Child abuse and neglect is associated with increased vulnerability to psychiatric and medical conditions including depression, bipolar and post-traumatic stress disorders, alcohol and drug abuse, possibly also schizophrenia, as well as low self-esteem, deficient communicative skills, anxiety and anger [1-4]. Behavioral indicators of abuse include self-destructive or risk-taking conduct, reluctance to go home, flinch when touched, etc. Victims may describe themselves as bad and feel that punishments are deserved [5]. Impulsivity and hyperactivity can appear, but decline if regularly punished [6]. Among others, child abuse is related to obsessive-compulsive disorder. A significant association was found between past trauma and compulsions, but not obsessions [7]. Details and references are in the preceding article [6].

Along with other derangements, there is evidence supporting an association of trauma and bullying during childhood/adolescence with persecutory delusions in a victim’s later life. The research demonstrated significant associations between adverse childhood experiences, including physical abuse, with paranoia [8]. An association between the brain injury and paranoid syndrome was suggested on the basis of some evidence [9]. Results from a multiple regression study indicated that father’s antipathy has a significant contribution to paranoia in the victim’s adult life, which generally agrees with the literature [10]. Grave consequences can occur when paranoid and delusional ideas coexist in a politician who otherwise is rational and efficient, but may be assisted or influenced by mentally abnormal individuals [11].

Child abuse has been rarely discussed in Russian Federation (RF). There were several publications in the period 1990-2016 but today the topic is largely avoided; details and references are in the preceding article [6]. During medical education, postgraduate training and subsequent practice of pathology, the author hardly ever heard about child abuse. In the literature, the accent is often on visible injuries: bruises, burns and fractures. Of note, child abuse can drag on for years with cerebral concussions, burns of oral/esophageal mucosa or external genitalia e.g. with hot soup, alcohol and other intoxications, without visible injuries. Medical child abuse or Munchausen syndrome by proxy is a variant of child maltreatment whereas the victim is subjected to unnecessary, potentially harmful medical treatments [12-15]. According to a recent publication, about 14% of children in RF are subjected to physical abuse, 2 million are regularly beaten by parents, while 10% of them lose their lives as a result [16]. According to other sources, ~40% of children are beaten in families [17,18]. As per a 2016 report, the General Prosecutor’s Office records about 2 million children beaten in their families yearly, whereas 10% of the cases end in death, of which about 2 thousand by suicide [19]. According to an estimate, the prevalence of family violence in RF during last decades has been 45-70 times higher than in England and France [20].

The self-referral rate of victims of domestic violence in RF is low due to distrust of authorities, fears of revenge from perpetrators, humiliations and breach of secrecy. In case of disclosure, not only abusers but also victims are sometimes blamed [21]. 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, fantasies 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 recognizable in many families [18]. The attitude of some professionals and a part of the population is tolerant [10,22]. Authorities, teachers and neighbors did not react to some known cases of child maltreatment. There is neither official standpoint nor agreed policies [20,23]. Investigations are started mainly on official request. Numerous children continue living in conditions of abuse potentially harmful for their physical and mental health [18]. The predominant way to solve problems of child abuse has been a placement in an orphanage [19]. The institutionalization means that not the abuser but the victim is removed from the familiar environment, suffers deprivation and discomfort [21].

In 2017 Vladimir Putin has signed into law an amendment decriminalizing some forms of domestic violence [24,25]. The physical abuse was described in Putin’s biographies [26-30]. His father is said to have beaten him [27,28]. It was hypothesized that Putin is re-enacting his traumas in conditions of an intergenerational traumatic chain [27,31]. There is a “danger of blundering into a nuclear war” [31] thanks to that case of child maltreatment. Apparently, it was not so much the Russian population who perceived external threats, as it did their ruler, re-enacting his puerile fears. This supposition does not contradict to the hypothesis that Putin suffers hubris syndrome enticing him to adopt immature coping mechanisms [32]. There are several psychiatric or related conditions, including paranoia, that belong to the continuum around hubris syndrome [33,34].

Blaming others is one of the ways to support compromised self-esteem. Paranoid individuals tend to be aggressive; the association between paranoia and violence is known [35]. A paranoid call may sanction destruction of supposed enemies [36]. Putin’s saying “If a fight is [perceived as] inevitable, you must strike first” could have originated from reminiscences of bullying [27]. Putin declared objectives for his military operation: to disarm and denazify Ukraine, protect ethnic Russians and Russian-speakers from “genocide”. It is known that Ukraine has not been governed by Nazis and that ethnic Russians were not victims of genocide [37,38]. The idea of denazification is obviously delusional. In regard to the ongoing demolition of the Ukrainian infrastructure, Putin may be in grip of the idea that the denazification must be achieved through extensive devastation; otherwise “the Phoenix could rise from the ashes” [39]. The difference between delusions and strongly held ideas is in the degree of conviction despite contradictory evidence, irrespective of logic and the “way of the world” [40,41]. Andrei Snezhnevsky and some other Soviet psychiatrists could diagnose sluggish schizophrenia on the basis of such symptoms [42]; details and references are in the preceding article [43]. Another ex-Soviet psychiatrist Anatoly Smulevich discussed paranoia within the scope of schizophrenia [44].

A psychological interpretation of the drawings by Putin’s own hand was attempted. A similarity with drawings of pediatric schizophrenia patients has been illustrated [45]. According to the expert graphologist, the pictures expose a paranoid, depressed and anxious leader [46]. In particular, a flat disfigured face with a puerile smile (Figure 1) may reflect the attitude to “paper” soldiers. Another sketch of a cat (Figure 2) demonstrates a similar attitude to animals and, parabolically, to women undergoing reproductive coercion. Birth control has been obfuscated by presumed national interests: the demographic growth is supposed to strengthen defenses and economy [47]. Some policies aimed at fertility elevation in RF disregard reproductive rights of women. Popular TV series depict unplanned pregnancies both in and out of wedlock as natural and unavoidable. For example, in the In the Episode 306 of the serial “Slepaia” (The Blind), a gynaecologist at a husband’s request furtively replaced contraceptive pills by vitamins, which was presented as a good deed. The risks associated with abortions and contraception are exaggerated or invented by the media and some writers, including medical professionals e.g. [48]. Apparently, the misinformation facilitates reproductive coercion taciturnly approved by the Putin’s government. Reverting to the topic of this article, it should be stressed that case histories of unwanted children sometimes include abuse and neglect.

Figure 1: Vladimir Putin draws on a multimedia blackboard at an exhibition in Moscow (Kremlin Pool Photo via AP) [49].

Figure 2: Vladimir Putin’s drawing of a cat from behind [45].

Paranoid rulers tend to promote mentally abnormal individuals and rely on their opinions [50]. An example is the ideologist Aleksandr Dugin, called the “Putin’s brain” [51], who often uses mystic vocabulary. Here follow several citations from his works (translated): “To close down America is our sacred duty” [52]; “The prohibition of war propaganda is pharisaic. You can’t get away from the war and you shouldn’t try” [53]; “Only a traitor would wish peace today” [54]; “We must forget about the nightmare that is called political correctness, liberalism and human rights. We must forget this terrible nonsense” [55]. His writings are indicative of grandiose and persecutory delusions, for example: “If we lose, we will blow up the whole world” [56]. Dugin’s delusion-like or overvalued ideas include the “Western plot to undermine Russia” and “Eternal struggle between Land and Sea” [57], the latter probably being a reminiscence of the novel 1984 by George Orwell. Some more citations: “The will of any people is sacred. But the will of Russian people is hundred times more sacred” [58]; “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” [56]. Dugin’s daughter Darya was killed in August 2022 in a car bombing. The carriers of inhumane ideas are transforming their personal and our collective history to tragedy. Considering the above and other Dugin’s discourses, some analysts considered him to be a mental patient [59]. Of note, Alexandr Dugin was born into a family of a Soviet colonel-general [60]. The former party and military functionaries (so-called Numenklatura) promoted their children sometimes irrespective of the latter’s abilities and health condition [61].

The psychopathological approach to politics is successful if it identifies politicians or ideologists with a limited mental competence [62]. If a leader is psychotic while other functions are more or less intact, he can preserve abilities to remain in the position of power [63]. Several Soviet leaders had mental abnormalities [64]. Certain populations can subscribe to delusions at large. It is possible for a majority to be deluded and minority not to be deluded [65]. Paranoid individuals are prone to dismiss disconfirming evidence [36]. A belief that others intend harm contributes to aggressive behaviors. Some paranoiacs are aggressive against delusional goals. Such leaders are on alert against supposedly ever-present danger. Paranoids may initiate a crisis out of the belief that preventive action is necessary. Negotiations and diplomacy are viewed by them as either efforts to ratify the military status quo or exercises in deception. Another feature: overreliance on historic analogies such as the World War II [66]. These phenomena are observed in RF today.

Defensive behaviors in certain individuals include attacking weaker persons and submitting to dominant ones [67]. Apparently, the latter is reflected by Putin’s relationships with Ramzan Kadyrov, head of the Chechen Republic, who behaves like a dominant personality. There has been a stereotype of “chechenophobia” in Russia [68]. Certain non-European subjects of RF may be interested in a continuation of the Ukraine war, and there are concerns that Putin has come under their influence. The same might be true in regard to the newly appointed Kursk governor Alexander Khinshtein. An important topic in this connection is the inter-ethnic difference in the birth rate and migrations [69], which is avoided by Russian media and officials today.

Paranoid politicians look for new enemies and reanimate old hatreds [37]. They 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. Certain war instigators 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 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. A lack of knowledge about other nations, suppressed shame and envy contribute to hostility. In the former Soviet Union, paranoia was recognizable both in authorities and in the whole society [70].

Envious people blame those who make them feel ashamed by comparison. Some functionaries are descendants of rural people who burnt mansions in 1917 and committed violent crimes out of envy. The psychological projection in paranoiacs is regarded to be an aberration of shame; they project it onto others and thus disown. Conversely, intense shame confers vulnerability for paranoia [37,71]. Results from a multiple regression study indicated that shame is a predictor of paranoia [10]. Moreover, shame was described as the affective core of paranoid ideation [72]. Shame confers vulnerability for paranoia and amplifies the latter’s association with stress [71]. Repressed shame may cause aggression [73]. There are reasons to be ashamed in RF, as reflected e.g. by a comparatively low life expectancy mainly due to suboptimal healthcare, characterized by paternalism, authoritative management style, tendency to disregard the principles of informed consent, professional autonomy and scientific polemics, which contributes to the use of invasive procedures without indications [74].

Child abuse has not been sufficiently counteracted in RF. In 2017, Vladimir Putin signed a new law decriminalizing some forms of domestic violence. Physical maltreatment was described in his biographies. Child abuse is associated with various psychiatric abnormalities in the victims. Among others, persecutory delusions and paranoid ideations can develop in their later life. The world is in danger of global war thanks to paranoid ideation in Vladimir Putin and his advisors. Mental derangements in politicians should be diagnosed by psychiatrists on the basis of speech, writings, and behavior. More expert opinions are needed. Many people subscribe to delusions at large. It is possible for a majority to be deluded and minority not to be deluded.

The author declares no conflict of interest.

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