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include the possibility of a tardive dyskinesia which can also occur with the above medications, or when they are withdrawn.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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