This report examines the allegations that Presidents Joe Biden and Donald Trump exhibited “mad” or erratic behavior during their tenures, juxtaposing critiques of Biden’s purported cognitive decline with analyses of Trump’s psychological fitness. For President Biden, multiple journalists and aides have raised concerns about his verbal slips, memory lapses, and debate performance, suggesting a disconnect between his public persona of wisdom and underlying mental frailty. In contrast, Trump’s presidency has been characterized by mental-health professionals and family members as emblematic of severe personality disorders marked by narcissism, impulsivity, and potential cognitive impairment, leading some experts to warn of a clear and present danger to American democracy. This report lays out the primary criticisms leveled against each president, assesses the evidence put forward, and contextualizes the broader implications for leadership and public trust.
Joe Biden: “Mad” Under a Guise of Wisdom
Verbal Slips and Public Gaffes
Journalists have documented an uptick in Biden’s verbal missteps, noting sentences left unfinished and incoherent pauses that critics argue go beyond the occasional presidential gaffe. At the 2025 White House Correspondents’ Dinner, Axios reporter Alex Thompson criticized the administration and the press for “covering up” these slips, arguing that the public was misled about Biden’s true mental state.
Debate Performance and Internal Concerns
Biden’s poor showing in the June 2024 presidential debate against Donald Trump heightened internal alarm among aides and Democratic leaders, prompting questions about his capacity to serve a second term. According to Chris Whipple’s recent book Uncharted, key administration insiders privately described Biden as disengaged and overly reliant on staff for basic communications.
Special Counsel Report on Memory
A Department of Justice special counsel report noted that Biden’s memory appeared “hazy” and “poor,” suggesting limitations that could impact his performance under pressure and corroborating public perceptions of diminished cognitive acuity .
Donald Trump: “Mad” by Definition
Psychiatric Assessments and the Goldwater Rule
Over two dozen mental-health professionals contributed to The Dangerous Case of Donald Trump, concluding that Trump exhibits traits consistent with narcissistic personality disorder, sociopathy, and other pathologies that “pose a clear and present danger” to the nation . This collective assessment represents an unprecedented breach of the American Psychiatric Association’s Goldwater Rule, justified by authors as a “duty to warn”.
Malignant Narcissism and Public Warnings
In December 2024, a full-page New York Times advertisement signed by 225 psychiatrists labeled Trump as suffering from “malignant narcissism,” characterized by “a lack of empathy, manipulation, and joy in inflicting suffering,” and warned that his presidency threatened democratic institutions.
Erratic Public Behavior
Critics highlight Trump’s inflammatory speeches, impulsive policy announcements, and refusal to adhere to factual constraints as evidence of deeper mental instability. Commentators have likened his rallies to “disturbing spectacles” that echo historical authoritarian movements and argue that his behavior catalyzes collective irrationality in the electorate .
Family Concerns Over Cognitive Health
Fred C. Trump III, the former president’s nephew, publicly compared Donald Trump’s recent confusion and disorientation to their grandfather’s Alzheimer’s decline, underscoring worries about underlying cognitive impairment within the Trump family .
Psychological Profiles and NPD Diagnosis
Beyond anecdotal accounts, specialist publications detail how Trump’s conduct aligns with the DSM-5 criteria for Narcissistic Personality Disorder (NPD), including grandiosity, need for admiration, and exploitative tendencies, reinforcing claims of inherent “madness” .
Implications and Conclusions
The scrutiny faced by both presidents underscores a growing expectation that leaders not only project strength but must demonstrably maintain mental acuity. For Biden, the narrative of a “wise elder statesman” has been challenged by tangible signs of cognitive decline, fueling debates about age and capacity. Trump’s case, meanwhile, presents a more overt clash between professional psychiatric warnings and political normalization of erratic behavior. In both instances, the erosion of public trust in presidential competence carries significant ramifications for governance, media accountability, and democratic resilience.