Biden's Mental State: What the Experts Are Saying

As the candidates and the public prepare for tonight's presidential debate in Cleveland, Joe Biden's mental state and alleged proneness to gaffes continue to be the topic of much discussion.

In recent months Donald Trump has called Biden “Sleepy Joe” and termed his Democratic opponent just plain “stupid.” After taking the Montreal Cognitive Assessment (a screening test for dementia), Trump said: “Joe should take that test, because something’s going on … We can’t have somebody that’s not 100%.”

Biden, he said, “is not going to be running the government. He’s just going to be in a home someplace.”

Trump’s son Eric has appeared on Fox News to make a similar point. Biden, he said, “doesn’t have the mental capacity to be commander-in-chief of this country.”

But it is hard to find a psychiatrist or psychologist who has commented on the Democratic nominee in the media. Is psychological comment merely partisanship in professional disguise?

For years it has been known that psychiatrists tend to vote Democratic. In 1968, for example, President Lyndon Johnson’s pollster noted that doctors were overwhelmingly Republican—“except for psychiatrists.” As of 1964, as Johnson’s men noted, psychiatrists had polled Democratic by a margin of 67% to 33%.

One can, it is true, find a rare moment where a medical professional discusses Biden. In August of 2020, host Sean Hannity of Fox News expressed concern about the apparent confusion, fatigue, rapid aging, and cognitive changes he said he could see in Biden. Hannity turned to Dr. Marc Siegel, a Fox medical correspondent and clinical professor at NYU Langone Medical Center in New York.

Siegel, who is an internist rather than a psychiatrist, declined to diagnose Biden’s cognitive status from a distance. But he did mention several known medical issues and risks in Biden’s history: his age, his history of a brain aneurysm and repair in 1988, and his reported atrial fibrillation and anticoagulation. Siegel suggested that these issues increase Biden’s risk of small, silent strokes.

Siegel said he was “concerned” about Biden and recommended testing. “It’s right to have an assessment.”

Siegel then said he had spent an hour with President Trump and found him to be “very cognitively advanced.” It is unclear what Siegel’s party affiliation is, if any.

Meanwhile Bandy Lee, the Yale psychiatrist who is a leader in the movement to assert that Trump is dangerous, has repeatedly called for a psychiatric evaluation of Trump. But she has declined to comment on Biden.

She only comments, Lee explained, “on matters serious enough to affect public health.”

Outside the glare of the media, one can turn to the groves of academe for careful study of Biden's personality. Anne Marie Griebie and psychologist Aubrey Immelman of the College of St. Benedict and St. John’s University have recently conducted an empirical study of Biden’s public personality. Their Biden profile is the latest in a long and systematic series of at-a-distance evaluations of presidential candidates conducted by Immelman’s group since the 1990s.

Griebie and Immelman assembled open-source material on Biden, then conducted empirical ratings of his personality using the Millon Inventory of Diagnostic Criteria (MIDC). The MIDC’s personality typology is related to, although not identical to, the DSM system.

The results? Biden’s personality, the researchers found, is predominantly outgoing/gregarious, with lesser features of accommodating/cooperative and ambitious. The leadership of individuals who have this profile has an interpersonal focus that involves “flexibility, compromise, and an emphasis on teamwork.”

Their point has some echoes in Jules Witcover's thorough and admiring biography of Biden. There, the candidate is described as strikingly "garrulous" and empathic over many years, often reaching out to others in times of tragedy and loss even as he aimed repeatedly for the presidency.

Griebe and Immelman believe his gregarious and accommodating personality style may make Biden vulnerable to “manipulation by pressure groups” and may make negotiations with world leaders difficult.

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In some ways, the group’s evaluation of Biden resembles their past findings about Barack Obama, whom they found also showed accommodating traits. Before Obama’s election, Immelman expressed concern about whether Obama was tough enough to succeed in the presidency.

The group sees Kamala Harris, Biden’s choice for vice president, as dominant/asserting, with elements of ambitious/confident and outgoing/congenial. This kaleidoscope of traits adds up to a style that the group sees as “high dominance charismatic.” It is not clear how Immelman believes a candidate with such a personality will get along with the outgoing and accommodating Biden.

And Donald Trump? Immelman’s group sees him as “ambitious/exploitative”—that means narcissistic, they explain—and also outgoing/impulsive. This is an unusual combination, one they have not found in the 2020 Democratic nominees.

Can Biden defeat Trump in 2020? Mental health professionals have a poor track record of predicting adverse events in their patients, let alone election results involving candidates they have never met. But Immelman and colleagues have developed an empirical instrument they call the “Personal Electability Index” (PEI).

The PEI, has predicted correctly—“before Super Tuesday,” no less—"the outcome of every presidential election since 1996.”

The PEI uses ratings of personality traits, “as publicly perceived,” to predict each candidate’s appeal to independent voters. Independents allegedly base their decisions on personality more than politics—and are said to favor outgoing, confident, and dominant candidates while disliking those who are introverted and overconscientious. (Such candidates tend to have trouble connecting with people during the campaign.)

In March 2016, while polls heavily favored Hillary Clinton, the PEI calmly predicted she would lose to Donald Trump.

What does all this mean for the 2020 election? Last year Immelman’s group used the PEI to assess the candidates’ personality traits, comparing Trump with all of the Democratic primary candidates, including Biden and Harris. The PEI predicted that Biden’s outgoing personality would lead him to surpass all of the other candidates in the Democratic primary race.

And according to the PEI, Donald Trump will win in November 2020.

Claims of infallibility for the PEI, of course, should be taken with a grain of salt. As described, its value rests on a set of very changeable assumptions. And there have been only six elections since 1996, making its sample size extremely small and its track record a very thin basis for prediction. Still, as predictions go, it at least appears to have some empirical foundation.

Presidential candidates, no matter how accommodating or conciliatory, are unlikely to concede a year before an election because of a research finding by a psychologist. In our system, it is, finally, up to the voters and not to the mental health professionals to decide.

So what’s a voter to do?

Psychological formulations by experts can be seductive. But as the philosopher and psychoanalyst Jonathan Lear has cautioned, diagnosing a president psychologically can often serve as a defense against “trying to understand the larger historical context in which the president has operated and succeeded.”

There is no substitute for listening to candidates and learning about their positions on questions of the day.

Reading a well-researched biography can provide a deep and textured understanding of a candidate and his life—including how he or she has developed over time and in a political context. Readers interested in learning more about Biden might try Witcover’s Joe Biden: A Life of Trial and Redemption, which explores multiple episodes of loss and persistence in Biden’s life. David Maraniss’s First in His Class and David Remnick’s The Bridge offer the reader similarly exhaustive, though more independent and critical, takes on the lives and careers of Bill Clinton and Barack Obama respectively.

With this kind of information in hand, readers may be well prepared to deal with one of the concerns that our country’s founders had about the republic they were founding. John Adams, Thomas Jefferson, and James Madison were preoccupied with examples from history and often worried about the tendency of republics to degenerate into demagoguery and then into tyranny.

Madison, more than anyone else the architect of our Constitution, believed that an educated public is essential to maintaining the health of a republic. “A popular Government, without popular information, or the means of acquiring it,” he said, “is but a Prologue to a Farce or a Tragedy.”

A people “who mean to be their own Governors," said Madison, "must arm themselves with the power which knowledge gives.”