What's Going On With

What’s Going On With Putin?

                        Robert A. Levine, M.D.  March 8, 2023

I am a retired neurologist. Last week, I watched a five to ten second video of President Putin’s meeting with Lukashenko in a villa outside of Moscow online. Instead of being seated behind a table which would hide his lower body, he was in a chair with nothing blocking his legs. During the period he was visible, constant movements of both legs were noted in an asynchronous fashion. One might call these “restless legs,” but medically they looked like a syndrome called akathisia or psychomotor restlessness. Minimal movements of the hands and fingers were also noted.

Akathisia is most often caused by an adverse reaction to drugs, particularly with anti-psychotic medications. However, other drugs can also be responsible less often, including antidepressants such as tricyclic medications (nortriptyline and amitriptyline) and (SSRIs) selective serotonin uptake inhibitors (Prozac, Zoloft, Paxil, Celexa, Lexapro). In addition, calcium channel blockers (Cardizem), which are utilized for high blood pressure can rarely produce akathisia. Even if Putin is taking anti-psychotic medications, it does not indicate he is psychotic as some physicians may also prescribe these drugs for anxiety. And he may be taking anti-depressants or calcium channel blockers and having an adverse response, though akathisia is seen uncommonly with these compounds.

The National Library of Medicine of the NIH also mentions that akathisia can be seen with anti-emetic drugs (Compazine), drugs for vertigo, sedatives used for anesthesia, and abuse of cocaine.

Other considerations besides akathisia for Putin’s leg movements include the possibility of a tardive dyskinesia which can also occur with the above medications, or when they are withdrawn. However, movements of the arms and facial tics are present more often with tardive dyskinesia than mainly leg movements.

Less likely possibilities are that Putin has a neurodegenerative disorder or a movement disorder such as Parkinson’s or one of its associated syndromes. There are medications that can treat akathisia, but Putin may not even be aware of his problem or may not want any additional medications. And the treatments are not always successful. Those used include mirtazapine, beta blockers and anticholinergic compounds. The mechanism in the brain that produces akathisia is uncertain, but may have to do with dopamine or other neurotransmitters, and an imbalance between neurotransmitter systems, such as dopamine and acetylcholine. A blockage of dopamine type 2 receptors is also a consideration. There are no specific laboratory tests that can help with the diagnosis of akathisia. It is merely a diagnosis made by observation.

Patients with akathisia usually feel restless with a need to move. They may also feel subjectively uncomfortable. The akathisia may be short lasting or may persist indefinitely, even after the precipitating medications are withdrawn and treatment is initiated. We don’t know how long Putin has had these movements as there have not been videos of him with his legs exposed. Usually, he has been seen sitting at a long table, with his advisors or guests at the far end. There have been suggestions that this was a manifestation of paranoia, as Putin was afraid of catching Covid or of being assassinated. But perhaps this was related to his akathisia.

As far as we know, Putin is cognitively intact, but it would be helpful if his physicians told the world what is going on since he is the leader of a powerful nation with nuclear weapons. However, Putin wants to project an aura of strength and determination to the world and certainly does not want it known that he has an illness of any sort or is taking medications on a regular basis. In an autocratic state, the leader controls the release of all information, particularly those of a personal nature.


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Global Suppression of Women's Rights

Global Suppression of Women’s Rights

                        Robert A. Levine

Even as more women appear to be participating in the political process worldwide and holding high offices, women’s rights in many nations appear to be under attack by the patriarchal order. This is true in both democratic and autocratic countries where men want the power to control women and their bodies.

The most obvious and brutal suppression of women’s rights appear to be occurring in nations such as Iran and Afghanistan. But it is true in all Muslim nations where men still rule the roost, allowed to have up to four wives and to determine where and when women my go to school, the jobs they hold, and even whom they may marry. Saudi Arabia recently lifted some of its most restrictive rules regarding women’s lives, but men still control women to a large degree.

In Iran, riots and demonstrations have erupted led by women in multiple cities protesting the death of a young woman who was arrested by the morality police because her hijab wasn’t covering all of her hair. Her captors claimed she died of a heart attack while imprisoned but there were signs that she was beaten severely. In response, women have been burning their hijabs, setting fires to police cars and demonstrating in the streets along with men. The Revolutionary Guards have reacted by firing against the rioters with live ammunition and tear gas, killing a number of them. The rules regarding modest dress and Islamic law have been promulgated by elderly hard line mullahs who will not give way to the women and the youth of Iran who want more freedom. Women’s lives in Iran are completely dominated by men in what can be called “gender apartheid.”

In Afghanistan, since the Taliban took control of the country, they have reneged on all of their promises regarding freedom for women. Girls can only go to primary schools with no further education, cannot pursue careers, need male chaperones when they go out, and have arranged marriages decided by their fathers. Their fathers or their husbands run their lives.

In the United States, a conservative Supreme Court in the Dobbs decision had six Catholic justices overturn precedent in delegitimizing Roe v Wade, leaving abortion law up to individual states. Subsequently, a number of states have restricted abortions with various laws, taking control of women’s bodies. A restrictive abortion law in Kansas was soundly defeated by referendum, but legislatures are fighting against referenda in other states to maintain strict abortion laws. Whether or not Congress will pass a federal law in the future to legalize abortion nationwide again depends on the make-up of the House and Senate. And the glass ceiling still exists in many US businesses though women have been slowly climbing the ladder.

In China, their one child policy per family was too successful and their population started to shrink. The law was subsequently modified to allow two or three children per family to stabilize the population and help the economy. But many women remain happy having one or no children because of the cost and the desire for additional freedom. The Chinese Communist Party is anti-feminism, believing that all ideology should come from the Party itself. There have been no women leaders of China since the Party took over in the 1940s with the Communists supporting the primacy of men.

In Mexico, one of the most violent states in the world, women are being murdered, raped and often disappeared in what is known as “femacide.” The perpetrators are rarely caught or brought to justice.

Trafficking of women for sexual purposes is rampant in Eastern Europe and parts of Asia, but is a problem in virtually every nation. These enterprises are often run by gangs or cartels controlled by men and can be quite profitable.

Various other nations have also been trying to suppress women’s rights, viewing women as baby-making machines and being unwilling to provide them with agency. This is most prominent in conservative or religious countries where men are accustomed to power and do not wish to see women with equal rights challenging them. Many men are afraid of women achieving equality or superiority and taking control of politics and businesses. At universities, women generally perform better than men and their life expectancies are greater in all economically advanced nations.


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Sex and Abortion

Sex and Abortion

            Robert A. Levine

The recent Supreme Court ban on abortion is not the first time religious conservatives have tried to take away women’s rights. And we are not the first society where there have been attempts to make women subservient to men and dependent on them. And this is not the first time that religious zealots have tried to tie sexual relationships to having children, trying to deny women the right to sexual pleasure without bearing children. What is wrong with men and women having sex purely for pleasure and not to conceive?

Religion and ancient societies have always been patriarchal in structure, emphasized in the Bible and all religious texts. Remember that Eve was fashioned from Adam’s rib. She was just part of a man while Adam was the superior being. In some primitive societies, women are still considered chattel at the disposal of the men who are their protectors and actual owners. There is even an aura of evil in some religions regarding women, who are labeled as temptresses who will lead men to sin and infidelity. Religious texts do not emphasize pleasure for women in sexual congress, believing that sex is for men to have pleasure and to create children.

Islam allows men to have four wives and original Mormonism also allowed men multiple wives, showing that men were superior beings. Conservative Protestant religions expect their women to stay home and have children, rather than pursue education and careers separate from their men. Religious Catholics believe that use of contraceptives is a sin and that the purpose of sexual intercourse is to produce children. Orthodox Jews are split on abortion but it is felt to be a conjugal duty that a man provide pleasure for his wife in conjugal sex.

In none of the western religions is there any text on the right of men and women who are not married to have sex purely for pleasure. Banning of abortion by the Supreme Court furthers the idea that sex that does not produce children is evil and that the mother must be forced to carry an unwanted child because she sinned by having sex. Of course, many married women become pregnant and believe they cannot afford or do not want to have a child and so have an abortion.

It is not a surprise that all of the Supreme Court Justices who voted to overturn Roe v Wade are religious Catholics, though Justice Gorsuch labels himself as Anglican/Catholic. The fact that these six justices allowed their religious beliefs to guide their decisions against the views of the majority of the nation is a detriment to our democracy. Though it is certainly not necessary to have justices proportional to the nation’s population, it is aberrant to heave 6 or 7 Catholics on the highest court in the land, with all of them appearing to follow religious dogma. How could they not overturn Roe v Wade when they have been taught all of their lives that abortion is a grave sin?

When John Kennedy was elected president in 1960, many Americans called him a papist, believing that he would be adherent to church doctrine. This did not occur but it is now the Supreme Court that is following the precepts of their church against the popular will. Their decision to allow religious schools to receive state funding in Maine that was given to private schools is further evidence of their religious beliefs and is contrary to the Founders desire for the separation of church and state. No religious institutions should be receiving government funds. And no teachers or coaches should be able to hold prayer sessions on public property after or during a school function where students might feel obligated to participate.

These justices who are Catholic acolytes might do better to try and clear their church of its rampant pedophilia which seems to be an ingrained problem at all levels, instead of interfering with secular laws that have been on the books for fifty years and have the support of the majority of the population. It is also unfair that presidents who did not win the popular elections and senators who represent a minority of the population have been able by hook and crook to fashion a minority Supreme Court who follow their religious precepts in ruling on their cases, bringing America back to a less open and less modern age. There are a number of ways that the Court could be changed to be made more modern and realize that sex for pleasure between loving individuals is not such a bad thing after all, even if it results in an unintended pregnancy. Women should be able to have children when they desire it, and abortion and contraception should not be made more difficult because of prudish men and one woman.

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Pro-Life Hypocrisy

Pro-Life Hypocrisy

            Robert A. Levine

There seems to be a pattern of beliefs associated with those who are so-called pro-lifers. They are against abortion as they believe the procedure takes a life even if it is done prior to the fetus’ viability. Yet once a child is born they do not mind if it is killed by a crazed gunman or someone seeking publicity or attention by killing children. The same people who are pro-life are also pro-guns and want gun rights in this country to be expanded even though gun deaths in America are higher than in any other nation in the world. For the most part, those who are vehemently against abortion are vehemently pro-guns.

They do not see any reason why the possession of assault weapons by civilians should be curtailed, even though these weapons were designed primarily for maximal killing on the battlefield. Their mantra has been “guns don’t kill, people do.” Of course, if people did not have guns, they couldn’t use them to kill innocents. The pro-life adherents generally don’t want enhanced background checks for people buying guns, age limits on the purchasing of guns, or licensing of guns. They see no reason why laws should prohibit the carrying of guns in public and it appears as if the conservative Supreme Court may go along with this idea.

Why should America be such an outlier among all the developed nations in the world, with more guns than people and more gun deaths and mass killings than all the European nations and Japan combined? Countries that are most similar to America like Australia and Canada have strict gun regulations. Common sense and rationality should show Americans that our gun laws need to be more restrictive. And the majority of Americans and perhaps even gun owners agree with this. But not the most ardent pro-lifers.

But aside from guns, pro-lifers in general do not want to help families properly care for children after they are born. They do not want to increase the availability of health care for poor families, including post-partum care for mothers and babies. They do not want federally subsidized day care to allow mothers to work. They are against food assistance for poor families. They are against spending more money on education, both K-12 and college. In fact, they are usually against any increased social spending by the federal or state governments, as increased spending can lead to increased taxes.

These interconnected ideas- pro-life, pro gun, decreased social spending, decreased taxes- are all part of the conservative agenda in America. Conservatives claim to favor individual rights over government regulation, but make an exception for pregnant women. As far as women who become pregnant and do not want the child for various reasons, the conservatives expect state and federal governments and the courts to force women to carry their pregnancies to term. They refuse to acknowledge the contradiction between their views regarding individual rights and government laws and regulations where women’s bodies are concerned. If one was truly pro-life, gun control and government assistance for poor children would be part of conservative policy prescriptions. Life does not begin and end in the womb.


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