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include the possibility of a tardive dyskinesia which can also occur with the above medications, or when they are withdrawn.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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How Does the Russian-Ukraine War End?

How Does the Russian-Ukraine War End?

                        Robert A. Levine

There are many different possible scenarios about how the Russian-Ukrainian war might end. The main factor standing in the way of a settlement is the fact that Putin cannot lose face, unless he dies or is deposed, both of which seem unlikely. Thus far, Russian troops have performed abominably, being unable to conquer Kviv or any major city aside from Kherson. They have succeeded in destroying Ukrainian infrastructure and residences in many cities and are guilty of committing horrendous war crimes which Russian propaganda has been unable to keep hidden from the rest of the world. Aside from other autocratic nations, the world seems to be fairly solidly opposed to Russian aggression in Ukraine, the damage they have wrought and the innocent civilians including children that they have killed.

The fact is, however, that Putin doesn’t give a damn about his or Russia’s reputation. He just wants to end this” special operation” with what he can label a victory for his military and the Russian people. Unless this new focus on the Donbas region by the Russian military rewards Putin with some significant territorial gains, Putin is going to have difficulty claiming victory despite the loss of Russian lives and military equipment. A revolt against Putin or his assassination by his military or FSB personnel would probably end the war, but appears very unlikely. His control of the Russian propaganda machine and the media have heightened his approval ratings among the Russian public who have supported his actions against the ”Nazi” regime in Ukraine.

Putin stepping down from his position as president voluntarily is also improbable. If there is a stalemate in the conflict, it is hard to imagine Putin allowing the special operation to continue for years, draining the Russian treasury of what little it has, and losing more Russian manpower. Another consideration if for Putin to use tactical nuclear weapons to try and end the war, either bombing a Ukrainian city or a relatively uninhabited area as a warning to Zelinsky and the Ukrainian government. Of course, that would earn Putin even more approbation from the nations of the world, perhaps even from China.

Another way this war could be ended would be by a major power or an ally of Russia stepping in and suggesting negotiations, either at this point before the battle for the Donbas begins or if a stalemate is reached. The United States would be unable to suggest that since Putin has branded the U.S. and the West as the real participants in the current conflict. China and Xi would be the perfect interlocutors as they are seen as allies of Russia and a world power. They could make it seem as if Russia has been winning by destroying Ukrainian cities and Xi wants to end the bloodshed and destruction. This would certainly make China be perceived positively in the world’s eyes and would be a great triumph for Chairman Xi, particularly with Chinese Communist Party elections on the horizon. The question is whether Xi is farsighted enough to realize the benefits that would accrue to him and to China. At the moment, the CCP is spouting Putin’s lies and at least giving him political support.

Orban of Hungary and Erdogan of Turkey could also try to intercede but do not appear weighty enough to influence Russia. If no leader is able to intercede, one can see this war dragging on and on, since Putin seems to have no regard for the lives of Russian soldiers or Ukrainian civilians. Putin just wants to save face at this point and be able to claim a victory of some sort for a “special operation” that he never should have started in the first place.

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What Happened to the Brotherhood of Ukrainians and Russians?

What Happened to the Brotherhood of Ukrainians and Russians?

                        Robert A. Levine  4-7-22

We see the bestiality of Russian soldiers every day on television as they kill innocent civilians, destroy housing, torture people, loot and rape women. This is not all Putin but must be built into the Russian psyche. These are both conscripts and battle hardened soldiers who perceive the Ukrainians as their mortal enemies, deserving of Russian wrath. How can they so brutalize innocent civilians who in the past were considered the brothers of the Russian nation and whose many citizens speak Russian? All along, Putin has claimed that Ukraine was not a nation but a part of Russia.

Have the Russian soldiers succumbed to the unending lies and propaganda of the Russian state depicting the Ukrainians as Nazis, in spite of the fact their leader Zelinsky is Jewish and was elected by a wide margin as president of Ukraine in a free democracy? Is it revenge for seeing their companions killed by a supposed inferior force and losing battle after battle to the Ukrainian military. What do they gain by destroying cities and homes, killing and torturing citizens and earning undying hatred from the Ukrainians? If the Russians win the war it will never end, as an insurgency will flourish in the soil of hatred that the Russians have fertilized and planted in Ukraine.

The big question now is how can the war end without Putin losing face? Though the Russians have destroyed many cities and villages and killed numerous civilians, they have taken no territory in the center or west of Ukraine. They may be martialing their forces for all out pushes in the east and the south, to cut off Ukraine from the Black Sea and build a land bridge between the Donbas region and Crimea. But will they be able to win these battles and if they succeed will they be able to hold the area against Ukrainian onslaughts.

The war in Ukraine has demonstrated how disorganized and chaotic the Russian military is when fighting a smaller and supposedly weaker enemy. How would their conventional military stack up against NATO forces without using atomic weapons? Most likely they would soon be routed. It appears that the claws and teeth of the Russian bear are decayed and cannot stand up against a determined adversary. Unfortunately, Russia can always fall back on a threat to use nuclear weapons if their military is unable to obtain its objective. But it is hard to see an end game to their war against Ukraine without a decline in status for Putin and the Russian leadership. And perhaps at some point, the Russian people will see through the fog of lies and propaganda that has been fostered upon them by the Russian state. Will there be a reckoning?

Robert A. Levine

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Putin, Russia and War

Putin, Russia and War

                     Robert A. Levine March 22, 2022

When the Iron Curtain finally came down in 1991, it appeared that a new dawn had arisen for mankind, with autocracy trending downward and democracy on an upswing. Certainly, China was still on an autocratic path, but its economic interdependence with America and the West offered some possibility of liberalization in the future. And with the Soviet Union having disintegrated, Russia under Boris Yeltsin provided hope for the establishment of democratic change. And all the Soviet vassal states were now free, with most of them opting for a liberal democratic form of government.

However, those who saw the future ascension of liberal democracy in the world were grievously mistaken. Democracy in Russia was a mirage, with deep corruption as state assets were sold off to private businesses and individuals in converting to a capitalist-style country. Wealthy oligarchs became engrained in the system of government with the majority of the populace neglected. Yeltsin turned out to be an incompetent drunkard who was unable grasp the power inherent in his position and what he could do to stabilize and improve governing. One of his advisors was Vladimir Putin, an ex-KGB officer. Finally, in 2000, Yeltsin surrendered his position and handed the reins of government to Putin who was approved by the Duma (Russian Parliament).

From the moment Putin assumed the presidency of Russia, its flight from democracy accelerated with an autocratic, personalist ruler in change. Since Putin became Russia’s leader, he has tightened his rope around the neck of any dissenting forces, assassinating some opponents and imprisoning others. Freedom of speech and anti-government rhetoric has gradually been banned, with long prison terms for those who flout the law. With term limits in the Russian constitution, Putin allowed his associate Dimitri Medvedev to be president for one term in 2008, with Putin as prime minister. Putin was reelected president in 2012, being perceived as in charge of the Russian state for over two decades, for even while Medvedev was nominally president, Putin held the power. A referendum in 2021, allowed Russian presidents to remain in office for more than two consecutive terms, which means Putin will likely be Russia’s leader until he dies or is deposed, the latter very unlikely.

Putin sees himself as someone in a long line of strong Russian leaders going back to Czarist times and including Ivan the Terrible, Peter the Great, Stalin and himself. He has said that the fall of the Soviet Union was the greatest geo-political disaster of the 20^th century and he is trying to reverse its effects through military action. In 1994, Russian troops invaded Chechnya, a breakaway republic, to return it to Russian control. In 20 months of war, an estimated 100,000 Chechnyans were killed. Yeltsin was nominally in charge then and Putin’s role is unclear. However, the second Chechnyan War occurred under Putin from 1999 to 2009, with Islamists calling it a holy war. Grozny, the capital city of Chechnya was leveled and the war waxed and waned for a decade, with tens of thousands or more of Chechnyan civilians killed as well as numerous soldiers on both sides.

Georgia was next for Putin in 2008, with a short destructive war and seizure of the regions of Ossetia and Abkhazia, claiming Georgian genocide against the two republics. Disinformation from Russia was rampant with statements that the Russians were peacekeepers who had come to save Russian citizens. Putin also launched cyberattacks and blamed Georgia for starting the war.

In 2014, he grabbed Crimea from Ukraine and sent Russian troops into Donetask and Luhansk, to fight the Ukrainians, often disguising his military fighters as volunteers or local soldiers. Putin claimed he was protecting ethnic Russians and his troops were peacekeepers.

Then in 2015, after supplying the Syrian government with weapons since 2011, he had Russian forces enter the conflict on the side of the Syrian dictator Bashar al Assad. The Russian Air Force and missiles pounded the opponents of al Assad as well as civilian populations, hospitals and medical facilities. In addition, either the Russians or Syrian forces or both attacked civilians and opposing fighters with chemical weapons. Will Putin follow this formula in Ukraine?

The recent invasion of Ukraine which Putin calls a special military operation employed the same pattern of lies and destructive tactics he has used elsewhere. However, Putin did not expect to meet such fierce resistance from Ukrainian troops. Unable to capture any cities thus far except Kherson, Russian troops have targeted civilians, destroying residential buildings and non-military structures to try and break the will of the Ukrainian population. He talks of de-nazification of the country when a Jew is the president and seems not to care how many of his own troops and Ukrainian civilians are killed.

The question that must be asked is what will Putin do if his troops continue to be stalemated by the Ukrainians. Will he turn to chemical or biological weapons, or even consider the use of tactical nuclear weapons on the battlefield or against Ukrainian cities? Here is a man dedicated to restoring Russia’s empire, an imperialist who considers himself a great leader. Can he handle the thought of losing in Ukraine without resorting to even more horrific tactics? And how will he deal with nations in the West who support Ukraine with weapons and financial sanctions? It is hard to read the mind of a paranoid narcissist.

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Putin's Madness

Putin’s Madness

            Robert A. Levine 2-7-22

How does the world deal with a madman who controls one of the largest nuclear arsenals in the world and appears to be deranged and blatantly paranoid? Very carefully. But will that be enough. He has no compunctions at killing tens of thousands of people so why not millions? Obsessed with power, he wants to live in the past and reconstitute the Soviet Union and the Soviet Empire. He has said that the demise of the Soviet Union was the greatest geopolitical catastrophe of the 20^th century. Now it appears as if he is determined to change the course of history and return the world to where it was fifty years ago. And he won’t listen to reason from other world leaders and possibly to his own advisors. Putin says the Russians and Ukrainians are one nation, which means that he doesn’t care about killing his own people.

Does Putin believe any of the lies he is telling the Russian populace and world leaders about why he is invading Ukraine?  Putin claims that there is no war between Russia and Ukraine but a special military operation. The Russian government has forbidden all the media and the opposition to Putin to label the fighting in Ukraine as a war. He says the Ukrainian government and military are neo-Nazis and are a danger to Russia. Can he really believe that when Zelensky, the president of Ukraine, is a Jew? And how can Ukraine be a threat to Russia when the latter has nuclear weapons which Ukraine returned to Russia when the nukes were stationed on Ukrainian soil. Putin also claims that Ukraine has always been a part of Russia and not an independent nation. Russia has four times the population of Ukraine as well, a much larger and stronger military, with the latest weapons and a far superior air force and number of tanks.

Putin says the Russians are not targeting civilians in Ukraine, though they are bombing civilian apartment houses and residences in the large cities and shutting down sources of water and electricity. They’ve also attacked the largest nuclear plant in Europe which could be disastrous if it exploded, with radiation many times that of Chernobyl. Whether Ukraine survives as an independent state or as a Russian vassal, rebuilding the destroyed infrastructure of the country with ravaged buildings and residences will cost hundreds of billions, if not trillions of Euros.

The videos of Putin sitting at one end of a very long table, with advisors, or cabinet members, or visitors at the other end is another manifestation of his paranoia. It may have been valid when Covid 19 was rampant, but is now unnecessary and shows Putin as being isolated from other human contact. Was he afflicted with Covid and did that change his cognitive function and mental acuity? Was it just his prolonged isolation and listening to his own propaganda?  He has placed his nuclear weapons on a higher alert status, threatening their use if any nation interferes in his war with Ukraine. These are not the actions of a rational man.

But the only people who can stop Putin are the Russians themselves, though most of them seem to believe his propaganda regarding the war. The Russian people’s only access to news is through Russian state radio and television, though the young people get some information through the internet which is also inundated with government lies and propaganda. Some brave Russian souls have demonstrated against the war and thousands have been imprisoned because of their opposition.

The world’s economy is being hit hard by Putin’s misadventure. Not only are gas and oil supplies diminished, but important metals for technology like cobalt, titanium, nickel and lithium are all being squeezed. And even worse is the decrease in supplies of grain which usually come from Russia and Ukraine. Wheat, barley and corn are all in short supply with prices rising quickly. This will cause even worse inflation in the developed world and hunger and famine in Third World nations. Putin doesn’t care. He sees himself as returning Russia to its rightful place in the world’s power hierarchy and himself as one in a long line of strong Russian rulers. He wants to restore Russia’s empire and sphere of influence and abolish the rules based relationships between nations that became prevalent after World War II and atomic weapons. Putin may next go after other previous Soviet vassal states. How it will end is uncertain as it is difficult to read the mind of a madman.

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What Does Putin Want?

What Does Putin Want?                                                                                                                              Robert A.  Levine

The answer seems simple. Putin has said several times that the collapse of the Soviet Union was the biggest catastrophe of the 20^th century. As an old KGB officer, he would like to right what sees as this wrong and reconstitute Russia as a world power in the mold of the Soviet Union. Putin was angry when George H.W Bush said that the Soviet Union had lost the Cold War and was outraged when Obama declared that Russia was just a regional power.

Now Putin is trying to show the world that Russia is still a world power and that the United States and NATO cannot stop him from achieving his goals. He believes that Russia should have a sphere of influence that includes all the nations that surrounds it and that NATO troops should not be stationed in any of those countries, what Putin calls Russia’s ‘near abroad’. He also believes that Ukraine is part of mother Russia and does not want it to become a western democracy right on Russia’s doorstep.

However, while Putin has modernized Russia’s military to put it on a par with the U.S. and China, he does not have the industrial base or the economy to maintain his large army and fight wars. His economy is in the doldrums, the Russian people lacking many modern conveniences. His only exportable products are fossil fuels, oil and gas, which does give him a lever to use against European nations. But with the movement towards renewables, fossil fuels will only be of value to Russia for a few more years, or a decade at most. As energy from renewables goes up, fossil fuel exports will be going down.

Putin has not been preparing Russia for the day when fossil fuels will no longer bring in capital to Russia and will not be helpful as a bargaining point. He needs to diversify Russia’s economy and have high tech products that they can sell to other nations. And he has to stop spending so much of Russia’s funds on his military and subsidize other industries. He also has to tax the oligarchs who support him and distribute some of their wealth to the ordinary Russians. The quality of the average Russians life has to improve or there will be a breaking point in the future. People cannot live on the glory of military victories when they don’t have the conveniences of modern life. Social media and the internet allow them to see what the citizens of western nations have that they lack. And propaganda will just go so far.

Russia is a vast land and aside from fossil fuel, they have many different natural resources that have not yet been fully exploited. There is also plenty of land that can be utilized for agriculture. Putin should stop looking for military victories to sustain him in power and instead look inward to see how he could help Russians improve their quality of life. He should concentrate on new industries and welcome investors from other advanced countries to provide funds for Russia to achieve first world status in other realms besides military power. Of course, he would have to provide guarantees before wary westerners would consider investing. As a narcissistic dictator who does not brook opposition, it is questionable whether Putin would be willing to surrender military parity with the United States and put his money elsewhere in the Russian economy to generate consumer goods and high tech products.

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Understanding Putin and Russia

Understanding Putin and Russia                                                                                                                            Robert A. Levine

When the Soviet Union and Communism dissolved in 1989-90, Russian citizens were shell shocked. They had no concept of how democracy and capitalism actually worked when it appeared that these were Russia’s next steps. The Russians had been fed a steady diet of propaganda for over 70 years, demonizing liberal capitalist democracy, lauding Marxist economics, the Soviet empire and praising Russian exceptionalism and greatness. When parliamentary elections took place in December 1993, the populist and ultranationalist Vladimir Zhirinovsky and his party were the winners with 22 percent of the vote. Russia’s Choice Party, whose goals were democratic and western oriented, avoiding populist promises that could not be fulfilled, received only 15 percent of the vote.

Without a background or education in democratic principles, Russians were politically illiterate and unprepared for the advent of democracy. Having also been inculcated with the idea that they were one of the world’s great powers and rulers of the Soviet Empire, Russians were unaccepting of a lesser role. President George H.W. Bush’s comment that America had won the Cold War also stuck in the craw of many Russian citizens to whom Russian power was important. It was as if America and the west had stolen their dignity and dishonored them.

In 1996, Boris Yeltsin was elected president of Russian against a communist opponent, Gennady Zyuganov, in a campaign controlled and directed by Russian oligarchs and media tycoons. Yeltsin was perceived as a weak leader whom the oligarchs could manipulate and exploit. And they were largely right. It was not a victory for liberal democracy or the Russian people, allowing the oligarchs to acquire previously state owned resources and properties at cut-rate prices, then using capitalist techniques to grow their wealth. Youthful reformers in the government who favored liberal democracy and western ideals were forced out of their jobs, tarnished by the media, money and prostitutes. And some like Boris Nemtsov, who was fighting for a liberal democracy, were assassinated by those afraid of his ideas and charisma.

The liberal media was also destroyed by the oligarchs, with western values derided and a nostalgia for Soviet times and a leading place in the world. The siege of Sarajevo in the Bosnian-Serbian war and the bombing of Serbia, a long-time ally of Russia sharing the Orthodox religion, also soured the Russian public on NATO, America and the west. Nationalist sentiment greatly increased just as Putin’s star began to rise. While Yeltsin was still president, he and the oligarchs supported Putin, a former KGB agent. TV and the media fawned over Putin, a young, sharp and dynamic man, energetic and healthy.  In August of 1999, Yeltsin appointed Putin as prime minister and backed Putin to succeed him as president when he resigned on New Year’s Eve 1999.

Subsequently, Putin consolidated his power while keeping the outer vestiges of democracy intact. With the price of oil rising, the Russian economy thrived and Putin was able to increase consumer goods, build up the military and satisfy most of the Russian population. He limited his presidency to two terms initially, making Dimitri Medvedev president while Putin became prime minister. But there was no question of who really held the reins of power. After Medvedev served four years, Putin was re-elect president again. In a referendum in 2020, Putin was elected as president until 2036 when he will be 83 years old. Thus he is essentially president for life.

There has been some opposition to Putin from a small coterie of liberals who do not want Russia run by a dictator for life. Recently, the opposition has been led by Alex Navalny, who was poisoned in Siberia, most likely by the FSB, and almost died. He is now back in Russia and was sent to prison. All the media outlets that criticize Putin have been shut down, and liberals and human rights supporters have been labeled as enemy agents, many of them also thrown in prison. Thus, Russia isn’t even a pseudo-democratic state at this point.

Under Putin’s guidance, Russia has been involved in multiple military ventures, to assuage the nationalists and restore the nation’s great power status, at least in Putin’s mind. There was the second Chechen war, the war with Georgia, Russian intervention in Syria, the annexation of the Crimea from Ukraine, the intervention in Khazachstan, and now the threat to invade Ukraine. Putin wants Russia to be recognized again as a great power and himself as a great leader. He wants to restore some of the dignity and honor that Russia lost when the Soviet Union imploded. Putin feels that he and Russia are disrespected by the west and wants to display his nation’s power, which will help him at home as well as abroad. He is the longest serving Russian leader since Stalin.                                                                                                www.robertlevinebooks.com                                                                                                                       Buy The Uninformed Voter on Amazon and Barnes and Noble