In 1978, James Groves, a psychiatrist at Massachusetts General Hospital, published a now classic paper in the New England Journal of Medicine titled “Taking Care of the Hateful Patient.” In it, Groves acknowledged a truth widely, if quietly, known among medical professionals—that some patients are true nightmares. Groves wasn’t referring to the common jerks and complainers. “The fact remains that a few patients kindle aversion, fear, despair or even downright malice in their doctors,” he wrote. He cited the example of an attorney with multiple sclerosis who harangued his doctors and threatened to sue the previous “bastard” who had tried to help him: “He was like Job, who raged, ‘Ye are forgers of lies, ye are all physicians of no value.’ ”
Groves divided these dreaded people into four categories. The “clingers” were “overt in their neediness,” requiring constant explanations, affection, and attention. Even absent any actual ailment, they demonstrated a “self-perception of bottomless need” and saw their physicians as “inexhaustible.” At least they showed gratitude, though, unlike the “manipulative help-rejectors” (a.k.a “crocks”), who constantly replaced one symptom with another and were never more self-satisfied than when the doctor’s diagnosis was wrong. The “self-destructive deniers,” meanwhile, ignored medical advice in a different way; they were the hepatitis patients who still drank heavily, the guys with heart disease who kept “forgetting” their physicians’ warnings not to shovel snow. And then there were the “entitled demanders,” who used “intimidation, devaluation and guilt-induction to place the doctor in the role of the inexhaustible supply depot.” They were like the clingers, but hostile. “The patient may try to control the physician by withholding payment or threatening litigation,” Groves wrote. “Such patients often exude a repulsive sense of innate deservedness as if they were far superior to the physician.”
It’s hard not to see a place in Groves’s schema, maybe more than one, for Donald Trump. As one New York-based psychiatrist, who preferred not to be named, told me recently, “He’s precisely the kind of person who comes for two sessions, doesn’t pay, and is never heard from again.” Of course, we don’t know how Trump interacts in private with the White House physician, Ronny L. Jackson, who, last Friday, administered the President’s first physical examination in office. (Jackson, a rear admiral in the Navy, also oversaw Barack Obama’s physicals and was involved in at least one of George W. Bush’s.) But, if Trump treats Jackson at all like his other advisers, one can’t help feeling sorry for the man. Last Thursday, when asked about the physical, Trump said, “I think it’s going to go well.” He added, “It better go well; otherwise the stock market will not be happy.”
And it did go well, apparently. Speaking at a press conference this afternoon, Jackson reviewed the results of Trump’s exam, which described a man in “excellent” physical health. Shortly before Trump was elected President, he appeared on “The Dr. Oz Show” brandishing a letter from his personal physician stating that he was six feet three and weighed two hundred and thirty-six pounds; that put his body-mass index at 29.5, half a point below what the Centers for Disease Control and Prevention considers obese. (There is some indication that he dodged the “obese” category by falsely adding an inch to his height.) Since then, Trump has gained three pounds, bringing him to within a tenth of a point of official obesity, and his cholesterol level is higher than is ideal. But everything else—cardiac and pulmonary tests, teeth and gums, fasting blood-glucose level—showed “normal” results, Jackson said. “He’s just like every other President I’ve taken care of: on occasion, I have to get the First Lady involved to make sure that he’s doing what he’s supposed to be doing.”
Of course, the Presidential physical has always been more performative than informative, at least where the public is concerned. We’ve learned a few things about our leaders over the years: George W. Bush got scraped up more than once after falling off his bicycle; Obama gained weight his first year in office and smoked the occasional cigarette; Bill Clinton suffered from gastric reflux and received allergy shots every ten days, according to the results of his final physical. Today, we learned that the President takes Crestor to control his cholesterol and Propecia to manage his hair situation, that he sleeps just four to five hours a night, and that he does not wear dentures. “He has a lot of energy, a lot of stamina,” Jackson said.
The seeming normalcy of the results came as something of a surprise, given what we know about Trump’s life style, which bears all the marks of a man wholly uninterested in heeding anyone other than himself. Elected at age seventy, Trump was the oldest President to enter office and the heaviest in decades. His diet famously consists of fast food, red meat, ice cream, and a dozen Diet Cokes a day. (In April, the Associated Press reported that there is a red button on Trump’s desk, the “butler button,” which he often uses to summon a Coke; like that other Presidential button, the nuclear football, it is portable.) Obama exercised daily—aerobics, basketball, resistance training. Bush ran regularly, bicycled, and cross-trained with swimming, free weights, and an elliptical. Trump, who has said that exercise is bad for people—he once claimed that the body is like a battery, with a finite amount of energy—has no fitness regimen whatsoever. Last May, at the G-7 summit, in Sicily, he took a golf cart several hundred yards while other leaders walked. “It says to me that he is in horrible shape and he knows it,” Jack O’Donnell, a former Trump casino executive and triathlete, told Politico. “He’d walk if he could, but he knows he can’t keep up with the group, so he rides the cart instead.” Jackson, pressed on the incongruous results, insisted that “there’s absolutely nothing I’m withholding” and then punted to biology. “It’s called genetics,” he said. “Some people just have great genes.”
Jackson further surprised the press pool by noting that he had given Trump a quick cognitive exam—the Montreal Cognitive Assessment, which looks for early signs of dementia and Alzheimer’s—and that the President had scored a perfect thirty out of thirty. Jackson had done this, he said, not out of any clinical concern but rather at Trump’s behest, perhaps because the White House was looking to quell the recent wave of concern about the President’s mental fitness. In December, Trump slurred several words at the end of a speech on Jerusalem; last week, he seemed to forget the words to the national anthem and, during a meeting about immigration policy, had to be reminded what his official position was. Jackson appeared to take partial blame for the slurred-speech incident—he had prescribed the President Sudafed, he said, which may have “inadvertently dried up his secretions”—but he was adamant that Trump is as sharp as ever.
At this point, it’s difficult to imagine any medical condition that would disqualify Trump, short of death or a coma. If the question is whether he is fit to serve as President, the answer, it seems, is that he’s no less fit than he ever was. The real issue is that he’s barely serving as it is. Cocooned in his residence for hours a day, watching TV and tweeting and talking on the phone—what the White House calls “executive time”—Trump appears to have divorced himself from any real engagement with policy or governance. With every passing day, he seems to venture farther into the echo chamber of himself, enabled by the people around him. The President, more than any other individual in American government, embodies the national will; his body is the body politic, and Trump very obviously cares for neither.
We the people now find ourselves in the awkward role of doctor, trying to handle a patient who simultaneously needs, despises, and ignores us. Groves wrote his 1978 paper in no small part to help relieve physicians of the anxiety, anger, self-doubt, shame, fear, and depression that their “hateful” clients can induce. What these patients want, he emphasized—“an undivorceable marriage with an inexhaustible caregiver”—cannot realistically be provided. That may be good advice for Jackson, who is free to pack his medical kit and go. For the rest of us, it’s till death, 2020, or the Twenty-fifth Amendment do us part.
