Perhaps out of growing desperation over Donald Trump’s precipitous decline in the polls, his supporters and his campaign have engaged in sustained and wild speculation that old photographs and more recent film clips can be used to insinuate that Hillary Clinton has never recovered from her 2012 concussion, that she has suffered a stroke, is possibly epileptic or conceivably suffering neurological damage that makes her incapable to making rational decisions as president. None of this is backed up with any sort of documentation and Hillary’s doctor has now been forced to issue yet again another statement suggesting she is in “excellent health and fit to serve as president of the United States.” In receipt of this statement issued on August 16th, the press has now returned to the letter issued by Trump’s doctor back in December 2015. Like much of Trump’s campaign that letter is unconventional and at a minimum suspect. And like much of his campaign, the letter raises questions about Trump’s own sanity.

The letter from Trump’s doctor is highly questionable. It is not on letterhead. It provides a defunct website for the doctor. It has numerous grammatical errors and typos unusual for such an important letter. It offers un-medical assessments of Trump’s health, and it reads as if it were written by Trump himself. It states that Trump’s recent medical exam yielded only “positive results,” which is not only vague but implies the opposite of what a healthy person would get, testing “negative” for various conditions. In quintessential Trumpese, the letter adds that Trump’s laboratory results were “astoundingly excellent.” The top of the letter simulates letterhead for both father Jacob and son Harold Bornstein and is signed by Harold who is thankfully still alive, though his father passed away in 2010 (even though his name remains on top of the letter). The letter is nothing less than suspicious.

Did Trump see the doctor? Did the doctor write the letter? Is Trump’s health really “astoundingly excellent?” Perhaps it is as astoundingly excellent as his proposed wall is beautiful? What goes around comes around. Trump and his supporters started out as they often do picking up on extreme alt-right conspiracy theories that manufacture indictments of their enemies based on sheer speculation free of any fact-checking. This time the blowback starts out being about Hillary’s health, but the end result blows back onto the unconvincing medical assessment that says Trump has astoundingly excellent health. Trump’s indulging in the weirdest most irresponsible conspiracy theories that the right likes to spread in order to validate condemnation of their enemies ends up feeding speculation about himself. What goes around comes around yet again: as it has when Trump claimed that Hillary was crooked or a liar only to come into criticism for his business practices, that she covered up her emails only to end up hearing a cacophony of questions about what he is hiding in his unreleased tax returns, etc., etc.

You would think that Trump would learn. But that seems to be the larger point. The larger point is not that he is a fraud (which he is), that he has no respect for facts or rational argument (he does not), or that he only knows how to smear people rather than engage in sustained debate about legitimate political and policy differences (his repertoire is limited). The larger point is that Trump is not educable. Even though he has previously suffered blowback for his wild accusations, he suffers again and again. The very definition of insanity is banging your head against the wall and expecting each time you stop you will get a different result (instead of a constant headache — if not a concussion). In fact, not to add too much more wild speculation to the whole absurd situation, there is more evidence that it is Trump as opposed to Hillary who acts like he has never recovered from a concussion.

Trump’s inability to learn from his mistakes has now been taken to a much higher level. His decline in the polls is widely seen to be about his failure to pivot from his successful strategy in winning the primaries to a more conventional campaign for the general election. Trump won the primaries with a most unconventional campaign that relied heavily on his revving up large crowds with outrageous statements about Mexicans, Muslims, competitors in international trade, the Obama Administration, Hillary and also his Republican opponents. But to build a majority coalition in the general election, he was told again and again, he needed to tone it down, give substantive speeches, appeal to moderates and conduct a campaign with a ground game, television advertising and other standard features of a presidential bid. The recurrent pattern: Trump pivots, gets frustrated that he is being prevented from continuing to act the way he thought he should (and enjoyed) only to return to form.

And he has done it again this time changing the leadership at the top of his campaign to bring in people who support allowing Trump to be Trump. In particular, he has named Stephen Bannon, the head of Breibart News, to be his campaign’s chief executive, which means he is bringing on board the person who heads one of the most popular alt-right news organizations responsible for spreading lies, smears and wild conspiracies theories about just about anybody who does not support Trump. What goes around comes around. Trump tried to learn, but cannot. He has a primal need to be true to who he is: a serial liar who loves to inflame hatred by spouting the most fantastic stories about his enemies. It raises questions about just who is right in the head. Should we believe Hillary’s doctor or that doctored letter Trump released?