Both somatic and psychiatric abnormalities are not uncommon among politicians. Clinical insights may help to understand their suboptimal decisions and behavior. If a leader is psychotic while other functions are more or less intact, he or she can preserve abilities to remain in a position of power. Grave consequences occur when paranoid ideas persist in a dictator, so that delusions are put into life. Some people suffering from paranoid personality disorder are belligerent against delusional goals. Governments in democracy are more transparent; therefore, it is less probable that power would be kept by mentally abnormal individuals. In the author's opinion, there is danger of a large-scale war thanks to paranoid ideation in Vladimir Putin. Arguments in favor of this hypothesis are discussed here. More expert opinions are needed. In his childhood, Putin was a victim of maltreatment. Reportedly, child abuse statistically predicts psychosis and some other mental disorders. Putin formulated the aims of his military operation, one of them being protecting Russian-speakers from genocide. It is known that ethnic Russians have not undergone genocide. Apparently, this idea is delusional. Many people subscribe to delusions at large. Besides, there is a hypothesis that Putin has hubris syndrome. In conclusion, mental derangements in politicians should be diagnosed by psychiatrists on the basis of language and behavior.