WE ELECTED GRANDPAS
And Then Acted Shocked When They Acted Like Grandpas
A few years ago, it seemed as though half the country had suddenly enrolled in medical school and earned their internet-MDs. Millions of Americans became amateur neurologists; scrutinizing Joe Biden’s every movement with the intensity of residents preparing for board examinations. Every stumble was clipped, replayed, enlarged, and distributed. Every verbal slip became evidence. Every pause became evidence. Every moment of confusion became evidence. Social media transformed itself into the largest memory clinic in human history.
What fascinated me wasn’t that people were paying attention. Joe Biden was the President of the United States. His health mattered. His cognition mattered. His ability to perform one of the most demanding jobs on earth mattered. What fascinated me was the shock. Americans reacted as though they had just discovered that aging existed.
As a psychiatrist, I have some version of this conversation almost every week. A family member arrives worried that Dad keeps repeating stories. Another notices that Mom falls asleep halfway through television shows she insisted she wanted to watch. Someone else reports that Grandpa now wakes up at four in the morning and reorganizes the garage because apparently that’s when screws and extension cords become most interesting. Everyone looks at me expectantly, waiting for a diagnosis.
Sometimes there is one. Sometimes it’s Alzheimer’s disease. Sometimes it’s depression. Sometimes it’s hearing loss. And sometimes the diagnosis is simply that an eighty-five-year-old has begun acting like an eighty-five-year-old.
The uncomfortable reality is that aging is not a pathology, a character flaw, or evidence of moral weakness. It is simply what happens when the alternative does not. Yet Americans seemed almost personally offended that an octogenarian might display characteristics associated with being an octogenarian. We elected someone who qualified for Social Security, Medicare, senior discounts at Denny’s, and probably an AARP tote bag, then spent years wondering why he occasionally behaved like someone who qualified for Social Security, Medicare, senior discounts at Denny’s, and an AARP tote bag.• Age of Joe Biden when he left office: 82¹
• Average age of the first ten U.S. presidents: 57²
• Americans over age 65 in 1960: 9%³
• Americans over age 65 today: nearly 18%³
As Mark Twain reportedly observed, “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.” That is a wonderful line unless you’re running for president, in which case Americans suddenly mind very much.
Then Biden exited center stage. Donald Trump remained. What happened next was fascinating. The conversation about age, cognition, judgment, and decline didn’t disappear.
It simply changed jerseys.
The Trump Exception
I have never interviewed Donald Trump. I have never reviewed his medical records. I have never administered a cognitive examination. Whatever conclusions I may draw about his public behavior remain observations rather than diagnoses.
That distinction matters because Americans have become extraordinarily comfortable diagnosing public figures from a distance. Somewhere along the way, we collectively decided that a smartphone, a social media account, and a Wi-Fi connection were roughly equivalent to medical training.
Trump presents a fascinating challenge because nearly every criticism directed at him exists simultaneously in two different realities. To some observers, he is obviously declining. To others, he is obviously thriving. To some, he displays signs of dementia. To others, he displays the same personality that made him famous decades ago. To some, his public statements demonstrate disorganization. To others, they demonstrate authenticity.
The longer I watch these debates unfold, the more I think of Joan Didion (writer), who observed, “We tell ourselves stories in order to live.” Politics increasingly feels like a competition between stories. Americans are often looking at the same speech, interview, or event and constructing entirely different realities around what they have witnessed.
Psychiatry runs into a frustrating problem here. To identify decline, one must establish change. To establish change, one needs a baseline. Donald Trump may be one of the most difficult public figures in modern history from whom to establish one. He was promoting himself forty years ago. He was attaching his name to things forty years ago. He was making outrageous claims forty years ago. He was making critics furious forty years ago.
If someone has spent half a century acting like Donald Trump, determining whether Donald Trump has become more Donald Trump becomes surprisingly complicated.
As Yogi Berra said, “It’s tough to make predictions, especially about the future.” It’s also tough to diagnose decline when the baseline already resembles performance art.
The Diagnoses We Keep Reaching For
Before long, every conversation about Trump arrives at the same destination. Someone asks whether he is a narcissist. Someone asks whether he has dementia. Someone proposes Frontotemporal Dementia. Someone else brings up sociopathy or psychopathy. Somewhere online, a man whose profile picture contains an American flag, wraparound sunglasses, and a pickup truck is diagnosing tertiary syphilis from a photograph taken at an airport.
What strikes me isn’t the diagnoses themselves. It’s how desperately people seem to want one.
Diagnosis is comforting because uncertainty is exhausting. Human beings would often rather have the wrong answer than no answer at all. Faced with ambiguity, many of us react the way medieval peasants reacted to eclipses. We immediately start inventing explanations. Once we have a label, we feel as though we understand the person. The diagnosis becomes the explanation. The explanation becomes the story. The story becomes reality.
Psychiatry, unfortunately, is rarely that tidy.
The diagnosis most commonly proposed is probably narcissism. Actual pathological narcissism involves grandiosity, entitlement, hypersensitivity to criticism, a need for admiration, and difficulty appreciating the experiences of other people. Trump’s critics frequently argue that he embodies these traits. His supporters often argue that what critics call narcissism is actually confidence, resilience, charisma, or political effectiveness.
What fascinates me is that both groups are often looking at exactly the same behavior. One observer sees arrogance while another sees strength. One sees insecurity while another sees confidence. One sees pathology while another sees leadership.
The behavior remains unchanged. The observer changes. It is the political equivalent of those internet arguments about whether a dress was blue and black or white and gold. Half the country sees narcissism. Half the country sees leadership. Everyone is convinced the other half needs corrective lenses.
As Friedrich Nietzsche wrote, “There are no facts, only interpretations.” That’s probably an overstatement. Facts certainly exist. But after ten minutes on social media, you begin to understand how he got there.
Then there is Frontotemporal Dementia, or FTD. Unlike Alzheimer’s disease, which often begins with memory loss, FTD frequently begins with changes in personality, empathy, judgment, impulse control, and social behavior. Critics point to those symptoms when discussing Trump. Supporters often respond with a version of the same argument: “He’s always been that way.”
In some ways, the debate reminds me of something Maya Angelou (writer and poet) once said: “When someone shows you who they are, believe them the first time.” Whether one agrees or disagrees, the statement highlights psychiatry’s central challenge. Before we can identify change, we must know who someone was to begin with.
• Americans who report disliking narcissistic traits in others: overwhelming majorities
• Americans who enjoy admiration themselves: also, overwhelming majorities
• Politicians throughout history who preferred criticism to praise: approximately none
The Night Shift President
One of the recurring observations about Trump concerns sleep. Americans have watched him appear sleepy during public events, legal proceedings, and interviews. At the same time, reports describe a man who remains highly active late into the evening making calls, posting online, watching television, and engaging in political combat while most of the country is asleep.
For some observers, this is evidence of dementia. They may be right. They may also be completely wrong.
Sleep-wake reversal can occur in dementia. It can also occur in sleep apnea, anxiety, depression, obesity, being a teen-aged boy in America, stress, insomnia, aging, excessive caffeine consumption, or spending six consecutive hours arguing with strangers online about tariffs, windmills, or pronouns.
The internet prefers dramatic explanations. Medicine usually prefers boring ones. If a politician falls asleep for thirty seconds, the internet will diagnose dementia, Parkinson’s disease, a secret stroke, alien mind control, and possibly lizard DNA before lunch.
As Sigmund Freud reportedly remarked, “Sometimes a cigar is just a cigar.”
Sometimes a sleepy eighty-year-old is simply a sleepy eighty-year-old. This may be the least satisfying explanation medicine has ever produced, which is probably why nobody likes it.
Is Corruption A Symptom?
Trump’s critics frequently point to what they perceive as self-dealing, self-promotion, conflicts of interest, and an apparent willingness to place personal interests above institutional norms. Some ask whether these behaviors represent psychopathology.
The uncomfortable answer is that greed is not a diagnosis. Vanity is not a diagnosis. Self-interest is not a diagnosis. If selfishness were a mental illness, psychiatry would need stadiums.
As Robert Sapolsky (neuroscientist) has written, “A behavior can be simultaneously understandable and unacceptable.” Understanding behavior is not the same thing as excusing it. Explaining behavior is not the same thing as endorsing it. Yet Americans increasingly demand that every explanation become either a defense or an attack. Psychiatry rarely cooperates with that demand.
The Tribe Always Comes First
One of the most useful concepts I’ve encountered comes from Jonathan Haidt (social psychologist), who wrote, “The emotional tail wags the rational dog.” In other words, we often decide first and reason later.
Republicans spent years pointing to Biden’s age, memory lapses, verbal mistakes, and physical frailty. Democrats frequently argued those concerns were exaggerated. Now the roles have largely reversed. The scripts barely changed. Only the actors did. The same people who spent years insisting age didn’t matter are now explaining why age matters very much. Meanwhile, many of the people who spent years insisting age mattered very much are now explaining why age is basically a social construct. If nothing else, American politics demonstrates an astonishing degree of flexibility.
This may be why I keep returning to Rebecca Solnit (writer and historian), who wrote, “Certainty is a closing of the mind.” Certainty feels wonderful. It removes ambiguity. It reduces anxiety. It allows us to stop questioning ourselves. Unfortunately, it also allows us to stop questioning our assumptions.
The more I listen to both sides, the more they sound like mirror images of one another. Each group believes the evidence is obvious. Each group believes the other side is blinded by ideology. Each group sees itself as objective and the opposition as irrational.
The symmetry is almost beautiful. If aliens landed tomorrow and studied American politics, they would probably conclude that both tribes are running the same software with different bumper stickers.
Perhaps that is why I find myself thinking of Brené Brown (researcher and author), who wrote, “People are hard to hate close up. Move in.” Political tribes increasingly encourage distance. Distance makes caricature easier. Distance makes certainty easier. Distance makes contempt easier. And contempt, unlike curiosity, is remarkably easy to maintain.
The Geriatric Republic
The longer I sit with these questions, the less interested I become in diagnosing Donald Trump or Joe Biden and the more interested I become in diagnosing the expectations of the people observing them.
For decades, America has drifted toward what can only be described as a gerontocracy. Congress is old. Party leadership is old. Presidential candidates are old. Then we somehow become surprised when aging appears. We elect elderly leaders and become shocked when they repeat themselves. We elect elderly leaders and become shocked when they repeat themselves. We elect elderly leaders and become shocked when they take naps. We elect elderly leaders and become shocked when they become preoccupied with legacy. We elect elderly leaders and become shocked when they dislike change. We elect elderly leaders and become shocked when they complain about younger generations. At some point we’re going to elect a ninety-year-old president and then hold emergency congressional hearings because he accidentally called the remote control “the clicker.”
What exactly were we expecting? George Clooney with a Senate voting record?
Listening to these debates sometimes feels like watching someone buy a golden retriever and then become furious when it sheds.
As Atul Gawande (surgeon and author) wrote, “Our ultimate goal, after all, is not a good death but a good life to the very end.” Aging changes priorities. People become increasingly concerned with meaning, identity, legacy, and how they will be remembered. Politicians may be especially vulnerable to this because history is literally part of their job description.
The Real Diagnosis
The longer I practice psychiatry, the more suspicious I become of certainty.
As Americans retreat further into separate information ecosystems, I increasingly find myself thinking about Hannah Arendt (political philosopher), who wrote:
“The ideal subject of totalitarian rule is not the convinced Nazi or the convinced Communist, but people for whom the distinction between fact and fiction no longer exists.”
Arendt was writing about something far larger than contemporary American politics. Yet her observation feels increasingly relevant. We often no longer begin with shared facts and argue about their meaning. We begin with entirely different realities and then wonder why conversation feels impossible.
As Daniel Kahneman (psychologist and Nobel laureate) observed, “We can be blind to the obvious, and we are also blind to our blindness.”
That line should probably be engraved above every cable news studio entrance.
The truth may be that Biden displayed age-related changes that some people minimized and others exaggerated. The truth may be that Trump displays age-related changes that some people minimize and others exaggerate. The truth may be that both men became giant psychological inkblots onto which Americans projected their fears, hopes, frustrations, and tribal loyalties.
The longer I sit with these questions, the less interested I become in diagnosing politicians and the more interested I become in diagnosing expectations. The psychiatrist in me finds all of this fascinating. The citizen in me finds it concerning. The public-health guy in me finds it entirely predictable. The comedian in me can’t stop laughing.
After all, we built a gerontocracy. We selected leaders from one of the oldest generations available, then spent years expressing shock when they displayed characteristics associated with advanced age. We elected grandfathers and then devoted an entire decade to wondering why they acted like grandfathers. Then we spend years arguing about who should be unlucky enough to try taking away the car keys.
And if history is any guide, we’ll probably do it again.
Because nothing seems to unite Americans quite like repeatedly touching the same hot stove and then acting surprised that it’s still hot. The entire debate increasingly sounds less like politics and more like a family meeting that nobody wanted to attend.
Sources
U.S. National Archives. Ages of U.S. Presidents at Inauguration and Departure from Office. Presidential historical records.
Pew Research Center. “The Aging of America’s Political Leadership.” Washington, DC. Various reports, 2023-2025.
United States Census Bureau. Older People Projected to Outnumber Children for First Time in U.S. History. Washington, DC, 2023.
National Institute on Aging. Aging and Sleep: Understanding Changes in Sleep Patterns with Age. Bethesda, MD. Accessed June 2026.
U.S. Bureau of Labor Statistics. Labor Force Participation and Retirement Trends Among Older Americans. Washington, DC, 2024.
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