At Your Request, a Mental Health Report on Joe Biden

Since you keep asking, here is my report on Joseph R. Biden Jr.:

I do not diagnose without examination and do not speak about public figures in general, unless there is evidence of such profound danger to public health and well-being because of serious signs of mental instability in a public servant, that it would be a public disservice not to share my knowledge and training. Biden has not risen to this threshold. A few stumbled words are not the same as the extreme dangers that result from: delusions of grandeur, omnipotence, and impunity; pathological lying to the level where almost no truth can be found in any of his words; making up fake news and threatening anyone who would contradict him, including calling legitimate news sources “the enemy of the people”; encouraging and promoting violence; traumatizing children and expressing glee at others’ suffering; belligerence against enemy and allied nations in ways that have dramatically worsened geopolitical instability; near-complete lack of empathy and detachment from reality; programming and hypnotizing his followers to believe only his words and not “what you’re seeing and what you’re reading”; neurological emergency-level slurring of speech, movement abnormalities, frequent memory lapses, dramatically shrinking vocabulary, repetitions, tangential thinking, or loss of direction; and stumbled words.

That I have not volunteered reports “on both sides” should be proof that this is not a political exercise. I never spoke up about a president or a presidential candidate either before or after Donald Trump, and neither have thousands of other mental health professionals who have come forth with similar concerns in ways that are unprecedented in U.S. history, for any president of any party. I only speak up when there is a medical need of such great magnitude as to risk the survival of the human species. This is definitively Donald Trump, not Biden. Nor is it Bernie Sanders, Hillary Clinton, or any other false equivalences people wish to create for political purposes.

In sum, I do not endorse candidates, but Joe Biden does not nearly meet my threshold for signs of dangerous mental instability. I still encourage all presidential and vice-presidential candidates to undergo fitness-for-duty exams that include a mental capacity evaluation. I recommend a repeat of these tests annually for sitting presidents and vice presidents. Meanwhile, Biden should not even come up if we cannot address the catastrophic dangers of Donald Trump, whose mental impairments are presently costing lives, tangibly and quantifiably, through his mishandling of the most serious epidemic in recent years. And this is only one of many disasters, which I would be happy to enumerate if necessary, in case my previous writings have not been enough.

Addendum (3/7/2020): Since my comments have been widely circulated under a misinterpretation, I would like to clarify, I did not say that Joe Biden shows no disturbances. Some medically insignificant signs can seem dramatic to the layperson’s eye, and vice versa. But, again, as long as we refuse to confront the current emergency that is existential for the entire human species and historic in proportion, this will only be a distraction. In medicine, when you have a person before you bleeding and about to expire, you attend to the imminent emergency first and triage far less urgent cases for later.

Response to your request on how to deal with Trump supporters (3/7/2020): One of the reasons why people are hearing a lot about Joe Biden’s cognitive problems is because of projection: Biden’s minor and insignificant issues will be magnified to the degree to which they are real problems in Donald Trump. If you look at my “translations” of Trump’s words, you will see that whatever he or his followers say about others will be a direct reflection of himself or themselves. “Projection” is a psychological defense of denying characteristics that one cannot tolerate in oneself by attributing them to others. Hence, here are my suggestions: (a) do not confront them with facts, for it will only rouse resistance (subconsciously, they already know what is true, which is why they project very accurately); (b) do not invest in trying to persuade, for the problem is in granting an impaired individual power (which spreads pathology in a previously healthy populace), not in their cognitive system; and (c) continue to state the facts elsewhere, without intimidation, so that a delusional narrative does not overtake the truth.

Addendum after Donald Trump’s “tweet” that Joe Biden “cannot pass the test I ‘aced’. He should give it a try!!!” (7/3/2020): To clarify, the Montreal Cognitive Assessment (MoCA) Trump took is not a valid test for his condition. A series of studies, including one by Trezpacz and colleagues that showed even patients clinically diagnosed with Alzheimer’s dementia could score up to 30 out of 30, and another by Gierus and colleagues that showed hospitalized schizophrenia patients could achieve normal scores, led researchers at an Alzheimer’s Disease Neuroimaging Initiative consortium to underscore that the MoCA should not replace a thorough neuropsychological assessment. It is unfortunate that the now-removed White House doctor, not being a specialist, did not know about appropriate uses of this quick screen. Why this 10-minute screen is too insensitive to be useful in this case should be evident from looking at the actual screen.

Forensic psychiatrist, violence expert, president of the World Mental Health Coalition (, and editor of "The Dangerous Case of Donald Trump.”

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