical processes. Yet, we can still evaluate and rule out alternative explanations while setting up a path for the patient to be formally diagnosed as an outpatient once the acute medical issue is resolved. I also teach a course in clinical reasoning at our medical school, which among things, includes sessions on distinguishing dementia from delirium from other causes of altered mental status. If you're interested in learning more, I have a video on the topic on this channel here: th-cam.com/video/nphDKgi3HXo/w-d-xo.html&pp=ygUVYWx0ZXJlZCBtZW50YWwgc3RhdHVz Lastly, I don't understand the relevance of quoting Harris here. Yes, that phrase had been a part of her stump speech, but it's common for politicians to reuse particular and distinct phrases for that specific context. It would be like asserting Trump's 10,000+ uses of "make America great again" was necessarily a sign of cognitive problems, which is not something I or anyone I have heard suggest. And despite claims by conservatives on social media that her use of the phrase represents "word salad" (a complete misuse of the term as I mention in another comment here), if you watch clips of her in which this phrase is included within it's full context, it is coherent and evocative.
Have you considered the possibility that he's just trying to defend indefensible positions, and the only way to do that is to sling a bunch of nonsense out there to confuse your audience? Maybe there's no pathology there, and he's just a bad person.
This is not just about not liking him. I legit think he is an interesting example of some neurocognitive findings that are important for medical professionals to be able to recognize. In particular, his use of language is fascinating. I was getting frustrated by so many people reflexively saying he has dementia (of which I'm not currently convinced), or mislabeling his speech as "word salad" (which it is not). Or on the other side, I'm also frustrated by the number of people who listen to something like him responding to the child care question and say it was totally normal communication. Irrespective of his politics, there's medicine to learn from watching him. The same could be said of other famous individuals, but no one's speaking mannerisms are as universally recognized as Trump's, which makes him the best possible real-world example to discuss to a diverse, international audience.
This is a person with ADHD. Difficulty in being simple, precise and coherent; difficulty in keeping focussed and only addressing the essentials; lack of restraint in following every single response, due to emotional stimulation; too caught up in the intensity of reactive retorts, that provide immediate satisfaction and short term wins, but losing self regulated, self-focussed autonomous direction and keeping his voters' concerns as a priority, etc. etc. A chaotic, lively and over-stimulated mind!
Good evening sir Your work is exemplary. I have been following you for many years now. I like how you break down any topic so systematically and analyze in great depth and give evidence to support the same. This topic is no different sir. Really appreciate the efforts over all the years! And this video is the need of the hour for Americans.
I mean as an undergraduate in Neuroscience and as a someone that have studied learning by Associations ... you're just plainly wrong about this one . Alot of and I mean alot of people college proffesors and students and public speakers use this type of language when conveying their speech , when they're trying to advertise something or sell their product , it is not unnatural at all . And Trump is not speaking like this all the time , there are alot and I mean alot of interviews where he doesn't . In the public and where people see you it matters to be entertaining and him choosing to speak in such a way will always be benefitical for him to gain votes . Humans are emotinal beings that react on emotional stimuli and him dumbing it down for them speaking in simple yet funny and entertaining pattern ...will always be of benefit . Please I thought you could've tried and criticize him for other stuff that we have evidence that he is guilty and wrong . But this aint it . Iam sorry .
As a professor of medicine and as someone with 20 years of experience in treating individuals with a variety of neurological and psychiatric illnesses, Trump's thought process is decidedly *not* normal. I know of neither colleagues nor students of mine (save maybe 1-2 over the past decade) who speak like he does. If you disagree, I suggest you find one of your neuroscience professors who you think sounds like Trump when they speak, and ask them if they agree with you; if Trump's speech is normal, the professor shouldn't be offended, right? I do agree that his speech is not equally disorganized all of the time. I mention in the video that different types and degrees of disorder of thought process can occur in the same person at different times. For example, while Trump's debate performance yesterday was riddled with lies, there was nothing that was as disorganized as either of the two longer clips I included in this video. However, to your point that he may be deliberating speaking in an entertaining or "dumbed-down" way for the benefit of the audience, that second clip was him speaking to The Economic Club of New York. That's not a rally, but instead a room full of highly educated business people, academics, and local politicians. Entertainment was not their motivation for attending. Trump wasn't clearer with his answer to a question on how to lower the financial burden of child care because Trump, at least at that moment, lacked the capacity to be clearer. It was not because he was trying to be funny. Unless you are Michael Peña riffing to a minimalist jazz track, there is nothing entertaining, funny, or beneficial about incoherent rambling in response to a serious policy question. As far as the "other stuff" that you are alluding to, that's outside the scope of this medical-themed channel. I suggest Legal Eagle as a TH-cam channel that offers informed analysis on Trump's numerous legal problems.
Pretty sure you didn’t watch this video. Props to Dr Strong for giving you such a nuanced response. If you are being educated by people who speak in such chaotic fashion and by your own admission “Dumb things down” really evaluate your argument and biases here.
The number of professors I had (including in clinical chairs in Med School) with thought and speech patterns not dissimilar to Trump's makes me think that such a thing is indeed a variant of normality. A weird one to be sure - and I am not an USA voter, so I wont enter the discussion if this makes someone unable to be president - but I highly doubt we all don't interact with at least one person that speaks "Trump" on a weekly basis.
@@StrongMed I sincerely think you are letting your negative opinion on the person of Trump - one that I share - cloud your judgment on this one. I really can't imagine you don't deal frequently with people - otherwise completely typical and well functioning adults - who have a similar speech and thought pattern. I don't agree with your characterization of his extreme use of digression (there is an academic linguistics book by Scheinder et al that engages with that) and elision in discourse as the same as the clinical loosening of associations we see in schizophrenia or mania. I know this is an subjective evaluation, but the frequency of the digression, the internal coherence and the fact that his connections are not evidently bizarre (even the pet-eating one, it makes sense in the obviously wrong and full of prejudice context he was trying to frame). His speech patterns - albeit there is some evidence of cognitive decline with age, such as a couple of published articles on the quantitative rising trend of "filler" words in his discourse - were there even when he was 30, 40 years old, and there is no evidence to suggest he had a clinically significant learning disability or speech pathology in his childhood. At least some of what you consider as clinically relevant loosening of associations - his "I’ll-let-you-fill-in-the-gaps-style", as Pullum, a linguist, has put it on Vox - might be explained by dialectal expectations of his upbringing. Also, I would agree, those classes I had were extremely frustrating, but one of those professors was the most productive researcher at the my University, so she was there to stay - and was the most helpful person for students wanting to pursue research instead of clinical medicine. Collectively, we just decided to read Guyton cover to end at least twice and pray for the test to be graded by the associate professor instead.
@@tykos6 You could simply know an unusual number of "not normal" people who have these thought processes, and a researcher with these difficulties could simply be coping with them well in the course of their work. The video indeed presents evidence of a learning disability. It doesn't have to be "significant," nobody said he was nonverbal.
@@tykos6 I'm in medical school and agree with SM. We have a professor that has similar tangential and circumferential speech as Trump so I hear ya; the broad consensus among students and faculty (yikes!) is that they should not be teaching us. They do bring in $$$ to the school, however, so they stick around. Similar to Trump, they're riding on their reputation.
The way the guy in the movieclip speaks looks to me like pressured speech as in mania / hypomania seen in bipolar disorder or substance abuse etc. And I think it's not mutually exclusive with the theme discussed in the video. I salute you with ability to write Trump's speeches beside the clips 😅
Excellent video Dr. Strong (very cool name by the way). Some of these concepts crossed my mind too as he was talking, but this video really fleshes out some of the nuance distinguishing these disorders. IMO, his though process is a mix of circumstantial, and tangential and at times loosely associated depending on the answer being examined. For example, in the clip about childcare, he answers the questions after touching on a number of peripherally relevant to not relevant ideas. Towards the end/ somewhere in the middle, he does touch upon an answer, however shallow/vague it might be (i.e., childcare needs will be aided by taxation of imported childcare products (he says he wants a "very substantial tax when they send product into our country"). This might be a semantic paraphasia. He further goes onto to say that the revenue from these taxes will be in surplus of the current demand from childcare (I'm paraphrasing). On the other hand, yesterdays thing about immigrants eating dogs was definitely a loose association. From the listeners perspective, understanding becomes exceedingly convoluted when there are so many ideas interspersed and as the length of time between question and answer increases. As a result, it sounds like he never comes to an answer. I think he does come to an answer but it takes some digging to understand it and even then its not very detailed.
I find this so fascinating and would love more videos about these concepts (political or not). Is there anything in this particular range that truly fascinates you? Why?
I'm fascinated by the observation that there exists two very large groups of people in the US, both of which are predominantly composed of individuals who are generally reasonable in most aspects of their routine daily life, but which also hold such polar opposite opinions on Trump. It's fascinating how the combination of propaganda, misinformation, cognitive bias, and tribalism is so strong as to overwhelm not just a person's critical thinking ability, but to also overwhelm a person's ability to observe what's right in front of them. Related more directly to the topic of this video, I'd be even more fascinated by a thorough, formal neuropsych evaluation of Trump to better understand what's going on inside his brain, but that's never going to happen. (EDIT: a grammatical error)
How about word salad when speaking freely. How debilitating is social anxiety to the presidency? Can you be an effective president when you struggle to find words when in public?
In retrospect, I should have addressed the very recent phenomenon of people in the media misusing the term "word salad". Word salad is really extreme incoherent speech. Nothing that Trump, Harris, or Biden have ever said falls into this category. I haven't found a great example of what it actually is on TH-cam, but this one comes the closest: th-cam.com/users/shortsBYnxADJDGnU And no, I don't think a person with significant social anxiety could make an effective president when speeches, press conferences, leading negotiations, and participating in formal diplomatic functions are all key parts of the position.
![Global Capitalism: The U.S. Election and Trump 2.0 in Historical Perspective [November 2024]](http://i.ytimg.com/vi/0-WR6Zq7Qec/mqdefault.jpg)
Not my finest work, but I wanted to be able to post it as quickly as possible after the debate.
EDIT: To address a few things that have come up...
1. "Why not do a video on Harris?" Well, it's because Harris doesn't display any of these signs of neurocognitive impairment. You might not agree with her policy positions and that's ok, but disagreeing with her doesn't make her ill.
2. "But Harris avoided answering questions too; doesn't that mean she has a thought disorder?" The issue here is whether avoiding a question is deliberate. If during a debate a politician deliberately avoids answering a question because either it's a hard question or because they want to use their limited time to make an entirely different point, that's not evidence of dysfunctional thought process (though it is frustrating!). For example, when one of the moderators asked Trump about the bipartisan border deal that he worked to kill, he responded with a rant about the size of crowds at his rallies which somehow morphed into his delusion about immigrants eating cats and dogs. The fact that he avoid the question was not pathological; what was pathological is that the ranting he did in place of an answer was a bit disorganized (though not to the extent of the two examples shown in this video).
3. "Don't both of these candidates sometimes exhibit "word salad"?" The short answer is no. Somehow, just in the last few months, the media has latched on to the term "word salad" and have been using it very loosely. In a medical context, "word salad" is the most extreme disorder of thought process in that there is no identifiable ideas within the string of unrelated words that comes out of a person's mouth. Neither Trump, nor Harris, nor Biden have ever said something which I think is accurately labeled "word salad". IMO, t's a relatively modest example, but here's the best attempt of it that I could find in 3 minutes on TH-cam: th-cam.com/users/shortsBYnxADJDGnU
Sorry, I should have included a brief mention of the "word salad" misuse within the video.
4. "How can I talk about his health without having personally examined him?" At no point do I give Trump a diagnosis. In fact, I explicitly state in the video that I don't know the underlying etiology of his neurocognitive findings. But it is definitely possible to watch a video of a person saying the wrong word and label what form of paraphasia it is. Just like it's possible to watch a video of a person speaking and identify an abnormality of thought process. This is no different than a cardiologist listening to a heart murmur recording and stating the murmur is a systolic, high-pitched, crescendo-decrescendo murmur; or a dermatologist looking at a picture of a rash and describing its appearance with dermatological terminology. Or a radiologist interpreting a CT scan of a patient for whom they don't have the complete medical history. These doctors couldn't say what specifically is causing the abnormality in that particular person, but they can still identify the presence of the abnormality, describe it using medical terminology, and list a few possible causes of that abnormality in general. That's all I'm doing here.
I don't know if it is your finest work or not. Your channel just appeared in my feed and this video was tempting enough for me to watch and caused me to subscribe. I appreciate your professional analysis.
I'm curious: in the furniture -> future example, though furniture is a real word, if we pretend Trump doesn't know what furniture is (very possible), could this be considered a phonemic paraphasia due to the similarity it has to the word "future"?
Edit: holy shit, that linguistic professor's analysis is brutal lmfao.
Is there a linguistic test that assesses the mental fitness? The mental test that Trump touted that he passed right flying colors looked like too basic to judge a person with the status that Trump has.
The test that Trump has bragged about for years, called the Montreal Cognitive Assessment or MoCA, is pathetically easy. Unless you have dementia, of course. Trump took it years ago. Plus, it was administered by Ronny "Dr. Feelgood" Jackson, who is full of shit (pardon my French). While I don't know if Trump literally has dementia, I'd bet the house that he would not "ace" formal neuropsych testing administered by an objective expert.
@@StrongMed Totally agreed. I saw the contents of the MoCA before. He just has so little sense of self awareness that he doesn’t know it is so embarrassing to brag about passing such a test. That Dr. Jackson is a Congressman now, endorsed by Trump. His opinions and talks are so biased, boarding total lies. I guess Ronny must have done a superb job for his boss :d.
In terms of linguistics / language testing tools to assess mental health, it seems there are some active researches, such as this one on Nature Digital Medicine 7 (2024):
《Robust language-based mental health assessments in time and space through social media》. One of the authors is from Stanford. Not sure if they counted “TruthSocial” | TruthMedia” as social media, perhaps Trump could be a subject ;)
Here is one perhaps more relevant article:
Schizophr Bull. 2023
《Language Analytics for Assessment of Mental Health Status and Functional Competency》
@@StrongMed totally agree. I saw the contents of the MoCA test, so basic, like 1+2=3 for a child, but he boasted it like he passed a Mensa :d. He just wouldn’t recognize how embarrassing it is to boast his IQ and mental acuity based on passing such tests :d. That Dr. Johnson was so self serving and unhinged that his opinions and talks are boarding total lies, yet he became a Congressman now, endorsed by the person he loyally served 😂.
For linguistic / language tools to detect mental health issues. It looks like it’s an active area of research, with advent of AI and various language models (including some from Stanford HAI).
He calls it a “Weave”!!!
It is “mind boggling” to see and hear a political “leader” perform this way. He is ill, needs help.
The LR+ of any Dr. Strong video is high enough to cross the "threshold to watch" for any given topic.
excellent video and helpful working examples. appreciate your breakdown of thought process and verbal functioning.
Lol the linguistics professors analysis was brutal though.
Before you answered the question in the video, I was thinking that maybe you could classify the two examples you cited as Circumstantial speech? His answers were definitely meandering, disorganized and nearly incoherent, but in both clips he did sort-of get around to answering the original topic ("Iranians are great negotiators...they just killed us" in regards to the Iran Nuclear Deal and basically a rambling answer about how expensive child care is and repeating his usual "make America great again" points in regards to making child care affordable). He's definitely giving non-answers, but that's just typical politician behavior a lot of the time. Just having difficulty with the classifications, I know it's like this for a lot of other conditions, which typically use some kind of scoring system (like the GCS and whatnot), so wondering if anything similar might exist for these kinds of speech classifications? Thanks!
That's a good question. There's no scoring system for these designations. It's just subjective opinion, and equally experienced people can still disagree on them.
As far as those 2 examples go, I don't know if "Iranians are great negotiators" was really intended as the punchline to the story. My guess is not, although I haven't seen a more complete excerpt of the speech on line. I'm guessing Trump was intending to use the outcome of the Iran nuclear deal to criticize Obama (it was approved during the Obama administration) because he's done that many times before. Unfortunately, the clip does get cut off.
In the second clip though, the question was asking for whether Trump would commit to any specific legislation, and he never discusses any legislation or plan to lower child care costs at all. He mentions the phrase child care many times, but I don't think he ever really came back to the original question. The closest he approached to an actual answer was - in his own, meandering way - implying that economic growth for the country would be so good with him in charge that paying for child care wouldn't be a problem. I think that was the point he was trying to make, maybe?
If ever there was an example of a person unfit for the office of the president, Donald is it. Thank you for your insights and putting science to what all of us are already seeing….. well those of us seeing clearly anyway 😊
This feels a bit political …
"They're eating the dogs." 😂
You are a hospitalist. What is your expertise in this field? You seem to forget about what can be, unburdened by what has been
I've been a hospitalist for 18 years. For anyone unfamiliar, a hospitalist is an internal medicine physician who specializes in the care of hospitalized patients. During that time, when considering the number of days worked, average patient census, length of stay, and readmissions, I would estimate I've seen 6000-9000 unique patients (another 1000+ if you add in IM residency). Approximately 1/3 of the patients I see (i.e. >2000) present with some form of cognitive impairment. Sometimes a patient arrives with an established diagnosis of dementia, other neurodegenerative disease, drug abuse, or a primary psychiatric diagnosis, but many times they do not. For the many patients who do not, the hospitalist is the primary individual responsible for ultimately making a determination of the reason for cognitive impairment and guiding treatment. We do have neurologists and psychiatrists who are invaluable in assisting in that process, but for the patients who are admitted to the inpatient internal medicine service, the primary responsibility belongs to the internal medicine service. In addition, some of the diseases - particularly dementia - are very challenging to diagnose in the inpatient setting due to confounding factors such as delirium and other acute medical processes. Yet, we can still evaluate and rule out alternative explanations while setting up a path for the patient to be formally diagnosed as an outpatient once the acute medical issue is resolved.
I also teach a course in clinical reasoning at our medical school, which among things, includes sessions on distinguishing dementia from delirium from other causes of altered mental status. If you're interested in learning more, I have a video on the topic on this channel here: th-cam.com/video/nphDKgi3HXo/w-d-xo.html&pp=ygUVYWx0ZXJlZCBtZW50YWwgc3RhdHVz
Lastly, I don't understand the relevance of quoting Harris here. Yes, that phrase had been a part of her stump speech, but it's common for politicians to reuse particular and distinct phrases for that specific context. It would be like asserting Trump's 10,000+ uses of "make America great again" was necessarily a sign of cognitive problems, which is not something I or anyone I have heard suggest. And despite claims by conservatives on social media that her use of the phrase represents "word salad" (a complete misuse of the term as I mention in another comment here), if you watch clips of her in which this phrase is included within it's full context, it is coherent and evocative.
Would've been ace if you drew the "tangential" line geometrically tangent to "answer" circle, but I understand the logistical hurdles.
Word salad 😭
Great work!
Have you considered the possibility that he's just trying to defend indefensible positions, and the only way to do that is to sling a bunch of nonsense out there to confuse your audience?
Maybe there's no pathology there, and he's just a bad person.
thank you for another wonderful video, dr eric
Bro we get it you don’t like Trump
This is not just about not liking him. I legit think he is an interesting example of some neurocognitive findings that are important for medical professionals to be able to recognize. In particular, his use of language is fascinating. I was getting frustrated by so many people reflexively saying he has dementia (of which I'm not currently convinced), or mislabeling his speech as "word salad" (which it is not). Or on the other side, I'm also frustrated by the number of people who listen to something like him responding to the child care question and say it was totally normal communication. Irrespective of his politics, there's medicine to learn from watching him. The same could be said of other famous individuals, but no one's speaking mannerisms are as universally recognized as Trump's, which makes him the best possible real-world example to discuss to a diverse, international audience.
Touched a nerve?
This is a person with ADHD. Difficulty in being simple, precise and coherent; difficulty in keeping focussed and only addressing the essentials; lack of restraint in following every single response, due to emotional stimulation; too caught up in the intensity of reactive retorts, that provide immediate satisfaction and short term wins, but losing self regulated, self-focussed autonomous direction and keeping his voters' concerns as a priority, etc. etc. A chaotic, lively and over-stimulated mind!
Good evening sir
Your work is exemplary. I have been following you for many years now. I like how you break down any topic so systematically and analyze in great depth and give evidence to support the same. This topic is no different sir. Really appreciate the efforts over all the years! And this video is the need of the hour for Americans.
I mean as an undergraduate in Neuroscience and as a someone that have studied learning by Associations ... you're just plainly wrong about this one . Alot of and I mean alot of people college proffesors and students and public speakers use this type of language when conveying their speech , when they're trying to advertise something or sell their product , it is not unnatural at all .
And Trump is not speaking like this all the time , there are alot and I mean alot of interviews where he doesn't . In the public and where people see you it matters to be entertaining and him choosing to speak in such a way will always be benefitical for him to gain votes . Humans are emotinal beings that react on emotional stimuli and him dumbing it down for them speaking in simple yet funny and entertaining pattern ...will always be of benefit . Please I thought you could've tried and criticize him for other stuff that we have evidence that he is guilty and wrong . But this aint it . Iam sorry .
As a professor of medicine and as someone with 20 years of experience in treating individuals with a variety of neurological and psychiatric illnesses, Trump's thought process is decidedly *not* normal. I know of neither colleagues nor students of mine (save maybe 1-2 over the past decade) who speak like he does. If you disagree, I suggest you find one of your neuroscience professors who you think sounds like Trump when they speak, and ask them if they agree with you; if Trump's speech is normal, the professor shouldn't be offended, right?
I do agree that his speech is not equally disorganized all of the time. I mention in the video that different types and degrees of disorder of thought process can occur in the same person at different times. For example, while Trump's debate performance yesterday was riddled with lies, there was nothing that was as disorganized as either of the two longer clips I included in this video. However, to your point that he may be deliberating speaking in an entertaining or "dumbed-down" way for the benefit of the audience, that second clip was him speaking to The Economic Club of New York. That's not a rally, but instead a room full of highly educated business people, academics, and local politicians. Entertainment was not their motivation for attending. Trump wasn't clearer with his answer to a question on how to lower the financial burden of child care because Trump, at least at that moment, lacked the capacity to be clearer. It was not because he was trying to be funny. Unless you are Michael Peña riffing to a minimalist jazz track, there is nothing entertaining, funny, or beneficial about incoherent rambling in response to a serious policy question.
As far as the "other stuff" that you are alluding to, that's outside the scope of this medical-themed channel. I suggest Legal Eagle as a TH-cam channel that offers informed analysis on Trump's numerous legal problems.
Pretty sure you didn’t watch this video. Props to Dr Strong for giving you such a nuanced response. If you are being educated by people who speak in such chaotic fashion and by your own admission “Dumb things down” really evaluate your argument and biases here.
The number of professors I had (including in clinical chairs in Med School) with thought and speech patterns not dissimilar to Trump's makes me think that such a thing is indeed a variant of normality. A weird one to be sure - and I am not an USA voter, so I wont enter the discussion if this makes someone unable to be president - but I highly doubt we all don't interact with at least one person that speaks "Trump" on a weekly basis.
Anyone who routinely displays loosening of associations as Trump does probably should not be teaching medical school... It is definitely *not* normal.
@@StrongMed I sincerely think you are letting your negative opinion on the person of Trump - one that I share - cloud your judgment on this one. I really can't imagine you don't deal frequently with people - otherwise completely typical and well functioning adults - who have a similar speech and thought pattern.
I don't agree with your characterization of his extreme use of digression (there is an academic linguistics book by Scheinder et al that engages with that) and elision in discourse as the same as the clinical loosening of associations we see in schizophrenia or mania. I know this is an subjective evaluation, but the frequency of the digression, the internal coherence and the fact that his connections are not evidently bizarre (even the pet-eating one, it makes sense in the obviously wrong and full of prejudice context he was trying to frame).
His speech patterns - albeit there is some evidence of cognitive decline with age, such as a couple of published articles on the quantitative rising trend of "filler" words in his discourse - were there even when he was 30, 40 years old, and there is no evidence to suggest he had a clinically significant learning disability or speech pathology in his childhood. At least some of what you consider as clinically relevant loosening of associations - his "I’ll-let-you-fill-in-the-gaps-style", as Pullum, a linguist, has put it on Vox - might be explained by dialectal expectations of his upbringing.
Also, I would agree, those classes I had were extremely frustrating, but one of those professors was the most productive researcher at the my University, so she was there to stay - and was the most helpful person for students wanting to pursue research instead of clinical medicine. Collectively, we just decided to read Guyton cover to end at least twice and pray for the test to be graded by the associate professor instead.
@@tykos6 You could simply know an unusual number of "not normal" people who have these thought processes, and a researcher with these difficulties could simply be coping with them well in the course of their work. The video indeed presents evidence of a learning disability. It doesn't have to be "significant," nobody said he was nonverbal.
@tykos6 I've met perhaps 3 functional adults that speak as Trump. Always functionally illiterate, all doing menial jobs.
@@tykos6 I'm in medical school and agree with SM. We have a professor that has similar tangential and circumferential speech as Trump so I hear ya; the broad consensus among students and faculty (yikes!) is that they should not be teaching us. They do bring in $$$ to the school, however, so they stick around. Similar to Trump, they're riding on their reputation.
It's crazy he ever became president
The way the guy in the movieclip speaks looks to me like pressured speech as in mania / hypomania seen in bipolar disorder or substance abuse etc. And I think it's not mutually exclusive with the theme discussed in the video. I salute you with ability to write Trump's speeches beside the clips 😅
It’s berries good!
Excellent video Dr. Strong (very cool name by the way). Some of these concepts crossed my mind too as he was talking, but this video really fleshes out some of the nuance distinguishing these disorders. IMO, his though process is a mix of circumstantial, and tangential and at times loosely associated depending on the answer being examined. For example, in the clip about childcare, he answers the questions after touching on a number of peripherally relevant to not relevant ideas. Towards the end/ somewhere in the middle, he does touch upon an answer, however shallow/vague it might be (i.e., childcare needs will be aided by taxation of imported childcare products (he says he wants a "very substantial tax when they send product into our country"). This might be a semantic paraphasia. He further goes onto to say that the revenue from these taxes will be in surplus of the current demand from childcare (I'm paraphrasing). On the other hand, yesterdays thing about immigrants eating dogs was definitely a loose association.
From the listeners perspective, understanding becomes exceedingly convoluted when there are so many ideas interspersed and as the length of time between question and answer increases. As a result, it sounds like he never comes to an answer. I think he does come to an answer but it takes some digging to understand it and even then its not very detailed.
I find this so fascinating and would love more videos about these concepts (political or not). Is there anything in this particular range that truly fascinates you? Why?
I'm fascinated by the observation that there exists two very large groups of people in the US, both of which are predominantly composed of individuals who are generally reasonable in most aspects of their routine daily life, but which also hold such polar opposite opinions on Trump. It's fascinating how the combination of propaganda, misinformation, cognitive bias, and tribalism is so strong as to overwhelm not just a person's critical thinking ability, but to also overwhelm a person's ability to observe what's right in front of them.
Related more directly to the topic of this video, I'd be even more fascinated by a thorough, formal neuropsych evaluation of Trump to better understand what's going on inside his brain, but that's never going to happen.
(EDIT: a grammatical error)
How about word salad when speaking freely. How debilitating is social anxiety to the presidency? Can you be an effective president when you struggle to find words when in public?
In retrospect, I should have addressed the very recent phenomenon of people in the media misusing the term "word salad". Word salad is really extreme incoherent speech. Nothing that Trump, Harris, or Biden have ever said falls into this category. I haven't found a great example of what it actually is on TH-cam, but this one comes the closest: th-cam.com/users/shortsBYnxADJDGnU
And no, I don't think a person with significant social anxiety could make an effective president when speeches, press conferences, leading negotiations, and participating in formal diplomatic functions are all key parts of the position.