Elon Musk is burnt out. He has been working for 120 hours a week, he told The New York Times in a deeply personal and occasionally alarming interview. He has not taken a week off since 2001, when he contracted malaria. Work forced him to miss celebrating his own birthday and his brother’s wedding. His friends are worried about him and he has trouble sleeping. He is obsessed with his enemies, the traders short-selling his electric car company Tesla, who have caused him “extreme torture.”

Musk’s online persona—a kind of swaggering nerd king, a subreddit come to life—is all about punching back at his critics. But in the Times interview he comes across as damaged, at the end of his rope, unsure if he can continue at the grueling pace he has set for himself, not only micromanaging Tesla through serious growing pains, but also running three other companies simultaneously. “This past year has been the most difficult and painful year of my career. It was excruciating,” Musk told the Times. “I thought the worst of it was over—I thought it was. The worst is over from a Tesla operational standpoint.” He continued: “But from a personal pain standpoint, the worst is yet to come.”

Musk’s erratic behavior has cost Tesla periodic dips in market value, though investors’ faith in the company has always led to a subsequent rebound. (Tesla’s stock fell sharply once again in response his interview with the Times.) But the interview raises serious questions about whether the tech billionaire is able to run a $50 billion company whose value is largely predicated on the vision of its idiosyncratic owner.

Tesla has come under scrutiny in recent months, thanks to its negative cash flow, production problems, and high-profile crashes of its semi-autonomous cars. Musk has been very open about how stressful it has all been. He has taken to sleeping in the factory producing Tesla’s Model 3 in an effort to boost production. Nervous about profitability, he laid off 9 percent of the company’s workforce in June. These moves calmed investors, who bought his argument that the company was headed toward smoother seas. But now we know that Musk’s attempt to be an all-encompassing CEO, an executive involved with every aspect of his business, is causing serious personal and professional problems.

The sense that Musk may be losing it is most apparent in the public statements he has made over Twitter. Musk has spouted off about the free press, called a diver who helped rescue a trapped Thai soccer team a “pedo,” and, most dramatically, invited scrutiny from the Securities and Exchange Commission by tweeting that he had secured funding to take Tesla private, even though he had not. Musk told the Times that he does not regret the tweet about taking the company private, but it is likely to cause problems for him and the company, since many legal experts believe that he committed securities fraud. In all likelihood, he will simply have to pay a fine, but the damage done to his reputation may cost him more.

In the Times article, Musk also speaks about his dependence on Ambien. There is a strong implication that many of Musk’s bizarre late-night tweets stem from taking the prescription sleep aid and “recreational drugs”—and that Tesla’s board of directors is “aware,” if not concerned, about his drug use.

Musk’s drive to become a CEO with a hand in every aspect of each of his companies is simply not possible. Even a control freak like Steve Jobs, who Musk is often compared to, let others, notably Tim Cook, handle technical issues and logistics. Musk, in contrast, appears to aspire to a state where there are no distinctions between himself and Tesla.

This is most notable in Musk’s approach to short-sellers, whose trades appear to wound him personally. Tesla is among the most shorted companies in the history of Wall Street. Musk told the Times that he expects “at least a few months of extreme torture from the short-sellers, who are desperately pushing a narrative that will possibly result in Tesla’s destruction.” In Musk’s view, this is a kind of postmodern situation in which short-sellers are inventing an alternate reality for Tesla, then attempting to profit from it. In fact, short-sellers have lost billions betting against the company. Furthermore, these bets are highly rational given Tesla’s general shakiness. But in Musk’s view, critics of Tesla can only be haters.

Taken together, is there another motive to Musk taking the very risky move of opening up to the Times? Given his reputation for genius, there are always those who see his erratic outbursts and stunts as part of a larger game—Musk playing eight-dimensional chess. In the wake of the SEC reportedly handing down a subpoena over Musk’s taking-Tesla-private tweet, Musk could be floating a public relations strategy aimed at quieting regulators: the “ambien and stress” defense. In his telling, Musk’s devotion to the company is totalizing, costing him friendships, preventing him from even leaving its factories for days at a time.

But no amount of personal investment from Musk is going to suddenly start producing cars at a profitable clip. It doesn’t matter if Musk spends 40 hours working at Tesla or 120 or 160. Its problems are real and will require intensive, structural work. Musk’s “woe is me” interview keeps the focus on him and his struggles, rather than those of the company.

Either way, it’s clear that Musk is having problems. As the Times interview makes clear, he’s feeling sorry for himself and blaming his missteps on others. There are things Musk can control—he should sleep more and tweet less and find time to do things like attend the weddings of siblings. But so much of his ongoing spiral comes from him obsessing over things he can’t really control. Musk can’t single-handedly will Tesla to make more cars more efficiently, or for its autopilot to function properly. He is increasingly becoming a cautionary tale of the Great Man as CEO—he just doesn’t realize it, at least not yet.