2. #TrumpIsNotWell

Trump’s Mockery of Disability

During the 2016 campaign and continuing into his presidency, questions about Trump’s mental health were a media mainstay. Again, disability scholars and activists argued that the problem is not that Trump is mentally ill but that he is a bigot with authoritarian tendencies and that, in opposing him, activists should focus on his ableist policies not his personality. Despite this push by disabled activists to focus on his policies, Trump mocking a disabled reporter in November 2015 on the campaign trail in South Carolina became one of the lasting images from the 2016 presidential campaign.4 Although I agree with disabled activists on this point, I do want to look back briefly at the incident as an example of illness politics and because people tend not to remember the context of Trump’s mockery of New York Times reporter Serge Kovaleski, who has arthrogryposis, a condition that involves joint contracture and stiffness. At the rally in South Carolina, Trump was repeating his anti-Muslim assertion that “thousands and thousands of people were cheering” in Jersey City, New Jersey, when the World Trade Center was attacked and collapsed on September 11, 2001. Trump claimed to have seen these celebrations on television and cited as additional evidence a story written by Kovaleski and Fredrick Kunkle in the Washington Post that mentioned an FBI investigation into a possible terrorist cell operating in northern New Jersey. In that article, Kovaleski and Kunkle wrote, “In Jersey City, within hours of two jetliners’ plowing into the World Trade Center, law enforcement authorities detained and questioned a number of people who were allegedly seen celebrating the attacks and holding tailgate-style parties on rooftops while they watched the devastation on the other side of the river.”5 When asked about the article later, Kovaleski said he couldn’t recall the exact details of his reporting but denied that there was evidence of widespread celebrations. As is clear from the article itself, “a number of people” is not “thousands and thousands,” but that hasn’t stopped Trump from continuing to maintain that he saw thousands and thousands of Muslims celebrating on September 11, 2001. I bring this story up not to rehash one of Trump’s favorite false claims. As Bonnie Honig has shown convincingly, through his constant tweeting, as well as through his rallies and the clips that would circulate after, Trump has practiced adeptly as both candidate and president what Honig calls the “shock politics two-step,” which combines disorientation and desensitization in a mechanism that exhausts people into submission. I want to connect my concept and practice of illness politics with Honig’s shock politics two-step by noting how, in Trump’s performance at the rally in South Carolina in 2015, ableism is used to discredit a reporter’s trustworthiness and as validation of Trump’s racism. Here we see stigma power in action: Trump’s performance of bigotry and bullying is expressed through a (verbal and visual) suturing of racism and ableism.

Polls showed most Americans did not like that Trump made fun of a person’s disability. In a Bloomberg Politics poll in August 2016, for example, a higher percentage of Americans said “Trump’s criticism of a reporter that was seen as mocking the reporter’s physical disability” bothered them more than any other incident or position mentioned by pollsters.6 Only 15 percent said the mockery did not bother them at all. Yet, even despite the polling showing widespread disapproval of Trump’s mocking of disability, Trump would demonstrate a similar show of contempt for apparent weakness when he imitated Clinton’s collapse at the fifteenth anniversary of September 11, as I discussed in the last chapter. It is possible that at least some Americans were less concerned about Trump’s personal attacks on the fitness of his opponent (politics can be dirty, after all) but found his belittling imitation of Kovaleski to be reprehensible. Still, it’s important to note that disability activists consistently tried to turn the conversation from the spectacle of Trump’s mockery of disability to the ableism of Trump’s policies, including, for example, the proposed replacement plan for the Affordable Care Act (ACA). I will explore some of the activism to save the ACA led by disabled people in the next chapter when I turn my analysis away from electoral politics and toward illness and disability activism.

Mental Health Professionals and the Goldwater Rule

Speculation about Trump’s fitness for office continued after he was elected president in 2016. Shortly after his inauguration, a group of thirty-five psychiatrists, psychologists, and social workers published a letter in the New York Times challenging the American Psychiatric Association’s Goldwater Rule, which they described as a “self-imposed dictum about evaluating public figures.”7 In the brief letter, the mental health professionals offered the following diagnosis of Trump:

Mr. Trump’s speech and actions demonstrate an inability to tolerate views different from his own, leading to rage reactions. His words and behavior suggest a profound inability to empathize. Individuals with these traits distort reality to suit their psychological state, attacking facts and those who convey them (journalists, scientists).

In a powerful leader, these attacks are likely to increase, as his personal myth of greatness appears to be confirmed. We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.8

Tellingly, there is no mention of Trump’s policies in the letter, only a vague reference twice to “Mr. Trump’s speech and actions.” Psychological language is used instead, presumably to give authority to the diagnosis: “rage reactions,” “profound inability to empathize,” “distort reality,” “personal myth of greatness,” and “grave emotional instability.” Here, the psychological becomes political. In proposing the revocation of the Goldwater Rule, the letter writers argue that they have a public duty to diagnose someone who, based on their psychological training, they are convinced is a danger to society.

In another letter to the editor of the New York Times in response to this group letter from his professional colleagues, Dr. Allen Frances, emeritus professor of psychiatry and behavioral sciences at Duke University and chairperson of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV, responded to the “fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis” that had led some mental health professionals to weigh in publicly on questions about Trump’s mental health.9 Dr. Frances argued that Trump should be taken to task not for being “crazy” but for behaving badly. His letter was prompted by concern for the fact that mental health professionals were disregarding “the usual ethical constraints against diagnosing public figures at a distance.”10 This concern, however, did not stop Dr. Frances from asserting in no uncertain terms that Trump does not have narcissistic personality disorder, because, well, as he asserted, I should know, I’m the person who wrote the criteria on NPD. Dr. Frances ends his letter by arguing that the “antidote to a dystopic Trumpean dark age is political, not psychological.”11 While I don’t disagree with Frances’s call to do politics, I would also contend that it is not possible to separate the psychological from the political. I say: do politics, yes, but this includes illness politics, and by this I mean, consider how illness is used politically in tandem with race, gender, sexuality, and class.

In drawing attention to the illness politics surrounding both Clinton, discussed in the last chapter, and Trump in this chapter, it is helpful to consider the uses of illness as metaphor in 2016 within the context of a longer history of illness politics. The references to the American Psychiatric Association’s Goldwater Rule in relation to Trump suggest some of this longer history. In a press release in March 2017, the APA reaffirmed support for the Goldwater Rule, writing, “The American Psychiatric Association (APA) today reaffirmed its support behind the ethics guideline commonly known as ‘The Goldwater Rule,’ which asserts that member psychiatrists should not give professional opinions about the mental state of someone they have not personally evaluated.”12 The APA’s news release provides a brief history of the Goldwater Rule, explaining that in the 1964 presidential election, Fact magazine had polled over 12,000 psychiatrists about whether presidential candidate Senator Barry Goldwater was “psychologically fit to be president. A total of 2,417 of those queried responded, with 1,189 saying that Goldwater was unfit to assume the presidency. Goldwater would later sue the magazine, which was found liable for damages.”13 The Goldwater Rule was first implemented by the APA in 1973. In reaffirming the Goldwater Rule, the APA clarified and even expanded the rationale for the decision as follows:

1. When a psychiatrist comments about the behavior, symptoms, diagnosis, etc. of a public figure without consent, that psychiatrist has violated the principle that psychiatric evaluations be conducted with consent or authorization.
2. Offering a professional opinion on an individual that a psychiatrist has not examined is a departure from established methods of examination, which require careful study of medical history and first-hand examination of the patient. Such behavior compromises both the integrity of the psychiatrist and the profession.
3. When psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness.14

Debate and discussion over the APA’s stance would continue throughout Trump’s presidency, culminating in a fierce denunciation of the APA’s reaffirmation and clarification of the Goldwater Rule by Trump’s niece Mary L. Trump, who has a PhD in Psychology. In an op-ed in the Washington Post in October 2020, Mary Trump argued that the APA’s stance not only prohibited members from diagnosing public figures, but it also now meant “they could no longer offer a professional opinion of any sort, no matter how well supported or evidence-based, even if they believed that a public figure posed a threat to the country’s citizens or national security.”15 Here again we see illness politics in action in relation to the contested political uses and abuses of diagnosis.

Illness politics was also at work in the 1960 presidential election. In one of his “Doctor’s World” columns in the New York Times published a month before the 1992 presidential election, Lawrence K. Altman, M.D., discussed what the article’s title identified as the “disturbing issue of Kennedy’s secret illness.” Altman noted that “many Presidents have suffered serious illness while in the White House. All too often they, their families and aides have misled, if not lied to, the public about their health, with the malady becoming known only many years later.”16 Altman goes on to discuss a then just-published report in the Journal of the American Medical Association in which pathologists who were at John F. Kennedy’s autopsy revealed that Kennedy’s adrenal glands were “almost completely gone,” confirming that he had Addison’s disease, a diagnosis he and his family had always denied, including during the 1960 presidential election.17 As Altman explains, if the public had known in 1960 that Kennedy had Addison’s, he might have lost what was a very close election to Richard Nixon.

Altman points out that since 1960 there has been an “enormous expansion of coverage of health issues” in the media,18 and I contend that the 1960s and 1970s is also the moment when illness (both mental and physical) begins to figure as a site of political struggle, though it has been largely overshadowed in contemporary interpretations of the period by a focus on gender, race, and sexuality as sites of struggle. Many have noted that Trump’s call to “make America great again” is an attempt to hearken back to a 1950s America that is more fantasy than reality. The illness politics of the 2016 presidential election suggest a wish by some to go back in time to before 1960, to before the rise of the new social movements that made it possible for us to have the first African American president and (almost) the first woman president. Recall Trump’s comment that Clinton did not have a “presidential look” as a counterattack to her attempts to portray him as not having the right temperament to be president.

Weaponizing Weakness

If initial doubts about Trump’s fitness for office tended to focus on his temperament and narcissistic personality, in 2020 we saw an increasing number of attempts to portray him as not only temperamentally but also physically unfit for office. These attacks resembled some of the illness politics used to generate uncertainty and concern about Clinton’s health in 2016 under the hashtags #SickHillary and #HillarysHealth, as discussed in the last chapter. We saw a similar illness politics at work against Trump when clips from a commencement speech he gave at the United States Military Academy on June 13, 2020, circulated widely on social media. The clips seemed to indicate Trump had difficulty drinking water and walking down a ramp. Just days after Trump’s speech at West Point, the Lincoln Project, a group whose stated mission was to “defeat President Trump and Trumpism at the ballot box,” released a forty-five-second mash-up video designed to weaponize weakness as a form of illness politics.19 The video was merciless: “He’s shaky. He’s weak,” the voiceover intoned, visually connecting physical decline with moral decay. The irony, of course, is that weaponizing weakness, or a perception of weakness, had been, and still is, one of Trump’s signature political strategies. The clip of Trump drinking lasts approximately three seconds, while the clip of Trump walking down a ramp lasts fifteen seconds. In no time, then, word and images are out: Trump is not well. The evidence can be watched on loop and shared easily via hashtag. Repeat and retweet after me: #TrumpIsNotWell. Trump, like Clinton, was diagnosed by gif, and hoist on his own ableist petard.

The Lincoln Project was organized by a group of Republicans disenchanted by the direction Trump had taken their party. In a feature about the Lincoln Project in The New Yorker in October 2020, Paige Williams describes the group as “a super pac of Republican operatives who have disavowed their own party in order to defeat President Donald Trump.”20 She explains that the group’s founders, including Republican consultants Steve Schmidt and Rick Wilson, decided to call themselves the Lincoln Project in order to invoke the Republican party’s connection to Abraham Lincoln and “weaponize it.”21 She also describes their media and social media tactics as influenced by their study of “a combat technique, developed after the Korean War, called the ooda loop—Observe, Orient, Decide, and Act—in which a fighter outmaneuvers an opponent by processing and acting on information quickly, rather than waiting to develop a definitive assessment. Such a rapid offense is meant to disorient and overwhelm a target. The Project’s strategists metabolize news quickly enough to create spots within hours, or even minutes, of an event.”22

Here we have an example of what philosopher Michel Foucault described in his lectures at the Collège de France in 1976 as an inversion of Carl von Clausewitz’s famous dictum: not “war is politics by other means” but “politics is the continuation of war by other means.”23 Of course, the strategy deployed by the Lincoln Project is not so unlike Trump’s own use of Twitter as, in Bonnie Honig’s analysis, “a device of disorientation, blocking access to the solitude and plurality that are the conditions of critical thinking and reflection.”24 Indeed, in a piece for Sidecar, the New Left Review blog, Michael Hardt, drawing on Foucault’s lectures, asserts that, “One principle that gives relative coherence to the political rationality of the Trump faction is this: politics is merely the continuation of war by other means.”25 Thus, it makes sense to me that it would be Republican operatives who would seek to discredit Trump through a combative illness politics that weaponizes weakness, in this case, Trump’s own weakness.

The example Williams gives of this combat technique in action on social media is the Lincoln Project’s video and hashtag #TrumpIsNotWell. As Williams explains, “The viral spot subjected the President to one of his own tricks: he mocked Hillary Clinton when she stumbled in 2016, and constantly suggests that Biden is senile. Trump was soon wasting time at a campaign rally defending his ability to walk and to drink water.”26 Williams doesn’t spend any more time analyzing the #TrumpIsNotWell video: both Trump and the Lincoln Project are presented as mocking their opponents by highlighting moments of weakness and vulnerability. The story Williams tells is one of comeuppance for a bully: Trump getting a taste of his own medicine from the Lincoln Project. In her discussion of the different types of videos the Lincoln Project has produced, and the multiple intended audiences for various videos, Williams explains that some are produced for an “audience of one”—that is, their goal is to “destabilize Trump” like a “military ‘PsyOp.’”27 While the #TrumpIsNotWell ad clearly had a broader audience in mind, it also worked through stigma and ableism as a means to humiliate Trump. In one three-second shot, for example, we see the legs of a man from behind as he climbs the steps up to an airplane—presumably Trump boarding Air Force One, but we never see his head, so we can’t say for sure. The video gag is that the footage has captured the president with a piece of white paper—haha toilet paper!—stuck to his shoe. The voiceover during this sequence says, “Why do so many reporters who cover the White House pretend they can’t see Trump’s decline?” As with Clinton slipping as she goes up a flight of stairs, the question to ask is: how and why is this a sign of decline?

As in 2016, many disabled writers and activists immediately objected to the Lincoln Project’s #TrumpIsNotWell ad and the ableist attitudes that the tactic of weaponizing perceived physical weakness reveals. Disability advocates like Rebecca Cokely, director of the Disability Justice Initiative at the Center for American Progress, rightly argued that the focus on Trump’s difficulty drinking water and walking down a ramp detracted from the real issues, including that his policies and positions have been harmful to disabled and chronically ill people.28 Senator Tammy Duckworth (D-Illinois), who was disabled in combat and uses a wheelchair, also called out the ableism of the clips on Twitter, retweeting David A. Graham’s article in The Atlantic which offers a more extended case as to why the “search for some disqualifying physical ailment is a distraction.”29

Visual tactics like freezing and looping, cutting and splicing, slowing down and speeding up, all of which amount to forms of manipulation—or “doctoring”—of evidence are used to help us see something that we are led to believe might otherwise remain unseen. Put all together, we viewers participate in the practice I have been calling “diagnosing by gif,” in which a short video played on loop allegedly reveals a person’s secret illness and related moral failing. The Lincoln Project’s #TrumpIsNotWell ad is a classic of the genre. “Trump doesn’t have the strength to lead. Nor the character to admit it,” the ad tells us, directly linking physical ability with moral character (Figure 2). The images accompanying these two statements are of Trump yet again appearing to have difficulty drinking followed by the by-now oft-repeated image of Trump mocking Serge Kovaleski. The ad creates a chain of verbal and visual associations connecting Trump’s supposed physical weakness with his mocking of disability. The juxtaposition of images suggests that the best way to respond to Trump’s mockery is with more mockery of his own weakness and disability. Social media is then used to circulate the ad quickly and widely and generate increasing doubt about Trump’s health via the hashtag #TrumpIsNotWell.

The Lincoln Project understood this process well and frequently shared the forty-five-second video on Twitter. In one instance, for example, they shared the video and repeated speculation from the ad about a visit Trump had made to Walter Reed: “Why did Trump have a secretive, midnight run to Walter Reed Medical Center?,” the tweet asked, adding, “It’s time to talk about it. #TrumpIsNotWell.”30 In the video, when this question is asked, we see a short two-second clip repeated twice—the first repetition of the clip shows Trump at a distance walking toward a black SUV with what appear to be two Secret Service officers on duty, one along the path Trump walks and the other standing guard at the back of the SUV; the second zooms in to give us a closer look at Trump. There is clearly a bright sun in the footage, shining on Trump’s face, casting shadows, and creating a reflection on the SUV, so we are not witnessing the midnight run itself, though perhaps this is the morning after the midnight run? When the video zooms in, what are we meant to see? Trump gazes downward, is hunched a bit forward as he walks, and he seems to frown, but there is no way for me to tell that this is showing a person who is sick, without the voiceover and tweet urging me to make this association. As in my analysis of similar tactics of illness politics used against Clinton in 2016, I believe that it is crucial that we understand these visual tactics so that we do not fall prey to the spurious message that illness and disability make a person unfit for public office.

Diagnosing by video is not a new political tactic. I first became interested in this phenomenon in 2005 in relation to the use of a videotape provided to the media by the parents of Terri Schiavo as evidence that she was not brain dead. I have written at greater length about the Schiavo case as a “mediatized medical event,”31 but here I simply want to mention some of the ways illness politics operated visually in this case. Although social media was only just emerging at the time, images from the videotape of Schiavo were shown over and over on cable television, often in a constant loop as background to reporting on the story. In another twist, Senator Bill Frist, a former transplant surgeon and at the time presidential candidate, took to the Senate floor to proclaim that Schiavo was not in a persistent vegetative state. His diagnosis was based on his examination of the videotape, not of Schiavo herself. Although he hoped his diagnosis of Schiavo would breathe life into his presidential campaign, Frist was widely criticized for this stunt. Moreover, although there was clearly sympathy for Schiavo’s parents throughout the case, the images of Schiavo on loop did not generate recognition among the public so much as fear of her condition and horror at the media spectacle surrounding it, as the increase in calls to the National Hospice and Palliative Care Organization’s (NHPCO) helpline before and after Schiavo’s death indicated.32

The looping phenomenon has since become standard fare on 24–7 cable news channels. Now with social media, the phenomenon is more condensed and concentrated, and images can circulate even more widely. Looping and other visual techniques direct our attention to something that has been made visible that we too can now see. Look closely. Look again. There it is: Donald Trump mentally and physically declining, Hillary Clinton having a seizure,33 Nancy Pelosi slurring her words,34 Biden suffering from dementia.35

“We’re not doctors,” the Lincoln Project video admits, as it shows an image of Trump’s doctor Harold Bornstein.36 This visual gag plays on the assumption that we can see for ourselves that Bornstein doesn’t look much like a “typical” doctor, visually calling into question his diagnosis of Trump as fit. “But, we’re not blind.” In other words, we are not disabled and thus, we—and now you too—can diagnose Trump. It helps to recall that the verb “to doctor” means both “to restore to good condition” and “to adapt or modify for a desired end.” Diagnosing by gif is a form of doctoring—“to alter deceptively”—because it takes a brief moment out of context that focuses the viewer’s attention on a sign that is then claimed to be symptomatic of a personal problem. This is what we need to see better: Using visual tactics promotes an illness politics that weaponizes weakness and limits our image of what makes a leader. Only when we recognize this, can we begin to counteract the ableism that undergirds and undermines our politics.