What ails Russian President Vladimir Putin — if anything? A lot of people seem to think they know.
Hardly a day passes without fresh speculation about the health and welfare of the Russian leader. Putin has blood cancer; he has thyroid cancer; he has a brain tumor. He has Parkinson’s disease or early-stage dementia.
The symptoms? He doesn’t walk normally — or at least not the way he used to. He behaves irrationally and appears disoriented. His face is puffy, his posture isn’t right. He has hand and leg tremors. He disappears from public view.
A Telegram channel run by a former Russian foreign intelligence officer said Putin will soon undergo cancer surgery — the report goes so far as to identify the official who will stand in for Putin during the operation. A study prepared for the State Department more than a decade ago resurfaces; according to its author, Putin has Asperger’s Syndrome.
Noteworthy names have joined the conversation. Richard Dearlove, a former head of MI6 — the British spy service — said the “best explanation” is that Putin has Parkinson’s disease. The economist Anders Aslund tweeted that Putin had undergone surgery in mid-May; “rumors claim that it was abdomen cancer.” Three days into the war, former secretary of state Condoleezza Rice said Putin “was always calculating and cold, but this is different. He seems erratic.” Boris Karpichkov, an ex-KGB counterintelligence officer who defected to Britain, diagnosed a cocktail of maladies — Parkinson’s disease, dementia and “numerous” other ailments. “He is — or at least acts — insane and obsessed by paranoid ideas,” Karpichkov told the Sun.
Diagnosing Putin is obviously more than a matter of curiosity; a correct assessment might help the world better anticipate his next moves in Ukraine and inform its response.
It’s also an area in which respected physicians and psychologists tread carefully, for the simple reason that they cannot examine the patient in person.
“I think something is going on from the medical perspective,” Les Pyenson, who led the CIA’s ”leadership analysis” department for 15 years, told Grid. “Something is wrong with him — but I don’t know exactly what.”
The Kremlin has denied claims that Putin has cancer, and this week Foreign Minister Sergei Lavrov became the latest senior Russian official to push back against the suggestion that his boss is unwell. “You can see him on the screens, read his speeches, listen to his speeches,” Lavrov said. “I don’t think sane people can discern any sort of symptom of disease in this man.”
But plenty of people have discerned symptoms, often from those “screens” and “speeches” to which Lavrov referred. Grid reviewed the available information and spoke to doctors and professionals with experience in “leadership analysis,” the practice of evaluating people who are not always easy to evaluate — former president of Cuba Fidel Castro, former Iraqi president Saddam Hussein and former North Korean leader Kim Jong Il, to name a few.
“You can’t say anything with certainty about Putin, other than the fact that something isn’t right,” a prominent American neurosurgeon told Grid. He spoke on the condition of anonymity, but he and others offered Grid their own “diagnoses.” We’ll get to those in a moment.
First, a review of what one might call the “evidence.”
Videotapes, public appearances and one oligarch’s claim
Amid all the hearsay and vaguely-sourced reports, here are a few items worth highlighting.
Exhibit A: isolation — and that long table
In the fall of 2020, though covid restrictions across Russia had been relaxed, the New York Times reported that Putin was tightening his own isolation, restricting access to his Kremlin rooms and imposing stringent protocols for visitors — including isolation for two weeks and the requirement they pass through a disinfectant tunnel. The measures seemed particularly severe given that most Russians had returned to more normal rhythms of life.
By February 2022, in the days leading up to the invasion of Ukraine, Putin had taken to conducting in-person meetings at a now-familiar long table. Questions swirled about his “wildly paranoid” behavior; others noted an “unexplained bloating of his face” and the possibility that he was taking steroids for an undisclosed medical condition.
Exhibit B: gripping the table
During an April 22 meeting with his defense minister, Sergei Shoigu, Putin sat slightly slouched and held the edge of a small table for a full 12 minutes. At a minimum it looked odd. To some it appeared that Putin was steadying himself against a tremor.
The video prompted more speculation — this time that the Russian leader might be suffering the effects of steroid treatment or Parkinson’s disease.
Exhibit C: Victory Day
As Grid and others reported, the May 9 Victory Day parade — always a highly symbolic and important day for Russia — carried particular importance this year, given the war and the absence of obvious “victories” worth celebrating for Putin.
When the day came, the Putin health watchers found more grist. Again there was the puffier-than-normal face; also the fact that this famously macho figure, occasionally seen bare-chested in winter, draped a blanket across his legs as he watched the procession. The temperature was reported to be 9 degrees Celsius — 48 Fahrenheit. That’s almost balmy for early May in Moscow. And when it came time to march in the square, Putin did so with his left arm swinging; the right arm did not move.
Exhibit D: an unexplained twitch
On May 23, the Kremlin posted a video of Putin with Belarusian President Alexander Lukashenko, in which the Russian leader sat hunched over, his left hand and foot twitching occasionally. When the two men met a month earlier, Putin’s right hand shook slightly.
Exhibits E and F: traveling doctors — and the oligarch’s account
Two bits of nonvisual “evidence” merit a mention.
First, from Proyekt, a respected Russian investigative news outlet, a series of reports have stated that Putin is regularly accompanied by specialist physicians: a pair of head and neck surgeons, an orthopedic traumatologist, and a neurosurgeon who has written about thyroid surgery and thyroid cancer. Three of these doctors, according to Proyekt, are Putin’s “most frequent travel companions.”
And in early May, New Lines magazine said it had obtained a recording from an oligarch close to the Kremlin who described Putin as “very ill with blood cancer.” The oligarch, given the alias “Yuri” by New Lines, also said Putin had undergone back surgery in October 2021. On the one hand, New Lines said it couldn’t verify Yuri’s claim; on the other, the recording offered rare testimony from someone with known ties to the Russian government. And while many Russians might have a motive to spread false narratives about Putin’s health (indeed, Yuri raged openly at Putin and the damage done by the war) New Lines said that Yuri had not known he was being recorded. “We all hope” Putin dies from his cancer, “Yuri” said on the tape.
How it’s done: from Castro to Putin, analyzing dictators
How to “diagnose” a prominent individual who does not wish to be diagnosed — at least not by an outsider? Grid spoke to people with experience in this field, all of whom spoke with a degree of humility about the work.
“The craft of leadership analysis is complicated because you’re trying to understand leaders at a distance, especially adversaries who are very hard targets,” said Ken Dekleva, a psychiatrist and former State Department official who has studied Putin, Chinese leader Xi Jinping and Kim Jong Il.
“Look at Putin himself,” Dekleva said. “Even though he’s met with a lot of world leaders, written an autobiography, he’s given many interviews … in spite of all that a lot of people still have gotten Putin wrong.”
Dekleva and others listed core elements of these long-distance “diagnoses”: primary sources — people who have recently seen or known the leader; secondary sources that might include videos, writings and statements made by the leader; then, writings and analyses about the person in question.
Pyenson majored in psychology, became a medical doctor and parlayed those skills and an interest in public service into a long career in “leadership analysis” for the CIA.
“We would get requests from Congress or the president, or sometimes from the military,” Pyenson told Grid. “Basically somebody wanted to know, for example, why is Fidel Castro walking strangely? Is such-and-such leader deathly ill, or what’s really wrong with him?”
Pyenson’s CIA work involved a who’s who of difficult targets — Castro and Hussein, Kim Jong Il and Latin American narcotraffickers, to name a few.
“We would take every opportunity to see these people in person,” said Pyenson. “Any occasion to get close to them, or bump into them, shake hands, anything. It’s like a physical exam. Assuming you get the chance.”
Pyenson had a “chance” with Putin’s predecessor. By the mid-1990s it was well-known that Boris Yeltsin drank heavily, but rumors abounded — then as now — that Russia’s president had other problems. In 1995, the CIA provided Pyenson the highest-level clearances for that year’s sessions of the United Nations General Assembly in New York. Pyenson used these to “bump into” Yeltsin on the sidelines of the U.N. meetings.
“I noticed his hands were really puffy, and when I looked down, I saw his ankles were swollen and he was moving awkwardly,” he said. Not a man to leap easily to conclusions, Pyenson leapt to one that day: “It was clear to me based on what I saw physically with him that he was at risk of congestive heart failure. No question.”
Pyenson sent his assessment to Washington. A report was prepared for the Kremlin, the gist of which was that if Yeltsin stopped drinking and underwent cardiac surgery, he might avert a potentially fatal heart attack. The following year the acclaimed American heart surgeon Michael DeBakey supervised a Russian team that performed quintuple bypass surgery on Yeltsin.
It’s a great story, but the idea of such a run-in with the current Kremlin leader is far-fetched, to say the least. U.S.-Russian relations were relatively strong then, and Putin’s inner sanctum is famously impermeable. No modern-day Pyenson is likely to have a chance encounter with the man.
Diagnosing Putin: the leading candidates
The ex-MI6 chief, Dearlove, speculates that the “best explanation” for Putin’s condition “is that he may have Parkinson’s disease.” In an interview with GB News, he said this was based on exchanges he had with “several neurologists.”
The American neurosurgeon Grid spoke with landed in Dearlove’s camp. “You cannot label him or label the condition with certainty,” he said. “But if you ask me about the best bet, the one that fits the most, it’s Parkinson’s.”
He pointed to Putin’s appearance in the videos: a decrease in recent years in animated expression — the clinical term is “masklike facies”: the constant gripping of that table, the limp arm on Victory Day. Asked to explain other occasions when Putin showed no signs of twitching or tremor, the neurosurgeon said medications can help a patient with Parkinson’s disease “be OK for a while.” Tremors can be tamed for an important occasion.
Dekleva’s assessment is less dramatic. He believes Putin is an aging leader suffering from chronic back pain.
“He’s almost 70. He’s not 50 anymore. So a lot of what we see is probably normal aging,” Dekleva told Grid. “His face is a little puffier — not uncommon. Lately he probably hasn’t worked out as much, he’s more isolated, maybe put on a little weight like everyone else did during the pandemic.”
For Dekleva, any discussion of “evidence” must include Putin’s famous passion for sport. There may be a stunt quality to some of the Russian leader’s televised appearances on horseback or the judo mat, but Putin is a decent hockey player and accomplished practitioner of martial arts. He is known to have sustained serious back injuries; he fell off a horse during his first term, and in 2017, at age 64, Putin took a near-somersault fall on the ice in an exhibition hockey game. As Dekleva put it, “that hurts.”
“He probably has recurrent, chronic low back pain,” Dekleva said. “And so if you catch him at a time when he’s having a flare-up he’s going to be uncomfortable. I mean, he needs a standing desk!”
Dekleva said he doesn’t see enough to convince him that Putin has Parkinson’s disease or another neurological illness: “Is it possible? Yes. We just need to be careful there.”
Pyenson, the longtime CIA analyst of global leaders, offered a pair of hypotheses.
“He could have cancer,” he told Grid. “He did look a little puffy and steroids can be one of the early medications that you give for something like that, whether it’s a lymphoma or other cancers. Thyroid cancer, perhaps.”
Thyroid cancer is serious but often not life-threatening. It might account for the puffiness, the presence of the thyroid expert in that circle of Kremlin doctors and the fact that there have been plenty of occasions when Putin looked fine.
But Pyenson wouldn’t rule out Parkinson’s disease, having watched what he calls “that table-gripping business” and the video of Putin on Victory Day in Red Square. “A normal person, your arms swing back and forth, but he doesn’t swing his right arm and his left shoulder is down, so there’s something going on there.” He says that might be the result of “an old judo injury, or it may be that he has Parkinson’s.”
Grid found no support for the notion that Putin is terminally ill, that he has Asperger’s Syndrome, or that he has dementia. And in a May 23 report, Western officials cast doubt on some of the rumors. One said: “President Putin is firmly in control of his inner circle, the country, and the decisions which are being made, irrespective of any speculation about his health.”
The dangers of “RUMINT”
Given the opaque quality of Kremlin information and high stakes of the war in Ukraine, we almost certainly will see more “news” and vaguely sourced reports about the Russian leader’s condition. Cautionary notes abound.
For one thing, anyone disillusioned by Putin’s totalitarian leadership may find advantage in portraying him as incapacitated in some way. A worst-case scenario might embolden the Ukrainian resistance, the Russian opposition or even rattle the Russian leader himself. Western governments may be similarly inclined to spread bad news about Putin’s well-being.
Others note that people have been “diagnosing” Putin for a long time; “reports” of cancer, for example, have persisted for years.
Dekleva has a term for this — “RUMINT” — a twist on “HUMINT” and “SIGINT,” the intelligence community’s shorthand for “human intelligence” and “signal intelligence.” “RUMINT” would mean “rumor intelligence” — which of course isn’t really intelligence at all.
“There’s a lot of ‘RUMINT’ out there right now,” Dekleva said.
Those involved in “leadership analysis” also note that a diagnosis is only the first step; equally important is what Pyenson calls the “so-what” factor — the practical implications. In other words, a terminal cancer diagnosis might bring leadership change and perhaps alter Putin’s own psychology; other cancers — thyroid among them — can be handled with medication and minimal impact on day-to-day function. Parkinson’s disease might mean a yearslong period of decline; chronic back pain just a lot of discomfort.
“In terms of Putin,” said Pyenson, “people should be thinking about not only what is wrong with him, but what would we do? What are the possible outcomes here, and how can we plan for that?”
Beyond the hypotheses about Putin’s physical condition, Pyenson and the other analysts offered assessments of his mental and psychological state.
“One thing everyone agrees on, those that have been interviewed about him, including people that have met with him recently: his inner circle is narrowed,” Dekleva said. “And what often happens with authoritarian leaders is the longer they’re in power, there’s a sense of more black-and-white thinking, what they call cognitive rigidity … you start to miss some of the nuances in decision making.”
Which is why former CIA acting director John McLaughlin — while quick to remind us he is neither a medical doctor nor a psychologist — believes in a diagnosis he names as “rattled.”
“I think what’s afflicting Putin is the enormous nature of his error here, because up till now, everything was working for him,” McLaughlin told Grid. “Whatever he did in the past, he got away with. And I think part of what’s going on with Putin is he knows his base of support is dependent on success, and on the support of the military and the intelligence people. And he’s looking really bad right now, and I think it’s got him rattled.”
Thanks to Alicia Benjamin for copy editing this article.