I treated a judge for forty years who had fronto-temporal dementia. [View all]

He lived into his late 90’s and was an extremely well-respected and politically powerful judge and then Senior Judge in Philadelphia Common Pleas Court. I am not speaking “out of school“, he is deceased and his entire first-degree family is as well with the exception of one estranged daughter who woukd welcome the exposition of her progressively insane father.

In the early 1980s he was referred to me for dental treatment. He had apparently “fired” his previous dentist and was looking for a new one. He had moderate dental issues at that time, but was aggressively refusing treatment by his Periodontist and was very angry that he had been diagnosed with any chronic deteriorating condition at all. He was a large, powerful man, who spoke in absolutes, and whose mood could change on a dime. I cannot tell you how many times we would be having a civil discussion, I would make some offhand comment about something fairly innocuous, and he would absolutely go, for want of a better word, bullshit. It would take me many minutes to calm him down after I had apparently straightened out my comment to him, if I could even do that.

As he got older, of course, since he had refused treatment, his dental condition deteriorated dramatically, and it was a cyclical thing because he became angrier and angrier, and was ultimately blaming me or his previous dentist. Now before I go further, I want to answer those people who are saying that I should just have dismissed him from my practice. This was impossible. This was not going to happen. If he left me, that would be his decision and that would’ve been fine, but he had this very peculiar allegiance to me, almost the way an abusive parent “loves“ his or her children.

Anything and everything became very big deal and his fuse was shorter than ever. An hour with him, felt like one of those fever dreams that you have when you’re sick and you’re just pissing into the wind, trying to make sense of things. In addition to his dental issues, he would make inappropriate comments to the female staff, which were provocative to say the least, but they actually took it rather well because they were afraid of him too and too naive to under stand their meanings. I was made to understand that when he would go for a haircut at his salon, he would disrobe from the waist up, which I am certain was not a pretty sight. The owner had made a mistake of asking him not to do that and all hell rained down upon him. The judge actually threatened to exercise his powers, call the police and have the owner detained and held by the sheriff at the judges discretion. Believe it or not this is sort of legal in Philadelphia. Don’t ask …

He was fairly well to do and would play financial games with his children, his ex-wife, and his present wife, and everybody was on tenterhooks, trying to stay on his good side. He would bark at anyone, whether it be in a restaurant, in a concert hall, in a taxi cab, or just on the street. He was really a frightening individual and wheeled a great deal of influence and power, and there was nothing anybody could say or do to get through to him.

Finally, in his mid 90s, he needed to be committed to a assisted-living facility and according to his daughter, began assaulting, sexually, the employees there, including, but not limited to, the men. At the request of his wife, I went to see him just before he passed away to adjust his denture, and he was totally completely out of control and had a look of rage behind his eyes, which, even at his worst, I had never seen before.

If someone told me that the staff did him in, it would not surprise me in the least.

The point of me posting this is that I spent probably 25 years of my practice, living in low-grade fear that I would receive a phone call from him, often at home with demands which were extremely difficult to satisfy and waiting for the blowback following. To be Frank, one of the reasons I sold my practice what I did was that I had collected a number of very difficult people and just wanted to get away because escape was crucial to my survival. I can only imagine what it must be like to deal with this guy living in the White House, who was never close to normal. Quite frankly, I cannot recall a literary villain possessing this amount of rage coupled with all the other disorders which he manifest and has manifested his entire life. The judge, by comparison, would be considered benign.