Trump’s Five Stages of Grief

In my last column, I discussed the battleground state pilgrimages my cousin and I made during previous presidential elections and why my patients’ need for the protections of the Affordable Care Act led us to Get Out The Vote in Arizona. Unfortunately, coronavirus restrictions kept us at home. Instead, we transformed my home into an intense phone banking operation for the run up to the election. Our many calls to voters in Georgia, Pennsylvania and elsewhere contributed to the 88 million calls made by 103,000 volunteers. In the key state of Pennsylvania, 14.3 million calls helped the ticket to an 81,000-vote margin of victory.

Trump’s impending departure offers my patients and the millions of others hope that their healthcare access through the Affordable Care Act (ACA) will be protected. But the early days of the interregnum have not gone as well for President Trump. Although I celebrated the election outcome with like-minded friends, I felt a touch of sympathy for Trump, as well. In deep blue circles like mine, such sentiments are best not expressed. Whatever else he is, Trump is a fellow human being clearly going through a tough time. Trump doesn’t have much personal experience with losing. The term “loser” is one of his strongest attack words, and his contempt when using it goes far to explain his difficulty in accepting his loss in the election.

But as a physician, I can’t help but note that Trump’s response to the loss recalls the stages of mourning once described by Dr. Elizabeth Kubler-Ross: denial, bargaining, anger, depression and acceptance. His refusal to acknowledge the electoral math fits the denial stage, evidenced by his all-caps tweets on November 7 that he “WON THE ELECTION” and that “BAD THINGS HAPPENED WHICH OUR OBSERVERS WERE NOT ALLOWED TO SEE.” Trump’s aides and allies also feed this denialism — Secretary of State Pompeo’s indulgence, expressed by his anticipation of “a smooth transition to a second Trump term” long after the networks called the election for Biden, stood out for fantasy mongering inconsistent with the dignity and traditions of the State Department.

Trump’s deployment of legions of lawyers to challenge legitimate election practices in multiple states fits the bargaining stage of the Kubler-Ross paradigm. Biden won the critical states with margins comparable or greater than those Trump had secured in 2016. Biden’s margin in the key swing state of Pennsylvania, for example, is nearly two times that of Trump’s in 2016. The legal attempts to “bargain” his way out of a loss also resemble Trump’s modus operandi in his business career: whether in bankruptcy or other contentious matters, Trump’s lawyers would mitigate his losses or turn them into victories. Unfortunately for Trump’s equanimity, American political processes are non-negotiable. Despite recounts and challenges, the voters ultimately speak with finality.

Far from being a new behavior, denial is a standard Trump administration approach to what Al Gore once labeled the “inconvenient truth.” Whether the facts involved global warming, the character of leaders like Vladimir Putin or Kim Jong-Un or the coronavirus pandemic, if Trump didn’t like the facts, he simply stonewalled. On coronavirus, Trump realized early on that the epidemic threatened his re-election. Rather than press on public health measures to contain the spread, Trump chose to deny the realities of the pandemic, claiming that it would go away when warm weather arrived and falsely equating its severity with seasonal flu. Throughout the election campaign, he acted as though acknowledging the need for inconveniences like mask-wearing would break the illusion that the virus was merely a distraction rather than a serious threat to “making America great again.”

If Trump didn’t like the facts, he simply stonewalled.

As the president continues to navigate the Kubler-Ross stages, anger may lead to more petulant firings, like those of Defense Secretary Mark Esper and Chris Krebs, the nation’s top cybersecurity official. Depression may cause him to withdraw from the limelight and (thankfully) reduce the volume of tweets. Hopefully the president and his supporters will eventually consider the electoral numbers and reach the stage of acceptance.

For my patients and for the rest of Americans, despite the disturbances posed by the pandemic, the improved security of healthcare and imminent end of governing by denial offers reason enough for true celebration at this year’s Thanksgiving table.

Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.