Putin’s Health and State of Mind are very Hard Targets

Opinion

Dr. Kenneth Dekleva served as a Regional Medical Officer/Psychiatrist with the U.S. Dept. of State from 2002-2016, and is currently Associate Professor of Psychiatry and Director, Psychiatry-Medicine Integration, UT Southwestern Medical Center, Dallas, TX; and a Senior Fellow at the George HW Bush Foundation for US-China Relations.  He is also the author of the novel The Negotiator's Cross.  The views expressed are entirely his own and do not represent the views of the U.S. Government, the U.S. Dept. of State, or UT Southwestern Medical Center.

View all articles by Kenneth Dekleva

OPINION — The current horrific invasion of Ukraine – including aerial bombing of civilian targets in large cities – by Russian military forces, and Russian President Putin’s veiled (and not so veiled) threats involving nuclear weapons, have raised questions as to Putin’s state of mind and associated health issues.  While Putin has long been recognized as a ruthless, calculating, and masterful tactician, strategist, political leader, KGB-trained intelligence officer, and diplomat, his recent speeches, political actions, and decision-making calculus have raised questions both in the media and among current and former senior Western politicians – including those who have met with him – that “something is off,” or that Putin is “erratic,” “different,” or has “gone off the rails.”  In the upcoming weeks, as the war continues, or when a cease-fire is declared and a return to diplomacy becomes possible, it’s very clear that a lucid and rational understanding of Putin’s political ambitions, decision-making calculus, and state of mind become critical to an understanding and resolution of this tragic war.  For if Putin is a ‘hard target,’ his state of mind and health are the hardest targets of all.

Putin’s decision to invade Ukraine, following a relentless combination of long-term strategy, tactics, hybrid warfare, and management of the information space, caught many observers – myself included – by surprise.  Why he would do so, facing a robust alliance of American, Asian, and European allies, and even significant Chinese displeasure, after essentially achieving many of his strategic goals, raises many questions.  Putin’s invasion of Ukraine implies that he’s a man in a hurry.  Does this reflect something awry in Putin’s rational decision-making?  Or rather, does Putin’s decision to invade represent a massive intelligence failure?  For Putin was likely told by FSB, SVR and GRU leadership that America’s President was weak politically, that NATO (and the EU) was fractured, that Ukraine’s President Zelensky would flee, that Ukraine would not fight for its freedom, and that western unity regarding sanctions was unlikely.  Putin (and his national security council) did not imagine or foresee what has occurred – a ‘curveball.’  In such a case, it may be more tempting for analysts to imagine that Putin’s mental state has changed, rather than relying upon a more pragmatic explanation for this intelligence failure on his part.  Heads – (SVR Director Naryshkin?  General Gerasimov?) – might roll as well, for a reportedly-enraged Putin does not take kindly to weakness or failure.

Putin’s age could have relevance, and Putin is 69.  Aging leaders, faced with competing pressures of ambition, their legacy, and their mortality, sometimes make rash decisions, bolstered by cognitive rigidity and a lack of integrative complexity.  In Putin’s case, his isolation, compounded by a siloviki ‘groupthink,’ could have played a role in the above-noted intelligence failure.


Cipher Brief Subscriber+ Members got an exclusive expert briefing with former MI6 Chief Sir Alex Younger, former Senior Member of the British Foreign Office Nick Fishwick and other Cipher Brief Experts as the situation in Ukraine unfolded last week.  Upgrade to Subscriber+ today. 


Could medical factors be at play here?  Rumors of Putin being in poor health abound, with media reports that he suffers from Parkinson’s disease, long COVID, prostate cancer, or chronic low back pain.  If true, this begs the question of possible medication, radiation, and/or surgical treatments, and their impact upon emotional health, cognition, and potential side effects.  Putin’s face has also appeared ‘puffy’ in recent months, with some medical analysts suggesting a ‘moon-faced’ appearance, indicative of Cushing Syndrome, an endocrine disorder treated with steroids.  Mild steroid side effects can include irritability, impatience, and moodiness, even short of more severe conditions such as steroid-induced mania or psychosis.  Putin has also practiced judo at a high-level for decades, and the orthopedic surgery literature describes a high incidence of chronic orthopedic injuries in such expert practitioners.  The use of opiates and other pain medications in such situations can bring with it undesirable side effects, including irritability, disinhibition, or emotional lability.  A putative cancer diagnosis could also account for Putin’s recently-increased physical isolation, and subsequent realistic concerns regarding COVID exposure, due to a heightened risk of immunosuppression.

Yet caution is warranted here.  The mere presence of a putative medical condition does not necessarily explain Putin’s recent decision-making and aggressive political behavior.  Putin has railed against NATO, its western expansion, and color revolutions since his 2007 speech at the Munich Security Conference, and he has long believed, spoken publicly, and written that Ukraine is not a ‘real’ country, but a part of a larger, historical Russian politas.  His revanchist views and rage at the humiliation and loss of empire are unanimously endorsed by Putin’s National Security Council colleagues, as well as by many Russian elites and members of the general public — even if many don’t desire or support war.


Read With the World Turning Against Him, Putin’s Going to Need a Way Out from Former National Security Advisor to the Canadian Prime Minister, Richard B. Fadden only in The Cipher Brief


It’s worth recalling that today’s Putin is more of a pariah than ever – akin to Serbia’s late Slobodan Milosevic – and a leader eagerly willing to start a devastating war in Europe, and to disrupt and upend the post-Cold War security architecture in Europe.  But his brutality is hardly new.  It reflects the same ruthlessness seen in the bombing of civilian targets in Chechnya, Syria, Georgia, and the Ukraine since his earliest years in power.  And it reflects his willingness to kill persons abroad and at home – ‘traitors’ – such as Litvinenko, Skripal and Navalny with Polonium-210 and Novichok — banned nuclear and chemical weapons.

What comes next?  It is facile to wish for, or to clamor for ‘regime change’ in Russia, a nuclear superpower.  Such thinking is dangerous, and mostly emanates from those who don’t understand, or who misunderstand Russia and its history.  A cornered and weakened Putin – as in a combination of a diplomatic negotiation and hostage-negotiation with a nuclear-armed hostage-taker – is a dangerous Putin.  Talk of finding creative diplomatic solutions or ‘off ramps’ in the current war should not be equated with appeasement.  Once a cease-fire is achieved, attempts can be made to employ a respected mediator (ex: Nobel Peace Prize winner Martti Ahtissari comes to mind) to develop a lasting solution to this tragic, cruel war.  After a sustained period of defiance, Putin might be open to mediation by such a figure of international stature, which would allow a measure of face-saving.  It is sometimes better to let a wounded bear run back into the forest and out of the cage.


Read A Picture of Putin’s Nuclear Option from Senior National Security Columnist Walter Pincus only in The Cipher Brief


Putin is a cruel and yet tragic figure.  The contrast between Putin’s brilliant, majestic 2001 speech to the Bundestag in which he spoke – in perfect German, receiving a standing ovation! – of Russia as an integrated part of European history and culture, and his rambling, angry speech last week justifying the invasion of Ukraine, is nothing short of jarring.  Prior to 2008, and even according to many Russians thereafter, he might have, before this war in Ukraine, been considered one of the greatest leaders in Russian history.  But history may now judge him differently.  And with or without Putin, genuine peace will not come to Ukraine, Russia, and Europe, until Russia bears witness to the creation of meaningful democratic institutions, and the healing of a generation’s political, economic, and psychological scars.


French officials warned this week, the worst is yet to come in Ukraine after a phone call between French President Emmanuel Macron and Russian President Vladimir Putin.  Subscriber+Members can access a piece by former Ukraine and an Assessment of how a Bad Situation Could get Much Worse by Cipher Brief Expert and former Chief of CIA’s Central Eurasia Division Robert Dannenberg.  Upgrade your access today.


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Opinion

Dr. Kenneth Dekleva served as a Regional Medical Officer/Psychiatrist with the U.S. Dept. of State from 2002-2016, and is currently Associate Professor of Psychiatry and Director, Psychiatry-Medicine Integration, UT Southwestern Medical Center, Dallas, TX; and a Senior Fellow at the George HW Bush Foundation for US-China Relations.  He is also the author of the novel The Negotiator's Cross.  The views expressed are entirely his own and do not represent the views of the U.S. Government, the U.S. Dept. of State, or UT Southwestern Medical Center.

View all articles by Kenneth Dekleva

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