He is literally insane, and that's something that should be discussed more in the media. He has depressive episodes that he medicates with mail-order ketamine, and people around him have described his destructive manic episodes. (That's what I've heard, He claims the drugs make him more productive, demonstrating a profound lack of insight into his behaviors. (Doing more does not mean one is producing more.) That's manic depressive or its little brother, cyclothymic.
Did I mention he rewarded his mail-order ketamine suppliers with government jobs or was that in the DOGE thread?