Entrepreneur Elon Musk has baffled observers seeking rational explanations of his success or ‘4D chess’; a major irrational explanation, however, is that Musk is likely on the mood disorder spectrum—in particular, high-functioning bipolar disorder with hypomania (bipolar II disorder).

• Bipolar disorder is not rare, but common: 1–3% prevalence (ie. ~3–9 million people in the USA alone, or more than the Jewish; and >80m worldwide, or the population of Germany), and is a leading burden of mental disease. (How many people, celebrities or historical figures can you think of which have bipolar? And is that more or less than 3%?)

• Like most mental disorders, bipolar is comorbid with other mental disorders (correlated phenotypically & genetically)—especially autism, which can mask depression

  • Unusually among mental disorders, bipolar disorder appears uncorrelated or positively correlated with traits like intelligence, education, and SES (perhaps connected to the autism correlation), and so is more common than one would expect among elites (tail effects)

• Bipolar is especially common among risk-taking careers, such as entrepreneurs

• Bipolar is much more obscure than other psychiatric disorders of comparable prevalence like schizophrenia, despite being quite dangerous (manic episodes can destroy lives & careers, while depressive episodes cause suicide)

• Bipolar is under-diagnosed, like personality disorders: people often never seek diagnosis, especially when they enjoy the highs (“The reality is great highs”), and clinicians often differ in diagnosis.

  • Mood disorders can be hidden in plain sight, as the manic aspects get written off as merely a ‘public persona’¹ or ‘moodiness’ or ‘having a temper’ & the depressive phases are inherently self-concealing or excusable as “burnout” etc

    eg. Andy Dunn; or Elon Musk’s friend, Kanye West, who was diagnosed with bipolar in 2016, to the surprise of an adoring public—at least, adoring before West’s increasingly erratic behind-the-scenes behavior as he “resisted treatment” finally bled out into highly-public manic phases that destroyed his career. (Or, have you ever noticed how, pre-lithium, famous hardworking figures without tuberculosis are constantly having “nervous breakdowns” or developing “neurasthenia”, and needing to recover in sanatoriums or hot springs?)

• Bipolar is highly heritable and runs in families; Elon Musk has a family history of “wanderers and adventurers”: “Our family is different from other people. We risk more.” (Tosca Musk)

  • Father Errol Musk has a particularly striking personality & career I will not attempt to summarize

• Mood disorders persist over a lifetime—as have Musk’s impulsive decisions.

  • Musk’s risk-taking & persuasiveness are described by family & friends as emerging in adolescence—long after his autism spectrum disorder traits became apparent as a child, but more consistent with mood disorder lifecycles

  • Musk has engaged in unwarranted risk-taking at least since college, long predating more famous SpaceX/Tesla/Twitter risks, eg. refusing to get insurance on his McLaren supercar (which represented a meaningful percentage of his net worth²) because he didn’t think he would crash it, and then crashing it.

  • Even at age 51 he makes snap-decisions like purchasing Twitter (in order to change text to things like “What is happening?​!”)

• Hypomania is associated with:

  • “notable decrease in the need for sleep, an overall increase in energy, unusual behaviors and actions, and a markedly distinctive increase in talkativeness and confidence, commonly exhibited with a flight of creative ideas.”

    • Musk frequently sleeps only a few hours a day (often not for work, but recreationally—concerts, video games etc), and must use Ambien (often prescribed in bipolar) to force himself to sleep

    • Musk is noted for his personal energy, confidence and “gift of gab”, and having many ideas (very good & very bad)

  • “feelings of grandiosity, distractibility, and hypersexuality”;

    • Musk has an admitted hero complex and routinely attempts to do things like broker peace between Ukraine & Russia or propose that Taiwan become a part of CCP China (by adopting Hong Kong’s successful one-country-two-systems approach).

    • binge-buying behavior, often accompanied by grandiose plans for the purchases; Musk routinely goes through purchase fads of new toys he loses interest in, ranging from stunts like flamethrowers to submarine-cars—a James Bond movie prop called “Wet Nellie” purchased in 2013_11ya for ~$1.36^$1₂₀₁₃m with grand plans to turn into a true submarine-car using Tesla car parts, and never heard of since.

      This particularly characterizes his Twitter purchase—as one person with bipolar put it, “Him purchasing Twitter reminds me of people who buy boats/homes in mania”; Isaacson characterized Musk’s main motivation as making a lot of money and then saying “I didn’t want to just leave it in the bank”.

    • Musk is notoriously distractible, and distracted by his accumulating businesses & Twitter use; his schedule is irregular in the extreme. Musk relies on executives like Gwynne Shotwell or Jon McNeill to actually run his companies, the executives at his companies like Tesla rely on manipulation of his distractibility & outlasting his attention span to avoid disastrous decisions by the “king-crazy” Techno-Emperor of the Universe.

      When employees are not able to defuse Musk delusions like a driving-wheel-less Model 3 using solely FSD, Musk issues disastrous decisions like the Model 3 ‘alien dreadnought’ debacle that brought Tesla to its knees, or the Twitter acquisition (which has wasted almost 2 years of Musk’s life, much of his reputation, −$20b+, and counting).

      Musk routinely makes absurd claims he apparently genuinely believes, like that a federal judge in Delaware would not force him purchase Twitter, despite his having signed an ironclad contract to do so, because “It would not pass muster with the public.” (Eventually, as his mood cycled, his belief flipped to the opposite: “I should just pay full price…The potential is so great…These [Twitter] people are…such blockheads and idiots.” As of November 2023, Musk’s return on his Twitter investment has been −72%.)

    • Musk has (thus far) married 3× and had 1 mistress and unknown number of girlfriends at SpaceX & elsewhere³, had >11 children, & a flight attendant sex scandal⁴

• Severe mood dysregulation/lability:

  • Musk, unusually among CEOs, appears highly sensitive to criticism and at times almost about to cry

  • “Demon mode”: whiplashes between munificent & magniloquent moods to malicious (“light and dark, intense and goofy, detached and emotional, with occasional plunges into what people around him call ‘demon mode’”)

• Depressive phases:

  • Acknowledgement of suicidal ideation in adolescence (accompanied by “very wild storm” of thought & “demons…for the most part, harnessed to productive ends [but] Once in a while, they, you know, go wrong.”)

  • Musk self-medicates with ketamine; Musk has reportedly told people he microdoses ketamine to treat “depression”⁵, referring to suffering from “terrible lows”

  • Catatonia: catatonia is one of the most signature features of bipolar, while highly unusual elsewhere; biographers have often described Musk freezing for periods of time, describing it as for thinking, leaving catatonia ambiguous (if they have ever heard of it) but biographer Walter Isaacson describes “foul moods that led to catatonic trances and depressive paralysis” during depressive phases, severely interfering with running companies, where Musk would lay on the floor paralyzed in the dark, unable to carry out critical duties like Wall Street earnings calls⁶. (Employees would desperately rouse Musk long enough to give an initial speech, and then take over when Musk collapsed back into his withdrawn catatonia.)

    These catatonic episodes led an employee with a bipolar relative to convince Musk to seek treatment for bipolar disorder; Musk did not.

  • Walter Isaacson, after two years shadowing Musk, admits that the “mercurial” Musk could “fluctuate wildly” with “erratic emotional oscillations” and go from ‘very excited’ to ‘somber’, noting that “Musk goes through manic mood swings and deep depressions” (emphasis added). Musk periodically mentions his depressive phases and the struggle to “not look like the most depressed guy around.” (in part by leaning on stimulants like caffeine) and the fear of being alone

Is it any surprise that Elon Musk has stated publicly on Twitter & to Isaacson that he may be bipolar, employees urge him to seek treatment for bipolar, and a number of psychiatrists & other observers have speculated about bipolar disorder?

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1. Aside from ‘Ye’, see also Hank Asher, Tim Ferriss, Geohot, Martin Shkreli, Ridley Scott (who is fascinated by Napoleon Bonaparte).

   • A particularly sobering example of the masking effects of fame & wealth & PR handlers is Tony Hsieh: despite multiple severe substance abuse disorders, there was little or no public knowledge until he burned himself to death in a freak accident involving nitrous oxide inhalers—his circle of sycophants & enablers, and Hsieh himself, had successfully driven away anyone who might criticize him or blow the whistle.

   • Kanye West, for example, appears to have taken everyone by surprise, as all public commentators apparently bought excuses like “exhaustion” for his 2016 psychotic break & hospitalization prior to his public announcement of a bipolar diagnosis; indeed, even afterwards, when all of the subsequent behaviors became public knowledge as well, commentators often seek to explain a Musk or Kanye as anything other than bipolar disorder (autism is the catch-all diagnosis these days). This shows the success of compartmentalization, legal & financial settlements, confidentiality requirements, and the general refusal to connect dots.

   ↩︎

2. At $1.91^$1₁₉₉₉m+, the car was >5% of his wealth since he reportedly earned $38.24^$20₁₉₉₉m from the Zip2 sale. Fortunately, he did not crash the small plane he bought & was learning to fly at the same time, and die or suffer traumatic brain injuries like many small aviation enthusiasts (eg. Steve Wozniak, or just in March 2024, Simon Riggs & the Petrushkas).↩︎

3. See also Errol Musk’s 7 children & 3 wives (the last of whom was also his step-daughter by his second wife).↩︎

4. Musk justifies this behavior in part by appealing to concerns about long-term Western demographic collapse in decades or centuries to come (concerns few experts agree with and which have poor historical track records), and despite his techno-optimism, and indeed, his own projects like X.ai intended to create AGI within years.↩︎

5. Given the poor track record of microdosing and the mechanics of ketamine’s short-run anti-depressant effect, this would probably not work well, and although the timings remain unclear, Musk appears to still experience depressive phases. Musk prefers ketamine to standard depression treatments, harshly criticizing the use of long-acting SSRIs for depression. Interestingly, SSRIs are of unclear efficacy & sometimes said to worsen depressive phases in individuals who have bipolar II instead of ordinary MDD. (Has Musk been prescribed SSRIs before for ‘simple’ depression?)↩︎

6. Isaacson2023, Elon Musk § “Are you bipolar?”

   Devastated by the breakup with Amber Heard and the news that his father had a child with the woman he had raised as his stepdaughter, Musk went through periods when he oscillated between depression, stupor, giddiness, and manic energy. He would fall into foul moods that led to almost catatonic trances and depressive paralysis. Then, as if a switch flipped, he would become giddy and replay old Monty Python skits of silly walks and wacky debates, breaking into his stuttering laugh. Professionally and emotionally, the summer of 2017 through the fall of 2018 would be the most hellacious period of his life, even worse than the crises of 2008_16ya. “That was the time of most concentrated pain I’ve ever had”, he says. “18 months of unrelenting insanity. It was mind-bogglingly painful.”

   At one point in late 2017, he was scheduled to be on a Tesla earnings call with Wall Street analysts. Jon McNeill, who was then Tesla’s president, found him lying on the floor of the conference room with the lights off. McNeill went over and lay down next to him in the corner. “Hey, pal”, McNeill said. “We’ve got an earnings call to do.”

   “I can’t do it”, Musk said.

   “You have to”, McNeill replied.

   It took McNeill a half-hour to get him moving. “He came from a comatose state to a place where we could actually get him in the chair, get other people in the room, get him through his opening statement, and then cover for him”, McNeill recalls. Once it was over, Musk said, “I’ve got to lay down, I’ve got to shut off the lights. I just need some time alone.” McNeill said the same scene played out 5 or 6 times, including once when he had to lie on the conference room floor next to Musk to get his approval for a new website design.

   Around that time, Musk was asked by a user on Twitter if he was bipolar. “Yeah”, he answered. But he added that he had not been medically diagnosed. “Bad feelings correlate to bad events, so maybe the real problem is getting carried away for what I sign up for.” One day, when they were sitting in the Tesla conference room after one of Musk’s spells, McNeill asked him directly whether he was bipolar. When Musk said probably yes, McNeill pushed his chair back from the table and turned to talk to Musk eye to eye. “Look, I have a relative who is bipolar”, McNeill said. “I’ve had close experience with this. If you get good treatment and your meds dialed right, you can get back to who you are. The world needs you.” It was a healthy conversation, McNeill says, and Musk seemed to have a clear desire to get out of his messed-up headspace.

   But it didn’t happen. His way of dealing with his mental problems, he says when I ask, “is just take the pain and make sure you really care about what you’re doing.”

   ↩︎

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