Donald Trump’s “mental block” is killing Americans and renders him incompetent to manage the federal response to the COVID-19 pandemic

President Donald Trump has what a layperson might describe as a permanent “mental block” — a persistent inability to recognize the reason for and importance of a comprehensive program of testing non-symptomatic people in the United States for the presence of the virus that causes COVID-19. That mental block presents a serious, ongoing danger to the population of this country and renders him mentally incompetent to manage the federal response to the pandemic.

Trump’s failure to acknowledge the need for adequate testing capability has killed many thousands of people and will kill many thousands more. The mental block may be the product of Trump’s well-documented pre-existing mental illness, or it may be caused by some other problem. Later I will explain why I believe that it is a component of an alternative reality — a delusion — constructed by Trump’s disordered mind.

Teams of neurologists, psychiatrists, and psychologists can sort out the exact causation later. Right now, the important thing is that action be taken to prevent more unnecessary deaths because of Trump and whatever ails him.

If Trump refuses to cede full responsibility for managing the federal response to the pandemic to someone else, Vice President Michael Pence should initiate the process for removing the president under the 25th Amendment. Too many lives are at stake to dither any longer.

Let me use an analogy. If a person does not recognize the danger of wandering into traffic on a busy street, that person must be restrained in some manner to protect him from harming himself. It does not matter whether the cause of that lack of recognition is a delusion of invincibility, a decline in reasoning because of dementia, or some other impairment. The danger is the same, and immediate action must be taken to ensure that the person does not walk in front of a speeding truck.

Trump does not comprehend the value of widespread testing. His failure to grasp a straightforward and critically important fact, however, is much more than stubbornness or lack of mental acuity. It is a sign of a serious impairment in his mental functioning that renders his judgment flawed and, in the context of a deadly pandemic, highly dangerous. It must be addressed immediately.

It was apparent from his interview last week with Jonathan Swan of Axios that Trump is not the brightest bulb in the chandelier. But this is not simply his lack of intelligence at work. The concept that slowing the transmission of the virus in the community requires testing as many non-symptomatic persons as reasonably possible, so that carriers of the virus can be identified and isolated before they spread the virus further, is easily understood by a reasonably intelligent nine year old.

The explanation of Trump’s failure to acknowledge the concept goes beyond his intellectual shortcomings. It is a sign of a mental illness.

Trump’s curt response the day after the Axios interview to Yamiche Alcindor of PBS during a press conference was an indication of what we are dealing with. Alcindor asked: “You said there can be too much testing. What could possibly be wrong with testing people too much for the virus and why not give a date on when all Americans will have access to same day testing?

Trump, obviously annoyed, answered: “It’s expensive and the more you test the more cases you have.”

It is a theme to which he has returned over and over again — more testing is bad in his view because it means more cases of COVID-19 are diagnosed. This is not just Trump the pathological liar trying to pitch nonsense to a gullible public, which he certainly does on a routine basis.

In this case, the idea and its implications are so stupid and nonsensical that even the dullest members of his political base know better. They understand that not checking their blood glucose levels does not mean that their diabetes has gone away. This is Trump the man who is dangerously mentally ill, as we have been warned repeatedly by psychiatrists and psychologists, most recently by his own niece.

A trip down the rabbit hole

Trying to parse the “reasoning” of someone as deluded or otherwise mentally disordered as Trump is a fraught undertaking. But there is, I believe, a certain internal logic to what appears to me to be a delusional construct — an alternative explanation for events that Trump has concocted within his own troubled mind and that no amount of objective evidence to the contrary will persuade him to abandon.

Trump’s obsession with television ratings as a measure of his success (and as a measure of his own fragile sense of self-worth) is well known. He openly boasts about the ratings for his briefings on a pandemic that has killed over 160,000 people in the United States. To paraphrase legendary football coach Vince Lombardi, ratings are not everything for Trump, they are the only thing.

As mental health experts have explained, Trump has an insatiable ego in constant need of gratification. Television ratings are the go-to source to feed his ego.

The number of COVID-19 cases = Trump’s ratings

It was obvious from the outset of the pandemic that Trump equated the number of cases of COVID-19 in the United States with television ratings — the lower the number of cases, the higher his “ratings,” at least in his own mind. On March 7th, Trump infamously stated that he did not want a cruise ship with sick passengers to dock because of what that would do to the number of cases reported in the United States:

“[My experts] would like to have the people come off. I’d rather have the people stay, but I’d go with them. I told them to make the final decision. I would rather — because I like the numbers being where they are. I don’t need to have the numbers double because of one ship that wasn’t our fault.”

That was a warning that something was seriously amiss in the way the president viewed the pandemic. Was it surprising, then, that Trump refused to embrace an aggressive national program of comprehensive diagnostic testing?

I believe that in Trump’s deluded mind testing is “bad” because it identifies more cases of COVID-19 and hurts his “ratings,” which in turn makes him more vulnerable to his enemies. I believe that it is likely that he even sees efforts to do more testing as persecutory, intended to make him look bad.

A necessary component of that delusional construct, however, is rejection of the idea that testing is necessary to control the spread of the virus. Therefore, that idea simply does not exist — it is blocked, if you will, from his mind.

Yes, the delusion defies common sense, but that is what delusions do. And yes, it sounds crazy, because that is what it is.

There are other delusional aspects to his thinking, as brought out in the interview with Swan. Also excluded from the worldview that exists only inside Trump’s head is the proposition that COVID-19 deaths measured on a per capita basis is not a fair basis for comparing the success of this country’s response to the response of other countries. But it is his fixed and firm belief that testing is bad (sometimes he says “overrated”) that has driven his deadliest decisions.

Unfortunately, few reporters seem to have the interviewing skills of Jonathan Swain. I suggest that one of the better ones take a stab at this question:

“Mr. President, many experts now recommend that the federal response to the pandemic be reset to include a national effort to support more comprehensive and efficient testing. Do you agree that, going forward, a comprehensive program of widespread testing is important for controlling the spread of the virus?

To my knowledge, no reporter has tried to pin down an answer to that fundamental question. Unless his guard is unusually high that day, the word “widespread” will trigger a revealing response.

Fixing the testing

Of all the blunders on the federal level in managing the pandemic, the deadliest was the failure by the Trump administration to use the financial, legal, and logistical resources of the federal government to implement a national program of testing adequate to control the spread of the virus that causes COVID-19. Almost seven months into the pandemic the problems with testing still have not been fixed.

The need for such a program has not gone away, and experts now are pressing for a “reset” of the federal response that includes renewed emphasis on testing to try to save the country from further catastrophe. There is no indication that Trump, who continues to deny the magnitude of the crisis at hand, will change his position on testing.

Testing must be ramped up to pull the country out of the pandemic nose-dive that it is in, and only the federal government has the capability to do that quickly enough. If Trump won’t make that happen then someone else must.

Trump will always bear primary responsibility for the devastation from the pandemic caused by his indifference and incompetence. But if it was not clear before, it is clear now that Trump is mentally incapable of saving the country from further unnecessary deaths. People like Pence who fail to do their duty to prevent Trump from causing further harm will have some of the blood of the victims of Trump’s incompetence on their own hands.