Stalin's last years: delusions or dementia?

The sheer scale of Stalin's achievements and institutionalized terror has prompted some authors to label him as a paranoid megalomaniac. Whatever the merits of this diagnosis, his undeniable accomplishments and the rationality of many of his actions cannot be explained by the workings of a disturbed mind. In his last years, however, his life-long suspiciousness became florid paranoia. He eschewed medical advice, listening to a veterinarian and treating his hypertension with iodine drops. Stalin feared his own shadow and trusted no-one, even himself. He increasingly withdrew from official functions and he muttered menacingly to his close associates that it was time for another purge. Stalin suffered at least one stroke prior to his fatal intracerebral haemorrhage in 1953. Given his untreated hypertension and the autopsy report, it is probable that he had a number of lacunar strokes. These tend to predominate in the fronto-basal areas, and disconnect the circuits that underpin cognition and behaviour. The most plausible explanation of Stalin's late behaviour is the dimming of a superior intellect and the unleashing of a paranoid personality by a multi-infarct state.