Either way he's strung out on some sort of amphetamines... could be prescription. Also could be contributing to screwing up the scam. Lack of sleep, impulsive behavior, inability to think as critically as normal while thinking you are thinking critically. That's dangerous when gambling with billions in crypto. I definitely don't think he was expecting the ship to sink this soon.
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In every single video I've seen of him, his leg is constantly bouncing up and down. Seems likely he was wired consistently. Yes, you can't do that for extended periods without your neurology falling apart to some extent. In the vox interview he basically says that customer deposits went to the research company because FTX didn't have a bank account. lol.. then he 'forgot' about the $8B that was in there. Obviously that sounds like a lie, but given his apparently deluded state of mind, I guess it's possible they just ran it all terribly due to being so wasted and distracted.