On the morning of October 27th, Robert Bowers murdered 11 worshippers at the Tree of Life Congregation in Pittsburgh, Pennsylvania. While in a firefight with police, he unloaded anti-Semitic rants to explain his crime.
Twelve hours later, at a campaign rally in Murphysboro, Illinois, President Donald Trump described Bowers as “sick,” evil,” and — notably — “demented.” By lumping those descriptions together, Trump not only willingly perpetuates a falsehood, but also further stigmatizes those currently living with dementia.
Just four days prior to the murders in Pittsburgh, retired Supreme Court Justice Sandra Day O’Connor announced in a letter that she has dementia: “Some time ago, doctors diagnosed me with the beginning stages of dementia, probably Alzheimer’s disease.”
O’Connor’s announcement, like President Ronald Reagan’s 1994 letter to the nation about his own diagnosis, is an act of bravery. Dementia is an emotionally charged diagnostic label that people do not share as readily as they do a diagnosis of cancer or a heart attack. Many delay seeking help because of these emotions. Persons with memory problems, as well as their concerned loved ones, worry about the harms of the “dementia” and “Alzheimer’s disease” labels. They have reason to.
Dementia describes a condition in which an adult has progressive losses in cognitive abilities, such as memory and executive function, often accompanied by behavioral changes such as apathy, anxiety, and disinhibition. These losses cause the person to suffer disabilities performing usual and everyday activities such as managing money, cooking, and traveling. A person with dementia typically needs a caregiver to assist with these activities.
In the U.S., the most common disease that causes dementia is Alzheimer’s disease. The number of persons is estimated in to be as many as 5 million. Other causes include, for example, vascular disease, Parkinson’s disease, and HIV infection.
Alzheimer’s is among the most feared diseases, a fear sustained by lurid metaphors, such as “death before death,” and “a demon that attacks the brain.” These metaphors stoke fear and disgust, which in turn cause stigma. Stigma degrades the person’s quality of life and dignity. My patients and their caregivers tell me how friends and family distance themselves. Rather than face this isolation, they delay seeking a diagnosis and so care. After they do finally receive a diagnosis, they often, like O’Connor, retire from public life. Among the ways to counter this stigma, is to talk like adults about dementia. Describing terrorists and mass murderers as demented is not helpful.
Trump routinely uses “demented” to describe the perpetrators of mass murderers and terrorist acts.
The gunman who murdered concert-goers in Las Vegas: “a very demented person.” At a cabinet meeting he speculated about the murderer’s neuroanatomy: “He was a demented, sick individual. The wires were crossed pretty badly in his brain — extremely badly in his brain.”
In a March 2016 speech to the American Israel Public Affairs Committee, he reflected about Iranian missiles with anti-Israel slogans: “What kind of demented minds write that in Hebrew?”
“Sick and demented” was his assessment of the September 2017 London terrorist attackers and following the August 2016 Pulse Nightclub shooting in Florida.
Dementia is a medical diagnosis. Until Bowers has a medical exam to assess his cognitive and behavioral health, we should assume he’s cognitively healthy.
Trump’s use of the term to describe terrorists and mass murderers inflames the stigma of dementia. It frustrates our National Alzheimer’s Plan’s strategy to maintain the dignity of persons with Alzheimer’s disease. It is insulting to people like Justice O’Connor, Glenn Campbell, Coach Pat Summitt, and others who have spoken up and out about their diagnosis.
It is also repeating a factually inaccurate belief that persons with dementia are inherently “irrational,” even criminal in their behavior. This false medicalized explanation for mass murder and terror obfuscates the cruel, deliberate rationale people like Bowers use to justify their willful acts of terror. Bowers’ social media posts were litanies of anti-Semitic rhetoric and conspiracies. Just prior to his murders, he accused Jews of supporting Latin American refugees seeking asylum in the U.S.
It is true that some persons with dementia have impairments in their ability to make a decision, and these impairments can be severe enough that the person makes bad decisions. It is simply not true that the diagnosis of dementia equates with irrational decisions or violent acts.
Words matter. Trump’s description of Bowers as “demented” is the latest in his repeated misuse of the term. It confounds our civic responsibility to call people like Bowers what they are: mass murderers and terrorists who commit deliberate and intentional acts. It is also an insult to patients and their families.
Jason Karlawish is a Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania.