In recent months, psychologist John Gartner has circulated video clips and quotes to argue that Donald Trump shows signs consistent with behavioral variant frontotemporal dementia (bvFTD), mapping his public behavior onto widely used diagnostic criteria. But neurologist David Nicholl and physician Trish Greenhalgh caution that this kind of exercise—however detailed—does not meet the standard of clinical assessment.
Matching qualitative criteria such as "loss of manners or decorum" or "early loss of sympathy or empathy" to publicly available material, they write, "falls far short of rigorous clinical assessment," particularly for a condition as diagnostically challenging as bvFTD. Even in specialist settings, the disorder is frequently misidentified as a primary psychiatric illness. A proper evaluation would require far more than observational analysis: formal cognitive testing, detailed neuropsychological profiling, and brain imaging. There is no public evidence that such a workup has been performed.
But the authors' argument goes beyond any single diagnosis. What concerns them is a broader conceptual error—one that collapses two distinct forms of medical speech.
On one side is clinical diagnosis, which demands direct examination and adherence to established standards. On the other hand is what they call "clinically informed concern": the use of medical knowledge to interpret patterns of behavior that may have real-world consequences, even in the absence of a formal evaluation.
The distinction matters. Physicians are bound by professional norms—including long-standing cautions against diagnosing public figures they have not personally assessed. Those norms are not arbitrary. As Nicholl and Greenhalgh note, psychiatry has a "long and shameful history" of being used to discredit political opponents. At the same time, the stakes are unusually high when the individual in question holds power over decisions affecting millions.
That tension is not easily resolved. The authors stop short of endorsing public diagnostic claims—and explicitly avoid offering any themselves. Notably, they state they offer "no clinical comment on statements made by doctors who have attempted" to diagnose Trump. But they also do not argue for silence. Instead, they point to a precedent: in 2016, three psychiatrists wrote to President Obama expressing concern about then–president-elect Trump. They made clear that professional standards prevented them from offering a diagnosis, while still urging an impartial medical evaluation.
For Nicholl and Greenhalgh, that approach strikes a better balance. It acknowledges both the limits of clinical authority and the responsibilities that come with it.
Their conclusion is careful and measured: the profession needs clearer ways to separate clinical commentary from clinically informed concern. Without that distinction, public discourse risks sliding into something that looks like diagnosis—but lacks its rigor, and its safeguards.
Disclosure: Trish Greenhalgh is a member of Independent SAGE, an independent scientific advisory group that provided evidence-based advice during the COVID-19 pandemic.
Source: BMJ