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He's a ketamine abuser, so it checks out.
From NIDA.
As someone that abused Ketamine for years, it is so easy to be so caught up with delusions (especially those of grandeur, or that are fed into by your environment) especially if abusing in tandem with other drugs that reinforce such delusions like Cocaine.
But those delusions still don't just manifest out of nothing, the stew that is Elon's brain has been continually cooking under these circumstances, but mine was under similar and I am no Nazi.
I think it is likely the money, subsequent power and unwillingness to take on board criticism that leads him to be surrounded by sycophants that reinforce his growing mental illness.
Having our false perceptions of reality be reinforced will cause loss of touch with reality over long enough time frames, especially when our actions are devoid of material consequences, and certain stimuli just expedite the process.
Though that isn't to say there isn't a huge correlation between brain damage and conservative belief, and that excessive use of drugs such as Alcohol, Cocaine and Cocoethanol, Nitrous Oxide, Alcohol, PCP, Meth and Ketamine causes significant brain damage.
Guess just yapping but I see ketamine abuse in this case as something that would have made him hugely more susceptible for sure despite maybe not being the sole cause, as over a similar abuse time frame I also struggled with distortions of reality and occasionally mania - especially if stressed and combining with cocaine.
the 2nd to last paragraph is probably what he has. he is laso known alcohol drinker to, which would amplify the symptoms, plus a little cocaine because all that energy is explained with him being on twitter all day
Man someone should introduce him to whippets