Psychiatric disorders are not uncommon among politicians [1,2]. Psychopathological insights may help to understand their suboptimal decisions. In many cases, the need to warn the public overrides the duty of confidentiality [3]. Several Soviet leaders had mental and/or neurological abnormalities [4]. The psychopathological approach to politics can be successful if it identifies leaders with limited mental competence. If a leader is psychotic or neurotic, while other functions are more or less intact, he or she can preserve abilities to remain in a position of power. Unfavorable consequences may occur when paranoid ideation persists in a dictator along with rationality and efficiency, so that delusions are brought into reality. In particular, child abuse is associated with psychotic symptoms, paranoia, as well as low self-esteem, anxiety and anger in a later life [5-8]. A child grown up in a dysfunctional family has difficulties of recognizing the chaos and craziness going on around [9]. Such individuals tend to have insufficient control to avoid extremes [10].

Vladimir Putin

Physical abuse was described in Putin’s biographies. His father is said to have maltreated the boy [11-15]. Presumably, Putin’s early childhood experience of physical maltreatment was recapitulated at school, where he was bullied. His saying “If a fight is [perceived as] inevitable, you must strike first” could have originated from reminiscences of bullying. It has been suggested that Putin is re-enacting his childhood traumas in conditions of an intergenerational traumatic chain [15,16]. Thanks to this case of child maltreatment there is a “danger of blundering into a nuclear war” [17]. Indeed, Putin has hinted at the tactical use of nuclear weapons. Apparently, it is not so much the Russian population who perceives external threats, as it does their leader, re-enacting his juvenile fears. This supposition does not contradict the hypothesis that Putin has hubris syndrome (HS), enticing him to adopt immature coping mechanisms. The symptoms of HS have been described by David Owen [18]; since then, the condition has been surmised in different politicians [19,20]. HS describes individuals with excessive confidence and pride. People having this type of personality tend to use immature coping mechanisms that may lead to the underestimation of a crisis, particularly when facing unpredictable consequences [20]. The overconfidence may prevent collaboration with global agencies and limit ability to learn from experience [21]. In some of its aspects HS is close to narcissistic, antisocial and histrionic disorders [22]. Several psychiatric or related conditions may belong to a continuum around HS: adult attention deficit hyperactivity disorder (ADHD), hypomania and paranoid syndrome [23,24].

A supposition that Putin lives with autism spectrum disorder (ASD) has been put forward, based on videos [25]. In particular, Asperger syndrome, a variety of ASD without intellectual impairment or significant communication derangements, has been suggested. In the author’s opinion, this hypothesis is reasonable but insufficiently substantiated. In view of the high detection rate of ASD and potential overdiagnosis, conclusions must be based on thorough examination [26]. As discussed below, autistics traits may result from physical maltreatment during childhood.

Putin formulated the aims of the Ukraine invasion, one of them being protection of Russian-speakers from genocide. It is known that ethnic Russians have not undergone genocide in Ukraine. This claim is either utterly irresponsible or delusional. The difference between delusions and strongly held ideas is seen in the degree of conviction despite contradictory evidence, irrespective of logic. Andrei Snezhnevsky and some other Soviet psychiatrists could diagnose sluggish schizophrenia on the basis of such symptoms; details and references are in the preceding article [27]. Another ex-Soviet psychiatrist, Anatoly Smulevich, discussed paranoia within the scope of schizophrenia [28]. Apropos, the last genocide of ethnic Russians since the Stalin’s time was the anti-alcohol campaign (1985-1989) with mass consumption of technical ethanol and other surrogates, and its aftermath with deterioration of the healthcare and toxic surrogates sold in vodka bottles through legal shops, when the average life expectancy in males decreased to 58-59 years [29,30]. There have been mass poisonings by legally sold beverages [31].

Grave consequences can occur when paranoid or delusional ideas coexist in a dictator who otherwise is rational and efficient. Behaviors of paranoiacs may include presumption of privilege and exploitation of weaknesses [32], which is recognizable in some politicians. Moreover, paranoid rulers tend to promote abnormal individuals and rely on their opinions [33], which may distort appreciation of reality. An example is the ideologist Aleksandr Dugin, called the “Putin’s Brain” [34] (discussed below).

As governments in democracy are more transparent, it is less likely that power falls into the hands of mentally abnormal persons. Paranoid leaders can remain in positions of power in societies that lack appropriate checks and balances [35]. This is particularly likely in one-party states with mass intimidation and far-reaching homogeneity of thinking. Paranoid individuals are often self-centered, arrogant and vulnerable at the same time. In a sense, paranoid grandiosity is a shield for a fragile ego. A belief that others intend harm leads to aggression. Paranoia is generally characterized by a hostile disposition and aggressive behavior against perceived enemies. Certain war instigators and terrorists are paranoid in their tendency to present themselves as prophets, world saviors, etc. Some of them are aggressive against delusional goals, as it seems to be the case with the “denazification” of Ukraine. Of note, such ideas are virulent. Mentally healthy people can be susceptible to psychotic appeals, a predisposing condition being fear of strangers and projection of hatred upon them. In the former SU, paranoia was recognizable both in authorities and in the whole society [36]. Paranoid politicians search new enemies and reanimate old hatreds [37]; this is what we are observing today. A lack of knowledge about other countries, suppressed shame and envy contribute to hostility.

Envious people blame those who make them feel ashamed by comparison. Some today’s functionaries are descendants of rural people who burnt mansions in 1917 and committed all sort of violent crimes out of envy. The psychological projection in paranoid individuals is regarded to be an aberration of shame. Being unable to tolerate shame, they project it onto others and thus disown. On the other hand, intense shame confers vulnerability for paranoia [37]. Repressed shame may cause aggression [38]. Shame was described as the affective core of paranoia [39]. Shame confers vulnerability for paranoia and amplifies the latter’s association with stress [37]. There are reasons to be ashamed in today’s Russia, as reflected e.g. by a comparatively low life expectancy mainly due to suboptimal healthcare [40].

Aleksandr Dugin

Paranoid rulers tend to promote mentally abnormal individuals and rely on their opinions [59]. An example is the ideologist Aleksandr Dugin, who preaches Russia’s westward expansion often using religious and mystic vocabulary. Here follow several citations from his works (verbatim translations): “To close down America is our sacred duty” [41]; “Anti-Americanism is a Creed. The prohibition of war propaganda is pharisaic. You can’t get away from the war and you shouldn’t try [42]”; “Only a traitor would wish peace today” [43]; “We must forget about the nightmare that is called political correctness, liberalism and human rights. We must forget this terrible nonsense” [44]. His writings are indicative of grandiose and persecutory delusions, for example: “If we lose, we will blow up the whole world” and “Americans cause rejection, repulsion, a desire to hide from their influence” [45]. Dugin’s delusion-like or overvalued ideas include the Western plot to undermine Russia and eternal struggle between Land and Sea, the latter probably being a reminiscence of the novel 1984 by George Orwell, where the word “victory” is often used (Fig. 2). Some more citations: “The will of any people is sacred. But the will of Russian people is hundred times more sacred” [46]; “For peace to be without war, the war is first necessary. We make the war. It originates in our heart. We give birth to the war. Through the war we create the world, our Russkiy Mir” [45]. Considering the above and other Dugin’s discourses, some analysts considered him to be a mental patient, albeit a widely read and influential one [47]. Alexandr Dugin was born into a family of a Soviet colonel-general [48]. The former party and military functionaries (so-called Numenklatura) promoted their children sometimes irrespective of the latter’s abilities and health condition [49]. Admittedly, some recent Dugin’s writings contain reasonable conclusions. Criticizing globalization, he noticed that for a large part of national bureaucracy (read: Nomenklarura) it would imply loss of status [50]. This seems to be the main motive of the anti-globalist ideology prevailing in the Russian officialdom these days.

Ramzan Kadyrov

Some individuals, maltreated during their childhood, respond by acting out fight or flight responses [16]. Defensive behaviors include attacking weaker persons and submitting to dominant ones. This can be exemplified by Vladimir Putin’s relationships with Ramzan Kadyrov, the head of Chechen Republic, who appears as a dominant personality. There has been a stereotype of “chechenophobia” in Russia [51]. Of note, North Caucasus regularly receives federal donation: 70-88% of local budgets [52]. In addition, federal funds have been purloined on a large scale in the North Caucasus [53]. Kadyrov claimed that Chechens in Ukraine are participating in a holy jihad against the “Western Satanist ideology” [54]. Some non-European subjects of the Russian Federation (RF) are obviously interested in a continuation of the Ukraine war, and there are concerns that Putin has come under their influence. The most important topic in this connection is the inter-ethnic difference in the birth rate and migrations [55]. According to Wikipedia, Kadyrov has more than one wife and 12 children. His son Adam has been promoted and decorated after having publicly beaten a prisoner. Adam’s sojourn in the prison was illegal but arranged by the authorities. Thereafter, Vladimir Putin personally met Adam. Vitaly Kaloyev was promoted to deputy minister having committed intentional murder. A petition was filed to the government in 2015 to dismiss Kaloyev from his position, reproduced as illustration in the article [56]. Apparently, Vladimir Putin is ready to collaborate and share power with non-Russian subjects just to preserve the privileges of the Nomenklatura [49]; while the Ukraine war is used as distraction. Crises are often used by oligarchy to distract from internal problems.

Dmitry Medvedev

Below are several citations. Offensive and obscene terms, ad hominem attacks and threats, used by Medvedev and known from the media, are not cited here or replaced in the following quotes by dots […]: “Our weapon is the truth. That is why our cause is right”; “Our main task to inflict a devastating defeat on all enemies – the Ukronazis, the US, […] NATO including […] Poland, and other Western […]”; “UK, our eternal enemy” (Wikiquote). In the author’s opinion, the utterances by Medvedev and some other politicians are compatible with HS. Hubris denotes over-confidence and exaggerated pride. The misuse of alcohol tends to accentuate the features of HS [57]. Nemesis, sometimes discussed in the context of hubris, denotes destruction that can follow in the wake of hubris [58]. The rudeness inhibits international cooperation, among others, in the field of science healthcare and environmental protection.

Jacob Zuma and Analogies to Africa

There is not enough information to formulate a diagnosis, if any. It has been suggested that Zuma is a narcissist personality [59,60]. Reportedly, his lacking sense of risk and concern around taking personal responsibility for prevention of the human immunodeficiency virus (HIV) infection had a trickle-down effect and impacted on public attitudes. He admitted to having had unprotected sex with a woman living with HIV, and remarked that he had taken a hot shower to minimize his chances of getting infected. The lack of responsibility demonstrated by the President had also another effect. In the rape trial, Zuma argued that his accuser had seduced him by wearing “revealing clothes”. Supposedly, this resulted in the perpetuation of harmful and toxic notions of masculinity [61]. The singing by the President of the Dubula iBhunu song with its incitements to murder should be mentioned in this connection. Analogously, excessive masculinity is propagandized in RF, especially in Chechnya, led by the “hyper-masculine” Ramzan Kadyrov [62].

Liberal theories of democracy groundlessly suppose all ethnic and confessional groups to respect moral principles. Multiculturalists assume a safe world or “grass-roots reconciliation” [63]; however, according to experiences of the Soviet, post-Soviet and some other societies, multiculturalism does not generally contribute to safety. Continuing the parallel between the former Soviet Union and SSA, the fratricidal war in Ukraine and RF [64] can be compared with the first and second Congo Wars, also known as Africa’s World Wars. Countries that have recently emerged from conflict are at risk for another war [65]. It can be reasonably expected that another “Special military operation” will follow somewhere in the South or East of RF. The war in Ukraine and RF, having undermined the internationally agreed status quo, has triggered armed conflicts in different parts of the world. It should be recollected that the Soviets destabilized several governments in Southern Africa, supporting and arming their adversaries. Considering inter-ethnic differences in birth rates and migrations, a similar future awaits RF. Return of the Tatar-Mongol Yoke (1237-1480) to Russia would be a logical conclusion, which is a real perspective in view of demographic and economic developments.

Continuing the analogy with Africa, it should be noticed that the image of enemy or “significant others” [66] is easily formed in collectivist societies such as the African and Russian ones. This facilitates revolutions and wars. As we can see, the image of Ukrainians has been transformed from fraternal to inimical. Apropos, African ethical concept of Ubuntu is analogous to collectivism, propagated in the Soviet Union. During war, many people demonstrate loyalty and argue in favor of the warfare [66]. Dissidents are judged to have fallen outside the bounds of the national endeavor and become endangered [67].

Another similarity between RF and SSA is the widespread child abuse and family violence. Studies report high rates of child abuse in SSA, with the prevalence as high as ~64% [68]. Sexual abuse of children is more frequent in SSA than in any other part of the world [69]. One of five girls ≤18 years old experiences rape or sexual assault [70]. Fertility pressures are widespread; many African men prohibit their wives from using contraception [71]. The prevalence of past-year reproductive coercion (RC) was the highest in the Democratic Republic of Congo (20.3%) [72]. Niger has the greatest adolescent birth rate worldwide [73]. In the latter country, 11-17% of female adolescents reported RC, the highest percentage being in the 13-14-year age group [74]. RC is pervasive in Kenya, with 10% of all births being unwanted and 25% mistimed [75]. Approximately 27.3% of pregnant women reported RC during past year in Ethiopia, with 14.3% facing its most severe forms [76]. In Cote dIvoire, 49.8% of women experienced physical or sexual intimate partner violence, and 18.6% experienced RC [77]. According to an estimate, Zimbabwe has one of the highest rates of intimate partner violence, whereas 33% of girls had unwanted sexual experiences before the age of 18 years [78]. Furthermore, the prevalence of elder abuse in SSA is relatively high, physical maltreatment being its most frequent variety [79]. In particular, the high prevalence has been recorded in Uganda, where this figure was estimated at 89.0%, being higher than in India (50.2%), Iran (38.5%) and China (36.2%) [80]. South Africa is experiencing a scourge of violence against women and children. Despite voices of protest, the political will to change this seems to be lacking [81]. Females under the age of 18 comprise ~40% of all rapes and other forms of sexual assault. Infant rape is pervasive [82]. More than 88% of child rapes are estimated to be never reported [83]. The disproportionately high child homicide rate motivated by sexual assault is linked to the belief of hegemonic masculinity [84]. A study found that the homicide rate in children younger than 18 years in South Africa was 5.5 per 100,000, compared to 2.4 reported internationally. The age group most at risk for fatal child abuse was the 0-4 years old [85]. Of note, sexual violence had been minimized before 1990 but increased thereafter, most dramatically in 2001-2002 [86].

For comparison, the prevalence of family violence in Russia during last decades has been 45-70 times higher than, for example, in England and France [87]. According to a recent report, about 40% of all serious violent crimes in Russia are committed within families; 14% of children are subjected to physical abuse, 2 million are regularly beaten by parents while 10% of them lose their lives as a result [88]. According to other sources, 40% of children are beaten in families [89]; 31% experience sexual abuse and 41% suffer cruel punishments [90]. It was reported in 2016 that the General Prosecutor’s Office records about 2 million children beaten by their caregivers yearly [91]. In 2017 Vladimir Putin has signed into law an amendment that decriminalizes some forms of domestic violence [92]. As mentioned above, physical abuse was described in Putin’s biographies [12-15].

Many cases of family violence remain unrecorded both in SSA and in RF [91,93]. In Russia, among reasons of low self-referral rate in victims are distrust of authorities, fears of revenge from perpetrators or breach of secrecy in the course of investigation. In case of disclosure, not only abusers but also victims are sometimes blamed [91]. Detection of family violence often depends on victims. It is easier to denounce a socially unprotected abuser e.g. an alcoholic. Otherwise, various defenses can be applied by perpetrators: denial of facts, allegations of slander and/or mental abnormality in the victim, threats and intimidation, appeals to preserve honor of the family or nation. The intergenerational transmission of violence is evident in many families [90]. The attitude of some professionals and a part of the population is tolerant [91]. Authorities, teachers and neighbors did not react to some known cases of child maltreatment. There is neither official standpoint nor agreed policies [87,94]. Numerous children continue living in conditions of abuse that is harmful for their physical and mental health [90]. The predominant way to solve problems of child abuse has been placement in an orphanage [88]. The institutionalization means that not the abuser but the victim is removed from the familiar environment, suffers deprivation and discomfort [95].

Adaptive behaviors observed in abused children may be interpreted by the social environment as a mental abnormality [90,95]. The hypothesis has been proposed that a part of autistic individuals are physically abused children with ADHD, histrionic personality disorder (HPD), or initially typical ones [96,97]. Some ASD cases are caused by intrinsic factors while others may be induced or reinforced by environmental impact such as physical abuse. In this connection, the heritability of autism has a non-genetic mechanism in some cases: children of deviant parents are exposed to maltreatment, hence acquiring deviant traits themselves. Besides, children exposed to trauma or forced to cope with chronic danger may develop borderline or post-traumatic stress disorder. Apparently, the latter is more probable in disorganized conditions with haphazard traumas rather than under impact of regular and targeted physical punishments. This topic needs further research.

Neither ADHD nor HPD is usually mentioned in the literature among consequences of physical abuse. It was suggested that HPD may reflect a history of child neglect and/or sexual abuse [98]. Children and adolescents regularly punished for hyperactivity, hysterical fits or other conduct, regarded by abusers to be annoying or inappropriate, might discontinue such behaviors but develop adaptive, maladaptive and/or compulsive behaviors. Repetitive movements seen in ASD can be described as compulsive or catatonic [99-101]. Among others, autism is associated with the obsessive-compulsive disorder (OCD) spectrum on the basis of higher rates among first-degree relatives, serotonergic abnormalities and responsiveness to selective serotonin reuptake inhibitors [99]. ASD, ADHD and OCD with partly overlapped symptoms have been discussed within the framework of obsessive-compulsive spectrum [99,102,103]. In conditions of domestic violence, maladaptive behaviors compatible with autistic and/or compulsive patterns may come to the fore [104-107].

Autistic and other abnormal individuals are at risk of victimization and bullying, which is associated with anxiety and shame [96,108]. In the course of post-trauma processing, maladaptive cognitions centered on self-blame, shame and guilt may arise, sometimes intentionally reinforced by the abusive environment. In particular, shaming is used to control children [9]. Shame results when a person’s body is treated like an object, also when a child is small and powerless [10]. Some individuals mitigate shameful memories by compulsive acts [109], e.g. “jamming” by counting aloud or swearing. The same function may have repetitive movements, distracting from traumatic thoughts. Compulsions are recognized by the patients as abnormal. On the contrary to catatonia, they are controllable, but the control requires efforts. Various compulsive behaviors are used for relief from shame and anxiety: overeating, binge drinking and maltreatment of children. In particular, family violence can be compulsive [110]. The latter is a potential mechanism of trans-generational transmission of child abuse. Moreover, adverse childhood experiences, including physical abuse, are associated with risks of psychosis and paranoia [6,7]. In particular, memories of antipathy from father have emerged as a significant predictor of paranoid ideations in the adult life [111].

The paranoid patient may precipitate a crisis out of the belief that preventive action is necessary. Negotiations and diplomacy are viewed by suchlike individuals as either efforts to ratify the military status quo or exercises in deception. Another feature: overreliance on historic analogies e.g. World War II. This is what we observe in Russia today. As for HS, the differential diagnosis is difficult as persons with HS do not usually collaborate in examinations [112]. On the contrary, politicians tend to conceal mental disorders [58]. Hubristic leaders are contemptuous of the advice of others and reckless in strategic choices [113]. It can be reasonably assumed that ruling classes with experiences of leadership have lesser risk of HS and of other abnormalities than unknown people promoted by bureaucracy.

Mental derangements in politicians are dangerous and must be diagnosed by psychiatrists on the basis of speech, language corpora, drawings (Fig. 3) and behavior. More expert opinions are needed. A language (speech) corpus is a large sample or collection of texts that can be subjected to analysis, sometimes leading to unexpected insights [114]. Admittedly, studies of Vladimir Putin’s publications may be of limited value because they are probably written at least in part by his assistants. It must be an obligation of healthcare authorities to monitor the state of mental health of politicians, higher functionaries and officers.

No conflict of interest.

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