The mental health of the American president is critical to the future of the country–and it’s clear to even a casual observer of Donald Trump that his patterns of speech, inability to state the truth on just about any subject, and the apparent joy he gets out of watching other people suffer–indicate that something strange is going on in the way he perceives the world.
Psychiatrists are often reluctant to speculate diagnosing someone in the absence of a face-to-face clinical exam. And yet, it appears that Trump has taken several such exams–including brain scans and mental acuity tests–that he brags about, but never releases reports on. Which is why I have brought Frank George, Ph.D. onto the show today. George holds a PhD in Psychology and Neuroscience from the University of Colorado Boulder, and was formerly the Chief of Behavioral and Biochemical Genetics at the National Institutes of Health (NIH). He’s an expert on narcissistic personality disorder and writes a popular substack that focuses on Trump’s Mental state called “The Gaslight Report” which I highly recommend you take a look at.
His diagnosis: Trump is a Demented Malignant Narcissist.
This report goes public on Tuesday January 20th, but is available to premium subscribers now. Thanks to all of you who support this independent journalism.
(The following transcript was made with the help of AI. So there might be some errors where it does not correctly match the actual language of the interview.)
Scott Carney: Let’s dive right in. In a recent article, you wrote that Trump is—and I’m going to quote you here—a “dementing malignant narcissist.” What do you mean by that?
Frank George: Malignant narcissist is one thing; “dementing” is a whole other level on top of that. For years and years, people have been talking about Trump possibly having this personality disorder that we call pathological narcissism. He shows all the symptoms of having the more severe version of it that we call malignant narcissism.
That has been more on display over the past couple of years, and more people are talking about it, which is a good thing. But they’re talking about it in part because there’s this other thing that is now apparently going on, which is this form of dementia. One of the big problems with that combination is that the type of dementia is one that accelerates or exacerbates any underlying personality, rather than diminishing it. So, the “dementing malignant narcissist” is just a whole new level of malignant narcissism. It’s something that I don’t remember ever having seen, read a report about, or heard anyone talk about—that particular combination. And the point is, it’s very, very dangerous.
Scott Carney: Okay, so we probably need to dig into what this means specifically. I think a lot of people have watched Trump and said casually, “This guy is a narcissist; he’s always talking about himself; he’s very self-centered.” But there’s a clinical definition. Why don’t we start with some of these terms? What is a malignant narcissist?
Frank George: Sure. For decades—at least back to the ‘60s and ‘70s—the idea of a particular disorder called Narcissistic Personality Disorder (NPD) came on the scene and started to be included as a psychiatric diagnosis. It involved particular personality issues, one of the main ones being a sense of extreme grandiosity.
We see this expressed in Trump so often. It’s grandiosity with everything. You might say, “Oh, such a narcissist, they always have to have the best type of thing.” But if you notice, during COVID, one of the big issues that me and my colleagues noticed immediately was when he had the conference about ivermectin and bleach. He came up with the idea: “Why don’t we inject bleach up their butts?” That was him having to be “better” than everyone else—than all the MDs. “I have to know more. I have to be the best. I know more than the generals.” I think he actually said that: “I know more about ISIS than the generals do.” It goes on and on. It’s not just “I have the best cars”; it is “I have the most, the best, of everything.” It assumes his entire persona.
Scott Carney: Yeah, and we see that with the “biggest crowds” or the “best economic policy.” I mean, I could probably put together a 40-minute montage of Trump saying he’s the best at one thing or another. So, what you’re saying is—does he really believe he’s the best?
Frank George: That is one of the 64-million-dollar questions. But there’s this fine line—a bit of a gray area—between when it is total BS and when it is dementia. Some things you listen to and you go, “Oh, come on.” But other times, he is confabulating; he’s making it up as he goes.
For instance, a couple of days ago, the thing about getting Bin Laden. He was answering a reporter and he had to immediately say, “I said we should have gotten Bin Laden like a year before Obama did, and it’s in my book, in fact, there’s a whole page on it.” It was total bullshit. There was nothing in the book on that, and yet that’s what immediately comes out. So that raises the question: Is he making that up as he goes? With things like that, there are such deep feelings about Obama and Biden that his mind is obsessed. I think he really believes that stuff; in that instance, yes, I think he believes it, definitely.
But so many other things... what’s another great example? When he said a couple of years ago that the Air Force “took over the airports” during the Revolutionary War or the War of 1812. He would believe that.
Scott Carney: Now, okay, so he’s confabulating and making things up. But you’ve called him a malignant narcissist. I thought narcissism was just being self-aggrandizing and self-focused. What does “malignant” mean in this case?
Frank George: Okay, so if you take pathological narcissism—the self-aggrandizing and grandiosity—and you add what has always been called the “Dark Tetrad” of symptoms...
You add in the idea of sociopathy—total non-caring. People often use sociopathy and psychopathy interchangeably these days. He has no empathy, which is one of the hallmark symptoms. But when you get to malignant narcissism, you add in one more trait that is the overwhelming distinction: the characteristic of sadism, where someone enjoys causing others psychological or physical pain.
It’s not always physical; it can be psychological. One of the best early examples was at a rally during the last iteration of Trump. He mocked a physically challenged reporter—mimicking his arm movements and voice. That is a form of psychological sadism right there. Who would do that in the middle of a political rally except someone exhibiting these symptoms?
The way he enjoys getting revenge, being vengeful, throwing people under the bus... he’s not saying, “I’m sorry, I have to let you go.” He’s thrilled.
Scott Carney: He’s the guy who says, “You’re fired.” He built his whole television career on firing people. He still likes firing people and getting people out of office. I mean, the whole DOGE thing fits that, right? Where they cut the government and he just loved the fact that he was firing people. I think, maybe more than the actions, you’re pointing to almost a level of joy that comes from that.
Frank George: Yeah, a true sadist gets a level of pleasure out of doing those things. It’s not just the action; it’s the enjoyment, the reinforcement, the reward, the pleasure he gets out of it. One way of looking at that is that it’s an extreme example of what we would call “narcissistic supply.” All the adoration and the crowds—that is his supply. It’s like his drug. And in that sense, the sadistic enjoyment is another form of supply. He’s getting his own internal reward from doing that.
Scott Carney: So, about a month ago, Trump was on his plane and announced that he had this routine brain scan, which he said he passed—probably with the “best score anyone had ever passed a brain scan with.” But observers noted that MRIs are not “routine.” They’ve speculated online that it might have been part of an anti-Alzheimer’s protocol. But you wrote a scathing letter on your Substack, The Gaslight Report, where you said, “No, this is wrong. It’s not Alzheimer’s. It’s actually Frontotemporal Dementia (FTD).” Why did you come to that conclusion? And I think this goes back to that “dementing” part of what you’re saying is going on with Trump.
Frank George: Well, first, I want to clarify it’s not a “diagnosis.” I’m a PhD, not an MD, psychiatrist, or neurologist. It’s a matter of being a content expert and looking at the facts. The facts are consistent with this.
The easiest way to describe the distinction is that there are several forms of dementia. When people hear “dementia,” they associate it mostly with Alzheimer’s because it’s the most common. Alzheimer’s disease is one form. Another, likely the second most common, is Frontotemporal Dementia (FTD). Bruce Willis is another famous person who has a severe form of it, so it’s not uncommon.
The difference between Alzheimer’s and FTD is that Alzheimer’s over time becomes life-diminishing. As you forget things, your life becomes “less.” It just sort of fades away. FTD, unfortunately in this case, enhances, augments, and escalates behavior. The main symptoms of FTD are disinhibition.
One great way to look at this is: you go to a bar to have a beer. People say after a few beers they get a little looser and more social. Is that because alcohol is a stimulant? No, alcohol is a depressant. What it is depressing first is your frontal cortex—the inhibitory areas that allow you to make good judgments, plan, and think logically. Those areas get hit first. It’s a double negative: you’re inhibiting an inhibitor. The end result is an augmentation. That’s exactly what happens with FTD. It’s almost like, “Here, hold my beer.”
Scott Carney: Wow. So you’re basically saying that he’s neurologically drunk.
Frank George: In a sense, the analogy holds. And he’s had way too many, if you want to use that analogy. The thing is, with alcohol, hopefully you recover the next day. FTD just gets progressively worse over time.
Scott Carney: And this can make him more unpredictable? I’m thinking about a guy with his finger on the nuclear button, controlling the world’s most powerful military. You’re saying that if it’s the same as being drunk, that might not be great?
Frank George: The analogy holds, and it’s a really good point. There’s a disinhibition where people ask me, “What’s he going to do next?” I’m not a prognosticator, but I have an idea of the type of thing he’s going to do. It will always be an augmentation of what he’s been doing.
Take the Venezuela thing. You can have all kinds of political explanations, and they exist—I’m not denying that. But underneath that, 10 or 15 years ago, I really doubt that would have happened. He wouldn’t be standing there telling Pete Hegseth and whomever, “Yeah, go do this.” Back then, he had enough “guardrails”—friends at the bar saying, “You’ve had enough, let’s go.” But as FTD worsens, those internal guardrails go away. And if you look at his cabinet this time, those external guardrails are gone, too. He’s the most powerful person in the world and he has no guardrails. He literally said, “Why did we just go capture Maduro?” He didn’t nuke Venezuela because that would mess up the oil, so this was a “cleaner” try. But he has the power to do that, and he’s getting more disinhibited over time.
Scott Carney: You’ve probably seen these books written about how psychopaths and narcissists tend to rise or are overrepresented in the leadership of corporate America. Do you think that’s a real phenomenon, or just pop psychology?
Frank George: Oh, I think it’s a real phenomenon. Absolutely. Even going back to Freud, he considered that there was a “healthy narcissism” and it could get to an unhealthy point. You can look at any politician and ask, “Do they score high on the narcissism scale?” Of course. You can’t look at the paper every day where half the people hate your guts and deal with that unless you have some level of confidence.
On a scale of zero to ten, your average person has to be a two or a three, otherwise you have no self-interest. CEOs or startup CEOs—I’ve been a startup CEO myself—often score higher. One thing investors didn’t like about me was that I didn’t score a seven or eight. I show way too much empathy. They want someone who can make ruthless decisions—get rid of 100 people just like that. One time I cut my own salary rather than letting people go. That pissed them off! Investors look for people with narcissistic traits because they make “good” leaders in a cold sense. They’re confident; they’ll do the deal; they’ll make the tough decisions with less empathy.
Scott Carney: But when you get to the level of a corporate raider, or these malignant narcissists at the heads of organizations, what happens to the organization? How do decisions get made by the lieutenants right below them?
Frank George: Well, look at Trump as the poster child. If it’s his decision, it’s about him. When is it ever about the country first? January 6th is the ultimate example. It’s always about him.
What people don’t realize is that these entities will often fail. Some get so big they cruise along, but smaller programs or companies run by a pathological narcissist—I’d bet dollars to donuts they will fail. Ultimately, when a decision has to be made, it will be one of self-interest and not entity-interest. They’ll make decisions that are good for them but bad for the organization.
Scott Carney: One great example of this is climate change. We are living in a time of existential danger, and the whole world agreed it was happening, but Trump came out with an anti-climate change agenda, gutting scientific programs. It doesn’t make a lot of sense to do that. Do you have an explanation for why that would occur with Trump?
Frank George: Specifically on that issue, it’s hard to wrap it as a single thing. More broadly, it relates to things like Venezuela—it has an oil component. My somewhat informed opinion from a narcissism point of view is that the climate change issue is partly about making friends with that side of the industry—the petroleum industry. It’s great for making him and his pals more money.
Scott Carney: Could it also be that if he calls it a hoax, he sets himself up as the expert who knows what reality really is?
Frank George: Sure. To go right into that: he has to be the best. He has to know more. Calling it a hoax instantly demeans it. From a narcissism perspective, the point isn’t even necessarily to negate the science as much as it is to demean it. It’s a way of him becoming “better” than the experts.
Scott Carney: And you’re saying that he has... a word you used earlier was “confabulation.” What does that mean in this context?
Frank George: Confabulation is a fascinating and terrifying symptom often seen in various forms of dementia, especially those affecting the frontal lobes. In a clinical sense, it’s not exactly “lying,” though it looks like it to an outside observer.
When someone has a memory gap or a lack of understanding about a situation, their brain—specifically a brain with FTD—automatically fills in that hole with a fabricated story that sounds plausible to them. They aren’t trying to deceive you; they genuinely believe the new “fact” they just created.
Scott Carney: So, when he says the Air Force took over the airports in 1776, he isn’t just making a joke or a slip of the tongue—his brain is actually rewriting history in real-time to fill a gap?
Frank George: Exactly. And because he is a narcissist, that “filled gap” will always favor him. It will always make him the hero, the smartest person in the room, or the victim of a grand conspiracy. The danger is that you cannot argue a person out of a confabulation with facts, because in their mind, the facts have already been replaced by this new narrative.
Scott Carney: This brings us back to the idea of the “Dark Tetrad.” If you have someone who is losing their grip on reality through confabulation, but they still retain that sadistic streak and that lack of empathy, you have a leader who is essentially living in a world of his own making, where the only thing that matters is his own pleasure and the destruction of his enemies.
Frank George: That’s the “dementing malignant narcissist” in a nutshell. It’s the loss of the ability to tell what is real, combined with a personality that wants to punish anyone who disagrees with his version of reality.
Scott Carney: It’s a sobering thought, Frank. I think everyone needs to be looking at this through a clinical lens rather than just a political one. Where can people find more of your work and the Gaslight Report?
Frank George: They can head over to Substack and search for the Gaslight Report. I try to break down these daily events—whether it’s a rally speech or a policy decision—and look at the underlying neurobiology of what’s happening.
Scott Carney: Well, Frank, I really appreciate you coming on. This has been eye-opening, if a bit frightening.
Frank George: Thanks for having me, Scott. It’s an important conversation to have.
Scott Carney: And for everyone watching, don’t forget to hang out for a second while the files upload—and we’ll see you in the next episode.
